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My C-section birth plan

post #1 of 16
Thread Starter 
Hi ladies

Due to a myriad of circumstances, I will be birthing via C-section. How doe smy birth plan look? I should add that this hospital recommends rooming in *after* the initial routine nursery visit. My crunchy ped even suggested just rolling over and letting them have their procedure but just to get out of their asap. But that was before she knew about the c/s. I just won't accept that. Any ideas on how to get them on board with the "no nursery visit" thing? I've done my best here, even if I had to fib on a few point





To our caregivers at Cxxxxxxxx Regional Medical Center,

Below is a description of our preferences and things we will/won’t allow for our birth. We completely understand that birth is spontaneous and cannot be planned and appreciate that in an emergency safety comes before bonding, life and death matters are most important. Therefore, we will state what we wish to happen, will not consent to, etc in the event that mother and baby are stable. As well as what we prefer for an emergency situation. We thank you so much for your cooperation and we look forward to a wonderful birth with your help.


Pre-op and During the Procedure:

- I DO NOT CONSENT to interns or students to watch or perform any procedures.

- I am to be modestly draped at all times.

- Please use epidural for anesthesia.

- Please wait until numb from epidural to insert catheter.

- We realize that this is common procedure for surgeons and staff, however this is the birth of our child. Please respect the sanctity of this occasion and keep casual chatter to minimum.

- Please explain the steps of the procedure as they are occurring.

- I understand the importance of maintaining a sterile surgical field. Please leave my arms unstrapped to greet baby. Arms can be strapped if I become unable to maintain them.

- Sutures (dissolving) and Steri-strips instead of staples. NO staples please.

- Father allowed in O.R. for procedure.

- Option to lower screen to view baby’s birth to be offered.



Once Baby is Delivered:

- No vigorous suction, wiping or rubbing, no tight wrapping (burrito baby). Gentle wiping and light wrapping okay.

-No Erythromycin or Vitamin K*

- Healthy baby to be immediately handed to father to be greeted.

- If stable, I will be given the option of nursing baby on table.**

- Father to carry healthy baby behind stable mother to recovery room.
(If general anesthesia is required, baby to be brought to father and the couple to wait for mother in recovery.)

- I DO NOT CONSENT to healthy baby visiting nursery.
Reasons include, but are not limited to:

-Prior PPD due to mother/baby separation.

-Separation delays lactogenesis (milk “coming in”) in many mothers. Ceasarean also does this, so we would like avoid any other hindrances to successful nursing.**

- Baby will receive no artificial nipples, formula, glucose water, or plain water for any reason.**

-Bath to be performed in-room by parents.

-NO CIRCUMCISION and no retraction of foreskin

-Frequent opportunities at the breast should combat any need to test for high/low blood sugar.

-NO VACCINES*

- If baby needs warming, and mother and baby are otherwise stable, skin to skin holding by mother or father.

(If baby’s status requires nursery visits, father to accompany baby.)

-Post-op pain medicine options to be discussed and agreed upon and instructions for nurses for administration to be in place before surgery begins.

* See signed affidavit
**See related accreditation and certifications




Kxxxx xxxx

-has been a La Leche League Leader since 2006

-a Certified Lactation Educator and a Certified Childbirth Educator (CAPPA) since 2008

-has counseled hundreds of mother/baby dyads in numerous states

-nursed her own son from birth in 2005 until his self-weaning in 2007

-is currently nearing the exam certification to become an IBCLC
post #2 of 16
Is it automatic that they take baby to nursery even if he/she is term and seemingly healthy/doing okay? Both hospitals I've had c-sections at prefer to keep baby with the parents. Or like the last time I had a c/s with my surro son (his parents didn't make it in time), and the OB wanted the baby taken from the OR while they stitched me, they led my husband to recovery and he held the baby until I made it to recovery to begin BFing him. Both of my term/healthy babies never went to the nursery. Only my twins went to NICU (DH followed) and that was due to prematurity.

For *ME* (I've had three c/s) I'd leave out the epidural line. You will speak with the anesthesiologist before going to the OR the day of, and you will most likely make your wishes known at one of your doctor visits prior to the c/s as well. And the part about the father in the OR - another standard procedure (that someone be with mom) unless something goes wrong and you have to be put under general. I'd leave that off. That's just me though and what I'd leave off.

