OB-GYN-L Messages for June, 1997: Re: Birth Plans

Re: Birth Plans

From: Garry E. Siegel, M.D.

garrys@mindspring.com

Mon Jun 23 19:37:03 1997

>>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 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
>

Kelly:

That pretty much mirrors what I do, too. I try to avoid episiotomies, especially in multips, and point out to women in their 36 week "discuss labor" talk that epidurals, especially early ones in primips, may be associated with an increased chance of Cesarean. You correctly point out that, once in labor, all of the "little things" that they are worried about seem much less important, and when I talk to most patients, they will admit that their friends told them the same thing (ie who cares if you have to be catheterized; just get me the drugs!)

I guess we're putting in some more IVs because of routine GBS cultures and treatment.

Previous listers correctly mentioned that those who are inflexible (militant) are the real problem. I do tire of having to spend 10 minutes explaining something that should take about 10 seconds to 99% of Moms, ie yes you are a 35 weeker who is bleeding, so you'll need an IV, or somesuch.

I have a homemade handout that they read prior to the 36 week talk, and it works well to avoid birth plans, because it goes over the basics, and fills in the gaps from classes.

Garry

-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.

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