Birth Plan, plus post Doc visit edit

At the hospital Saturday the nurse asked if I had a written birth plan. Suffering too much for sarcasm, I just said no and left it there. But now here’s my thought, “Do I need one?” A friend wrote a plan for a subsequent birth that included a brief description of her loss of her first son. I considered one, and talked a few weeks ago with Dr. K about it. But when thinking of a term birth it seems extraneous. One of the advantages of New over Old Hospital was that more than likely Dr. K would deliver, or one of her partners would. All of whom know me, and all of whom share the desire for unmedicated vaginal births if that’s what the parents want. But, all of whom also recognize that desire one is living baby and know I will instantly change the plan if necessary. It’s a personal-enough environment to make the document sort of silly. My desires have already been communicated clearly.

Now, however, it seems the birth might be early and at Old Hospital. Is there a reason for a birth plan for a premature birth? I’m going to have a small army of doctors, residents, and possibly med students in that room, most of whom I’ll have probably never seen before.

The doctors at Old Hospital all read the chart it seems – in that no doctor has come into the room unaware of my history and that we’ve lost a son. The nurses are another matter [Why is that? I thought the stereotype was that nurses were supposed to be focused on the patient, doctors on the condition?]. Given the numbers of possible strangers I could have standing at my vagina, it seems like a birth plan might be helpful. But at the same time, a premature birth is sort of an emergency (caveat to birth plan #1 – nothing on it trumps the desire for a live baby) so I’m not all that sure it matters. If it’s going to be vaginal, I’m going to not want meds because I’ll want it fast & knowing my reaction to anesthesia I’m sure I’ll be the woman whose labor is slowed down by it. I will lose my mind if this baby gets stuck in the birth canal even if it is no big deal. But I’ll be perfectly happy to have an IV inserted or whatever in case of the need for an emergency caesarian.

Any thoughts? Is there anyway to plan for a premature birth?

We had a doctor’s appointment this morning. No cervical measurement because it was stable this weekend and Dr. K thinks it’s best to keep implements out of that area as much as possible. I’m fine with that for now – knowing the exact length of my cervix isn’t going to change anything about management. We’re just waiting for labor at this point. I told her what the doc had said Saturday about 34 being possible but probably not 37 weeks, and she responded that really anything is possible. I could lay here with no changes indefinitely. If I deliver between 30-34 it will be in an operating room and I will need an IV but no epidural. The team will be bigger than with a term delivery, but not as large as the one present for a 24-30 week delivery.

I think the kidney stone is still trying to work its way out. Pain is less, but I’m having some sensations I’d describe as strange in that area. One fairly bad attack while I was sleeping last night, but it woke me up from a nightmare where I was being chased by a giant placenta monster in a shopping mall while I was trying to kill Volde.mort with a spell for chicken pox, so that was okay. For Harry Potter fans, I was also trying the ava.da ked.avra on the placenta monster and Vol.demort but apparently I’m not evil enough because it didn’t work. My chicken pox were quite effective though.

I lost 3 pounds since Wednesday. Probably due to all the flipping water I’m drinking plus the fact that abdominal pain and eating don’t go well together. That’s not bad, but not good either so I had a fatty lunch. Of course, that’s wonderful for the 3rd trimester heartburn. I’m actually grateful for the chance to complain about normal pregnancy issues.

If things continue quietly here for a few more days, maybe I’ll try for a thoughtful post.

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16 responses to “Birth Plan, plus post Doc visit edit

  1. It’s a good question. It seems to me that your birth plan could be almost exactly what you just said. That your number one goal is to go home with a living baby. You could then list your secondary goals, ie. unmedicated vaginal birth, and any other things you can think of that would be your *preference*, secondary to a safe, delivery. Maybe it would help you relax just a little if you knew had all of that in writing?

    I am still pulling for you to get to at least 34 weeks!!

  2. Didn’t you hear? You have to mean those curses. Chicken pox must be a lot easier to mean. Plus, maybe you meant to finish Voldy off with a nice laugh after the pox worked.
    Sorry about the pain and the no appetite thing. I continue to hope you make it to 34 and the new hospital. Thinking of you, lots.

