Wednesday, March 19, 2014

My Birth Plan in Review

I'm mostly doing this for me for future births, but who knows- someone might find my birth plan helpful in determining what they do or don't want. I was thinking about the few things that I ended up abandoning from my birth plan but how, for the most part, my birth plan worked really well and I want to keep it for next time, but I also want to remember the things that didn't happen or that changed. So here is my annotated birth plan with the colored commentary being my follow up.

Birth Plan/Preferences for Induction
Mother: Stacy XXXX Father: Steven XXXX            Doula: Brittany XXXX

This birth plan is intended to express  the preference and desires we have for the  birth of our baby. It is not intended to be  a script. We fully realize that situations may arise such that our plan cannot and should  not be followed. However, we hope that  barring any extenuating circumstances, you  will be able to keep us informed and aware of  our options, and that informed consent will be obtained from myself or my husband for any procedure relating to mother or baby. Thank you. I totally copied this section word from word from an online example because I couldn't improve upon it!

First stage (labor):
I would like the ability to labor outside of the bed. They were amazing about this and I would definitely, definitely request this next time. Sitting in bed felt pretty awful. My two favorite positions were sitting on the birth ball and being on my hands and knees in bed. Even with continuous monitoring, the nurses were amazing about not confining me to bed.
Do not offer pain medications. I will request them if desired. The doctor went over them with me about a million times before induction day, but the nurses never mentioned nor offered them. I did end up requesting them but luckily did not get them. I had a 'code word' to use with Steven and will plan on doing that again next time.
Brittany is certified in the TENS unit and I may use this during labor. If we use a doula next time (which I think we will!), I would probably leave this in there although I don't really know how much the TENS unit really helped. But I'd like to at least have the option. My doctor didn't know what this was but was open to us using it once I gave him information.
As long as the baby and I are both doing well, I would prefer not being held to a strict timetable for laboring. This didn't really apply to my labor lol... TOO FAST! But I'd leave it for next time because I strongly believe that, if everything is going ok, I want to give my body and the baby plenty of time. My doctor reminded me that the curve they judge you by is for the bottom 5% of births, so he sticks to it pretty closely, so I'm not sure how much he would have honored this but I think I would have had wiggle room if I pushed it.

Second stage (birth):
If baby has issues with heart rate that are not an emergency while pushing, I would like to try different positions that might be helpful. Non issue this time and not sure if I need to leave it because my doctor said this is very standard.
I would prefer a prolonged length of pushing if everything is ok with the baby and progress is being made, even if it is slow progress. This kind of goes with the timetable one... I'd leave it, though, and let Steven know that he needs to advocate for more time if me and the baby are ok.
I would prefer to use people for leg support. My doctor said that was fine but that I could be pushing for hours so people might get tired and I might need to use the stirrups which I was open to. Turns out I did NOT want people holding my legs and requested (in a breathless, pushy manner) to put my legs in the stirrups. The stirrups (which are totally unlike the stirrups in the office, thankfully) were much more comfortable and stable feeling, and I preferred not having my legs move up and down like they would if people were holding them. So yeah, I'll take this out and rock the stirrups from the beginning next time. Also, I had no clue that there would be handles to hold on to while pushing but those were AWESOME.
I would prefer to tear rather than have an episiotomy unless I will tear towards the urethra. And tear I did! Everything I read suggested that episiotomies are kind of controversial now because you may tear worse with one than without and generally heal better without one. I would definitely leave this for next time even though I have nothing to compare it to.
I would like Steven to announce the sex of the baby. This was so fun! I've seen on birth shows where the doctor announces but I wanted hubby/daddy to do it! I actually had to ask him... I waited until she was out about 3 seconds and then was like "what is it!!?!?!?". :)

I'd add back in the thing about pushing for 6 seconds. I had it in there (the newest information suggests that 10 seconds is too long and can have negative effects on mom and baby), but my doctor said that most moms don't actually push well enough to get a whole 10 seconds out, making it closer to 6, so I took it out. Then he remembered it and had me just push for 6 seconds. Pushing was no big deal for me and I don't know if this was part of why, but I'd probably add it back in there next time just in case.

