how is my c-section birth plan?

[rakishchick]

we are doing a vaginal natural birth for our first baby at a birth center but in the event a transport for a c-section is required, i have come up with the following birth plan. your input/suggestions are greatly appreciated!!!

BEFORE
1)Pain relief via epidural or spinal? (I have yet to decide on this, if you have experience with either, I would love to hear them)
2)Catheter inserted after anesthesia is in effect.
3)No arm restraint.

DURING
1)Dad to be present at all times.
2)Mom's own music via headphones.
3)Volume down or off on heart monitor.
4)Low traverse incision to be able to attempt a VBAC.
5)Dad to announce the sex of the baby.
6)Drape removed when baby is delivered.

AFTER
1)Dad to cut the cord.
2)Dad will hand baby to mom immediately after delivery.
3)We politely decline the administration of Hep B, eye ointment, and Vitamin K shots.
4)Baby is not to receive any formula, sugar water, or pacifiers.
5)No circumcision or bathing of the baby.
6)Mom will nurse as soon as possible.
7)Baby will room-in with Mom.
8)Uterus to be sutured in double layers with dissolving stitches.
9)Catheter and IV removed as soon as possible so Mom can resume walking and eating.
10)Baby will be with parents at all times. If baby must go to NICU due to medical reasons, Dad will accompany him/her.

[Llyra]

I might put a time limit on the nursing-- as in, Mom will nurse within 45 minutes of birth, provided mother and baby are stable.

The hospital where I had my two c-sections had a policy like that in place; they required it to be within 60 minutes. But I was able to nurse both my daughters within 45 minutes-- as soon as I'd been stitched up and my vital signs were clearly stable. (Not my son-- but he was on breathing support, so everybody involved was doing the best they could. He nursed three hours after his birth.)

I would also recommend the spinal anesthesia, after having had both. With the epidural, I still had an awful lot of sensation, and it was really disconcerting. Plus, the epidural gave me the shakes as it was wearing off, and that was rough because it was right in the middle of me trying to latch DD1 on for the first time. With the spinal, I had a deeper level of numbness, so no unpleasant sensations during the birth and stitching up, and I had fewer side effects afterwards.

You haven't mentioned pain relief-- definitely have that discussion with your provider beforehand, so that you find out what your choices are and have time to do the research. Otherwise you'll wind up with what's "routine," which may or may not be what's best for you.

I might also just put low transverse incision. And leave off about the VBAC. Just because I wouldn't want to have to deal with some busybody nurse or whoever deciding to lecture me about how VBACs aren't a good idea, etc., right when you really just want to be left in peace.

[AlexisT]

Epidural vs spinal will be up to the anesthesiologist. Generally, they prefer spinal for a section unless the woman already has an epidural in (then it's easier to just top it up), though some anesthesiologists just love epidurals--I had one despite the fact that a spinal would've been easier and faster under the circumstances. If I'd known that at the time I would've asked why--I'm still curious! If it's a REAL emergency, you'll get GA and your husband won't be permitted in theatre.

You don't need to specify lower transverse incision. Unless it's not possible, they will do that. Nothing to do with VBAC: it's an easier operation for the surgeon, with better results (faster, improved healing, fewer complications). They don't like doing unusual incisions. VBAC came about because they developed the bikini incision, not the other way around. If the baby's wedged in so badly or oddly that they need to do a non-standard incision, they're going to ignore the birth plan anyway.

[JessicaS]

An epidural vs spinal is up to the person having surgery.

I would have a spinal because IME it takes effect faster and it just worked better for me.

I had an epidural with my first. It didn't take effect all the way and I got a local in my abdomen before they cut me. I could still feel quite a lot it just didn't hurt.

I would mention things about meds like no versed and I had "no morphine" on mine because it messes with my sense of reality.

[mommy2maya]

When I had my csection, I requested that dad cut the cord, and they cut the cord long, so that he could do a ceremonial cutting. He was not able to do the actual cutting due to sterile field. Same with drape- had to stay up, sterile field.

I would add in a request for glue closure over staples- I had the glue and my sister had staples- I think mine healed much faster and easier than my sister, plus nearly nonexistant scarring.

