Birth Plan

So I have to make up a guideline of a birth plan to start talking with my doctor tommorow. I was just hoping people could help me cover all the bases...

C-sec
vaccum
forceps
epidural
laughing gas
Episiotomy
pitoson
fetal monitoring
membrane stripping
breastfeeding
enema
shaving
IV's

I'm just gonna list them and add a comment on my preference than talk with him about it all... just dont wanna miss anything if you guys have more i have missed PLS add!!!

[peekawho]

There is no laughing gas used, at least in the U.S.  

Just be flexible.  That's my best advice.  You won't suddenly be unable to speak during labor.  You'll be well able to tell people what you want.   Its nice to have your wishes written down, but labor is so variable that you will have to be able to change things on the fly, so to speak.

[lostlilygirl]

there is laughing gas here in Canada... i'm not sure that's what they call it.... but its some kind of gas you breath in.... and my family has a history of complications so i wanna talk with the doctor about what i would like and what is actually possible.... i think i'm more doing this to calm me down than for him to know lol.... i'm just so nervous and i'm a HUGE control freak :)

[anxiousmomtobe?]

You can take eneman and shaving off the list, they don't do them in Canada anymore.  Which hospital are you delivering in?  Have you received any info from their L & D nurses?

I had a very detailed birth plan with my last.....and then had all sorts of complications.

This time I have an agreement with my doc that we will try and keep everything as natural as possible and that we will discuss any medical interventions if the need arises.  The main things I want to avoid this time is episiotomy and vaccuum.

[lostlilygirl]

why did you chose to avoid these 2 things? this is my first so this kind of gives me an idea on what i'm getting into... like i said it's more for me than him :)

[peekawho]

Its funny you mention that.  By far, it seems that people who have the most detailed birth plans often have the most complications!  

People who do the best just do exactly as you said: they hope to keep things as natural as possible, but are willing to go with the flow.  

Interesting that Canada uses Nitrous oxide (laughing gas).  It hasn't been used here for decades.  We don't do shaving or enemas either, in most hospitals.  

[anxiousmomtobe?]

I personally think the vagina is meant to stretch and if at all possible should not be cut in labour.  However, sometimes it is necessary.  

I found vaccum (and forceps) excruciating painful.

[ImmortalOne]

I worked out my birth plan with my doctor, however I will comment and hopefully help you.


C-sec - What point does your doctor do this?  The recovery is long, but personally I'd rather have a C-Section than Vaccum or Forceps delivery.
vaccum - Seen complications with the baby and the vaccum only prolonged the problem and therefor compounded it.
forceps - Read too many cases of lawsuits where the forceps were used and the baby ended up with brain damage from too much pressure used on the skull.
epidural - I'm afraid of things in my spine, but I've watched friends go through from 3cm to 10cm without feeling a single contraction and it went quickly for them.
laughing gas - Not used in the USA
Episiotomy - If the doctor is patient and you have done the keegal exercises this shouldn't be necessary. I only needed 1 stitch with #2 from "tearing" where as I had like 9 stitches with #1 from the Episiotomy.  I don't want one with this baby either.
pitocin - used for inducting labor or progressing labor when it has stalled, from my understanding.  After some minor research by the DH he and I agreed that Oxytocin seemed to be a better drug.
fetal monitoring - External is standard. Internal they attach things to the baby's scalp and it kinda creeps me out.  I don't like the idea, but if that's what it takes to keep the baby safe then so be it.
membrane stripping - Never had it done, only my water broken.
breastfeeding - Enjoyed it, the bonding time is irreplaceable.
enema - didn't need one, didn't do it, and they don't make them routine here in the states.
shaving - they don't do this in the states as routine anymore either (unless you need a C-Section).  I forgot to shave with the first 2, I'm trying to not forget to do it myself with this one (normal shaving, nothing extravagant, just legs and bikini)
IV's - At least have a "heplock" which is used as a port for if they need to administer medications or IV Fluids (Ice chips, no matter what is said, is NEVER Enough!)... who ever thought Ice Chips was the cure should've been hung by their toes.

Hope those help.

