Hospital L&D Consent Forms

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• Reply: William F. von Almen, II, MD, FACOG: "Re: Hospital L&D Consent Forms"

My concerns are valid, I believe, and the physician I have is showing signs of a new-found paternalistic attitude and what I have to say isn't worth a hill of beans from what I (and my husband) can tell. We've been patients of this doc for many years and several pregnancies - none of which he has attended the actual births for. Being from a large practice, I doubt he will make this birth either.

My concerns are: 1) Not wanting an episiotomy - I believe they can contribute to pelvic floor problems later on. I would rather have a natural tear than an episiotomy that may extend to 3rd or 4th degree. I have birthed vaginally with a preemie and an epis was done to expidite the birth and a year later birthed a full term large baby over an intact perineum. I believe I can do it again. ;) The OB says HE will decide if it looks like I won't stretch adequately and WILL do one. I want to note my wishes on my consent form but in such a way that I leave it open to have an epis done if there is well-documented need (fetal distress).

2) Not wanting my prior c/s scar manually checked after my baby is born - in the absence of heavy bleeding. We are assuming I am GBS+ since I was in my previous pregnancy 2+ years ago - and was never treated in labor due to lack of time between admission and birth. I am willing to assume +GBS colonization this time and receive abx in labor. I am not willing to risk vertical transmission and possible infection only to satisfy his curiosity.

I am not being a difficult patient, I don't believe. I have no problems with other routine procedures for a VBAC mom - hep lock, monitoring, pit AFTER birth to help the uterus contract, etc. but I do feel strongly on these two issues and want my beliefs respected.

How do I go about doing this on the consent form?

Thank you for any advice!

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