  3. It’s true that most things women focus on in plans are not automatically applicable to many premature births. But by writing that stuff down, you cover all your bases in the event you do get some choices in how things transpire. Since you have a realistic view about the plan not being a promise, it doesn’t seem like it would hurt to write it out.

    My own preterm high jinks with Little A’s pregnancy began around the same time yours have (week 29). In retrospect, there are two things I wish I’d done differently:

    1) More homework on the NICU experience. I knew about the level rating of the NICU and some basic stats, but I didn’t know any practical stuff, like if the postpartum rooms were on the same floor as the operating room (in case of c section) or regular delivery rooms, or if DH would be able to freely move between the NICU and my room right after the baby had been born. (And if he couldn’t, would nurses relay regular updates on my baby’s status once she was out of my sight, or would I be left wondering what was happening?)

    In fact, when Little A was born in week 35 she managed to avoid a NICU stay altogether. Your little one hopefully will be the same way. But I think that when your baby has a higher than average chance for landing in the NICU, knowing a little bit about the routine that comes with that would be handy up front.

    2) Breastfeeding issues. Invest in a good pump and try to familiarize yourself with how it works before the birth. If you have him early, you’ll be pumping a lot. Premies, whether in the NICU or not, almost always have some special feeding issues. It wouldn’t hurt to talk to a lactation consultant beforehand and see if they have any recommendations or advice.

  4. Wabi’s advice sounds good. I have a tendency to be on the side of “I don’t care about birth plans, birth experiences or any such thing just as long as I get to take home my baby, living and breathing, with no major issues”. Maybe you need a very concrete plan. Birth plans are also much bigger in the US I think than they are here. Actually I personally don’t know anyone who had a birth plan.

  5. Julia – Yes, it must be a lot easier to wish chicken pox than death even on the embodiment of evil. You know, I never had chicken pox so even as I was shouting “varicella” I wondered what it would feel like. My mom actually would send me to friends’ houses to try and get it but I never did. I got the vaccine in 2002 – uh oh might be time for it again soon as I think I was told 5 years….

    Thanks Wabi – I’m soo nervous about breastfeeding since I know it’ll be especially good for a preemie. The NICU is on the same floor as the high risk floor but I don’t know the answer about recovery rooms. Thanks for the tip. If I’m before 36 weeks, I have to deliver in an OR.

    Rosepetal, “a very concrete plan.” I wonder what that could be? I’m fairly easily able to verbalize my desires so now I’m thinking maybe no plan. In a non-emergency situation, my biggest desire is to use the big jacuzzi tub….

  6. I wish that I had written down things like my L&D nurse can NOT be a smoker. Every time she came back from a break, I thought that I was going to puke. Other odd things: find out if you’ll be able to sip water or ice chips. You’ll be hungry afterwards, have food in stock that you like. Do you want a catheter? Is it mandatory? If you are planning on a vaginal birth you might want to try to use the Depends underwear. I found that better than bleeding everywhere. I brought my own pillows. Have a bag packed. I didn’t have one for both deliveries, even though I knew better. Take a shower ASAP and wash hair. If your son is in the NICU you might want to have your own onesies for him. For me, that just felt like the babies were more mine than the NICUs.

    About natural deliveries. If you have “back” labor or a long labor with Pitocin it won’t be easy. I can be somewhat tough, but after 12 hours of labor and Pitocin and not moving past 2cm, I gave in for an epidural with Ace. With the twins I was told that I would be fine, and then I had the babies two hours later. Your Dr. is right anything can happen.

  7. That dream is one of the funniest things I have heard in a long time! I am glad the chicken pox worked on the placenta monster and Voldy, since avada kevadra didn’t work… 🙂

  8. Good news from the doctor — well, no news is good news! I like hearing you complain about normal pregnancy things…

    I never had a birth plan either, for any child…but then again i am also pretty good at verbalizing my desires. If you really wish to avoid an epidural in the OR, you might want to write that down. With the twins i did end up having one, by my doctor’s suggestion…and he also said that the anesthesiologists would be pissy about it if i didn’t want one.

