Re: Birth Plans
From: rbraun@indyunix.iupui.edu
Mon Jun 23 13:40:17 1997
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R. Daniel Braun, MD FACOG "Money will buy you a fine dog
Clinical Professor OB/GYN but only love will make it
Indiana University School of Medicine wag its tail"
Indianapolis, IN Richard "Kinky"
OBGYN.net, International Rep. U.S. Friedman
Kinky Friedman for President
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On Sun, 22 Jun 1997, Robert Radnich wrote:
> 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
IF SHE ASPIRATES, YOU ARE DEAD MEAT.
> > 2) Ambulation with epidural
iF SHE FALLS AND BREAKS A BONE OR HAS AN ABRUPTION, YOU ARE DEAD MEAT.
> > 3) Cord clamping after the pulsations cease
STUDIES MANY YEARS AGO SHOWED NO CLINICALLY SIGNIFICANT EFFECT IF THE BABY
WAS NOT PRETERM. IF PRETERM SOME DEVELOPED PULMONARY EDEMA
> > 4) No IV access
IF SHE HAS ATONY AND BLEEDS TO DEATH, YOU ARE DEAD MEAT.
PERSONALLY, I EXPLAIN THE REASONS FOR EACH OF THESE TO THE PATIENT AND IF
THEY STILL REFUSE, I SAY IT IS TIME FOR YOU TO GET A NEW DOCTOR WHO WILL
LET YOU DO THESE THINGS AND DOESN'T MIND BECOMING DEAD MEAT.
Dan
> >
> > 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
>
