Birth plan again

[ailbhe]

I'm trying to draft it. I've found the oomph somewhere - a few hours of almost continuous Braxton-Hicks contractions this afternoon might have something to do with it - and so here we go.

General - vaginal or c-section

• My birthing partners will be my husband (Rob Collier), my midwife (Fiona), and possibly my mother (Niamh Leamy).
• I want to avoid vaginal exams.
• I don’t need an audience of strangers for breastfeeding or cuddling my newborn.
• I want immediate skin-to-skin contact with my baby, before the umbilical cord is cut.
• I want the umbilical stump tied, not clamped.
• Only the minimum of staff should be present at the birth and immediately afterwards.
• I do not consent to any medical students or student midwives being present.
• I want the absolute minimum number of people in the room at all stages, and I want them all to introduce themselves to me and my birthing partner(s) by name and position.
• I want my older daughter, Linnea, to visit us - me and the new baby - as soon as possible after the birth. The recovery room would be ideal.

Possible trial of labour

• What can I try without a drip and without continuous monitoring?
  • Oral medication?
  • Membrane sweep?
  • Artificial rupture of membranes?
  • Medication inserted into the vagina?
• I want to be mobile during labour.
• I do not consent to an epidural.
• I do not consent to augmentation of labour with a syntocinon drip.
• I’m quite happy to use pethidine as pain relief if I need more than gas and air. I will ask for it if I need it.

"Elective" C-Section

Before the operation

• If pre-scheduled, I want to have the baby in the morning; I want the whole family to go to hospital, where I will have a private room, and await pre-op stuff together, and then someone (probably my mother) take Linnea away while Rob and I go to theatre, and then the birth, and then Linnea will be brought back to admire the baby.
• Under no circumstances do I want to see or hear the obstetrician who did Linnea's birth. Rob can check corridors to make sure he's not around before I go from one room to another.
• I wish to be scheduled in with Miss Allott of the traumatic birth clinic. Failing that I require an outpatient appointment to see the surgeon prior to the operation who will be prepared to discuss my concerns and be familiar with my obstetric history.
• I want to meet the anaesthetist before the day of birth to discuss anaesthesia options and the importance of these to my mental state. I do not yet know whether I would prefer a spinal or an epidural. I do know that as soon as I am ready for a c-section I must be guaranteed no pain, immediately. I can not and will not endure pain during prep or the operation itself.
• I will want gas and air available for the siting IV drips, administration of epidural/ spinal block and vaginal examinations.
• I want my husband and my community midwife with me at all times if possible. Under no circumstances is anything to be done to me while my husband or midwife is not present, including adjusting my support socks or "just" inserting a canula. I will not consent to be prepped for the operation unless my husband is present.
• If I have to have a catheter, and I'm sure I have, I don't want to see it, feel it, or have to carry it around. If I am mobile, no catheter. There has to be a way to arrange this.

During the operation

• I want to have the minimum of flesh exposed during the operation.
• I want at least one hand free during the operation this time. I wish to avoid having my legs restrained.
• I do not wish to see the incision at any point during the operation.
• I want to breastfeed as soon as physically possible – not practical, but possible, after the birth - preferably while being sewn up again, even.

After the birth

• I do not consent to any treatment or examination of the baby unless s/he is in my sight.
• If it is necessary to take my new baby to SCBU or similar, s/he is to be accompanied by my husband at all times and I am to be brought to him/her as soon as I can sit in a wheelchair.
• I want Rob and myself left alone with the new baby in a private room for about an hour after the birth, so I can try to feed it and we can goo over it.
• I do not want anyone on the postnatal ward nagging me to walk. I will get up and walk when I feel ready. I have had surgery twice since my previous birth, and both times I insisted on getting up to walk earlier than the nursing staff thought appropriate. If I can walk, I will. If I can't don't nag me.
• I want to know that I have EXCELLENT pain relief available for as soon as the anaesthetic wears off and for the weeks after the birth - most women I've met who had c-sections got decent pain relief for a very few days and then had to go to paracetemol. I refuse to experience serious pain after a birth again. Not happening.
• I want a follow-up appointment with the ob who does the op a week or less after the birth to have my stitches and incision checked for soundness, in addition to the regular 6-week check.
• I want access to a lactation consultant in case I need a galactogogue due to giving birth before my body is ready, which could affect milk supply in the first few days. I explicitly do not want anyone to even SUGGEST formula-feeding unless an actual paediatrician examines the baby and finds a problem, and then they'd better suggest some other things first. There's a milk bank in Oxford, for a start.
• I want to feel confident, the day I leave hospital, that I am well enough to do so, and that I have medical support available to me after I leave if I need it.
• But mainly I want to have no pain. No pain, no pain, no pain.