[lostlilygirl]

i'm trying to go with the idea that i want it as natural as possible... but i want to know the difference between what all these books i read and the REAL deal is... so i'm doing it this way. i already told him that i know that plans change... it's just a guide... as long as the baby and i are healthy and safe in the end... but i have no idea what alot of these are... and i just found out that some of these aren't even done anymore! lol

[anxiousmomtobe?]

My birth plan for Joseph was several pages long.  The nurses in L & D certainly took the time to be very familiar with it and everyone tried to respect it.  It just became useless when the complications started.

I don't believe they use Nitrous at my hospital.  I've never been offered it.  Have had demoral, and an epidural. Ideally, I am hoping to have nothing this time, but will go with the flow.  

I was really starting to get scared about L & D when they started reviewing what went wrong last time.  I know I have a great team and a wonderful hospital...so I am just trusting my body and if I need extra help I will be in the right place.

I also have a team of spiritual godmothers for this little one.  They all have committed to lighting a candle and praying the entire time I am in labour.  Some are family members, some are business acquaintances, some attend church with us, some are family friends.  I feel like they are covering me with prayers and positive thoughts.  I also think they will be wonderful role models for the baby as she grows.  Asking them to do this has given me a sense of peace.

[peekawho]

Labors are so unique and individual, that there is virtually no way to cover everything that could possibly happen.  You have the exact right attitude.  Keep it natural as you can, but roll with things as they happen.  You cannot script labor.  It is impossible.  

I hope you can quickly post when you go into labor, before going to the hospital!  We'll all send you our best thoughts and prayers.  

[lostlilygirl]

wow thanks! i had no idea about the forceps!!!! wow that's scary. what about the vaccum makes it worse exactly?

i'm learning more and more with this post that i REALLY have NO idea what the hell i'm walking into when i go into labour!!! i'm so scared now.... anyone else got more stories or input on the options

PLS I NEED THEM!!!!

[peekawho]

With all due respect, I've seen many a vacuum and/or  forcep delivery.  They can be lifesavers if the baby is in severe distress and easily deliverable.  It takes far more time to go back for a section in an emergency.  
This is not to say they are harmless, but in the right hands and under the right circumstances, they can absolutely save a baby's life.

Forceps are really hardly ever used in the US anymore, though.  Its a lost art.  I have no idea about Canada.  

Episiotomies are also not done much, unless the baby is in distress and has to be pushed out quickly.  

If you have an epidural, you have to have a regular IV, not a heplock.

Lily, just know what you prefer, and go with the flow.  You MUST trust at some point, rather than try to script every possible scenario.  

[ImmortalOne]

Lily these are just based on stories I've heard or read.  But then again I am so neurotic I wouldn't let them do a pap smear till I was past 30 weeks because I had heard of the risks of m/c.  

With both of my daughters my labor was really difficult because of back labor, with my 2nd one it was really bad and they asked me to sign emergency c-section papers... my husband and the time refused to let me do that... I'm glad in some ways, but know that in others it could've put the baby more at risk.

Also don't forget to cover the after the labor, do you want to hold the baby immediately?  Does the dad want to cut the cord?  At what point?  Do you want them to be telling you and counting the time you are pushing or to listen to your own body?  Do you want to be able to walk around throughout the labor and to change positions without having to worry about being bedbound by an epidural (some are "walking epidurals but I'm not familiar with those).  Do you want to have the baby room with you?  Do you want them to do all the necessary tests there with you in the room or does it matter if they take the baby elsewhere?  The questions go on and on.

Here is a few examples of birth plans.

http://www.childbirth.org/articles/birthplans.html
http://www.pregnancy-info.net/writing_birthplan.html
http://www.babyworld.co.uk/information/birth/birth_plan/examples.asp
http://www.mjbovo.com/BirthPlan.htm

Like I said I am working with my doctor to create a mild plan outline.  I didn't want to offend people or anything.  One of the big things I am insisting on however is holding her immediately after, even before the placenta is delivered, and that all tests are done in our presence.  More over another thing I found important was that my teenager was allowed in the room, and that I could choose how loud or quiet the room was and who was there with me.  Lastly, I had to kick a nurse out of the room with #2... I couldn't stand her and she made the L&D miserable - I want the ability to decide if a staff member is only making it more difficult on me or not (not that I don't need encouragement but the nurse was just down right mean, especially when going through a back labor baby and not progressing past 9 1/2 cm!)