  9. I think a birth plan is MORE important with a high risk birth as opposed to a low risk one.

    For example, you keep discussing your reaction to anaesthesia, but a general is no more like an epidural than heroin is like an emla patch. Completely and utterly different creatures. Plus there are up to 11 different drugs that can be put into a epidural space, all different. You have no idea what will happen in the delivery room, so have a meeting with the aneasthestist ahead of time. Reality is that an epidural is safer for the baby than a general, and if they need to do a c-section, or there is a problem, you might want to be awake and alert to see the baby before it gets whisked off to a NICU possibly at another hospital, depending on which level you are delivering at and if specialized surgery is needed.

    And that’s another issue. When Mac was being born we didn’t know what would happen, so we made a plan that during delivery, a close friend who was a SW at the hospital would stay with us at all times, and if the baby and I were separated after birth, she would be with me, and my husband would be with the baby, so that I would have someone with me constantly to tell me what was happening, and his job was to follow the baby everywhere (if necessary onto a medivac) and make decisions regarding care.

    As far as those decisions? We discussed every option we could after we spoke to our docs. When to resuscitate, when to end care, what we were willing to do or not.

    A birth plan also has things like a fully packed bag for every eventuality, and a list of people to call and what to say. If there is a crisis, who can everyone call for info? You don’t want them calling you two at the hospital? Soooo, can you designate one person who you call and who will call or email everyone else? Is there someone to update your blog, or where is the closest internet cafe you can access?

    I also had a rule that everyone who came into the room had to introduce themselves to me and look my in the eye before they looked up my vagina. (They always have time for this.) This was because during my first birth, everyone spoke into my vagina and since my ears are located somewhere north…I was pissed off. I also had a rule about how many residents, etc could be in the room. Frankly, there comes a point where they aren’t medically necessary and you have become a public spectacle. Let them learn off someone else. You’ve been through enough. This also applies to who you will allow to work on you and the baby? Med students? Residents? Attendings? Fellows? Or only fully certified OBs and Pediatric Neonatologists? You have the absolute right to choose, even if they guilt you about “teaching hospital, blah blah blah.”

    Episiotomies are medically unnecessary, always. They are completely useless but old Docs like them. The scarring & nerve damage can be a nightmare to recover from. Everyone loves vacuums, but if the baby isn’t in distress, they aren’t medically necessary. Forceps can be a life-saving godsend, dramatically faster than a c-section when saving a stuck baby, but deadly in unskilled hands. Who is an expert in them at either hospital? Anyone?

    Speaking of which, have you googled all the doctors, and done lexpert searches? You have access at the university. Josh should have a list in his pocket of who is the most incompetent and who ISN’T going to touch his wife and baby even if hell freezes over. Every OB gets sued, the question is, how many, what were the circumstances, the stories?

    Food at the hospital sucks, what restaurants are nearby? do you have a list with takeout and delivery numbers? What items can you pack that are nutritious and taste good afterwards?

    Most importantly, whether you deliver a baby now or later, YOU will need care, and you need to have things with you to help you recover and heal.

    Sorry, longest comment EVER, but there is a lot to think about, and I hope this helps a tiny bit!

  10. Aurelia’s comments got me thinking about my own anesthesia consults after the general failed in my termination/perforation repair surgery. I spoke with 2 anesthesiologists about what happened and got tips on how to give my history to other doctors for future surgeries. It is definitely something I would recommend, if you haven’t already done it. I could rattle off what the doctor told me to say and know that the anesthesiologist wasn’t going to misinterpret what had happened.

    Was it an epidural that failed for you? If so, you might ask about whether a spinal block might be a better opton. With my first baby I had a combined spinal-epidural, aka “walking epidural.” I was numb from below my ribcage yet retained the ability to move my legs. It was awesome!

  11. I know that many people feel strongly about birth plans or want to have a set of rules about who, what, where, when…. Aurelia, for example, certainly has lots of good ideas and thoughts. Personally, it’s not something that I cared about at all (and I do mean *at all*), so I guess I’m not too much help on this.