ETA: I would also like help from people who don't care about the birth bits but can tell that I've repeated myself six times or accidentally written something in pig latin or similar. Edit me!

Comments

[kcobweb.livejournal.com]

BRAVA to you for getting this down. I only have a glimmer of an idea of how hard it is for you to write this stuff.

[clare-s.livejournal.com]

Good job on getting this down ! I am just going through it now and will reply again with any edits etc.

[clare-s.livejournal.com]

Possible trial of labour
• I wish to be mobile during labour and do not consent to continuous monitoring or induction via a syntocin drip.
• My Birthing partners will be Rob, Fiona and potentially my Mother.
• I want to avoid vaginal exams.
• I’m quite happy to use pethidine as pain relief if I need more than gas and air.
• If I deliver vaginally, I want immediate skin to skin contact
• Only the minimum of staff should be present at the birth and immediately afterwards.
• I do not consent to any medical students or student midwives to be present.
"Elective" C-Section
Before the operation
• If pre-scheduled, I want to have the baby in the morning; I want the whole family to go to hospital, where I will have a private room, and await pre-op stuff together, and then someone take Linnea away for a bit while Rob and I go to theatre, and then the birth, and then after a bit Linnea and someone come back and admire the baby. Someone would probably be my mother.
• Under no circumstances should I be attended by or be aware of Mr .
• I wish to be scheduled in with Miss Allot of the traumatic birth clinic. Failing that I require an outpatient appointment to see the surgeon prior to the operation who will be prepared to discuss my concerns and be familiar with my obstetric history.
• I want to meet the anaesthetist before the day of birth to discuss anaesthesia options and the importance of these to my mental state.
• I will want gas and air available for the siting IV drips, administration of epidural/ spinal block and vaginal examinations.
• I want the absolute minimum number of people in the room at all stages, and I want them all to introduce themselves by name and position.
• I do NOT consent to the presence of medical students or student midwives.
• I want my husband and my community midwife with me at all times. Under no circumstances is anything to be done to me while my husband or midwife is not present, including adjusting my support socks or "just" inserting a canula. I will not consent to be prepped for the operation unless my husband is present.
• If I have to have a catheter, and I'm sure I have, I don't want to see it, feel it, or have to carry it around. If I am mobile, no catheter. There has to be a way to arrange this.
During the operation
• I want to have the minimum of flesh exposed during the operation.
• I want at least one hand free during the operation this time. I wish to avoid having my legs restrained.
• I want the umbilical cord tied.
• I want the baby delivered onto my chest and skin to skin, preferably before the cord is cut.
• I do not wish to see the incision at any point during the operation.
• I want to breastfeed as soon as physically possible – not practical, but possible, after the birth - preferably while being sewn up again, even.
After the birth
• I do not consent to any treatment for the baby unless they are in my sight.

[buzzy-bee.livejournal.com]

What she said. Its much stronger to simply say you do not consent to things and leave out the "unless necessary", "if possible" etc. If it really *is* necessary, they can come and get your consent. Not giving them escape clauses means they *have* to do that and leaves you in control. They're much less likely to do these things if they have to check them but they *will* get consent if they need to.

[pir-anha.livejournal.com]

i concur with these edits, for the most part. straight-forward, without mincing words, and without value judgments (whether or not you think it's crazy to put a towel under your newborn, that sort of writing is just asking for people to argue. don't give them that chance.). stronger statements about consent are going to work in your favour, i believe.

you're doing great!

[zinecure.livejournal.com]

It all sounds good to me. Perhaps you should print this out and take it to your next prenatal appointment, just to go over things with your OB and mid-wife....make sure they are on the same page as you;)

[rosefox]

I'm so impressed that you did this. Well done.

[griffen.livejournal.com]

Me too.

[bopeepsheep.livejournal.com]

Epidural vs. spinal - yes, a spinal is more likely to be "complete", epidurals can 'slosh' as you move around (mine tipped during labour and my left leg came back to life while my right leg disappeared entirely) which post-birth could be awkward. They topped mine up but also gave me IV narcotics as a double-up which made me feel dreadful 8 hours after, like a hangover. AIUI that isn't the case with a spinal. But you may be less able to move so soon post-birth with a spinal, which complicates your desires for baby time.

I can't see an obvious way around the delivery/screens thing although there should be one. If you are adamant about neither of you seeing the incision, remember to ask them to shade you from the overhead lights too, the fittings are generally nice and reflective for optimal lighting reasons.

There's more but I'm waiting on Lemsip and then going back to bed so I'll comment again tomorrow.

[genie22.livejournal.com]

Topping up an epidural can get annoying after a while. Having a spinal means you have just the one 'hit' and if you need to be taken for a Caesarean then they can cart you off (consensually, of course!) straight away.

I'm glad to see you've taken care of this. For the screens, we like to put two poles up above the bed, and tape the mother's gown and a dressing sheet up to create one.

