June 18, 2010

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.


Unknown said...

LOL, your first plan about gave me a heart attack, whew, LOL

Taking Heart said...

The more mag the better... tee hee.

I love the astromorph for my patients... but I can't imagine itching that bad... did you try nubain? It makes my pt.'s groggy... a little... but wears off quick... and works far better than the benadryl... I had a girl that itched so bad once that I gave narcan, too... she rubbed a blister on her nose.

Praying already for you... a smooth... non-nurse-cursed delivery. You deserve nothing less than a sweet... enjoyable... I will stop there as not to jinx it...

Anonymous said...

I had the perfect birthplan this time. One I didn't have to use-my 10 line birthplan was in my chart but never pulled our or referred to or talked about. I picked a doctor and hospital with SOP that was what was in my birthplan. Pretty much summed up in..
"I know I am a VBAC but leave me be as much as possible and I know my body well and will let you know what I am feeling and what is going on."
and that is exactly the way it went down. Lots of respect, lots of support, almost no interference or intervention except for bare minimum monitoring.

Anonymous said...

>>No chance for mistakes, no waiting on a sperm count, and no chance for birth control failure.>>

Umm... my tubal ligation failed. The failure rate is considerably higher for tubal ligation vs. vasectomy, and failures are higher for tubals done at the time of C/S vs. as the sole surgery.

Have a chat with your health care provider, and your husband. Really. You do not want an ectopic sometime in the future, or even an ectopic scare.

Nurse Lochia said...
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Nurse Lochia said...

Ok, poor choice of words on my part re: tubal. Yes, I am well aware of the 1:300 failure rate as well as the failure rate of a vasectomy. It's been discussed with my doc. I've changed diapers on several babies the were the result of tubal and vasectomy failures...nothing is 100%. It's the right decison for us and to be honest, Husband will be getting a vasectomy down the road...I just hadn't mentioned it. So we are taking precautions on both sides. And I no even then, nothing is 100% fail safe. If pregancy does happen, while unlikely, we'll accept it as God's will, even if it's an ectopic.

Tori O. said...

I'm working really hard to come up with a one, possibly slightly onto the second page, birth plan. It's the first one I've created and I'm on my third birth. I know that sometimes they are well received and sometimes they are not, but I'm citing sources in mine for my positions, but that may be a little excessive. The area I live in is very medical-oriented for labor and delivery. We shall see what my doctor says when I show it to her.

Laura said...

We don't do PCA's where I work. We go straight to Percocet, and Toradol PRN (but I usually just give it on a schedule to my patients). It worked well for me. Good luck with your very reasonable birth plan!

Anonymous said...

Just curious, what were the conditions that a c/s pt. had no anesthesia? I am assuming your hospital does not have 24 hr anesthesia? I had a pt this week not happy with her epidural during her c/s, can't imagine someone with nothing on board.

Totally get the "Nurse Curse". I may have to share your birth plan.

Anonymous said...
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Nurse Lochia said...

No we don't have 24 hour in house anesthesia, but they are available. There have been just a small handful of cases where the baby is seriously crashing, anesthesia isn't right there and it was cut or the baby would probably die - mom's chose to be cut. But it is VERY rare, and I can count on 1 hand the number of times I've heard it being done since I've worked OB.

So I may be hormonal and hope I don't sound too snarky here. While I appreciate all concerns regarding our birth control and obviously there are big vasectomy advocates out there, but, the best option for us is a tubal, they don't use clips here - the tube is removed and tips are cauterized, I trust my doc and will take my chances.

Anonymous said...

>>they don't use clips here

My failed tubal was not done with clips. It was done with loops, which is actually the technique with the lowest failure rate.

>>the tube is removed

You may want to check with your physician. It is not usual practice to remove the entire tube unless the tube is damaged or diseased.

>>and tips are cauterized

Cautery has a higher failure rate vs. loop, though those failures tend to happen years later and are more likely to result in ectopic pregnancies. Tubals done at the same time as a C/S are more likely to fail vs. those done as a separate surgery, BTW.

This shall be the last comment I'll post, and I really suggest you review this information with your physician.

FWIW, I trusted my physician, too... and I still would have, failure or not, if she hadn't accused me of being pregnant at the time of the surgery (I wasn't, and the surgical failure was confirmed via HSG).

Whether the pregnancy was ectopic or not was irrelevant to me (it wasn't); I had an immediate abortion. If you would carry a pregnancy to term, all the more reason to avoid tubal damage. Ectopics kill, and it's not possible to carry an ectopic pregnancy to term.

Joy@WDDCH said...

Whoa- what is with everyone dogging your tubal ligation? Back off people! It is her choice and guess what- she's a NURSE. I'm sure she's discussed it in great length and detail with HER doctor.

Anywho, cannot wait to meet your newest little one! We have three and hoping for a fourth sometime next year maybe. We'll see!

Unknown said...

Haven't been on blogger in ages, but congrats on your baby!! Your birth plan sounds great and hope it all goes well for you! I just had my 2nd baby two months ago and everything went beautifully (thank God my birth plan didn't jinx anything, :o) I did, however, keep it to a short 1/2 page 8 bullets points so maybe that is key. Short and sweet.