[kltroy]

Looks good. Def. go for spinal - no reason to have something sticking out of your back unless absolutely necessary.

You may or may not want them to drop the drape when it comes down to it - for me, I opted against it although I had toyed with the idea. Seing myself cut open wasn't very appealing at the moment of my son's birth!!

If you want to delay cord cutting you can probably ask about this. If you decide to do this I would specify a time (there's some good literature showing that waiting at least 2 mins has good outcomes compared to immediate cutting) rather than "until stopped pulsating" which is subjective. Then again, this may not be an option - ask the doctor.

Lots of this stuff you should just have a converation with the doc who is doing the surgery beforehand - some you may have a choice about and some you may not, depending on the procedure. Lots of what you're asking for may be standard operating procedure, in which case you should remove it from the plan b/c it clutters it up with things you don't actually need to ask for, KWIM?

Def. bring your camera into the OR and make sure someone takes some photos for you. Best of luck with your birth!!

ETA ah I see this isn't a planned c/s so there's no reason to talk to a doctor ahead of time. In that case, def. write down as much as you can, but realize that depending on the circumstances of the c/s, you may not get everything you want. A key in any situation -- planned or not -- is to ask for what you want WHEN you want it.

[momtoafireteam]

I also asked for minimal talking and no "chat". When DD2 was born the two OB's were talking loudly about the NFL draft and I was trying to interrupt with my questions.

[beep]

Your plan looks pretty good to me in concept. I just want to say, though, that if you end up being transferred it will be for a reason, and you may need to leave some lattitude for medical decisionmaking off-plan to account for your circumstances (whatever they are at that point). Also, things may move fast-ish. For these reasons and because they will do it the way you want anyway unless very unusual circumstances dictate otherwise, I would leave out the instructions about what kind of incision and how to suture. (Also, in case you decide to leave it in, I believe the name of the incision you're requesting is "transverse".) Similarly, you may want to let the anesthesiologist choose the type of anesthesia because you may prefer they do what they're best at/most comfortable with in the moment if you don't have a particular reason to prefer one over the other.

If I were you, I would make my plan very short (max 5 items) and focus on a few key points that really matter, may not be standard, and in a pinch can be communicated quickly as part of the transfer. These might be things like dad to cut the cord, no drops/vaccines, nurse right away.

[Storm Bride]

Originally Posted by mommy2maya

I would add in a request for glue closure over staples- I had the glue and my sister had staples- I think mine healed much faster and easier than my sister, plus nearly nonexistant scarring.

I don't know about the glue, as I only know a few women who have had it. (I'm not even sure every hospital offers it yet.) However, from personal experience and anecdotal evidence...staples suck. Get stitches, if the glue's not available. After having four sections (two emergency, and two scheduled) closed with staples, I had my fifth one closed with stitches. The difference in both pain and mobility was post-op was amazing. Everyone who has watched me go through my various recoveries commented on it, and I definitely noticed it myself. (I've also had staples twist/bend free twice, and both times I ended up with an infection in my incision. I hate staples.)

[smpayne]

I would suggest you interview the hospital staff (OBs and Anesthesiologist), find out what thier standard procedures are and what options are available. What would cause them to stray from the standard. If what you are asking for is already standard, leave it off the birth plan.

Have your dh memorize or have a copy of your detailed birth plan - so he can ask questions.

[AustinMom]

I haven't read the replies, but I'll say it's so great that you have a Plan B. It really is, I wish we would have with baby 1.

I would also make sure you fight for continous mom and baby contact. There is no reason baby should be taken away. They can do all the exams while baby is with you, finger prints, APGAR, and you should be able to bring your own scale too. I plan on if we end up with another CS, to absolutely refuse mom and baby separation unless baby is in distress. Oh, and baby is not going to 'get cold' while out of the warmer. Skin to skin regulates baby temp. I rolled my eyes on the inside when they told me this, and kept my baby.

Happy Birthing!

[mizznicole]

It might help to research your hospital as well. I was lucky to be transferred to a quite "progressive" hospital where nursing staff is 100% pro breastfeeding, babies room in, etc.