[jd1419]

I never did a birth plan--I figured I would go with the flow--my hospital does not do epidurals-so no need for me to worry about that.  I was induced with PIT both times--bearable used demoral for the pain when it got to a point of not tolerating it anymore--was able to sleep for about an 1 1/2 after that--woke up and was ready to start pushing--I did lay in a reclining chair on my side for a while insted of the bed...wonderful nurses in labor and delivery--don't worry about offending them they are used to seeing and hearing all sorts of things.  I had the vaccuum used on both my sons for they both got stuck on my pubic bone--second son even needed forcep pull--he is just fine and it really did not hurt that bad  considering you are already in the final moments of delivery the pain is great at that point anyway and you just want your baby out so anything they can do to get them out is the best thing.

[lostlilygirl]

peek

i dont know what i prefer cause this is my first and i dont know all the risks... or what is better for less risk on teh baby and what not.... that's why i wanted to get anything i can off here so i wont waste the doctors time explaining everything to me....

[ImmortalOne]

I totally understand and respect your education and experience.  As I told Lily the forceps and vaccum is something that I'm totally paranoid about.  I don't trust anyone to use their own strength on my baby's head, and that might sound strange.  I'd rather they cut me open and take her out (just not to use the same scar that has been used twice now for the appendectomy and my ovary removal!)

[lostlilygirl]

i had a friend tell me she was on demoral and she was SO spaced out that she didn't even clue in that her baby was born!!! her DH had to tell her 5 times that they had a baby girl.... and i heard the spinal one can make you numb for days if they do it wrong....

i realize children dont come with a manual but i'm seriously confused on what the hell i'm suppose to be doing and deciding here... all i know is i'm against a C-sec unless a last resort and i want to hold the baby right away and it not leave me... that's all i have been able to figure out!!! 2 things out of like 50+ (or it seems that way)

[peekawho]

The trouble is, under the best of circumstances, if there is severe distress and the baby is on the perineum, it takes about 10, sometimes 15 minutes to get you to the section room, anesthetized, and the baby out.   All the while, the baby may not be getting enough oxygen.  

A vacuum can be used and the baby out in less than a minute.  

I am not saying they are appropriate in every circumstance, nor do I want to scare Lilly!  But there is a very useful place for them, in the right hands and circumstance.

[anxiousmomtobe?]

The current trend here in Canada is as natural as possible.  If you tell your doc that and have a good birth coach to help you when decisions need to be made you will be fine.  

Labour is hard and sometimes scary, however, some women breeze through it.  My sister in law had very little pain.  I have a friend who just had her first.  She was in labour for 1.5 hours.  She only had to push three times and had two stitches.  You could very well have a lovely delivery.

Peek, I agree with you about vaccuum, without it son would not be here.  In fact, I am not sure I would have made it either.  Forceps are not routinely used here anymore.  They were when I had my dd 16 years ago.  Of the two, I think vacuum does the least damage to the mother.  

By the way, I recently read in a lamaze book that the pain of birth was imagined.....I threw the book across the room and had a big belly laugh.

[ImmortalOne]

I had demoral with both my daughters.  With #1 the doctor gave me a final dose too close to delivery and I couldn't hold her at all, almost dropped her and thankfully mom was there to take her.  I was completely aware of what was going on, and sleeping in between contractions with it.

With #2 I again had demoral and I fully remember that birth, the pain, the excitement, and every step of what was going on when I wasn't sleeping.  It's a good drug, it takes the edge off a difficult labor and helps to relax without having something stuck in your back (I have had too many spinal taps which is why I don't want an epidural, my back is not cooperative with needles).

And again just look over the samples, see what you like and what you don't, make a note of it and talk to your doctor about it.  Remember that the important thing is to be flexible about things.

