Birth Plan Help needed - doula requested my thoughts on revisions

[olien]

I have a Birth plan from baby #1, but my doula for #2 wants me to consider some revisions.

Any opinions on these things:
1. Pressure episiotomy - How is this different from just an episiotomy? I just stated no epis., she would like me to add pressure epis. only if necessary

2. Use suction, no forceps - Opinions on suction? I didn't add anything about this to my BP, she would like me to add the statement: If assistance in delivery becomes necessary, & positioning has not dislodged the baby, please use suction. No forceps during delivery.

3. out-patient prostaglandin gel/tape/suppository - What is this? I didnt add much about preferences if something did go wrong, so I am glad she is helping me with these parts. She would like me to add this as our 1st option if induction or augmentation becomes necessary if there is no fetal distress.

Any thoughts are appreciated.

[SallyN]

Hmmm... my birth plan wasn't that detailed. But I also had complete and total trust in my midwife. I would suggest talking to your care provider about those topics and finding out what their thoughts/positions are regarding them.

[mysticmomma]

For option number 2:

While vacuum assisted delivery tends to be more gentle, Older providers have been trained on and are more experienced with forceps. I would not want them trying out a vaccuum extraction on me and my baby. Younger providers are usually more experienced with vaccuums.

Also, where the baby is in the birth canal can determine which is devie is more appropriate. I would not add anything in this respect, but talk to your provider about which they use and why.

[mysticmomma]

For number three, she's talking about cervidil. This isn't and shouldn't really be an out patient option, but I guess some places do. It's a much gentler form of induction than pitocin, and of course you never want to use miso/cytotec.

[mysticmomma]

for number 1, a pressure epi is when the baby is crowning, they cut your perineum. A regular epi they cut at anytime and if you haven't had an epidural, they will inject lidocaine first. I'd stick with NO epi personally. Research shows that it does not expedite delivery or protect mothers tissues.

[womenswisdom]

I agree about vacuum vs. forceps. You want your provider to use whichever s/he is most experienced/comfortable with b/c neither is risk-free.

[olien]

Originally Posted by mysticmomma

For option number 2:

While vacuum assisted delivery tends to be more gentle, Older providers have been trained on and are more experienced with forceps. I would not want them trying out a vaccuum extraction on me and my baby. Younger providers are usually more experienced with vaccuums.

Also, where the baby is in the birth canal can determine which is devie is more appropriate. I would not add anything in this respect, but talk to your provider about which they use and why.

Good points. I didnt think of this.

Originally Posted by mysticmomma

For number three, she's talking about cervidil. This isn't and shouldn't really be an out patient option, but I guess some places do. It's a much gentler form of induction than pitocin, and of course you never want to use miso/cytotec.

Do these do the same thing as Cervidil? And why are they bad?

Originally Posted by mysticmomma

for number 1, a pressure epi is when the baby is crowning, they cut your perineum. A regular epi they cut at anytime and if you haven't had an epidural, they will inject lidocaine first. I'd stick with NO epi personally. Research shows that it does not expedite delivery or protect mothers tissues.

I thought that an epi did protect the mother if a tear forms that is starting to go up into the peri-urethral area.

[mysticmomma]

cytotec:

http://www.scienceandsensibility.org/?p=467
http://www.midwiferytoday.com/articles/cytotec.asp
http://enjoybirth.wordpress.com/2010...lly-bad-stuff/

[mysticmomma]

I will look for mmy info, as this is a new pc, but anectdotally I had a small peri urethral tear. A tear is usually superficial. An epi ALWAYS cuts skin, fascia and muscle. Its also not gauranteed to stop a tear going in that direction.

[Amatullah0]

i'd stick with no epi. if its needed you would be having an assisted delivery, and at that point(assuming the baby is actually in distress) you can't really choose between a pressure epi or not.

I wouldn't put anything in the birth plan about choice of induction/augmentation methods. thats something you have to decide on when/if it is suggested to you by your HCP.

you want a birth plan to be short and simple, so it will actually get read.

if you plan on declining routine procedures(iv, epi, meds, efm, cervical exams, etc) or have special requests(for me, it was no men in the room) or want your nurse to know something that your HCP told you you could do(like laboring in the water, eating and drinking) thats what I would include

also, include something about newborn procedures if you don't want circ/vax/vitK/eye ointment/infant-mom separation

I also included a c-section part for just in case, that said I wanted to nurse my baby in the OR, if possible, and not be left alone in recovery, etc. find out the hospital and HCP policies on that to know what to include, theres no point in asking for something that is routinely offered(like rooming in in a hospital that doesn't have a nursery)

[gcgirl]

Originally Posted by Amatullah0

you want a birth plan to be short and simple, so it will actually get read.

I agree. My doula has two versions of my birth plan: the detailed one that's for us to use to communicate with staff as things arise, and the short, 4-point one that covers the basics very broadly (i.e. no pain meds unless I ask, no interventions without my consent, etc.)

