A 29-Year-Old Primigravida at 36 Weeks Gestation Comes to the Office

A 29-year-old primigravida at 36 weeks gestation comes to the office with her husband for a routine prenatal visit.  Her pregnancy has been uncomplicated, and she has no chronic medical conditions.  Her only medication is a daily prenatal vitamin.  Vital signs are normal.  Fundal height is 36 cm, and fetal heart sounds are 150/min on Doppler ultrasound.  The patient says she has created a detailed birth plan and would like to have a natural delivery.  She says a vaginal birth is necessary for her to feel fully connected to her baby, and she is not interested in receiving any medication to decrease the pain.  The patient's wishes are acknowledged and documented in the chart; however, the physician states that unexpected events can occur during labor and delivery that require a cesarean delivery.  The patient replies, "A cesarean delivery is not part of my birth plan-I don't want to have one."  Which of the following is the most appropriate response?

A) "Birth plans are good for uncomplicated deliveries, but in an emergency, you can trust that my recommendation is the safest option."
B) "I don't feel comfortable not being able to perform a cesarean delivery in an emergency.  I can refer you to another provider if you would like."
C) "I would only recommend a cesarean delivery if it were absolutely necessary.  Let's talk about what the indications would be."
D) "If you do not want a cesarean delivery, I will not perform one.  I will make sure to document this in your chart."
E) "My priority is to take care of you and your baby, so if the baby is in distress during labor, I will need to do a cesarean delivery."

Correct Answer:

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