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Birth Plans? - Page 3

post #41 of 59

 


In my experience, having an OB sign your birth plan ahead of time and have it on file at the hospital makes a LOAD of difference -- it becomes a "prescription" for the kind of birth you desire, rather than a wish list you bring in and hope they'll follow.  I was a HB transfer, and my birth plan made a huge difference in terms of the way I was treated in my transfer.  The hospital staff was VERY good about following it, though they required reminders about some things (bright lights, Pitocin after birth, etc.)  No matter how good your birth plan is, you'll still need to stay on top of things a bit to make sure you get everything you want.

 

I concur with other recommendations above about birth plans, especially 1) keep it to one page, and 2) keep it short and sweet.  Bulleted lists are much easier for everybody.  You can make your requests sound more polite without making it too long. 

 

I think it's perfectly acceptable to refuse an IV and/or heplock until/unless you need one.  At the hospital-based birth center where we're birthing this time, a heplock/IV is NOT standard.  My MW is very clear about that.  They might give you a hard time about it, but if you're insistent (and can convince your OB to sign off ahead of time) you can usually get your way.  If you need an IV, they can place a line then.  I would not, personally, consent to a heplock in labor "just in case."  The whole point of a natural birth is that you don't do the "just in case" interventions. 


I had an IV placed during my last labor, but only after I was 3 days in labor and pretty dehydrated from constant vomiting.  I needed it at that point.  It made me feel loads better and gave me my energy back.  I wouldn't discount the value of one -- but it's definitely not appropriate "just in case."  They know how to place an IV line on a dehydrated patient, they would just prefer not to do it.  I'm not interested in the hospital's preferences; I'm interested in what makes my labor easiest and least interventive. Plus, I hated that they kept the stupid thing in me for hours after the birth and refused to remove it after several requests. 

 

Two things I would have included on my birth plan, in hindsight: "DH wishes to announce the sex of the baby" (we forgot about this one and were disappointed when the OB stole our thunder) and

"please do not disturb us in our room postpartum except when absolutely necessary for the health of the baby or the mother."  I hated having people walk into our room every five minutes for two days after DD was born.  I didn't get a wink of sleep, and the interruptions made me anxious and angry.  This time, we're delivering in a place that has a policy that babies delivered naturally are released from the hospital after 6 hours.  Thank heaven!

 

CookAMH, your birth plan is excellent.  I'm going to review mine for this birth and may be stealing some of your ideas!

 

OP, a couple of points on your birth plan that I noticed:

Quote:        

Whatever my GBS status, I DO request a hibiclens/chlorhexidine wash (or the equivalent) be administered at the time I go into labor or at rupture of membranes, whichever occurs first (If it has not already been administered)  I concur with a PP -- most hosp. staff won't know what this means and will probably ignore it in any case. 
 

I prefer that fetal heart tones be monitored intermittently with an external monitor or Doppler.  Where I delivered, CEFM was standard, so you should check to see if you need to include or not.  I had to fight over this one.  (They tried to place an internal monitor without even telling me -- I just happened to notice it go by my head and screamed bloody murder over it until they took it away.) 

I would like no internal vaginal exams (THIS INCLUDES DILATION CHECKS) during my labor until I have an urge to push.    Most L&D's will not admit you until after they have done a VE to ensure that you are in active labor.  You might have a hard time getting around this one. 

As long as the baby and I are healthy, I prefer to have no time limits on pushing.  I would use stronger language here.  Usually they will cut you off at 2 or 3 hours "for the good of the baby."  My OB knew how strongly I felt about this, and defied hospital policy for four solid hours while I pushed.  You should discuss your OB's "time limits" ahead of time, and be clear that you are willing to bend on this issue if pushing really isn't making any progress and baby isn't descending. 

We would not like babies to be removed from the room.  I would be stronger on this one too!  Something like "under no circumstances are babies to be removed from the room unless they are accompanied by one or both parents."  This was on my birth plan and I STILL had to get out of bed in the middle of the night when nursery staff came into my room and whisked my newborn away while I was sleeping!! 


