Birth plan shot to hell by OB (depressing update)

[Sleepyheaded_Mama]

Sorry this is long, but I have never written one of these before and would really like advice/insight before I present it to my OB. And then once I go over it with her, do I re-write it according to what is actually feasible according to hospital policy? I just want to be ready this time but have no idea where to start or how to proceed. TIA for reading and commenting!

Cesarean Birth Informed Consent / Refusal for Dawn * ***** and Her Newborn

I realize that cesareans are a common event in hospitals. However, I ask that the staff respect that this individual surgery is a unique and never-to-be-repeated event in the life of my family. For us, it is neither common nor routine, but rather is an event that will have effects lasting a lifetime. It is my goal that as a cesarean is necessary for this birth, that the entire process be treated as the joyful, celebratory and respectful event that birth was meant to be.

This cesarean birth plan is intended to express the preferences, consents and refusals I have for the the birth of my baby during my planned cesarean. It is not intended to be a script. I fully realize that situations may arise such that my plan cannot be followed. However, barring any extenuating circumstances, I request you keep me informed and aware of my options. Thank you.

- I do not consent to sedatives or amnesiac medications being administered, pre or post-op.

- I prefer epidural anesthesia.

- I do not consent to a catheter being inserted until after anesthesia is administered.

- I do not consent to strapping my arms down, unless I am unable to control them.

- I do not consent to (partner) being separated from me at any time.

- I do not consent to (partner) being separated from me even in the case of general anesthesia. It is important that the birth of my child be witnessed by a family member even if I am not in need of support at that time.

- I strongly wish to see my baby being born, either by lowering of the drape or providing a mirror.

- I would like everyone in the OR introduced to (partner) and myself, and their role in the delivery
explained to us.

- I would like conversation between staff focused on making (partner) and myself feel as at-ease as possible and to be kept informed as to what is taking place.

- I do not consent to weighing, foot printing, eye ointment or other routine tasks except suctioning for
the first two hours after birth. Blood glucose testing is expected.

- Instead, my baby is to be placed STILL WET immediately on my chest and covered with blankets for
warmth.

- Bulb suctioning only, unless my baby shows signs of problems. Any deep suctioning to be performed with a mobile unit while I hold my baby or at my immediate side.

- Baby to remain on my chest, in my arms throughout suturing, recovery, etc.

- If separation is mandatory, I request (partner) remain with baby at all times.

- All pediatric examinations done on my baby are to be performed in my presence.

- I do not consent to anyone bathing my baby at all. I wish to do this myself.




- I do not consent to any students, interns, etc. watching or participating in the surgery or care of
myself or my newborn infant.

- I do not consent to the administration of any vaccinations to my baby.

- I do not consent to the use of any bottles for my baby.

- If my baby has hypoglycemia, I wish to use breastfeeding to treat it. My second choice is pumped
breastmilk administered using a non-nipple feeding method. My last choice is formula (not sugar
water).

- My preference post-op is to utilize a PCA system for pain management. If oral medication is used,
orders to be written for me to be woken up for timely doses (not waiting for my request).

- I request full-time rooming-in with my baby.





_______________________________________
Dawn * *****, mother

[jess152]

It's pretty thorough...I can't think of anything you missed! It's good to go in prepared. When do you go?

[Fujiko]

DDC crashing...
Perhaps you should look into requesting the surgeon do a double-suture to close the incision. I know it's better for VBAC (don't know if you are able or want to do that) but it may also be safer for future pregnancies, since something like half of uterine ruptures occur before labor even begins.

[Sleepyheaded_Mama]

I'm "scheduled" for next Friday (the 20th). Was really hoping my body might have other plans and volunteer to deliver before then, lol, in which case I was just planning to stay home until the last minute. But that quite possibly will not happen, so I wanted to have SOME element of control when I go in for the surgery, and to have at least SOME things go the way they would if I delivered vaginally, kwim? I guess in a non-emergent situation I cannot see any reason why the flow of things should proceed any differently once baby is out than they would after a vaginal delivery. And yet they do if you don't go in with a plan - I know, because it happened to me with baby #1 and baby #4 (my two prior sections) - which is why I thought to write out a plan this time.