[peekawho]

We don't use Demerol anymore, either.  Nubain or Stadol, mostly.   Less risk of respiratory depression in the newborn.  

[ImmortalOne]

Really?  When did that change Peek?  LOL see Lily!  It's been 15 and 10 years for me and still they change the rules! :oP  

You rock Peek, what are the effects of Nubain or Stadol and what are the differences in those and Demoral?

[peekawho]

Demerol is very long acting, and if given too close to delivery time can completely depress the baby's respirations.  Not always, but more often than not.  Perhaps there are still some places using it, but not in the last 5 places I've worked at across the U.S.  Maybe in Canada its still used.  

Nubain and Stadol are shorter acting, and that's the advantage.  But, with the shorter action, it also wears off faster, and subsequent doses may not work quite as well.  I don't see much advantage of either on over the other.  They seem about the same.  

Demerol was great, and I was sorry to see it go, actually.  Used properly and not too late in labor, it was a great medication.  

[ImmortalOne]

Hmmm Well that throws my plan out the window... I should probably call my Doc and ask if they stopped using it too.  

[peekawho]

You're in Michigan...we didn't use it at any of the 3 places I worked there, either.  

Yep, ask what he uses for pain control.

[ImmortalOne]

LOL Peek, did you work at St. John's?  Damn it sounds like you travel/move as much as I do!  

[peekawho]

One was a branch of St. Johns...cr@p, I can't remember the name, it was in a bad area near Detroit...Providence!  I worked there, I worked at...cr@p again...St. Mary's in Livonia, and then finally at...***@**** Howell...St. Joes!  

[peekawho]

The last Was St. Joes Livingston.  Why did it bleep that????  In Howell.

[ImmortalOne]

Wow!  Yeah you've moved often!  I'm having Lilith at St. John's Medical Center in Detroit, the one on the boarder of Grosse Point and Detroit on Moross.

[Nicole092907]

I agree with a lot of you guys its nice to have a birth plan but a lot of things can happen and change during delivery although I knew nothing about a birth plan with my DD so I guess I just decided to take it when it happens and go with the flow....I had back labor with my daughter I was mainly home through it all by the time I made it to the hospital I was 4 cm they asked if I would like an epidural and I said yes please!!  but they werent able to get the needle in the right place because the guy doing it said my bones are to close together that there isnt enough cartilage to get it through... so I had to deal with no epidural but I said ok fine as soon as I layed down I felt the need to push called a nurse in and she got the doctor and he said your at 10 already ready to have the baby and I started pushing although it took me at least 30 mins to push her out I didnt tear at all he said a couple little ones but not enough to put stitches in... so I plan just to take it how I took it with her although it went so fast it turned out ok!!

[ImmortalOne]

God I hope my labor and delivery with Lilith is that easy Nicole.  It was like 10+ hours with #1... and 36 hours with #2.  My SiL had her daughter in 4 hours, counting the onset and the pushing, I am so jealous.  But I guess its better than the baby being born in the backseat of my Jetta.

[Nicole092907]

Yeah my mother is absolutely worried about me going into labor again ... she told me just rent a hotel close to the hospital so you'll make it... Yeah I guess I just wish I had more time to sink it all and kind of enjoy it ... I packed all these clothes for my daughter to and when she came out she couldnt fit one out fit I packed she was 6 lbs 2 oz ..so my mom rushed to wal-mart and bought all these premmie clothes for her...Wow I thought they always said labor is a lot faster with the more children you have and you went longer than the first one ... wow I hope number 3 will go by a lot quicker for you then

[ImmortalOne]

Yeah that's what I heard about things as well Nicole.  I was rather annoyed that it wasn't the case, but then again #2 was purple and blue when she was born as well (cord around her neck and bruising on her face from my pelvic bone because she was born face upwards).  I never had normal BH contractions with their of them either, not like this baby, I am hoping for no more back labor, it might mean I can get through the labor.... I am concerned how my incision is going to feel with all that tightening though, even now (6 months later) its still sore....