      We would like ONLY the orally administered vitamin K to be given to our babies. If it is not available, do NOT administer vitamin K to our babies.  Check with your ped on this one -- you probably won't be able to get oral Vit K in the hospital at all.  And in some places, they will call CPS on you if you refuse it.  You can include something like "unless there is birth trauma, we refuse Vit K," because that acknowledges that you understand what it's for and aren't crazy child-endangering people.  

    We decline routine PKU testing at the hospital and have made other arrangements for this procedure at a later date this week.        You might want to think about where/when you will do a hearing test, too, if you plan to refuse this at the hospital.  We realized it would be super difficult to arrange for one afterwards, so we went ahead and did it in the hospital.  They're totally harmless and most babes sleep right through them, but they're a very good idea for a newborn (one of my BFF's is an audiologist) :) 



 And here are a few comments on a PP's plan too:

  • We want to take both placentas home with us.  Please ensure that they are placed in the provided containers which will be labeled to identify  baby A or baby B.  You might have to sign some crazy waivers for this, depending on where you deliver.  Some hospitals consider this "biohazard medical waste" and won't release it without a serious amount of paperwork.  Just a forewarning!
  • If baby B is breech we would like to request external version  Check with your HCP, but I don't think external version is something they ever attempt when someone is in labor. 
  • If baby B is not able to be turned vertex we would like to attempt breech delivery  Again, you definitely want to check with your HCP on this one.  If you have an attending OB or MW who does not have experience with vaginal breech deliveries, they can do more harm than good by intervening at the wrong moment.  If you have someone who does not know how to handle a vaginal breech birth (i.e., leave it the heck alone), the baby is probably safer with a C-section.  
  • Babies will be exclusively breastfed.  No formula, water/sugar water, or artificial nipples  I think sugar water is highly unusual now; this might be a red flag for staff to think, "oh yeah, this person has no idea how we do things here." 
  • If the babies are healthy, I would like to hold my baby and nurse immediately in [C-section] recovery.  You might want to specify that you want your partner or other support people with you in recovery.  Some hospitals keep you alone in recovery as a matter of policy.  

 


Edited by Comtessa - 12/31/10 at 9:23am
post #42 of 59

I'm short on time so I'll say more later, but Nanette and all other twin mamas I strongly suggest discussing NICU (intake) routines/birth plans with a neonatologist.  We knew DD would be in NICU at birth so we discussed everything with one of the neonatologists.  One thing they mentioned at our hospital was that the parents were not allowed to accompany the babies to NICU regardless of health.  So when DD was born I was fortunate enough to have my L&D nurse convince the NICU intake nurse to let me bond with DD (who was stable) while both were there for an hour and then they took her over.

post #43 of 59
Quote:
Originally Posted by rbkincaid View Post

I want to give you some encouragement as a nurse. I am not in L&D, but I'm friends with several smile.gif

 

There are some things that just come standard... if you address them in your plan, it might make it look like you "don't know what's up."

That can lead to them rolling their eyes and ignoring the rest of the plan (& your wishes).

 

For example, intermittent monitoring is a given at our hospital. Only high-risk situations call for continuous monitoring.

If I were delivering in my hospital, I'd just remind the nurse, "you're gonna take this off until we need to monitor again, right?"

 

When it comes to addressing emergency issues, there are staff who might see something on your plan and dismiss it immediately "for the health of the baby."

But if you and your partner just decide to flip onto all fours if something seems stuck, this is something the doctor will usually just go along with.

Oh look, a patient who knows about shoulder dystocia! And you didn't even have to freak him out with your hippie ways by talking about it beforehand smile.gif

 

Another issue is the eye ointment, etc. There are so many shift changes and chaotic things going on,

I wouldn't feel the need to set myself up for a lecture by writing that I don't want my baby to have the gentamycin ointment.

I would just maintain skin-to-skin and refuse each time it's offered.

 

Lastly, find an advocate on the inside! Most nurses are 1:1 with laboring patients. Make HER part of your birth plan, once you fill her in.

 

This might feel like you're being less prepared, but in reality...it's helping you sail under the radar.

Feel free to use empowered, educated, and sneaky tactics to get what you want out of a hospital birth!

Remember, you're on THEIR turf. Use it to your advantage!