Thank you for reading/previewing, Jess!

[Sleepyheaded_Mama]

Originally Posted by Fujiko

DDC crashing...
Perhaps you should look into requesting the surgeon do a double-suture to close the incision. I know it's better for VBAC (don't know if you are able or want to do that) but it may also be safer for future pregnancies, since something like half of uterine ruptures occur before labor even begins.

Good call! I'll add it in! I had read about that, but didn't think to include it, so thank you!

[CarrieCo]

I refused antiobiotics before the surgery because I did not want my babies born on antibiotics, thus compromising their immune system. My ob was not happy with this decision because he said it put me at increased risk for infection. I told him he could push the antibiotics as soon as the umbilical cords were cut.... and they did ... no infection. One question I asked was ... if it was an emergency c-section would there be time for antibiotics before the surgery?! He said no, but they would be more at risk still for an infection ... blah blah blah!

[Sleepyheaded_Mama]

Well I presented my birth plan to my OB this morning and she very, VERY snarkily (it's a word as of NOW) shot it down. "There WILL be this" "There will NOT be that" "I will NOT allow this", etc. etc. scratching out my bullet points and writing in her own notes as she went through it. I don't know if I caught her on a bad day or what, but she's never been like this to me before. Of course I've never come to her with a birth plan before either. I about bawled right there. I just do not understand why a non-emergent cesarean has to be treated so very, very differently than a vaginal delivery. I understand that it IS surgery, and the process IS physiologically different for the baby than a vaginal deliver is, but if he's not in distress and doesn't have problems breathing - why can't I hold him right away? Why does he have to stay under the warmer? Why *must* my arms be strapped down? Why *must* they take him away for observation for a "few hours"? Just because it's hospital policy??

I am so depressed right now. I just want to lay in bed and not get up, not move. I still have a lot of amniotic fluid, so his head isn't dropping fully into my pelvis (I think it does when I stand up, but he 'floats back' when I lie down, kwim?) so I will probably never go into labor before the surgery anyways. I hate my OB. Hate my stupid defective body.

[elisheva]

s, mama. I can't believe she was so mean to you. It's really not acceptable. My only advice is to relax and try to focus on enjoying these last few days of pregnancy. Any way you would push off the surgery to give yourself some more time? Remember, your OB works for you and she can't (by law, AFAIK) abandon you at this point.

[Lily's_Mom]

What a mean woman! I'm so sorry she's treating you this way.

[JJS]

I am sorry your experience was so terrible. I think your birth plan was a very wise one. It included your choices and decisions, while allowing that some things may not go according to plan. I would take a deep breath, give her 24 hours, and try again. This is your body, your baby, your day. You need to feel confident in yourself and your hospital staff. They need to be respectful of what you need to make this experience good for you. There has got to be room for compromise. I know there is. Can you go over her? Talk to someone in administration for some of the choices that are a must for you? You have options. You will be in my thoughts.

[CarrieCo]

Sorry about all this! C-sections are a disappointment .... if it's any consulation, you can't really hold your baby when you're laying flat and have neck pain as a side effect of the anesthesia and you're 'throwing up', but nothing is coming up b/c your stomach can't work right because it's numb.


I had asked that the babies stay in the OR with me as long as possible unless there was a problem..... which at least they weren't 'whisked away'. Then when I was in recovery I started to have anxiety b/c my babies weren't with me, so the nurse called and had them brought down right away, which was good. Then they went back to the nursery while I was being transported to my room and being moved to my bed. Then once I was settled, they were back.

Also, it's up to the anesthesiologist wether or not your arms are strapped down. Just promise him that you won't try to touch your belly, and he'll probably agree to not strap you down.

Try rewriting your birth plan with some compromises. Talk to the nurse who will be handling your baby in the OR, and review it with the anesthisiologist. Try putting your birth plan into sections like, OR expectations; C-section; and After baby care. Then go over it again with the ob.

