Please share your cesarean birth plan

[APToddlerMama]

I'm hoping some mamas who have had cesareans can share their birth plans.  I will paste mine below, but not having had one before, I am sure I'm missing some important things so would love to see some others. 

Cesarean Birth Plan
 
*Dr. X did a consult with me and asked that I mention that to the anesthesiologist who cares for me.  There is information about some blood pressure issues I've had in prior surgeries as well as our discussion about the use of narcotics.
 
*I am extremely sensitive to narcotics.  Please do not put any narcotics in the spinal nor in the post op pain medications.  I would much rather be in a great deal of pain than suffer from the severe nausea, vomiting, constipation, rashes, and itching that I have experienced with narcotics.  If the pain becomes unbearable with non-narcotic pain relievers, I will ask for narcotics at that point.  Please also do not give me any sedatives.  

 
*I had a reaction to the stitches used in my first birth and would like to discuss an

alternative suture material.
 
*Please reinforce my uterus with double stitches and please do not use staples.
 
*Please delay clamping the cord for two minutes.  (MDC mamas....they can delay cord clamping with a C, right??)
 
*I would like the baby with me in recovery.
 
*My husband would like to be present at all times, including during recovery.  My husband would like to go with the baby if for some reason baby and I have to be separated in an emergency.
 
*I will be breastfeeding. I prefer to nurse immediately in the OR with someone holding the baby to assist me.  (Does anyone have experience with how often they do/don't allow this?)

Any feedback or things you would add or take out?

[MsDolphin]

Originally Posted by APToddlerMama 

*I am extremely sensitive to narcotics.  Please do not put any narcotics in the spinal nor in the post op pain medications.  I would much rather be in a great deal of pain than suffer from the severe nausea, vomiting, constipation, rashes, and itching that I have experienced with narcotics.  If the pain becomes unbearable with non-narcotic pain relievers, I will ask for narcotics at that point.  Please also do not give me any sedatives.  

I've heard if your list is long and wordy, it's less likely to be read. Don't know how true that it, probably varies by hospital and staff. But with that in mind, I would consider shortening this part.

Maybe...

* I am extremely sensitive to narcotics.  Please do not put any narcotics in the spinal nor in the post op pain medications.

* If the pain becomes unbearable with non-narcotic pain relievers, I will ask for narcotics at that point.  Please also do not give me any sedatives.

[tracymom1]

Hmmmm... I don't think they would delay cord clamping. I worked in L&D for a brief time as an RN and I although nobody requested it back then, I can't see the doctors being agreeable to this. Maybe times have changed, though, since there is a lot more info out there of the benefits of delayed cord clamping.

Do you know what kind of sutures were used in your last surgery? They might want that info if you had a reaction to them so they know what not to use.

Sounds really good, mama! You are so prepared!

[_ktg_]

Let me see if I can find mine, it was a just in case I have an ERC (which I did)  and it was really nice to have. 

This is my own POV - but I agree with Ms. Dolphin - keep it short & sweet & simple. 

Also I would write up 2 plans - one for the L&D nurses and 1 for you to cover the points you wish to cover which can be in more detail. 

So instead the birth plan looks like this for L&D:

Pre-Op:

*Dr. X did a consult with me and asked that I mention that to the anesthesiologist who cares for me.  There is information about some blood pressure issues I've had in prior surgeries as well as our discussion about the use of narcotics.
 
*I had a <<insert type of>> reaction to the stitches used in my first birth, I need to discuss alternatives.
 
During the Procedure:

*Please reinforce my uterus with double stitches and please do not use staples. Have you talked with the OB about this, as it could be common practice & surgical technique?
 

*Please delay clamping the cord for two minutes.  (MDC mamas....they can delay cord clamping with a C, right??)
 
*I will be breastfeeding. I prefer to nurse immediately in the OR with someone holding the baby to assist me.  (Does anyone have experience with how often they do/don't allow this?)
 

Baby:

<<insert if you have items specific for the baby>>

Recovery:

*My husband would like to be present at all times, including during recovery.  My husband would like to go with the baby if for some reason baby and I have to be separated in an emergency.

*I would like the baby with me in recovery for breastfeeding.
 
************************************************************************************************

Personal BirthPlan:

Anethesologist:
*I am extremely sensitive to narcotics.  Please do not put any narcotics in the spinal nor in the post op pain medications.  I would much rather be in a great deal of pain than suffer from the severe nausea, vomiting, constipation, rashes, and itching that I have experienced with narcotics.  If the pain becomes unbearable with non-narcotic pain relievers, I will ask for narcotics at that point.  Please also do not give me any sedatives.

OB -

How do you typically close with c-sections?

Type of suture material used? Had a previous reaction to <<insert name of suture materials>> and I would like to avoid that this time.

