Primary care
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A number of analgesic and anesthetic options are available for patients during the intrapartum period. Appropriate attention in the prenatal period to patient education regarding these options is imperative. If pharmacologic anesthesia is required, risks and benefits both to the mother and neonate must be considered. ⋯ This discussion should begin during the prenatal period to ensure that the woman has an opportunity to make an informed choice. When the woman presents in labor, the anesthetic plan may again need to be revised. Continued patient-doctor communication throughout labor is essential with the woman's preferences, tempered by sound medical judgment, guiding optimal pain control.
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Recent position statements by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists and the emergence of legal and ethical analyses on the nature of compelled cesarean section have instigated much discussion on how the primary care physician should respond when a pregnant woman refuses to consent to surgery. This article clarifies the ethical obligations of the physician and mother and the nature of their relationships to the fetus. The formulation of an agreement, the physician-mother-fetal contract, is discussed as a teaching tool for helping to clarify the roles of all parties. Also, the function of the primary care physician as proactive educator is highlighted.