Thank you for your perspective Rachel. I am giving birth at a military hospital, and they take their standards of care very seriously. They gave me a spiral bound book with in-depth info about their standards of care for every step, from prenatal care through post-partum follow-ups. I think a lot of women aren't given that information from their care providers. I know the Ob I saw with DS (before I switched to a HB MW) certainly didn't give me any information like that. Where would someone look if they wanted that information about a hospital? Who should they ask? I imagine you could ask when you pre-register, but it's something I would want long before that.

 

I also think a birth plan (a short, concise one) can be a good reminder tool for mom, dad and doula, so that they have a plan set out, so that they remember to say "I want my baby with me in post-op recovery" before you head into the operating room. I guess, I don't expect my nurses to memorize my birth plan. I am going to write one out to discuss with my MWs and the OB before I go into labor, and to have as a reminder for DH and myself. It isn't something I expect the nurses to do much with. Maybe they will surprise me though.

 


 

Quote:
Originally Posted by CookAMH View Post

Here is mine for the current birth (posted old plans on first page). Revised somewhat from DS, and I may tweak it more.

 

Our Desires
•I would like to push only when I have an urge to push with no coaching

•I would like to have support of the perineum to avoid tearing.
•My husband and I would like to discover the sex ourselves
•My preferences for immediately after the birth are

-          to have immediate skin-to-skin contact between my baby & me

-          to be left undisturbed for 1 hour following birth, newborn procedures performed afterward.

•I would like clamping & cutting of the umbilical cord to be delayed until blood stops pulsing. If resuscitation is necessary, please do so with the cord uncut. I would like my husband to cut the cord.

•I would like to deliver the placenta spontaneously. Please do not pull on the cord.

•I would like all newborn procedures to be performed in our presence, preferably bedside. In case of an emergency with our baby, my husband will accompany our baby at all times.

What We Wish to Avoid
I do not wish to have

-          artificial rupturing of membranes without my consent

-          an episiotomyunless needed in the event of an emergency

•I plan to breastfeed our baby & would like to do so immediately after birth, please do not offer a pacifier or any bottles at any time during our stay, including formula & glucose water.
•We do not consentto the following:

-          CIRCUMCISION

-          Vitamin K shot

-          Hepatitis B vaccine

-          erythromycin treatment in the eyes

 

If a Cesarean is necessary

·                     Please administer anesthesia before inserting the catheter; I prefer a spinal

·                     Please set the curtain low so I can see the baby as he is born

·                     Please try to keep the cord intact for a few minutes before cutting it

·                     please show me my baby as he is born and place him on my chest if there are no complications, my husband will assist

·                     Please do a double closure

·                     I prefer subcutaneous stitches and tape rather than staples

·                     I would like to view the placenta

·                     I would like my baby to accompany me to my recovery room



I like this! This is good. I want mine to look like this, only pared down a teensy bit more. It is easy to scan, easy to read, simple. Good format!

post #44 of 59
Quote:
Originally Posted by Liora View Post



Quote:

It is incredibly important for you to have a discussion about your plans for your birth with your care provider as soon as possible.  Although I consider it reasonable, most care providers (particularly MDs) are not going to consider certain things negotiable like IV access, post delivery pitocin, etc.  Most of the items in your birth plan are provider preference (amount/type of monitoring, position, IV access, placenta delivery) and the nurses will not be able to change the provider's orders.  Obviously you can refuse anything, but it would be much better to have the provider on board in the first place.  Also, when you are interviewing peds run your preferences for the babies by them and make sure you get their support and see if they will come to the hospital when the babies arrive- most babies are not seen by a ped until the next day but there are standing order sets that call for things like the hep b vaccine that are activated at birth.

 

Hope you don't mind my input, it is easier coming from the other side to see how some of these things will be viewed.


I appreciate the views from the inside as well.  I'm shocked at the bolded part.  Can they inject that into your child without consent???

 

This is the reason I'm so lax about labor.  I want to choose my battles.  And even though I don't want an IV it pales in comparison to how UNBELIEVABLY ANGRY I'd be if they injected my child with this horrible, unneccesary "vaccine".  It makes me sick to my stomach thinking about it.  To the point that I only want my birth plan to include these things that are SO VERY important to me.

