Yay For Being Pro-Active!

I've found an OB, a doula who sounds wonderful and like she's going to be a really great asset in the delivery room and I've had all my Tricare questions answered. I'm feeling much less apprehensive about the move to Alabama. The only thing that is still freaking me out is moving so late in my pregnancy, but we really don't have any control over that.  I chose the OB based on the recommendation from my doula (he tends to be more open minded about natural birth and doing things that are not the "norm" for down there) as well as reading other things about him online.  I called the OB in Alabama and it was a total failure at first. I heard the girl on the voice mail and immediately started laughing because of her accent. I'm not used to that thick southern accent at ALL and it's definitely going to take some getting used to. Second attempt went well though and my first appointment with the OB will be the week we get there--I'll be exactly 35 weeks pregnant. Eek. God, please don't let the baby come on our 2,800 mile journey! Please, please, please!

So I had a few people comment about my natural birth plan yesterday. I emailed it to my doula, Stephanie, and she was able to give me some really great suggestions. She sounds like a really great person and I think having her by my side during labor and delivery is going to make a huge difference.  I thought I'd share the changes so anyone else who may be considering a natural birth can also learn a thing or two!

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Hi, Megan!

I have read your birth plan, and I think we have the same attitude towards alot of things. However, I would caution against saying the word "unnecessary" at all. To the medical professionals, they would never do anything unnecessary, and everything they recommend is (in their opinion) necessary. So they might not understand what you mean. You could try wording things like this: I prefer to continue laboring without Pitocin unless my baby is showing distress patterns on the fetal monitors. Or, try: I request a second opinion if my physician recommends a cesarean. And, again, you could say: I would like to follow the American College of Obstetricians and Gynecologists' recommendation of not inducing labor except at 42 weeks or beyond. I would love to go through this with you in person, because I want you to know where my heart is--I don't want to criticize at all, but I can provide alot of suggestions to improve how your dr and nurses will perceive your requests. So, although it seems like I am making alot of suggestions, I am just trying to help. Here we go...

I do not want to be induced unless there is a risk to the baby or myself. Your phyisicians will think there is a "risk" to the baby or yourself even if you or I don't think so. So, I would say, I plan on not inducing until after 42 weeks, in accordance with ACOG's recommendations (believe me, around here you will be the exception if you make it to 40 or 41 weeks; so even if you don't want to be induced at all, I would toss the doctors a "bone" by saying you will consider inducing after 42. It doesn't mean you will, though :-). )

 

Home Labor Goals

I would like to labor at home as long as possible, with our doula present, before going to the hospital. I don't think anyone would have a problem with this, or even be concerned at all about what you do before you come into the hospital. You could leave this out in the interest of making your list short and sweet. "Brevity is the soul of wit", right?

Hospital Labor Goals

• We plan to have myself, my husband and doula present. Please turn away all visitors and unnecessary staff until we have had time alone with our baby. You probably won't have visitors unless you invite them, so you could just leave this one off if you wanted to. But if you wanted to include the unnecessary staff part, you could say, "I would like to limit the number of people in our room as much as possible".
• We are attempting to have a natural, un-medicated birth without unnecessary medical or chemical intervention. I would put this at the top of the paper, right underneath your name, your spouse's/partner's name, your doula's name, your obstetrician's name, and your estimated due date. I also wouldn't say "unnecessary" because they will read it and think, "Well of course! I don't want to have to give you pitocin either, but sometimes we must. Why would she put that in here since we agree about it?" I think they will miss the point that we don't want medications, operative deliveries, an episiotomy, and other medical practices at all unless the baby will die or be harmed otherwise. I like to include a sentence that says "I do not consent to a cesarean delivery based on fears of what might happen to my baby if we don't. I only consent to a cesarean delivery if my baby is showing distress on the monitors and if there is a time-sensitive emergency. If there is time for me to wait for an operating suite, watch a consent video, or wait for my personal doctor to arrive to do the surgery, then it is not a time-sensitive emergency." You could say the same thing and put "induction" or "episiotomy" or whatever you want in there. Have you read the sample birth plan on my website? It might be of help to you.
• We understand that there are procedures which may become necessary. For the sake of keeping it short and sweet, I would leave this out.
• Please do not offer me pain medications or ask me to rate my pain. I like this one.
• Except in the case of an emergency, we ask that we be given the opportunity to accept or refuse any procedure or medication. I think this one is understood by both parties, so I would leave it out or say something like: "We reserve the right to refuse any procedure or medication." and remember, you do always have that right--even in the case of emergency.
• We request that the least invasive or restricting versions of procedures be used. I would be more specific. You could say: "I prefer limited vaginal exams and infrequent fetal monitoring with a doppler or fetoscope instead of the electronic fetal monitor."
• I prefer to have minimal monitoring and limited vaginal exams. Hahah, I just saw this one. Okay, omit one of the two.
• I prefer not to have any unnecessary medications or interventions. I wouldn't say unnecessary, so I would leave this one out.
• I would like to the opportunity to be up and moving around as much as possible during labor. I think this is a given, but you could include it if you would like. Or, you could say something like "I plan on walking as much as I feel able" instead of saying "I would like the opportunity to".
• Delivery Goals

