Birth Plan versus Birth Reality Part 2

My Birth Plan

So my last post I shared a bit about why I wanted an unmedicated birth and how I prepared for one.

After all my research and 10 weeks of birth classes, my husband and I were able to put down in writing what we preferred to happen once I was in labor.

Now of course we did have a few hiccups.  The biggest one was having Gestational Diabetes.  Because of GD, I was considered a "high risk" pregnancy and didn't have as much free reign over my options like I would have if I was a low risk pregnancy. 

But that was OK.  We made it work.

Below is what we drafted for my doctor (and he approved!) and shared with the nursing staff at the hospital.  I also added comments about why I wanted things a certain way.

**I included my birth plan so that my readers can have a base to start their own, if they wish.  I'm not offering any medical advice here, just sharing what I learned and what I preferred.  As always, check with your doc before insisting on any preferences or procedures.  I had my doc review this.  He also signed it and sent it to the nursing station before I was admitted.  It truly is a discussion that needs to involve the entire birth team**

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Birth Plan for Vanessa
Name of Hospital
Due Date: December 28, 2011 / Patient of Dr. Name of Doctor

We are very excited to be sharing the birth of our child with the wonderful staff at Hospital. We would like the opportunity to have an unmedicated birth and feel the staff at Hospital will be very supportive of us. We understand that complications do arise and we are fully prepared to be flexible with our preferences and work with Hospital staff to avoid any complications.
Pre-labor:

• We prefer to begin the birth process naturally and would like to try natural methods of induction before any drugs are used. We understand that with Vanessa’s diagnosis with Gestational Diabetes, induction will begin no later than 40 weeks. (Natural methods that I tried were Evening Primrose Oil to help ripen my cervix, exercises such as long walks and squatting to open the pelvis, Castor Oil, and acupressure.  Feel free to email me if you have any questions.  And as always, check with your doctor before trying any induction methods!)
• If there are no signs of complications (high blood pressure, high blood sugar, fetal distress), we prefer if Vanessa is allowed to carry to term (40 weeks). (Because due dates are estimates, most babies can be carried to 41 weeks without any health risks or complications.  In my opinion, it was better to carry baby longer than to be induced earlier.  I wanted to give baby the most time possible to grow and develop.)

Labor:

• For Vanessa’s comfort, we prefer to use dim lighting, light music, and aromatherapy in the labor room. (So I can be as relaxed as possible.  We used flame less tea light candles and a lavender room spray.  We didn't end up using music but watched TV instead.  Once active labor started, I didn't even pay attention to the sounds around me but focused inward on my contractions).
• We would like to be able to move around during labor, experiment with different labor positions, and use the shower for pain management. (Being active in labor is very important.  Lying flat on her back is one of the worse ways a woman can labor. Walking helps to open the pelvis and being upright helps baby moved down.  Different labor positions (squatting, leaning, rocking, being on hands and knees, lying on your side) help with pain management.  I didn't get to use the shower since I was hooked up to an IV.)
• We prefer no IV-hookup except for a hep lock for emergencies. We understand that if Vanessa’s blood sugar drops, an IV hookup of glucose may be required. We would like the option to use honey or honey straws before introducing glucose water intravenously. (Because I was induced, I had to have an IV hookup.  In Hawaii an IV is not required but a saline or hep lock is in case of emergencies.  Pitocin was administered through my IV but I was still able to walk around using a telemetry device offered by the hospital.  My blood sugar did get a bit low, but the nurse from the first shift allowed me to drink some milk to bring my sugars back up.  Usually I don't drink dairy but it was either dairy or more fluids through my IV, so I took the dairy. *Note* the telemetry device was HORRIBLE at tracking mine and baby's heart rate.  It caused a lot of false alarms! The nurses weren't panicked but I had to return to the room a lot so that they could readjust the monitors.) 
• Intermittent fetal monitoring is preferred. If continuous monitoring is required, we would like access to the telemetry unit so that mobility is not hindered. (Again, because I was induced with Pitocin, I had to be monitored continuously.  The telemetry unit was rubbish- the belts kept sliding around and baby was moving so it was hard to get an accurate reading, which resulted in a lot of concern from the nurses.  I'm glad they checked often but it was an added thing to worry about during labor.  And another thing to note** continuous monitoring has a strong correlation to C-Sections because of a lot of false alarms where the baby's heart rate drops on the monitor but really it's the sensors malfunctioning or the baby moving around.)
• Please do not offer pain medications. We will request them if needed.
• Vanessa prefers to push and breathe without a 10 second count (“purple pushing”). (Pushing past the point of comfort can lead to an episiotomy or tearing.  I unfortunately had a nurse that encouraged me to push as long as I can and then a few seconds longer to hurry and get baby out. I listened to her because I was in the moment and afraid of my baby's heart rate dropping.  Looking back, I wish I pushed as I had intended but either way I can't regret it because baby was healthy anyway!)
• Carl will support Vanessa and her legs if necessary.
• Vanessa prefers the use of pedals instead of stirrups.
• Vanessa prefers to not have an episiotomy. We would like to use warm compresses and perinneal massage before having an episiotomy. However, if an episiotomy is deemed necessary due to excessive tearing or a tear that goes upwards, she prefers a pressure episiotomy.(I did not want an episiotomy because sometimes a cut is actually deeper than a natural tear.  However, my doctor did use massage during the pushing stage but with me pushing beyond my comfort level, I ended up tearing anyway, in three places! Good news? I was virtually pain free within a couple days.  But still, tearing sucks!)

After Delivery:

• Please do not clamp the umbilical cord until after it has finished pulsating. (Cutting the cord before it's done pulsating prevents the oxygen rich blood from the placenta from reaching the baby.  All that blood needs to be in the baby.  The cord will actually start to constrict itself after pulsing the blood baby needs from the placenta.  Because of this, we did not donate or bank our baby's cord blood.)
• Carl would like to announce baby’s sex and cut the cord.
• We would like our baby to be placed immediately on Vanessa’s chest for skin-to-skin bonding. We request all testing procedures to be delayed until after skin-to-skin contact, breastfeeding, and bonding has occurred unless medically necessary. (We learned that the first hour after birth is the strongest window for bonding and breastfeeding.  My cord was too short so baby was put on my chest after the cord was cut.  I was able to hold him and breastfeed while being stitched up.  My husband also did skin-to-skin bonding until it was time to move to the recovery room.  Skin to skin helps baby regulate its temperature, heart rate, and breathing.)
• Baby is not to be separated from Vanessa and Carl at any time. If testing is necessary outside of the labor or recovery room we ask that Carl be able to accompany baby at all times.
• If baby is deemed to have low blood sugar and formula or glucose water is necessary, we prefer that the staff use a syringe versus an artificial nipple. We would like to avoid nipple confusion as Vanessa plans to exclusively breastfeed. (Breastfeeding is extremely important to me and I wanted to start off on the best possible foot.  Baby's sugar levels were great after birth and he did not need any formula or glucose water.  Baby was circumcised at the hospital and was given a small amount of glucose water in a nipple to distract him from the procedure.)
• Please no Hepatitis-B vaccine for baby at birth. (We chose to delay this until we spoke to our pediatrician.  We wanted as much time as possible to research the benefits and risks of both the vaccine and disease as well as have the time to discuss our concerns with our pedi.  We didn't want to consent to a procedure "just because" but wanted full understanding.  Our hospital didn't push the issue at all but did go over the risks of not vaccinating.  They did not give us the risks of the vaccination though- just food for thought)

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As always, if you have any questions or concerns or would like to discuss any part of my birth plan further, please email me.