 

I guess I'm extra frightened because of twins and the possible need that my babies would have to be taken from me for any amount of time.  DD couldn't have had anything done because I was always with her, you know? 



Usually they do require a specific consent for the Hep B vaccine from the mother.  The reason I mention the automatic order set is that nothing is done without an order from a doctor-- so the eye ointment, vitamin K, newborn exam, breastfeeding or bottlefeeding, checking blood glucose, etc are performed based on orders that automatically get ordered depending on the hospital's protocol.  So if for instance you refused antibiotics for GBS and the hospital's protocol called for a spinal tap and starting antitbiotics on the babies that is what would be ordered,usually without your pediatrician even seeing the babies or talking to you.  Of course you can refuse any of those things but it would be waaaay easier to have a ped who is on board with your plans, agrees to see the babies right away to avoid these automatic orders.  Becuase "refusing" orders is a big deal, but them not being ordered in the first place wouldn't be.  Basically this system is designed for convenience of the peds because in most cases babies do not see a pediatrician until morning rounds and nurses cannot do the things they do without physican orders.  did that make it any clearer?  You still haev the right to consent or decline but many of these things (eye ointment, etc) do not require individual consent and this is when you start to have to fight with people. 

post #45 of 59

I finally wrote up our birth plan. I plan on discussing standards of care and our birth plan with my MW at the next visit. Thanks everyone here for your inspiration to do this. I need to start doing this now, so that as I see each midwife I can discuss it with her, in the hopes of seeing each one at least once before the birth.

 

VBAC Delivery

  • Discuss before:

    • AROM

    • Using Vacuum or Forceps

  • Limited cervical examinations.

  • No Episiotomy, I prefer to tear.

  • No coached pushing.

  • May try alternative birthing positions, such as hands and knees.

  • Baby placed on chest immediately.

  • Delay cord cutting until it stops pulsing.

  • Spontaneous delivery of placenta – no cord retraction or additional Pitocin.

  • Delay vitamin K and bathing, etc for 1 hour to allow bonding.

  • No eye ointment.

 

Post-partum

  • No shots except vitamin K.

  • No artificial nipples or breastmilk substitutes.

  • No circumcision. No retraction of the foreskin for ANY reason.

  • Mother or father will accompany baby at all times.

 

Cesarean Delivery

  • Would like baby placed on chest immediately.

  • Subcutaneous stitches and tape preferred.

  • Father and baby with mom in recovery.

  • Father stays with baby at all times.

  • No eye ointment.

post #46 of 59

I didn't realize that you could request a closure other than staples...I didn't even think about it. I will talk to him on Monday about that. Those staples were horrible. I've been thinking about a birth plan more lately. I honestly don't know how to describe what I'm feeling...mostly a sense of being completely out of control. i did EVERYTHING right last time...had an awesome birth plan written up...and when it all came down to it, I might as well not have wasted my time. I did succeed in refusing the eye ointment and the hep B vax...but that's about all. They didn't listen to me about the cord, not rubbing all the vernix off right away, the curtain was literally over my face, and I was strapped down like a prisoner being tortured...all while throwing up over and over, even as they were cutting me open, and being on oxygen from the horrible epidural.

 

I simply cannot do this again. I feel the same helplessness and futility of even trying to plan anything...and also trying to avoid the unbelievable trauma again. I'm seriously leaning toward having general anesthesia, and demanding that they wait to put the IV/catheter/etc until I'm out. That leaves DH to fend off the wolves (ok, I love my nurses, but I'm feeling so cornered, that's what they are looking like from this angle) by himself...I just want the to weigh him, do Apgar, give him a diaper, hat, and wrap him in a blanket and GIVE HIM TO HIS DADDY. Is this too much to ask??

 

And if he's premature...then everything changes again. 

post #47 of 59

Be careful about the c/s closure.  I would MUCH prefer to have a sutured closure but only by someone who is good at it.  It's a doc preference how they close but if they never, ever close with suture I wouldn't ask them for it.  You'd be better off with staples than suture by someone who doesn't have a clue what they are doing. With that said some doc's are good at suturing but do staples routinely for convenience so its always worth the ask. 