[Tattooed Hand]

I'd be really upset too! OK, fine, so there are some things they can't do with a c-section. But it does not sound like she tried to be nice about it, explain it or try to reach some compromise. And that she can very well do, thank you very much.

I agree that you should go in there again and ask her to please explain to you (instead of dictate) what can and cannot be done so you can reach a compromise. Don't roll over and her stomp on anything she wants! Sometimes those things aren't even hospital policy or medically necessary, sometimes they are just what the OB thinks they should be. But these are your preferences we are talking about, not hers. Make her work with you.

[jess152]

Originally Posted by Sleepyheaded_Mama

I just do not understand why a non-emergent cesarean has to be treated so very, very differently than a vaginal delivery.
Hate my stupid defective body.

I'm so sorry you're feeling this way. I think you have such a good point that is worth bringing up with her. If it's a non-emergent c/s, they should do their best to work with you on these wishes! I didn't think anything you asked for was overly demanding!

How many weeks will you be? If you are confident in a VBAC, try out all the natural inducement methods you can. Your body is not defective!

[feminist~mama]

Oh mama- your body is not defective! I'm so sorry she was such a !

However, as a nurse I can explain that some of what you want is just difficult to figure out. For example, a sterile blanket is placed on the warmer, so that whoever hands the baby to the nurse remains sterile. Figuring a way to stay sterile and put the baby on your chest is difficult/ maybe impossible.

I absolutely understand why you want to hold the baby, but I can also understand that you're in the middle of a major abdominal surgery and that placing a newborn in your arms makes everyone responsible for ensuring the safety of the baby as well as your safety. If you were to pass out or have some sort of medical emergency it would be really horrific if something happened to you or the baby. I'm thinking about access to your IV which is suddenly different because you're moving your arms, breaking the sterile field with movement, possibly bumping a tray or worse, bumping the surgeon and something getting nicked or cut, what if you have a seizure, go into shock, etc. I generally avoid sections *and* I work at a tiny, rural hospital *and* we don't have many to begin with *and* we don't many high-risk patients- but I will say that I've never seen any of this happen. But the possibility is there and I can understand why your OB isn't on board.

Also- part of the reason that babies go to the warmer is that the OR is really cold. We pump warm air onto our mom's arms to keep her a bit warmer and the baby is dried and wrapped under the warmer, then taken over to mom.

As for the chatter and introductions to staff- I think it's totally reasonable and it always horrifies me how people chat about parties and shopping and vacations while in the midst of this mama's birth... I really don't think the "no chatter thing" would happen at my hospital either though!

You might want to try to find out what your hospital's routine is- we only give meds for stomach issues ahead of time, we always do spinal/epidural for non-emergent sections, we always wait until the epidural takes effect before placing the catheter... Don't forget to ask about the post-partum routine too- some hospitals have a time limit placed on recovery- so the nurse has 2 hours to bathe, footprint, give meds, do an exam, etc- and then she gets a new patient. Understanding this part of the routine allows you to find a way to have your needs met without setting up an unhappy situation for everyone involved...

I wish you the best of luck mama! I really hope that you can find a way to feel good and empowered and basically okay with what happens with your birth!

[JohannaInDairyland]

I'm so sorry your OB was so unhelpful. Just in case you aren't dealing with enough trying to plan a c-section you didn't want in the first place.

Would you be willing to share what she won't allow/agree to? What's her personal policy vs. hospital policy? A lot of what you requested seems pretty standard, or at least not that far out there. Maybe we can help you brainstorm ways to get closer to what you want. For instance, I recently learned that my hospital is pretty strict about the arm strapping down (which I REALLY dislike), but that they allow almost immediate skin-to-skin contact for baby with dad/partner. Also, routine procedures (in my state) must be done within an hour of birth, but can be done in room with parents observing - when my care provider and I went over my birth plan, she readily agreed to push it to the end of the hour.

[SunShineSally]

I am so so so sorry I would have bawled right there in front of her! here's hopeing baby wants to come sooner than the 20th!!!