I guess I'd just leave a couple of things off as I've always heard the shorter the birth plan, the better doctors and nurses pay attention to what IS on it. But your plan isn't that long either.

(And you're ahead of me, I have yet to really sit down and write my c/s plan for this go around and I'm due in three weeks, haha)
post #3 of 16
I agree with the point Ubermama makes. Overall it looks pretty similar to mine and they followed mine to the letter. My midwife made a point of telling me the c-section plan should be one page and one page only. You want them to be able to take it in quickly. I also had no problems avoiding the nursery. We mentioned it again to the ped. team in the OR even though they had all read the plan. As far as something you may want to add if you don't know the gender you may want to ask to discover it for yourself rather than have the Doc or nurse yell it out. We did this and the OR team actually got a kick out of it! They said no one had ever asked for that before and it sort of upped the excitment for them too!
post #4 of 16
I'm glad to see some were able to avoid the nursery. I wish to avoid it completely this time. Both my babies had apgars of 10 and still spent an hour in the nursery.

I do two pages. One birth plan and one newborn instruction sheet.

I would leave out the epi line, cath line, father being allowed. You will discuss that with the nurses and anesthesiologist before the surgery. Last time I made sure the anesthesiologist knew I wanted to be completely aware during the whole thing. They sometimes give you things like versed without telling you.

In my plan I have directions for the placenta since we're taking it home. Also, I have a line about "no newborn hat".

The line about dad carrying the baby...they never allow babies to be carried here due to insurance. However we do it anyway.
post #5 of 16
Just wanted to say that you are wise to include closure method on your BP. With ds1, I had staples. OMW, never again. Horrible. With ds2, I had the disolving sutures and steri-strips. Much much more comfortable.
Other than that, just agreeing with what others were saying. Oh, and realizing that maybe it's not such a bad idea to come up with my own c-sec BP!
post #6 of 16
The line about the baby being immediately handed to dad might be problematic in that the staff will insist upon checking the baby first. Also, for a number of the items you may want to talk to the staff well before the surgery to be sure your instructions are acceptable to them. Like with the pain meds, you may be prohibited from taking certain medications if your platelets are low. It might be helpful to discuss all of the options prior to surgery.
post #7 of 16
Ya know, I know the catheter thing needs to be there but it just boggles my mind that it does.

The anesthesiologist asked me about it and I am sure I had this "WHAT!!??!" look on my face cause he just kind of laughed. Who chooses to get a cath before being numbed??


Is there a reason you would prefer an epidural? I found a spinal block to work better for me, my epidural never took all the way and I got a local in my abdomen but different things work well for different people.

Hospitals sometimes have weird rules about the baby needing to be moved from room to room in a bassinet so you might get some resistance on that but just while they are moving the baby around. We didn't use the nursery at all.
post #8 of 16
Quote:
Originally Posted by MoonStarFalling View Post

I would leave out the epi line, cath line, father being allowed. You will discuss that with the nurses and anesthesiologist before the surgery. Last time I made sure the anesthesiologist knew I wanted to be completely aware during the whole thing. They sometimes give you things like versed without telling you.
.
Versed??!?! Are you kidding? What year is it in those hospitals?

I had versed for a colonoscopy I woke up and got in a fight with a nurse (who totally subdued me ) because I didn't know what was going on. Who gives people versed?!?!

OK I would definitely add something about being aware AND telling you exactly what meds they are giving you and not to do so without permission. I had "NO MORPHINE!!!" all over my chart because I um...I kind of have reality issues when given morphine.
post #9 of 16
Quote:
Originally Posted by abimommy View Post
OK I would definitely add something about being aware AND telling you exactly what meds they are giving you and not to do so without permission.
YES YES YES!!!!

During my first c/s (an emergency one!), I was on the table and began freaking out a bit. My BP went up, but not too much. I just needed DH to rub my hand and remind me he was there. But suddenly the anesthesiologist says, "I gave you something to calm down.. you may fall asleep in about 30 seconds" and my eyes got huge and I practically yelled, "NO!" I don't know what he put in my IV, but I did get sleepy, but I fought it hard. I even asked DH to run his nails along the back of my hand, as the sensation irritated me and kept me awake (of all things).
post #10 of 16
Quote:
Originally Posted by UberMama View Post
For *ME* (I've had three c/s) I'd leave out the epidural line. You will speak with the anesthesiologist before going to the OR the day of,...
Is that standard procedure in some places? I've only ever had it once, and that was after I requested a consult through my OB - went to the hospital a few weeks ahead, and had a completely pointless consult (the point I wanted to discuss couldn't be determined ahead, because it depended on which anesthesiologist I got), and then got to speak to the anesthesiologist in the OR before the surgery. With my other two conscious ones, I only spoke to him in a "Hi, I'm Dr. X, and I'm your anesthesiologist, and here's your drugs" kind of way. There was no discussion about preferences. The second guy didn't even tell me he was giving me that morphine crap.