As to these specific questions on your birth plan, I can't help you with those details (mine isn't that detailed, even in my long plan), but I can tell you my OB agrees that epis are very rarely necessary, only to be used in case of a serious emergency when the baby has to come out NOW. Research backs that up. I'd just go with NO epi.

[olien]

Thanks everyone.

My BP for #1 was 1pg & not that detailed. This doula has a 2pg plan she likes to model & it is very detailed. I agree too much so. Honestly it is making me confused. I must have a talk with her about it.

She feels that if it is detailed & specificially addresses problems that may arise & not just a prob free labor that the Drs will take it more seriously. I thought it made sense at first, but now I am thinking that if a prob does arise that whatever is going to be done will be discussed with you anyway.

She did include a section on cesareans as well. With things such as 1 arm not strapped down to embrace baby, baby to stay in recovery with mother & only incision site & area on back to be shaved.

[Quinalla]

I too would stick with no epi. If they really *need* to do one, they can always bring it up right then. I too wouldn't specify vacuum or forceps, whichever the attendant has more training with is what you want if needed for sure. I also wouldn't bother putting anything on there about inductions meds. There is tons of time to discuss induction meds if you need them, doesn't really need to be on the birth plan, but definitely good to think about ahead of time.

[mamabadger]

If you opt for prostaglandin gel, etc. for induction, I would suggest you add "no amniotomy, ever" to your plan. Breaking the waters during an induction (or at any time) increases risks and closes down options.

[mysticmomma]

Those sound like HER preferences. Look into what you want. I have 2 forms for my clients to fill out. One very long for them to use as education points, and one very short for hospital/bc staff. My homebirth form is even shorter.

[Amatullah0]

another thing you could do is, write 2 birth plans, a short one(the one you give to the nurses/on call OB when you get to the hospital) and a long one(so your doula knows what you are and aren't comfy with, and what she can do for you, and you can also share the long one with your OB in a prenatal.)

my birth plan was actually 2 pages long, i think. I listed all the interventions I did NOT want, and there were also some provisions based on religion(no men, no animal products) the first page was "being in labor in the hospital stuff" and the second page was c-section and newborn stuff(like, "get our permission before you do anything, and we don't want hep b vax, etc.")

but, I was lucky, I had a MW who actually read the BP, signed off on it, and remembered it(or at least read it before walking into the room) and all the on-call mws were cool with my BP.

Oh, my "long" BP wasn't shared with my MW, it was for DH(I didn't have a doula, and I hoped he could reference back to it while I was in labor) I don't think he looked at it, he was too busy, and probably forgot about it or something... it didn't have anything about intervention, but it listed things DH could say if intervention was mentioned, or if I asked for meds, and just other things he could do/remind me of while i was in the throes of labor.

I would be careful about a BP that states:
"no intervention without my consent" because that is legally implied, and everything is "consented to" upon signing into the hospital.

it was suggested to me to get a hold of the consent forms prior to being in labor, but they refused to give it to me, actually, they denied that it existed it wasn't very long, but I DO wish I would have made some corrections to it(but it was too hard to think with people pressuring you to not read it before signing it, and having ctx every 2 min that made the staff worry about me breaking the walls( I pushed against the wall so hard in one ctx that the wall let out a loud CRACK! ).

[devon]

Originally Posted by mysticmomma

Those sound like HER preferences.

I hear a lot of "My doula wants me to put" ... in your post. It is YOUR birth plan. The role of the doula is to help you get information. She can show you sample birth plans, etc, but it is YOUR birth plan. She really shouldn't have anything to do with it and shouldn't be _telling_ you what to put in it. I'd be especially questioning of her if she told you to put things in there but didn't explain the justification or reasoning for them (so you are still wondering 'why' you have them there or 'what' they are).

In our doula training, they stressed having a 1 page birth plan for providers, with the super key things highlighted. You can have a conversation about your preferences with your providers when you get there (or your husband can since hopefully you'll be in strong active labor about other things.

If it makes your husband feel better, you can have a birth plan that is more detailed laid out for him to refer too.

[megan sacha]

Originally Posted by devon

I hear a lot of "My doula wants me to put" ... in your post. It is YOUR birth plan. The role of the doula is to help you get information. She can show you sample birth plans, etc, but it is YOUR birth plan. She really shouldn't have anything to do with it and shouldn't be _telling_ you what to put in it. I'd be especially questioning of her if she told you to put things in there but didn't explain the justification or reasoning for them (so you are still wondering 'why' you have them there or 'what' they are).

In our doula training, they stressed having a 1 page birth plan for providers, with the super key things highlighted. You can have a conversation about your preferences with your providers when you get there (or your husband can since hopefully you'll be in strong active labor about other things.

If it makes your husband feel better, you can have a birth plan that is more detailed laid out for him to refer too.

I'm a postpartum doula, not a birth doula, but I too was disturbed by this and totally agree that your doula shouldn't be asking you to make changes or telling you what to add AT ALL. Seems that she may be trying to influence your birth with her own agenda, which isn't cool.