Re: Birth Plans
From: jay kulkin (jkulkin@mindspring.com)
Mon Jun 23 06:43:45 1997
I think you raise an xcellent point. It appears that CNM's are to be
Obstetricians colleagues. At my hospital, the docs didn't want them to share
the lounge on L&D. Time to get over this idea and learn from each other.
In residency, I always felt the CNM's taught me a gentler Obstetrics.
Jay
At 10:56 PM 6/22/97 -0500, you wrote:
>Birth Plans - excellent thread!
>But, since this thread occurred during the weekend, I ask everyone...why
>the heck we are spending so much time on the computer during the weekend?
>
>In Pasadena, I get a fair share of Birth Plans, and I have developed a
>philosophy. Most of the patients care much more how you respond to their
>Birth Plan, than what is actually on it! They want to know... are you
>flexible? Do you care about their desires and preferences? Can they talk to
>you? I usually tell them that I will always try to honor their birth plan
>as long as the labor is proceeding smoothly and safely. In the event of a
>problem, I tell them that I will likely have to intervene based on my
>medical judgement, and in some cases, this means throwing out the birth plan.
>
>Now, there are also unacceptable birth plans. I had one...No C/S, No
>Pitocin, No Fetal Monitoring, No IV, etc...This patient saw me for the
>first visit only, I then told her to find another doctor (I even gave her
>some names of my more "naturally oriented colleagues."
>
>Bradley patients tend to have the more detailed Birth Plans, bit I have
>noticed there are two types of Bradley patients. Those who go to Bradley
>because of an innate distrust and dislike of the medical profession, and
>those who like the fact that they get so many classes! The latter group has
>no clue about the anti-doctor agenda, but within a few classes they usually
>figure it out. By the way, is Bradley a national phenomenon or just a
>California (West Coast) thing?
>
>One more item: what about fetal monitoring? Intermittent external, vs.
>doptones. Comments?
>
>Regarding the specifics:
>clear liquids O.K.,
>walking epidurals - people ask while pregnant, but seem not to ask once
>they are in labor
>cord pulsing - I put the baby on mom's abdomen, so I clamp quickly to try
>and avoid pumping fetal blood back into the placenta
>I.V. - I encourage routine IV or saline lock as an "insurance policy" but I
>allow no I.V. for the low risk patient, based on an informed consent type
>discussion.
>
>Regarding midwives on the list: I APPROVE, because I can learn from their
>postings and their views. Face it, we all think our own views are right,
>and so should they. Ultimately, I strive to learn, and hearing what they
>have to say is helpful to me, as is hearing what all the DOCS have to say
>as well.
>
>BYE
>
>Bryan S. Jick, M.D., F.A.C.O.G.
>Obstetrics and Gynecology
>Pasadena, CA.
> voice: (626) 304-2626
> fax: (626) 796-6495
>e-mail: drbryan@earthlink.net
>
--
Jay M. Kulkin, MD, MBA, FACOG
Medical Resource Group
1117 Perimeter Center West
Suite 510 East
Atlanta, Georgia
Phone:770-392-3475
e-mail: medresourcegroup@mindspring.com
