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Re: Birth PlansFrom: Kelly Shanahan (mks@sierra.net)Sun Jun 22 17:46:38 1997
>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 think birth plans must be a West Coast thing -- I never saw one in 4 years
of med school (Charlottesville, VA), 4 years of residency (Temple,
Philadelphia, PA) or my first 3 years in practice (suburban Philadelphia).
Lots of my patients here (Lake Tahoe, CA) write birth plans.
>
>I feel it is my responsibility to adhere to the patient's requests, however
I tell my patients I will TRY to respect their wishes but they must trust my
judgement. I tell them my number one priority is healthy mom/healthy baby,
number two is a pleasant birth experience for the couple and number three is
having all this happen before my bedtime :-) . Frankly, most of the things
on their lists are things I've never even SEEN done (enemas, shaving)
>
>1) Eating during labor I allow clear liquids and popsicles, maybe an occasional cracker. In my "when to go to the hospital" talk during the course of prenatal care, I tell them it's okay to eat lightly once labor begins, but don't eat anything that would gross you out coming back up, i.e., pizza.
>2) Ambulation with epidural Our anesthesiologists aren't keen on "walking epidurals" and our hospital is very concerned about potential liability in case of a fall.
>3) Cord clamping after the pulsations cease
I usually put the baby on mom's belly and allow dad to cut the cord. I
haven't had many requests for waiting for the cord to stop pulsing, but I
don't see a problem with it. mom can hold baby for as long as she wants,
with the usual caveat of "if the baby's doing ok"
>4) No IV access
Don't routinely put in ivs unless she wants drugs, needs pit, is getting
dehydrated or strip is flat and worrisome after oral hydration.
> I, being of Irish descent, tell my patients to remember Murphy's law of birth plans -- don't get too attached or too adamant about your plan 'cause that will guarantee you'll be strapped to ivs and monitors and having a c-section. Kelly -- Kelly Shanahan, MD S. Lake Tahoe, CA
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