[deny_zoo29]

I am SO sorry! It's not like your plan was ridiculously demanding or anthing. Not sure why they want to strap your arms down (they didn't do this with me and I was shaking uncontrollably from the high dose epidural). They did strap my legs down but that was just because they kept falling off the edge of the table while they were prepping everything. And our LO was shown to me over the top of the screen and then taken over to be cleaned up (she was only 5 ft away and we could see her the whole time). She was wiped clean, suctioned, and wrapped in blankets, then immediately given to DP. I was shaking so bad I could not have held her right then. She was with us the entire time from delivery, into the recovery room, and then into the postpartum room. Never was out of sight.
I would try to bring it up to your OB again and see if you can get actual reasons why your birth plan is no good.
Good Luck!

[notjustmamie]

I'm sorry!

I didn't think anything in your plan sounded unreasonable. Your doc seems like she's just too tied to her usual way of doing things to try to work out something a bit different.

Can you remind us why you're scheduled for a c/s?

[Sleepyheaded_Mama]

Sorry, it took me awhile to calm down a little before I could even come back to the boards. I will attempt to explain what she nixed without throwing myself back into the anger/depression of yesterday:

What she is saying is that the "strapping down of the arms" is non-negotiable out of, I guess, some one-size-fits-all assumption that I will freak out and/or try to "help" with the surgery. She blamed it on "somnolence".

There will be no lowering of the drape or mirror, again out of some misguided assumption that the mother will freak out. Never mind that I'm a nurse and have attended many surgeries, and more than a few cesareans. But Heaven KNOWS what I'd do if I saw myself being cut open. Gawd this pisses me off to even type. ::sniff:: Her suggestion was "Just let your mom video tape it". Ok, but the sheet I got re/the surgery said NO VIDEO RECORDING. Furthermore, sure, I will just watch the birth of my son on tv later because it's ALMOST THE SAME &^%$#$%^ THING you stupid *&^%.

Sorry. Sorry. Finding my happy place....

Okay, moving along:

The weighing, and other 'routine tasks' are done in accordance to NICU protocol and are non-negotiable.

The baby will absolutely not go anywhere but into the warmer immediately after the cord is severed. No skin-to-skin allowed in the OR. Citing how disastrously unsafe it would be to even consider such an option, she wrote in big letters "NO! NOT TO HAPPEN!" across that bullet point.

I will not touch baby until recovery. Those arms simply MUST stay strapped firmly down. ::shiver::

Interns will absolutely be a part of the delivery, it is standard procedure that she is assisted by interns "I'm not going to do it all myself!" as if the notion were utterly absurd. How stupid of me.

I have been visualizing and praying like mad that I go into labor before the 20th. No one understands how badly I don't want this surgery. My family thinks it's just great that I can plan and get my mom down here and my sister can make plans for a back-up sitter while my mom is with me and my dad and brother can arrange to watch my older kids and - just -wow! How wonderful to be able to schedule a birth!

But you know what, if I went into labor naturally, randomly, and waited it out, called someone at the last minute - they would step up, watch my other kids, I know they would. And maybe they'd be inconvenienced, maybe they'd have to call into work, or leave work - but isn't that the way it's meant to be?? Aren't some things just supposed to follow their own course and aren't we just supposed to kinda go with that??

Please baby...please...

[Sleepyheaded_Mama]

Oh, and I'm scheduled for a cesarean because I've had 2 cesareans prior. My birth history goes like this:

1. ER cesarean - male OB
2. VBAC - midwife/doula
3. stillbirth VBAC (baby was gone 3 days prior to induction) - midwife/doula
4. cesarean for "failure to progress" - female OB

That last cesarean, done by this same female OB, was, IMO, utterly unnecessary. It was to be an induction (my flawed decision born of fear after the stillbirth), but she wouldn't turn up the pitocin. I kept telling them to turn it up because I wasn't contracting enough. Pretty lame when a mama is ASKING for more. I seriously get menstrual cramps far worse than anything they "let" me have during that induction. In hindsight now I suspect she just does not believe in VBACs and that was her passive-aggressive way of handling it. Of course then she said we had to do the cesarean because my labor was not progressing. I cried for an hour and then, stupidly, agreed to it.

And here I am today.