[tmv]

I think that one of the most misconceptions is that once you go into labor you cannot make any choices. That's just wrong. I worked and delivered in a small hospital, but also worked in the 2nd largest women's l&d in the state. Unless of an emergency ex. decreased hb in baby, crashing vitals, etc., you are in control of your birth. Things that are "routine" can be refused and it's not a big deal. Some dr's prefer certain ways and have reason's to back their beliefs. If you trust that your dr will do the best for you and the baby, I think that you would be able to do anything to get that little one out safely. I could not have an epidural bc of a past back injury and I told myself that I could do anything for 24 hours for my baby-luckily it wasn't that long but you get the point.
I've never met a nurse that didn't say whayt she was going to do before she done it. Like, I'm going to give you a shave or enema,etc-if that dr even uses it anymore. As for the episiotomy, the dr's and midwives that I worked around would let you push and see how well you could stretch out the perineum, some women are more prepared with it than others. Also, I've found that midwives are more patient in letting women push. BUT on the other end, in the event of fetal distress, an immediate delivery is necessary. Also, an episiotomy can help prevent jagged tears that are hard to repair and go into the rectum sometimes. There are medical reason's behind everything that is done, it's not done to be barbaric or whatever.
Anyhow, I'll stop here because I could probably go on for days. It is great to have an idea of what you would like or dislike before delivery. Knowledge is the key. But, just remember to be flexible. The staff is out to take the best care of you and your baby. They know what's best when emergencies arise.

[tmv]

Oh, forgot to add that especially with the midwives, if the woman has delivered before, almost never got an episiotomy.

[Trialanderror]

My doctor refused to even look at a birth plan saying that they would do whatever suits the situation best. Initially I was appalled but I do understand where they are coming from. So when I actually went into labor, I had a two-liner birth plan with a request to help avoid an episiotomy and a joke. They passed it around and laughed. I never saw my doctor and the delivery nurse made a huge effort to fulfill my only request. I got away without tears or episiotomy despite a large baby. Everything else we discussed during labor.

[Mummy2Lucy]

I wanted my birth to be as natural as possible aswell. I looked at a bithing plan but realised that it was just to hard to forsee everything. As it turned out I had all of the drugs available and ended in an emergancy c-section after 25hours (and we have laughing gas in Australia). I think the best thing to take into a birthing room with you is the trust in the medical staff. You will feel alot more relaxed if you let go and trust people that do this day in and day out then getting yourself worried about everything that may need to happen during your labour. I believe in being informed but I also believe in getting to much information, which then tends to cloud or confuse your judgement. At the end of the day, all that matters is that your baby arrives safely and healthy.

[ImmortalOne]

I talked to my doctors and the nurses at my hospital today during my NST.  I asked about walking epidurals (they don't do them anymore there), and the demoral (they still give this medication for labor and delivery with heavy monitoring).  *wipes brow*  I'm a creature of habit and familiarity, I'm glad they still do the demoral at least.

[luv_babies]

At my hospital, they only do walking epidurals. I liked mine, I was able to feel enough to push effectively and wasn't dying either. They also use Nubain. They almost had to use a vacuum on DS because his heartrate was so low, but at the last possible second before she was going to use it, I got him out. I also didn't want an episiotomy, but hearing that little beep so far apart, I didn't care how he came out.

[peekawho]

Immortal,
They must be some of the last to still use it.  I'm pretty surprised!  

[ImmortalOne]

I was as well, but considering I don't know how I will handle the other medications (I had an allergic reaction to a pain medication in a hospital about 2 years ago out of state and no way of finding out what it was without going through hoops).  I know how I handle demoral at least.  Though I am hoping that if this one is front labor I might be okay and not need it, that is my goal at least.

They told me they stopped walking epidurals because of the risk of cord prolapse and that it was more a concern than worth the ability to move about.

[luv_babies]

Maybe I didn't have a "true" walking epidural (that's just what the hospital called it) because I wasn't allowed to walk around during labor and I had to wait at least 2 hours after before I could try and get up. I had feeling, but I wouldn't have been able to walk around anyway.

[mature_enough]

You all sound like you've covered all of the bases. Very good input.

I hope you got the birth you wanted. Please share when you have the chance.