  12. Thanks all. I’ll compile these suggestions and begin writing something out.

    I keep talking about anesthesia but what I mean is any medication generally & I do mean the epidural and spinal block. I have a lot of unpredictability when it comes to metabolizing chemicals. Tylenol, for example, can be fine, or it can send me into shaking and vomiting. Motrin is even worse unless I am prepared with a very very full stomach and a big glass of milk. I had to be hospitalized after taking naprosyn when I tore the cartilage in my knee because my GI track went into revolt. That hasn’t happened for a long time, but I absolutely loathe taking anything for pain. Hence I can tolerate a hell of a lot with out it.

    Obviously tolerating a c-section is not possible but I’ve had stitches, probes in my knee, broken bones in my foot and fingers set all without taking even over the counter drugs. I had a laporoscopy and removal of an ovarian cyst with anesthesia of course but didn’t take a single one of my pain pills afterwards. Nor did I take anything after the cerclage. I refused morphine for these kidney stones as well.

    I know all of those drugs are not anesthesia, but it took so long for me to function normally after the cerclage with the spinal – not just the extended hours of immobility but the days of issues with bowel movements & bladder function – a feeling I remembered very well from the laproscopy that I’m extremely wary of anything that’s not medically absolutely necessary. My kidney stone issues in June and perhaps now are an aftereffect. I never took a thing for my miscarriage (and refused a D&C) or Natan’s labor. No, I don’t know exactly what will happen with this labor, but I think, and Dr. K thinks, I can tolerate anything that doesn’t absolutely require a general or a regional block. I consulted with an anesthesiologist at the Old Hospital both times I was there last week and the week before. I will consult with the anesthesiologists at New Hospital after 34 weeks. Everyone so far, however, agrees that no-meds is best for me unless we get into an emergency situation. I know that I can be prepped for a spinal or epidural really fast if necessary – it’s just a larger anxiety of mine surrounding it that I think will exist no matter how much I plan. I’ll consent to having an IV in in advance because that will at least be taken care of – I’m also a chore when it comes to finding a vein.

    My desires have nothing to with being tough or some ideal birth experience, it’s just a matter of knowing that introducing any foreign substance into my body introduces new risk. I’m one of those people who actually get the weird and rare side effects that sound so strange in TV ads. Any doctor who looks at my chart will know I’m not kidding.

  13. just wanted to add that i agree with Julia and the girls…
    you should have something in writing…and writing out the wishes you have, having them on paper can only be a good thing.

    do what you feel is right….ask for what you want….a healthy live baby!

    i am thinking of you so much and sending love.

  14. Ugh, my comment didn’t make it earlier. WordPress was not cooperating. Here it is again:

    You are in my thoughts. I’m glad you’re at home and not at the Old Hospital. It’s a good idea to have a plan written, just in case you have some choices. It makes it clear just in case you’re not available to give answers – and it may help Josh make those last minute or emergency decisions. Be an advocate for yourself, even if that means appearing to be a “bitch.” At my last L&D visit, a nursing student was trying to draw my blood, but she poked and missed. Lately, with the heparin shots, I bruise so easily, not to mention I don’t want to be a human pincushion. So I asked if someone else could draw my blood. I was polite, but I could see how that might come across. But even those little things are worth fighting for.

  15. Oh, totally Mary. Only tangentially related to your statement about the blood draw – I’m wary of going to the hospital again because I’m going to run out of veins since they insist on an IV. Not that I won’t if I need to. But Saturday when I went for the stones there was no way I was going to allow a speculum exam. I knew it wasn’t necessary, that it was more of a normal procedure issue, and that it wouldn’t give them any information about my pain anyway. Fortunately I didn’t have to argue or demand, the nurse midwife just said okay. I hope you are well – I’ve been thinking of you.

  16. I found myself totally unable to come up with a birth plan after the birth of my eldest. The second time around, I couldn’t let go of what happened, and I couldn’t let go of the nurses in the NICU who scoffed at some of the ridiculous birth plans they’ve seen. It seems judgmental to say that, but having been through what I went through – even *I* thought some of the stipulations on some birth plans was a bit much. That said, I wish I HAD put together a plan because I was totally unprepared for the birth – it was so different from the first experience, I was just not able to concentrate on some things – having it written down would have made that easier.

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