 

That's really all I have to add.  As an RN in L&D for the past 6 years I have pretty mixed feelings on birth plans. Fortunately, I have had low risk pregnancies and have providers who are the same page as me so I have never needed one. 

post #48 of 59

Not to hijack this thread, but StarCat, I wonder if you would be willing to elaborate a little about your perspective on birth plans?  You say you have "mixed feelings" -- could you explain what you see as the negatives/positives of a birth plan?  Do you have any particular advice for those of us who are planning to write a birth plan? 

post #49 of 59

I'm not planning a hospital birth but I though about a MDC mama's signature that may serve as a really cute, short birth plan for someone.  How about, "We do all that hippie stuff!"   I'm half joking but it seems like the L&D nurses would know what you meant, it's light and in a way respects the fact that they've been around the block a few.  (not that birth plans don't...just that they probably read them all the time and I imagine that they say similar things).   

 

Anyway, sorry -- not really my place but I do have a close friend who was a midwife and is now a L & D nurse and I know she would LOVE that sign and would totally "get" where most of you are coming from.  

 

FYI, I had a hospital transfer with my first and it turns out I LOVED coached pushing.  shy.gif  My MW at home was all hippie dippie and I pushed for 3 hours with no progress.  The hospital doctor was super athletic like and totally cheered me on and I swear it was just what I needed.  I actually requested it to my HB MW this time around.  Go figure.  Birth is crazy!  

 

I otta find one of the best plans on this thread though and copy it for a transfer bag just for my own reference!   

post #50 of 59

About the suture closing, it is something I want to have on the birth plan so I remember to ask about it. It is also one of those things that might get taken off, depending upon my discussion with my MW next week. I did not have a birth plan last time, but I want one this time. For one thing, I'm not birthing in my ideal environment. I'd prefer to be at home. I'd prefer to not be VBACing.  I want to have something to help me and my husband remember certain key points.

 

I think a birth plan can have it's place in birth, but it is no substitute for having some open and honest conversations with your care providers.

post #51 of 59

Just an FYI--the test for GBS isn't a urine sample--it's a swab, since the bacteria lives on your skin or on your mucus membranes. The bacteria that causes the vast majority of urinary tract infections in pregnant women is actually e. coli--and it won't be transmitted to the babies, it'll just make you miserable. Also, urinary tract infections, even asymptomatic ones, can trigger premature labor, so it's worth it to keep getting your urine tested--that test won't reveal your GBS status.

 

(Ask me how I know--I was asymptomatic until the sucker went into my kidney. greensad.gif )

post #52 of 59

My mixed feelings come from me being definitely more 'natural' in my personal birth beliefs yet having a lot of patients who bring in birth plans that are ridiculous.  I actually never mind birth plans.  I feel like it gives me a good guideline about what people want and I do my best to stick to it.  but most l&d nurses don't take them seriously- here's why:

 

1) many times the people with the most restrictive birth plans have the most conservative doc with the highest section rate.  That doc will never agree to all of that. You should have done your research at the beginning of your pregnancy when choosing a provider NOT at the end.  Ultimately, as a nurse I can do my best to follow certain things but I follow doctors orders. The birth plan needs to be reviewed with the doc or midwife. They need to be on board- if they agree and write orders appropriately then I will follow those orders and all is good.

 

2) I can not tell you how many times people come in with birth plans for induction. no IV/no continuous monitoring, etc.  You are being induced. You need to rethink the birth plan.  Often this is a 1st time mom and the induction is for no reason or a reason like "maternal misery" "tired of being pregnant". we are all miserable from 35 wks to delivery but its not a reason for induction. When someone comes in with a birth plan that they have already started crossing stuff off on you kind of don't take it all seriously. 

 

3) People often restrict themselves on birth plans.  labor and birth is so unique.  ANYTHING can happen.  saying you will NOT have this or that really sets you up for failure.  How many people have said they would NEVER have an epidural yet had a horribly long labor and ended up with one then felt like a failure.  I think as far as labor interventions its really best to just let go...be educated, know what you want and don't want and have your birth team (partner, doula, etc) know these things as well.  Instead of writing NO PITOCIN. Just let the nurse know to please discuss everything before doing it.  You can make a decision when/if it comes to that. 

