My Birth Plan for Delivery #4

I'm not anti-birth plans. Quite the contrary, I think they are a wonderful way for someone to think about how they would like their birth to go. But, there are 2 key points to remember with any birth plan: 1. show your doctor/midwife. and 2. be flexible. In a perfect world, everyone would have the birth they dreamed of, down to every last detail. We all know that sometimes things happen that make that ideal birth unobtainable - prolapsed cord, abruption, too small pelvis, etc. I've seen some very detailed birth plans, some 4 and 5 pages long and invariably, something doesn't go as mom planned and they are unsatisfied with their birth.
It's also a running joke among nurses, at least in the area that I work, that we are more prone to disasters during our births - hemorrhage, prolapse cord, severe pre-eclampsia, etc. Obviously, there isn't probably any truth behind it, but it all goes back to us being superstitious. To ward off those evil vibes, I posted this when I was pregnant with Isaiah, and thought it was still appropriate with this pregnancy, plus I added a few things.

A Labor Nurse's birth plan:

1. I want lots and lots of Magnesium Sulfate.
2. I'd like to have an emergency c-section without anesthesia due to a uterine rupture at my old incision site. (yes, unfortunately, we have done c/s sans anesthesia, luckily not often)
3. If I dont get a emergency c/s and can VBAC, I'd like an episiotomy with a 4th degree extension, please.
3. I also would like to be tethered to the bed for the duration of labor with internal monitoring.
4. I desire lots and lots of cervical checks
5. I also would like my baby taken from me straight away for at least an hour so it interrupts with breastfeeding and bonding.
6. Only internal monitoring for me, baby!

Ok, all kidding aside, I do have a plan for this delivery. Because I know this will be a scheduled c/s this time, I have a few things that I want that will help make the experience the best it can be. If I do go into labor on my own, I get to the hospital and I'm 8cm, I won't be going to the OR - that would be pointless because it is likely that by the time they get everything set up and ready for the c/s, I'll be complete and ready to push. Especially if my water breaks. I may have to argue a bit, and I've jokingly threatened to break my own water with the amniohook (again, just kidding) to prevent going back while in transition. (Really, it was just to get a rise out of one of our new nurses...you should have seen the look on her face because she took me seriously! Ha Ha! Yes, I am evil) But, anyway, that's not likely to happen. So here's what I have planned for my c/s delivery:

1. I will NOT be given any sedative (versed) after the baby is out. Sometimes moms want this, because they don't want to think about being stitched back up and just want to relax. I know what they are doing, and don't care - I don't want to be doped up.

2. I'm still debating in the whole duramorph(astromorph) thing. I probably won't want it and will take a PCA pump instead, even though the pain control isn't as good. A side effect of that wonderful duramorph (really, it works well) is itching. I itched myself into a rash after Clara's delivery and the itching was 10 times worse with Isaiah. I ended up getting 2 doses of Narcan to reverse the effects as I was about to go mad from itching. It's that deep itch all over that you can't get to no matter how much or how hard you scratch. It was horrible. The pain control was nice, and I did have more pain after the narcan, but I'm afraid of how bad it could be this time. I was itching before I even left the OR with Isaiah, and itched for 2 days.

3. Tubal ligation for me,please. Yes, this is indeed the last baby for us. It is a little sad that this will be my last time pregnant, but there comes a time when you know you are done. We are done. There are times I wonder how in the world I'll handle 4 kids...I can't even fathom 5! So while they are in there, they might as well take those tubes and be done with it. No chance for mistakes, no waiting on a sperm count, and no chance for birth control failure.

4. My baby will not leave the OR (unless need be for health reasons). It is completely possible to do the initial assessment in the OR. The scale is right outside the OR door so they can get the weight. I'm fine with letting him go to the nursery later - I just want to hold him. I bawled like a baby and couldn't figure out why after Isaiah was born. All I can come up with is he had been taken to the nursery per routine until I was settled into recovery and I was the last to hold him. I'm not sure if it was that or not, or just my hormones and tendency to cry anyway. But my plan is to be wheeled out of that OR, barring any complications, holding my baby, skin to skin. Skin to skin may wait until I'm in recovery, but it will happen at some point. I wish we did this more routinely for all c/s patients. Not everyone would want this, but we are working on being more baby friendly. Now watch me be wretching so violently that this can't happen. Oh well, if all goes well, that's my plan, if not, then I'll hold him as soon as I can.

5. Then, once I'm ready to be moved to my post-partum room, then I'll let nursery have him to do his bath. Depending on what's going on in the unit, I may want him to have a Leboyer bath - they like that much more than the standard wipe down under the warmer. We'll see.

Again, I know that things don't always go as planned. I could end up hemorrhaging, feeling like complete crap or the baby may need extra care. But, if it goes anything like my last uncomplicated delivery with Isaiah, it could be a great experience. We'll see how it goes. I plan on talking to the pediatrician to make sure she's comfortable with it - I doubt she'll care. I have a few months before we're really even close to D-day.