Baby Care:
If our baby is a boy, we will not have him circumcised. Moot this time, but we feel strongly about this so we'd leave it.
We would prefer a delay in cord cutting, even if only by a minute or two. I was kind of wishy washy about this because I'd read conflicting information. It ended up not happening since Felicity wasn't looking good and she needed to be checked right away. I think I would actually probably take this one out for next time because it just doesn't matter to me that much (unless some kind of convincing info comes out before then).
Delayed testing/weighing/vitamin K shot or done while on mother’s chest. This is funny... so of course they had to take her immediately since she was non responsive, but once they gave her to me, they did not push at all to do anything. About 15 minutes in, I asked "did you weigh her?" and the nurse was like "uhhhhh... no... your birth plan says to wait" and for some reason I just HAD to know how much she weighed so I handed her back for a weight. So weird! I still don't know what I was thinking, but it makes me laugh. Anyway, I'd leave this in because I do really think that initial bonding time is important, and of course I can change my mind again if I want. I loved that the staff was so cool about this.
We do not want erythromycin applied to our baby’s eyes and are happy to sign a waiver. They never made me sign a waiver, and never even questioned it. It can affect breastfeeding (haha, clearly moot), but we also just find it completely unncessary so I would leave this in.
Breast feeding only; I have markers of insufficient glandular tissue and would like to see a lactation consultant soon after birth. I'd leave it, although I'll go in armed with a little more knowledge next time. I had researched a TON this time, but now I'm armed with actual personal experience.
No separation of the baby and me; if necessary Steven will go with baby and remain until baby can come back to me. They were great about this. They had the pediatrician come in the room (normally they examine in the nursery), bathed her in the room (also usually in the nursery) and when she had to go there for the pulse ox test and a few other things, they let us come at our leisure and we stayed with her the whole time. It was so nice not being separated from her, and I would absolutely leave this in.
I would like to be skin to skin with the baby as much as possible immediately following birth. This is another one that didn't turn out like I thought. My doula unbuttoned the gown so she could go skin to skin, and somehow when I took her, I ended up putting he ron TOP of the gown lol. So I'd leave this but try to actually get the baby on my skin next time! (I fixed it a little later, but pretty sure she hung out on my gown the first 30 minutes to an hour!) This was somewhat impractical to continue during our hospital stay with visitors but, knowing the extent of our breastfeeding issues, I'll push it harder next time and just not care if I'm half nakey.
No hepatitis B shot in the hospital. They didn't question us, we didn't see a need for it after researching, and I'd leave it this way for the next baby.

Free hand to touch the baby after birth; baby placed upon chest for a few minutes if possible.
Breastfeeding initiated as soon as possible in recovery room.
Consent for any intravenous medications used after csection.
Steven will stay with the baby after birth and initiate skin-to-skin until I can be with the baby.
Double layer repair of the uterine incision to help with future pregnancies/deliveries.
I'd leave all of this. Obviously, thankfully, I didn't see how that would play out to revise, but I still like those goals so I'd keep them the same in case I needed a csection next time around.


  1. David announced the sex too, but she Lucia was probably already a minute long and the midwife or nurse had to ask us, "Sooooooo, is it is a boy or girl?" for David to think to check! We were just so busy looking at our baby!

  2. She has the prettiest eyes! Back in my day we didn't do birth plans... we just got what we got. My first birth was epidural/forcep/episiotomy and I didn't know I had a choice in any of those things. I was fortunate to have two unmedicated FAST deliveries after that first nightmare and overall, it was a positive process. Mothers are so much better informed now and I know it makes things easier. Congratulations again! Heather

  3. My OB FIL always says "suture each layer you open."

  4. You should be able to be upright to push, not have your legs held up or have them in stirrups! Last time I was in the hospital to have a baby I had a hard push as he was 11 pounds and posterior, and I squatted in the labor bed holding on to the two rails. That was in 1977 so it shouldn't be too advanced for 2014!

  5. I think delayed cord clamping is important. Baby will go much longer on just breast milk without anemia if he or she gets the full complement of blood he/she is supposed to have! I would also put in waiting for the placenta to come on its own, no "controlled cord clamping. "

    Oh, and you are much less likely to tear at all if you deliver in an upright position such as squatting or semistanding, than if you are in a "semisit" or lying position. I tore along my old episiotomy scar with all the kids until I finally got myself upright for numbers six on. Number seven was nearly 13 pounds and I didn't tear delivering him squatting.

  6. I appreciated reading this! I'm going to bookmark it and come back to it; we are planning a homebirth but transferred with my first, so I want something like this if we end up needing to transfer again.