Books You Should Buy

  

« Sheri's (Really) Big HBAC Story | "Patient Refusal" as Contraindication to Epidural Anesthesia? »
Friday
Dec102010

An Alternative OBGYN Birth Plan

Bookmark and Share

Share 

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.

 

Dear Patient:

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

 


PrintView Printer Friendly Version

EmailEmail Article to Friend

Reader Comments (45)

SO refreshing! Will recommend you to my friends in your area. Thank you!!!

December 11, 2010 | Unregistered CommenterKali,CLD

Great post Henry, I'd sign on with you as my OB but it would be a helluva commute.

I would like to suggest that if you give this to prospective parents you do electronically and embed the studies in each point in a clickable format so that they may participate in their care even more by seeing what the stats. say. I also would encourage you to add to this introduction some studies about the efficacy of doula care during birth. I like to envision a world where labor and postpartum doulas become standard team members at all births.

December 11, 2010 | Unregistered CommenterSaanenMother

I do believe we've found another Dr. Wonderful.

December 11, 2010 | Unregistered CommenterDou-la-la

Saanen, that's a GREAT idea, which I will certainly do.

If anyone one wants to help me dig up some of those research links, please send them along to me. That would be most appreciated, and would go a long way toward creating a cohesive, evidence based document that could be shared.

Facebook messaging works well (Henry Dorn MD) or you can email me at drdorn@drdorn.com.

December 11, 2010 | Unregistered CommenterHenry Dorn MD

I want to make it clear that I am not a Dr Wonderful, just a Dr Reasonable, most of the time, I hope.
I make patients angry or upset with me on a regular basis when I tell them things they don't want to hear, am often cranky after a run of nights on call, and very human in dealing with frustrations that occur daily in my practice.
I simply go with the mantra about practicing in a way that I would want to be treated, and let that guide me. I am not batting 1000 in that regard but that is my goal.
Clearly the American medical system is highly flawed, but at its core I believe well intentioned. Unfortunately a humanistic approach is not often rewarded under the current framework, and that will only change with public demand.
I look forward to participating more with this community to improve childbirth practices.

December 11, 2010 | Unregistered CommenterHenry Dorn MD

well, I think I'm going to move to High Point, NC. Glad that you are out there making the world better for moms and babies, Dr. Dorn.

December 11, 2010 | Unregistered CommenterBecca

Very kind comments. Unfortunate that the above seems exceptional. I had a wonderful chairman, Dr Dan Edelstonem currently at McGhee in PA, who I feel imparted a great deal of this mindset on me, as well as a number of other great clinical instructors at Albany Medical Center.

Regarding delivery of vaginal breeches, I am one of the lucky ones who received quite a bit of training in that and feel comfortable delivering them, or should I say as comfortable as anyone should feel delivering them, as they are always higher risk. When presented with someone who fails attempts at turning the baby externally, or who presents in active labor, I feel it is crucial to take into account all known factors such as OB history,maternal health, estimated fetal weight, fetal presentation etc before making a decision.

Regarding twins, I enjoy delivering these vaginally, but want to see baby A presenting headfirst, and baby B not being significantly larger if breech. I do feel strongly that when A is breech, there is too high a risk of head entrapment due to potential interaction with twin B and advice a cesarean, although certainly many twins have been successfully delivered this way, though usually accidentally if done in recent years.

Hope this helps.

December 11, 2010 | Unregistered CommenterHenry Dorn MD

Dou-la-la, (please don't kill me for saying this but) I could die a happy person if I never had to hear the grandiose moniker "Dr. Wonderful" again. It sets up an unrealistic expectation that someone would always behave in a certain (socially approved) way and assigns them a guru status.

There are a lot of doctors using social media and interacting with patients, non-medical folk, the public, etc., and, yes, it’s refreshing when one of them truly gives a shit.

December 11, 2010 | Registered CommenterJill

Thanks Jill, I wholeheartedly agree about the moniker.
I have had patients travel across the state to see me, hoping that I will give them the answers they want, only to be extra disappointed to find that I sometimes agree with their doctor back home. Having overblown expectations is often a recipe for tears.
It also is a bit insulting to the truly selfless folks out there who care for patients with little or no remuneration or recognition, such as the doulas, midwives, researchers and activists.
We doctors get paid well for what we do and should try our best to earn it every day.

December 11, 2010 | Unregistered CommenterHenry Dorn MD

Dr. Dorn:
I am also glad to read what you have written here, and look forward to contributions from a less rigid, if I may describe you as such, OB. I am particularly interested in your training right now. You mentioned Albany Medical Center; is this the one in Albany, NY? I wonder because you mention influential clincal instructors there, but I get a distinctly different impression from those I know there and their statistics. Would you contribute this to high-risk population, a change in ideology since your training, or something or
nothing else altogether?

December 11, 2010 | Unregistered CommenterANaturalAdvocate
Comments for this entry have been disabled. Additional comments may not be added to this entry at this time.