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Re: Birth PlansFrom: Cheri Van Hoover (cherivh@waonline.com)Sat Jun 21 17:29:48 1997
Geffrey H. Klein, MD wrote: > > I have listed a few of the items that I have no experience with. I am > wondering whether other list members have encountered these requests, > whether there is a reasonable explanation for the request, and what the > potential adverse consequences are, medically and medico-legally, of > complying with these requests. > > 1) Eating during labor We routinely allow clear liquids. At my previous institution we worked with dietary and created a "labor diet" for those admitted for long inductions or in prodromal labor. It featured low fat, low protein, high carbohydrate, easily digestible foods. Women in active labor rarely show any interest in food. If people are interested in eating in early labor I warn them that they may vomit it all up later and to avoid things they don't want to see again. I actively discourage the eating of foods which are heavy or greasy in any way.
> 2) Ambulation with epidural I have limited experience with this. The nurses at my current institution test motor strength and allow women to ambulate to the bathroom if they pass certain tests. I've never seen an epiduralized woman walk further than that or express much interest in ambulation.
> 3) Cord clamping after the pulsations cease I do this routinely, with the infant on mom's belly. I used to wait until the baby was breathing well and crying vigorously, then clamp and cut, but after discussions on the midwife listserve of third stage management I decided to wait until after the cord stopped pulsing. I've been taking this approach for a couple of years now and do like the results. The baby seems to make a smoother transition to external life -- I haven't done any formal study, but I think I see less TTN. Since I try to base my practice on physiologic principles and have never seen any species other than humans rush to clamp the cord, I think this approach has merit.
> 4) No IV access Again, this has been routine in all of the sites where I have practiced. Many women do end up with IVs. Everyone who desires analgesia, who vomits intractibly and/or can't tolerate po liquids, who needs antibiotics for GBS, who has a risk factor such as anemia or hx of PP hemorrhage or grand multiparity or a previous C/section, etc. gets an IV.
-- Cheri Van Hoover, CNM Midwifery Service at Stanford Palo Alto, CA
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