• I would like to push at my own pace (Mother-directed pushing.) To clarify what this means to the staff down here, I would be more specific. They might not have ever heard of or know what it means to say "Mother-directed". You could say, "During pushing, I plan on breathing and pushing to my own comfort unless distress is shown in the baby's heartrate. Please refrain from counting for me to hold my breath or from encouraging me to push hard, harder, or as hard as I can."
• I do not want an episiotomy unless medically necessary. I prefer to try perineal massage and a warm compress first. I might say, "I would prefer to tear naturally instead of having an episiotomy. I would like warm compresses and lubricating jelly on my perineum during pushing. To minimize tearing, I would like to push in positions that do not include lying on my back."
• I would prefer to push in whatever position is comfortable for me, rather than the traditional back and stirrups position. They don't use stirrups much anymore except as a footrest for you between contractions if you would like them. And if you don't want to be pushing on your back, then I would leave this part out.
  If labor seems to be stalling I would like the option to try different positions to get the baby to come down (hands and knees, squatting, birthing ball, etc.) I like this one, but I would say "I would like to try..." instead of "I would like the option to try..." just because we don't want to be wordy.
• Upon delivery I would like the baby to placed on my chest right away. I would like to have at least 1 hour of skin-to-skin contact before the baby is taken away for measurements. Great!
  
• I prefer to breastfeed our baby as soon as possible after delivery. I prefer not to be disturbed until after the first feeding. I like this one. You could say at the end of the second sentence: "Including uterine massage,blood pressure measurements (unless I show danger signs of drops in blood pressure), and post-delivery pitocin.
• We prefer to wait to cut the cord for 1-2 minutes or until it has stopped pulsating. Please offer my husband the opportunity to cut the cord. It should be much longer than 1-2 minutes before it stops pulsating. I would say something like "until the baby's breathing is well established, the cord is limp and empty, and the cord blood has completely transfused to my baby" to make it specific.
• Please retain my placenta for encapsulation. Great! They will require you to bring your own ziplock bags (bring 2 or 3 large (2-gallon) size bags so we can doublebag or triplebag your placenta, and bring your own cooler and icepack.
• I would like my doula to be allowed to take photos during the entire labor and delivery process.

If a Cesarean Becomes Necessary:

• I would like to be conscious with my husband and doula in the room. I would leave out the conscious part because almost all cesareans are with a conscious mother except in a true emergency where there isn't time to place an epidural catheter and they have to "put you under". They only use general anesthesia in real time-sensitive emergencies, and I would hope that you would consent to that. But you can leave this part in if you would like to state it, but I think the conscious part is understood. I would keep in the part about my husband and doula in the room.
• I would still like to nurse our baby as soon as possible and for my placenta to be retained. Great!

Recovery Goals

• I would like the baby to room in with us rather than in a centralized nursery. This is pretty understood. SAMC (the Southeast Alabama Medical Center) only has a centralized nursery if you ask for it. All other times, the baby is required to room-in with you. You could leave this part out.
• I would like either my husband or myself to be present for baby's first bath. They preform the bath right there in the delivery room, so you both will be there. You could leave this out.
• I would like to establish a strong breastfeeding relationship. Please do not introduce a bottle or pacifier without notifying us of a medical reason. Great!
• I would like to meet with a lactation consultant to have breastfeeding techniques checked. I would specify "meet with an Internationally Board Certified Lactation Consultant before being discharged". They have plenty of "lactation consultants" on staff who took a weekend course decades ago and who don't know what they are talking about, but they only have one IBCLC who is a medical care provider who specializes in lactation.