As for the catheter - there are these 20cm long mobile catheters of 5mm or so diameter you can use as needed.

[ailbhe]

I wouldn't get either unless I was definitely going for a section. And there's no "of course" about consensually - last time they forced me to sign a consent form. This time, mind you, I'd actually call the police, because this time I'm forewarned.

Incision

[tiggsybabes.livejournal.com]

I closed my eyes & imagined myself walking down the beach with my dog during my first c-section operation to stop the panic welling up. I made the mistake of opening my eyes & glancing towards the window & seeing a reflection of what was happpening behind the screen. I had nightmares about it. I've never, ever watched any birth programmes about c-sections as I don't want to know.

[barakta]

Having experienced too many hospital things to count I think everything you ask for is perfectly reasonable and should be automatic. I am sorry you have to ask for them at all.

I add my recommendation that you show this to midwife/other medics as and when, it it very clear and firmly written.

I think the repetitions you have made are relevant, they highlight your priorities as I understand them from the rest of your LJ. I especially like the introduction from people by name and role - you may want/need to specify more strongly that they introduce themselves to YOU (not just other medics or Rob et al). I know as a deaf person my problem is that people do introduce themselves, but unless I know they are about to do so I miss this, so miss their name and rank.

Private room afterwards

[tiggsybabes.livejournal.com]

Each time, we were taken to a recovery room wher we wer einitailly left with the mw who sorted the baby (Holly was bathed, don't know about KAte, I don't remember) I was then given skin to skin breastfeeding & we were left alone for an hour or so. Pam was with us with Holly & was in charge of checking the equipment monitoring my blood pressure.

I was then given a bed bath each time & wheeled to the ward for a "rest"

With Holls, I was then moved into a private room the next day, not at my request, just because one was available, I was low risk & they said I could have it so I could get some peace & quiet. I was very grateful for this as the woman in the bed opposite me was so noisy & shouted down the phone at people all through the night & I wanted to strangle her.

Pain

[tiggsybabes.livejournal.com]

I had very little pain from the actual c-section after leaving hospital & having come off the morphine. My worst pains were the retracting uterus when breastfeeding & back ache as I had back ache labour each time.

My second scar has healed badly & I still get pain underneath it, my period pains around scar are severe & require deep breathing to get through them & I have no feeling whatsoever in it. I can pinch my skin & feel nothing at all 18 months later. I also still get problems with my lowest disc that Andy has put down to the epidural as it's where it apparently went in. The operation & the epidural were done by students, so as you say, no students. I have no probelms at all from the first time as I had the consultant & top guy anaesthetist.

[mrs-warwick.livejournal.com]

re anaesthetics.
I don't know how typical this is (maybe the ladies who had C-sections can comment), but I was prep'ed for an emergency C, and I was numb from the shoulders down. Afterwards, I had such dreadful shakes that I was too frightened to hold R in case I dropped her. I had no control over my arms. Maybe it's something you could discuss with the anaesthetist.

Otherwise I agree with the suggestions made by clare_s.

[ailbhe]

Yes, this is what happened with L. I was't frightened to hold L, I just wasn't allowed without close supervision; my mother held her for me, on the postnatal ward.

[tammylc.livejournal.com]

I agree with the edits others have made, and congratulate you on getting it down on paper.

[pne.livejournal.com]

I want to be as not-naked as possible while in a room with thousands of virtual strangers. However, I also want immediate skin-to-skin contact with my newborn. Sheets?

A shirt/blouse/gown that you can unbutton to reveal skin? (Or tear open if you're in a hurry.)

[ailbhe]

For surgery, one is generally forced to wear a back-opening hospital gown and nothing else at all, not even nail varnish.

[pauamma]

You probably want as many people as you can manage to sign on this. Preferrably people in a position to make sure it happen. (Ob surgeon, midwife, ward nurse, operating theater nurse, anesthesist, etc... depending on the local pecking order.)

[tassie-gal.livejournal.com]

Just a thought...I know you say in your birth plan no Students, but I would also make sure they put it on ANY notes that you may acquire during the stay...preferably right on top in black magic marker and highlighted. (maybe also a sign on the door?)

[ailbhe]

VERY good idea. A stack of "No students - midwives, nurses, anaesthetists, obstetricians, or otherwise" signs

[flybabydizzy.livejournal.com]

I don’t need an audience of strangers for breastfeeding or cuddling my newborn.
I do not want extraneous staff present while breastfeeding etc
This would clarify what a stranger meant. I think you mean any member of staff not actively assisting you at the time; don't let them mistake it to mean any member of staff who you haven't already met. Or something like that


I have had surgery twice since my previous birth, and both times I insisted on getting up to walk earlier than thenursing staff thought appropriate

space between the... nursing.