An Alternative OBGYN Birth Plan
By Henry Dorn, MD
I read with dismay an older blog post here that showed a copy of a “Birth Plan” that an OBGYN presented to his patients which basically said “my way or the highway”.
The only good thing about it was the directness and honesty in telling patients in advance what to expect, giving them the early opportunity to seek care elsewhere. This I believe is slightly better practice than practicing the same way but leading patients to believe otherwise until its too late to transfer care.
What was perhaps more upsetting to me was that many responders to that blogpost expressed that they felt this was absolutely representative of all OBGYNs, which I know is not the case.
Therefore, in order to suggest that at least one of us does not fit that mold, I made some “corrections” to that Birth Plan. Though perhaps not the wording I would choose, and not the final product which I intend to post on my website (which is currently being revamped), it does reflect many aspects of my OB practice.
You may wish to reference the prior post for comparison.
I look forward to any comments or questions and thank Jill for letting me participate on her wonderful site.
As your obstetrician, it is my goal and responsibility to help you make the best decisions to improve your health and your baby’s safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications, but there is also much we do not understand, and therefore there are no hard fast rules for managing pregnancies. The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.
* Although I do not attend homebirths, I support patients who choose this option and work with their midwives. I like a dark room for delivery but unfortunately, our labor rooms are not equipped for water births.
* I encourage birth plans which help patients organize their thoughts about delivery before labor starts. There are few things I object to for healthy patients, but ultimately its your decision and we cannot force any care on you that you do not desire.
* Doulas and labor coaches are allowed & encouraged and are thought to be of great benefit to patients, partners and nurses.
* IV access during labor is optional in normal labor, but is strongly encouraged when there are risk factors such as hypertension, bleeding, VBAC etc, in case emergency medications need to be administered. Healthy women should be able to drink and do not always need IV fluids, which may hinder their mobility.
* Continuous monitoring of normal, healthy women has not been shown to improve outcomes, as long as there is an initially reassuring fetal heart tracing. Intermittent monitoring is however recommended during labor.
* Rupture of membranes may become helpful or necessary during your labor, but also carries some risks. The decision as to whether and when to perform this procedure will involve a discussion between us at that time.
* Epidural anesthesia is optional and available at all times. Although relatively safe, it does likely increase the rate of C sections as they often hinder movement which facilitates fetal descent and may cause drops in blood pressure which may result in fetal distress. Some women experience severe headaches afterwards requiring and injection into the spinal column to stop the leaking of spinal fluid.
* I perform most vaginal deliveries on a standard labor and delivery bed, however there are exceptions and depend on maternal comfort and labor progress. We try to find the position that benefits the mother and baby the most.
* Episiotomy is a surgical incision made at the vaginal opening just before the baby’s head is delivered in order to speed up delivery in an emergency situation, such as a prolonged drop in the fetal heart rate. It is not performed routinely.
* I will clamp the umbilical cord after it stops pulsating, unless there is an emergency which requires moving the baby for resuscitation.
* Normal pregnancies progress thru 42 weeks. If it goes beyond this we will offer induction, or biweekly monitoring due to somewhat higher risks. Some studies also suggest that there may be a decreased risk of C section if inductions are done after 41 wks, so this option will be offered.
* Compared to the national average, I have a very low c-section rate. However, a c-section may become necessary at any time during labor due to maternal or fetal concerns.
I look forward to collaborating with you in your care.
Henry Dorn MD
High Point NC