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Re: Birth PlansFrom: Robert Radnich (rradnich@DCA.net)Sun Jun 22 06:47:01 1997
Geffrey H. Klein, MD wrote: > > I hope that this topic does not start a riot. > > I have been reading birth plans recently in an attempt to familiarize > myself with the requests of patients who prepare them. Throughout my > residency and first year of practice, I have not encountered anyone who has > requested or prepared a birth plan. > > I am open to most of the concepts in the plans. There are a number of > things routinely done in L&D that are very paternalistic and done for the > convenience of the providers. I can understand the impetus for the mother > to avoid enemas, narcotics, shaving, routine episiotomy, and the rapid > removal of the infant to the nursery. > > I feel it is my responsibility to adhere to the patient's requests, however > I am concerned with medico-legal liability concerning certain issues. > > 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 > 2) Ambulation with epidural > 3) Cord clamping after the pulsations cease > 4) No IV access > > thanks.. > > Geffrey H. Klein, MD > listowner: OB-GYN-L > Advisory Board Chairman, OBGYN.net < http://www.obgyn.net > > Co-moderator: sci.med.obgyn > gklein@bcm.tmc.edu gklein@icsi.net > http://members.aol.com/gklein01/geff.html > 6800 W. Loop South #520 > Bellaire, Texas 77401 > (713) 664 8900 Dear Geffrey, I would agree with your philosophy of care. Most women who present with a list of birth options have the same topics. Usually they are what someone else has told them to include in their plans (ie. their childbirth educator, or author of a book they have read). Many times they are really not aware of, or have given little thought to what is on the list. The impression is that if they get what is on their list of care they will have a pleasant and uncomplicated experience. And unfortunately the converse is also believed. It seems to promote a certain antagonism that is not necessary, and that seems to undermine the patients trust in their caregivers. Anyway, my $.02 worth: 1) We allow liquids - even though our anesthesia people hate it. 2) I would love to have "walking epidurals" available, but our anesthetists, nursing staff and administration are so afraid of a fall or other problem that there is much resistance (to say the least). 3) I have seen reports recommending that the cord not be clamped until it has quit pulsing. I'm not impressed with the reasoning or the science behind it. I think what the underlying message is, is that they want to be able to hold their infant immediately. If the cord is long enough, I try to facilitate this and dry the baby on the mother's abdomen and cut the cord later (or have the father do it). If the cord is too short to do this, I will cut it first. 4) We have not used routine IV access in the past 15 years. It is greatly appreciated by patients. I have not yet regretted this policy. We do require them for epidurals or any other addtional risk factors that seem appropriate. Most of our patients do not have them, however. Forward along your findings from the rest of the group.
-- Robert Radnich, MD,FACOG rradnich@dca.net private practice Dover, DE
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