3.13.2011

the plan

here is the birth plan we came up with to prepare for Alice's arrival. I went over this with both Cynthia and Dr. Brett a few weeks before my due date to make sure everyone was on board. I knew that everything would most likely not go quite as planned, but just the whole exercise of figuring what I wanted and discussing it with those involved helped me to feel involved myself. It also made a big difference in the hospital - they don't normally get moms with birth plans, so I guess they really paid attention to it. (I'm going to add some notes as to how things actually went, in italics)

Birth Plan for Melissa (Missy) Henderson and Jeremy Jones

Location: Wayne General Hospital

Primary Care Providers: Cynthia Odom or Dr. Brett

Labor Support: Jeremy Jones, partner and father-to-be, and Michelle Brooks, doula. They are to stay at my side at all times, even in an emergency.

To the staff at Wayne General: My partner and I understand that childbirth is full of surprises and that decisions may need to be made in the labor room. We intend to work with everyone present to make good decisions if need arises. The following items are our preferences if the birth goes smoothly.

  • We'd like to have dim lighting and music of our choice. No loud talking or noises. (didn't end up using any music)
  • I would prefer to wear my own clothing.
  • I would like to stay hydrated by sipping small amounts of clear liquids. (the nursing staff seemed to have a hard time believing that this was ok)
  • IV only in the case of dehydration or for the administration of medication. A heparin lock is fine. (it was so nice not having to drag an IV around as I walked the hallways..)
  • Electric fetal monitoring is fine as long as I am able to change positions. (this was something I had to agree to for Cynthia and Dr. Brett to work with me on a VBAC. As often as the thing was reading incorrectly, I'm not sure why they even bother..)
  • I would like the minimal number of vaginal exams required for you to assess my progress.

Labor and Delivery:

  • No induction of labor. (this obviously didn't happen..)
  • Spontaneous onset of labor. If it is delayed or there are complications, we would like to discuss our options at the time. (they were very understanding that I was upset by the induction and we did discuss options)
  • No artificial rupturing of membranes without first explaining why and getting my permission. (we had a big discussion about this as well and everyone voiced their concerns and talked about pros and cons)
  • If my water breaks and I am not fully dilated for a long stretch of time, I'd like to discuss the pros and cons of taking antibiotics.
  • We do not wish labor to be hurried, unless signs show our baby is in trouble. (our labor was hurried. this was because they did not want to have a mom with a previous c-section on pitocin for more than 12 hours at a time, i guess)
  • Except for an emergency, I do not wish for my labor to be augmented. If there is a need to speed labor, I would like the option of trying a different position.
  • I am having a natural birth. Please do not offer me any pain-relieving medications unless I specifically request them. (they didn't ask me - not even once! when i was in with Oscar all they did was offer pain meds all the time!)
  • To relieve pain, my partner and doula will help apply counter pressure, apply hot and cold packs, and help with various positions and deep breathing.
  • Freedom of movement is important to me, as I am planning to move freely during the first stage of labor. Unless there is a serious contraindication, I don't wish to be still or lie in bed. (this worked out alright. it was rough with the EFM cords, pitocin drip and BP cuff, but i got to use my birth ball, a rocking chair and do some dancing with Jeremy. I ended up being most comfortable sit/squatting straight up in bed)
  • I plan to let my body guide me to the most comfortable positions during labor and birth.
  • Please allow my perineum time to expand around my baby's head as it is crowning. As long as there are no signs of fetal distress, I would prefer not to rush the baby out.
  • As long as the baby is OK, I am not overly fatigued, there is no pain at my earlier cesarean site, and my contractions are continuing productively, I ask that my second stage of labor be allowed to continue without intervention for as along as it takes, even if it is four hours or more.
  • No instrumental birth, except as a final recourse. In which case vacuum extraction is preferred to forceps.
  • I would prefer to tear instead of an episiotomy. (only a teeny tiny tear!)
  • I request that the doctor, nurse, midwife, or assistant massage and apply hot compresses to my perineum before and especially during the pushing stage to reduce the possibility of tearing. (we didn't end up doing this)
  • My body knows instinctively how to push. I would like to first try self-directed pushing before resorting to directed pushing.
  • Jeremy would like to help "catch" the baby.
  • No routine pitocin following delivery unless bleeding is excessive. I plan to do immediate skin-to-skin contact and breastfeeding, which lessen the need for such an intervention. (this was really didn't make much difference since i had been hooked up to pitocin for so long already. plus I had some seriously excessive bleeding going on anyway)

Cesarean Section: (didn't need this section!! I'm glad it was in there though. as i said in the birth story, i think i would have felt a lot better about a c-section that i was involved in)

  • In the event a cesarean section is necessary, Jeremy will accompany me. I would like my doula, Michelle to be ready to join me when/if Jeremy must leave my side.
  • If possible, I would prefer spinal anesthesia over general anesthesia.
  • Though I would prefer not to be able to see the majority of the surgery, I would like the screen to be lowered so I may observe the actual moment of birth.
  • Following the birth, if the baby's condition permits, we would like the baby to be given directly to Jeremy for skin-to-skin contact. He will stay with the baby while I go to recovery.

Postpartum and Breastfeeding:

  • As soon as the baby is delivered, she should be placed skin on skin with Missy and they should not be separated. Newborn evaluations and care can take place there. (this was just NOT standard practice for this hospital, so it was all new to them)
  • We choose to wait to clamp and cut the umbilical cord until after it stops pulsing. Jeremy would like the option to cut the cord.
  • No routine suctioning of the baby's mouth or nose unless medically necessary. (Cynthia did suction her mouth when she was born, but it didn't really bug me)
  • We would prefer to postpone the administration of vitamin K and eye drops until at least 1 hour after birth. Erythromycin is preferred over silver nitrate.
  • We wish to postpone the first bath until we are ready to do it ourselves.
  • The baby is to remain in our presence at all times and room-in with us. If mother and baby must be separated, Jeremy will escort the baby.
  • Our baby should be given no substance by mouth other than colostrum and breast milk. At no time should sterile water, glucose water, or formula of any kind be given. The baby should be allowed to nurse on demand and no artificial nipples should be given. If the baby's blood sugar level is of concern, more frequent nursing will be encouraged as maternal colostrum provides a more healthy and stable blood sugar level than processed glucose.

(so some things went as planned and some didn't but it ended up being perfect!)

2 comments:

Lauren @ Hobo Mama said...

Thanks for the birth plan rundown! So interesting to see what happened and what didn't, and I'm glad the outcome was so positive. It really is surprising but pleasing to me that the hospital staff were so unused to natural VBACs and other elements of natural birth (like letting the baby be skin-to-skin for exams but still tried their best to accommodate you.

We made a birth plan for Mikko's birth in the event of hospital transfer, but we didn't end up giving it to anyone. We were in the hospital only 3 hours before he was born, in any case, and my midwife who came along helped advocate for the things we had discussed beforehand. Having someone with you who has a clear head is so useful!

Missy said...

One if the nurses just didn't know what to think about us... when she was getting me checked in I was discussing some if the plan with her.. she had such a hard time grasping the fact that I didn't want the baby cleaned, poked, and eye gooped up before she was brought to me. She kept saying how she does all that so that the baby is all ready to breastfeed when I get it! Ha! (she was the oldest one, so probably has been doing it that way for ages)

Yes, having Michelle and Jeremy there to be my voice when I couldn't was very reassuring. This time around I was a lot better at voicing my concerns and communicating my needs, but I guess that sometimes only comes with experience or age