- What is your cesarean section rate?
- How do you feel if a patient disagrees with your advice?
- Do you believe that the ultimate right to decide what procedures are used belong to the patient?
How long can I “go” before you want me to be induced?
ACOG (the American College of Obstetricians and Gynocologists) does not recommend induction before 42 weeks gestation.
“Routine labor induction at 41 weeks likely increases labor complications and operative delivery WITHOUT significantly improving neonatal outcomes” (Obstet Gynecol 2000;96:291-4)
“[In first time moms,] median length of gestation (from the first day of menses to delivery) [is] 41 and 1/7 weeks, not 40 weeks. … [In moms of other children,] the median length of gestation is 40 and 3/7 weeks.” (Obstet Gynecol 1990;75,6:929-31)
Are you comfortable if I refuse continuous electronic fetal monitoring?
ACOG reports, “Current data indicate that FHR monitoring is equally effective whether done electronically or by auscultation” (ACOG Technical Bulletin July 1995)
The studies that support intermittent monitoring over continuous electronic monitoring required listening only for the first 30 or 60 seconds immediately following a contraction.
EFM is associated increase in cesarean delivery rates.
If my membranes rupture prematurely at term, will you be comfortable with a 72-hour expectant management?
“Regimens of 12-hour and 72-hour expectant management of PROM are comparable regarding infections complications and pregnancy outcome.” (Obstet Gynecol. 1995 May;85(5 Pt 1):766-8)