OP: I'm also curious as to why you prefer the epi? The women I know who have had sections with failed anesthesia were all under epi.
post #11 of 16
I'm curious about the no spinal thing too. I've had 4 c/s and only one was an epi left over from labor. A spinal is so much quicker.
post #12 of 16
Quote:
Originally Posted by Storm Bride View Post
Is that standard procedure in some places? I've only ever had it once, and that was after I requested a consult through my OB - went to the hospital a few weeks ahead, and had a completely pointless consult (the point I wanted to discuss couldn't be determined ahead, because it depended on which anesthesiologist I got), and then got to speak to the anesthesiologist in the OR before the surgery. With my other two conscious ones, I only spoke to him in a "Hi, I'm Dr. X, and I'm your anesthesiologist, and here's your drugs" kind of way. There was no discussion about preferences. The second guy didn't even tell me he was giving me that morphine crap.
With Ezra the anesthesiologist did sit and chat with me before the surgery. He was very nice.
post #13 of 16
Can you include the info that the * and ** denotes? Thanks!
post #14 of 16
You are definitely on the right track, but I think you need to be more decisive in tone, and keep it to one page. You might also bold the really important ones.

Start with "We have decided on a scheduled C-section..." followed by a series of "will" and "we do not consent" statements. Examples:

I have no apprehensions about surgical procedures. We do not consent to the administration of Versed or any other hypnotic drug.

The drapes will be lowered at the moment of birth.

Our baby will be placed upon my chest immediately after birth, and warmed via skin-to skin contact with Mom or Dad.

The newborn exam will be conducted in the surgical suite, with Dad's supervision.


We do not consent to the removal of our child to the nursery in the absence of significant and prolonged symptoms of neonatal distress.


My uterus will be closed with a double row of silk sutures. We do not consent to the use of surgical staples.

--------------------------------------------------------------------------

You might also want to add a "do not consent" to a newborn bath. In the hospital I used with #3, a unwashed baby was a biohazard, and every hospital employee who wanted to touch her had to wear gloves. Since I much preferred them to 1) not touch her and 2) wear gloves when they did so, this worked out very well for us.
post #15 of 16
Quote:
Originally Posted by Storm Bride View Post
Is that standard procedure in some places? I've only ever had it once, and that was after I requested a consult through my OB - went to the hospital a few weeks ahead, and had a completely pointless consult (the point I wanted to discuss couldn't be determined ahead, because it depended on which anesthesiologist I got), and then got to speak to the anesthesiologist in the OR before the surgery. With my other two conscious ones, I only spoke to him in a "Hi, I'm Dr. X, and I'm your anesthesiologist, and here's your drugs" kind of way. There was no discussion about preferences. The second guy didn't even tell me he was giving me that morphine crap.

OP: I'm also curious as to why you prefer the epi? The women I know who have had sections with failed anesthesia were all under epi.
For me, every c/s I've had they come in and talk with me to personally confirm my allergies (if any) and find out if I have any questions. My OB confirmed it the other day as well, as I need a more limited dose of the spinal, so my OB told me to remind the anesthesiologist when he came in prior to my c/s (they always come in when I am in triage waiting to be taken back to the OR).
post #16 of 16
Quote:
Originally Posted by UberMama View Post
For me, every c/s I've had they come in and talk with me to personally confirm my allergies (if any) and find out if I have any questions. My OB confirmed it the other day as well, as I need a more limited dose of the spinal, so my OB told me to remind the anesthesiologist when he came in prior to my c/s (they always come in when I am in triage waiting to be taken back to the OR).
I'm always interested in the differences from one region and/or hospital to another. I've never had this happen - even the one who talked to me, it was right outside the door to OR, and was solely regarding something I'd already put in a request about (having dh there for the spinal). I think she asked about allergies once I was on the table, but maybe not - I get asked that so often in the hospital that I lose track of who has asked.
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