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Availability of Facilities and Personnel

The patient must be warned if there is a possibility that the hospital may not be able to supply expected facilities. For example, the birthing room may not be available if there is a cluster of births on the day the patient delivers. It is imperative that the patient be warned if the hospital cannot provide essential services such as an emergency cesarean section within a short period. If the patient is being delivered in a non-hospital-based birthing center, then provisions for emergency transfer and its risks must be documented. The patient must be informed of the potential consequences of such deficiencies and given the opportunity to seek care elsewhere.

The physician should explain the call system, identify who will attend the patient if her primary physician is not available, and be given an opportunity to meet the substitute physician. If the primary physician is a member of a multiphysician call system, the physician should make it clear to the patient that she may be seen by any member of the group. It is critical that every member of the group be aware of the existence of the patient's birth plan. A substitute physician should not be allowed to abandon the plan unless it is necessary because of unexpected medical complications. Any substitute physician who disagrees with the way the primary physician manages deliveries should not be in the same call system.

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