Public Health Law Map - Beta 5 - Medical and Public Health Law Site

decisions not to use medical interventions be well documented and the patient carefully
educated.
1. Past-Term Pregnancies
Education about potential medical interventions should start at the first patient
encounter and should be part of the birth plan. It is important to determine, at the
earliest possible time, if the patient has unreasonable fears or expectations. The
patient must understand that whereas induction of labor is medically necessary in
many situations, it should not be done as a matter of physician or patient
convenience. Patients should be discouraged from seeing induction of labor as a
benign process, but they also must appreciate its usefulness in appropriate
circumstances.
A patient’s birth plan should detail the indications and risks of induced labor. These
should include the medical reasons for what might otherwise appear to be an
induction done merely for convenience. If the mother lives in a secluded area where
emergency services are nonexistent, then induction at near term may be safer than
risking an unattended home delivery in a snowbound mountain cabin. If a mother is
likely to need special care for herself or the infant and the entire area is under a
hurricane warning, it may be better to deliver her than to leave her to compete for
attention in a hospital on disaster status. These are valid indications for inducing
labor and should be documented in the chart. This documentation will be important if
the snow does not fall or the hurricane hits elsewhere and the delivery has an
unfortunate outcome.
The patient should understand that babies that are well past dates may need to be
delivered by induction or section. Physicians should enlist the aid of the woman in
ensuring that the progress of the pregnancy is appreciated. If the physician is
suspicious about the patient’s reported dates, this should be investigated before the
patient is grossly past term. The problem of past-dates babies has been exacerbated
by the fragmentation of the medical care delivery system. It is easy for a woman to
get lost in a group practice where all the prenatal care is delivered by nonphysician
personnel. If no one physician is responsible for her care, there may be no one to
notice if she misses an appointment or is several weeks overdue.
As changing health insurance plans force patients to move to new physicians, it is
difficult for a physician to know if the patient has left the practice or is just not
coming in for her appointments. Physicians must have tracking systems for pregnant
patients. If the patient has been lost to follow- up as her due date approaches, the
physician should attempt to contact her. If she is under the care of another physician,
refuses to come in for an appointment, or cannot be located, this information should
be documented in the chart.
2. Cesarean Sections
The possibility of a Cesarean section should be discussed with every patient as
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