 

My biggest advice if you are going into a more conservative hospital, go for a hospital tour,  ask if there are any nurses who support natural childbirth, when you come in for labor ask for one again.  If you had a birth plan and I was available- chances are I would get you and we'd probably do great. :-)

 

I know my midwife will make appropriate decisions for me.  I have no doubt.  I don't need to write anything.  If I am transferring to a hospital it will be because I want/need the interventions.  I realize I am lucky to have that and some people don't have the luxory because they are limited in the types of providers they have near them or because they are high risk. But I think you have to be somewhat realistic.  I work at a hospital that delivers over 1000 babies a month.  You are not going to get a 'birth center" type birth there.  But at the hospital I worked at before (100 babies a month) we often could give that type of birth. 

 

I argue all the time with docs and nurses who believe just as strongly in their way of doing things as I feel in mine.  We will never change them! But there are a lot who are more supportive- sometimes it is harder to find them but its worth it.

post #53 of 59
Quote:
Originally Posted by StarCat View Post

My mixed feelings come from me being definitely more 'natural' in my personal birth beliefs yet having a lot of patients who bring in birth plans that are ridiculous.  I actually never mind birth plans.  I feel like it gives me a good guideline about what people want and I do my best to stick to it.  but most l&d nurses don't take them seriously- here's why:

 

1) many times the people with the most restrictive birth plans have the most conservative doc with the highest section rate.  That doc will never agree to all of that. You should have done your research at the beginning of your pregnancy when choosing a provider NOT at the end.  Ultimately, as a nurse I can do my best to follow certain things but I follow doctors orders. The birth plan needs to be reviewed with the doc or midwife. They need to be on board- if they agree and write orders appropriately then I will follow those orders and all is good.

 

2) I can not tell you how many times people come in with birth plans for induction. no IV/no continuous monitoring, etc.  You are being induced. You need to rethink the birth plan.  Often this is a 1st time mom and the induction is for no reason or a reason like "maternal misery" "tired of being pregnant". we are all miserable from 35 wks to delivery but its not a reason for induction. When someone comes in with a birth plan that they have already started crossing stuff off on you kind of don't take it all seriously. 

 

3) People often restrict themselves on birth plans.  labor and birth is so unique.  ANYTHING can happen.  saying you will NOT have this or that really sets you up for failure.  How many people have said they would NEVER have an epidural yet had a horribly long labor and ended up with one then felt like a failure.  I think as far as labor interventions its really best to just let go...be educated, know what you want and don't want and have your birth team (partner, doula, etc) know these things as well.  Instead of writing NO PITOCIN. Just let the nurse know to please discuss everything before doing it.  You can make a decision when/if it comes to that. 

 

My biggest advice if you are going into a more conservative hospital, go for a hospital tour,  ask if there are any nurses who support natural childbirth, when you come in for labor ask for one again.  If you had a birth plan and I was available- chances are I would get you and we'd probably do great. :-)

 

I know my midwife will make appropriate decisions for me.  I have no doubt.  I don't need to write anything.  If I am transferring to a hospital it will be because I want/need the interventions.  I realize I am lucky to have that and some people don't have the luxory because they are limited in the types of providers they have near them or because they are high risk. But I think you have to be somewhat realistic.  I work at a hospital that delivers over 1000 babies a month.  You are not going to get a 'birth center" type birth there.  But at the hospital I worked at before (100 babies a month) we often could give that type of birth. 

 

I argue all the time with docs and nurses who believe just as strongly in their way of doing things as I feel in mine.  We will never change them! But there are a lot who are more supportive- sometimes it is harder to find them but its worth it.



Thanks. I know my hospital is more supportive of natural childbirth than others in this area, but I had never thought about asking about more supportive nurses. One of my MWs has done homebirths for her children and has been very supportive of my choices. So I will ask her if she has any nurse recommendations. It is really beneficial to hear the perspective of insiders, thanks for sharing.

post #54 of 59

I've had four previous hospital births. With the first two I was at their mercy (other than I refused pain meds/epi). I learned a lot from the first two births and was much more in tune with how I did not want things to go with my last two hospital births. I didn't write up birth plans but I was firm when it came to refusing any type of i.v. or pain meds/epi. I also did not allow vacs to be given after birth. I went home asap and am now planning a home birth with this pregnancy.  It's like there's an invisible time clock I'm racing against once I get to the hospital. For once, I want to be able to feel relaxed while giving birth!

post #55 of 59
Thread Starter 
Quote:
Originally Posted by Bird Girl View Post

Just an FYI--the test for GBS isn't a urine sample--it's a swab, since the bacteria lives on your skin or on your mucus membranes. The bacteria that causes the vast majority of urinary tract infections in pregnant women is actually e. coli--and it won't be transmitted to the babies, it'll just make you miserable. Also, urinary tract infections, even asymptomatic ones, can trigger premature labor, so it's worth it to keep getting your urine tested--that test won't reveal your GBS status.

 

(Ask me how I know--I was asymptomatic until the sucker went into my kidney. greensad.gif )


The GBS test in and of itself is a swab, I know, but they caught mine in a urine sample and not from a swab, which I would have refused.  One more thing I just learned (from my m/w) is when they do a GBS swab, they generally use the same swab to test both areas, and are therefore unable to tell you where the bacteria came from. Ugh.  I just had my urine tested and everything's negative, and I just don't feel like I need to have it done again. If I have a lot of protein in my urine, I'll know it's a UTI, because that's how mine always start, but for now, a cranberry pill every day, and a vinegar and water wash every day seem to be doing the trick :)

post #56 of 59
Quote:
Originally Posted by StarCat View Post

My mixed feelings come from me being definitely more 'natural' in my personal birth beliefs yet having a lot of patients who bring in birth plans that are ridiculous.  I actually never mind birth plans.  I feel like it gives me a good guideline about what people want and I do my best to stick to it.  but most l&d nurses don't take them seriously- here's why:

 

1) many times the people with the most restrictive birth plans have the most conservative doc with the highest section rate.  That doc will never agree to all of that. You should have done your research at the beginning of your pregnancy when choosing a provider NOT at the end.  Ultimately, as a nurse I can do my best to follow certain things but I follow doctors orders. The birth plan needs to be reviewed with the doc or midwife. They need to be on board- if they agree and write orders appropriately then I will follow those orders and all is good.

 

2) I can not tell you how many times people come in with birth plans for induction. no IV/no continuous monitoring, etc.  You are being induced. You need to rethink the birth plan.  Often this is a 1st time mom and the induction is for no reason or a reason like "maternal misery" "tired of being pregnant". we are all miserable from 35 wks to delivery but its not a reason for induction. When someone comes in with a birth plan that they have already started crossing stuff off on you kind of don't take it all seriously. 

 

3) People often restrict themselves on birth plans.  labor and birth is so unique.  ANYTHING can happen.  saying you will NOT have this or that really sets you up for failure.  How many people have said they would NEVER have an epidural yet had a horribly long labor and ended up with one then felt like a failure.  I think as far as labor interventions its really best to just let go...be educated, know what you want and don't want and have your birth team (partner, doula, etc) know these things as well.  Instead of writing NO PITOCIN. Just let the nurse know to please discuss everything before doing it.  You can make a decision when/if it comes to that. 

 

My biggest advice if you are going into a more conservative hospital, go for a hospital tour,  ask if there are any nurses who support natural childbirth, when you come in for labor ask for one again.  If you had a birth plan and I was available- chances are I would get you and we'd probably do great. :-)

 

I know my midwife will make appropriate decisions for me.  I have no doubt.  I don't need to write anything.  If I am transferring to a hospital it will be because I want/need the interventions.  I realize I am lucky to have that and some people don't have the luxory because they are limited in the types of providers they have near them or because they are high risk. But I think you have to be somewhat realistic.  I work at a hospital that delivers over 1000 babies a month.  You are not going to get a 'birth center" type birth there.  But at the hospital I worked at before (100 babies a month) we often could give that type of birth. 

 

I argue all the time with docs and nurses who believe just as strongly in their way of doing things as I feel in mine.  We will never change them! But there are a lot who are more supportive- sometimes it is harder to find them but its worth it.



The bolded part is why I'm trying to reduce my birth plan.  I mean I *want* to go natural but it is not the end of the world to me.  Most importantly, I want them to take me dead serious when I say NO, NEVER, NOT gonna happen to some things.  Vax?  I would seriously get an attorney if my kid gets a shot I didn't approve.  That is so important to me that I'm going to keep my other desires out of my plan and just discuss them with my provider/nurses. 

post #57 of 59

The problem is there are dangers/risks with both pitocin and epidurals. I personally would avoid them just as much as I'd avoid vaccines. The only way I'd get an epidural is if it were something they'd use if I needed an emergency C/S. I'd never again agree to pitocin, unless I was bleeding to death after the baby is born and they didn't know how else to stop it.

 

Also, I'm dead set on being able to choose my own birth positions and not getting an episiotomy unless there were some obvious reason for one.(something I sincerely doubt.)

 

I also despise vaginal exams. They are extremely painful and totally not helpful. This is of course why I will be having an UC unless some emergency happens. So, mostly this stuff doesn't apply to me, but if I were in the hospital those would be really important to me.

post #58 of 59
Thread Starter 

(Cross posted to Twin Mamas thread)

 

Just thought I'd give ya'll an update, since you all helped me so much with my birth plan. I managed to get it into one page, bullet points, and I didn't say "never" to anything. I'll post the signed plan when I get home :)

 

I had my 1st appointment with my OB today!!! I was up all. damn. night. worrying about it. Ugh.

 

So with heavy heart, and birth plan in hand DH and I waited in his room. He came in, and before he could get a word in edgewise I told him I had A LOT to go over with him. He said "I've got time" :) Started by stroking his ego- heard lots of good stuff about him, that he was really natural birth friendly....etc...etc. Then I was honest and said I've been dreading meeting with an OB, and it's been stressing me out and keeping me up at night etc...And he was really sympathetic. I told him I wanted to go over my birth plan before we went any further, because I didn't want to get "fired" later on for not doing things his way. HE SIGNED OFF ON EVERYTHING GUYS!!!!

 

No ABX (even though I had a +GBS urine culture) this is the only thing we kinda "fought" about, but it wasn't really a fight- and eventually he said, "Well there is proof that the ABX antibiotics permanently affect a child's GI fauna so I guess you gotta weigh your risks" and then just put a little disclaimer on the birth plan that he explained the risks of refusal to me :)

 

No delivering in the OR which is usually mandatory (he agreed to put me in the room next to the OR), no epi, no iv, no heplock, no time limits on pushing, no time limits between babies, he does not care one iota about what position baby B is in, as long as A is vertex.

 

He WANTS me to labor at home as long as possible. He'll let them cook as long as I want but will suggest induction at 40 weeks, because that's like going 42 with a singleton apparently- unless there's evidence of PIH/Pre-E/PROM prior to that, but that he really doesn't want them before 38 weeks.

 

And get this: his c-section rate for his laboring patients is..... drumroll please....: 15%!!!! (He said that because he's the chief of obstetrics at the biggest hospital in Orlando, they fly all mothers within a 35 mile radius to him if their hospital can't handle whatever birth emergency is happening, so his actual C-section rate is higher, but that's the rate for his personal patients)

 

He said he's avidly against sections (especially planned ones), and will not perform them unless there's some kind of REAL medical emergency (ruptured umbilical cord, Pre-E, or Baby A is breach and external version doesn't work for examples) He said his goal is a vaginal birth every time. He also said he would handpick my nurse for me!!

He signed my birth plan, and scanned it into the computer and kept a paper copy for my file. I.am.so.relieved.

 

I can't believe he just went with it- and he wasn't patronizing at any point. He and DH got along well too, and he spent at least a half hour with us, even though all he did (besides talk) was do a fundal measurement and check their heartbeats with the doppler.

 

So, yes Virginia, there are OBs out there that will work with natural minded crunchy mamas...

post #59 of 59

Holy cow!!!! Sounds like you found a really excellent doc, congrats! That has to be a huge burden off your shoulders. Happy birthing day to you! woot!

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