L&D recovery nurses:

<<insert any thing you wish to cover more fully with them>>

Sorry for the funky layout & editing - I will come back with updates once I get a hold of my birth plan for DS2.  Also will you have a doula with you, as they might be a nice middle road advocate to make sure all your points are covered, and also keep you company in recovery or in surgery during closing.   

[irishmamacat]

My birth plan was mostly for the midwives, paediatricans and anaesthetist, because my OB and I had already discussed exactly what I wanted to happen, and how, several times, in detail, during the pregnancy, as the decision to proceed with a planned c-section was made quite early.

It was something like this:

* I have good veins in my hands or wrists- my preference is for IVs to be sited there.

* If you plan to use an IV bigger than a green, please use local.

* My preference (based on previous experience) is for Fentanyl and Bupivacaine in the spinal.

* Please ensure I have a dose of a non-sedating IV anti-emetic before any cutting begins- please do not wait for me to become nauseated, as I will!

* Check my allergies before giving any antibiotics.

* Please let us know when our baby is about to be delivered- we would like the opportunity to take a photo and say a prayer, and would respect some silence at that moment (we got this, no problem).

* Please deliver the baby onto my chest if possible.

* Please ensure the baby has the most minimal time away from me that our health and safety will allow.

* DH will hold the baby if I am unable to do so while you close up the incisions.

* Please use staples to close the skin incision as I have had reactions to dissolving sutures in the past.

* I would like to breastfeed as soon as possible, please help me with this.

* No formula, no pacifiers unless specifically agreed to by us.

* Baby will room in with me, DH will accompany baby if it is necessary to transfer in order to provide care or treatment. 

There was no problem with anything at all- everything went according to plan, although I did feel pretty light headed from whatever drugs they used to try and push up my blood pressure after the delivery, but I let the anaesthetist know and the dose was adjusted until I felt better, and that only lasted for about 30 seconds or so.

I suggest if you have strong feelings about medications, rather than just putting it in a written birth plan, speak to the anaesthetist on the day when they do your pre-op asseessment or come to have you sign the paperwork for the spinal or epidural.

Worst case, you can sign a disclaimer that you specifically refuse consent for medications X, Y and Z, despite the advice of your Dr, which covers both you and them, and which may make them more willing to agree to your request.

[happyblessedmama]

I had an emergency c in 2010 and it was their procedurefor baby to have delayed cord clamping if they were not in distress. Our son had 90 seconds of delayed cord clamping. Not sure what benefits he might get from it but they did it and I did not ask them to. C was for position (transverse w/arm & cord presenting) but baby was fine.

I did not get to bf on the table but honestly I was too in shock to think about it all. I got baby back in recovery.

[hildare]

i'll post mine, but mine has both plan a and plan b.

i think if you perhaps specified about the breastfeeding that you wanted immediate skin-to-skin, that might help.  we didn't get delayed cord clamping with our first c; i don't know if it depends on hospital policy or what.  could you maybe tour and ask?  some of your questions seem individual with the care system-- like the recovery room rules, the cord clamping, etc.  and... if it were me, i would change the language of this part "I would much rather be in a great deal of pain than suffer from..."   to a more proactive/positive statement about your actual plans of pain management.  i am totally with you on the no narcotic ship, but i think that if you phrase it that way, they might be more likely to ignore your wishes.... 

here's what i have

Birth Plan for the M- Family

For baby:

• We will not circumcise.  Please do not retract the foreskin for any reason.
• Please don’t bathe baby.
• We wish to breastfeed only.  No formula of any kind (our first child has dairy/soy sensitivity) should be given, and we will provide pumped or frozen breastmilk if needed for supplementation or any other reason. 
• We decline eye ointment and the Hepatitis B vaccine. 
• We decline any other injections if offered, other than Rhogam for M- if baby happens to have a positive Rh factor. 
• We’re willing to consider a vitamin K injection if the birth has been unpredictably traumatic, otherwise we wish to decline this as well.

For the birth:

We wish to take the placenta home with us.

VBAC:

• We will be attempting a VBAC.  We would prefer:
• A nurse interested in/experienced with natural birth (medication-free) birthing techniques.
• No pain medication/epidural
• We will be attempting a VBAC.  In the event that the VBAC does not appear to be working successfully, and barring an emergency, we’d like:

Cesarean:

• A meeting with the anesthesiologist as soon as possible before surgery happens.  We will be requesting reduced medication/opiates. 
• M- wishes to have hands free
• To facilitate breastfeeding, we would like the baby to have immediate skin-to-skin contact, and to use an OR that allows mother and baby to be together right away.  Baby should be placed immediately upon M-s chest and remain there.
• We prefer to treat the pain after surgery with Toradol, if possible, as we had much success with this with our first birth/c-section.
• J- is to accompany the baby at all times, and testing should be done in-room if possible.
• We’d like to request two relatives/friends in the operating room if possible
• J- should announce the baby’s name/sex and cut the umbilical cord
• We would like the opportunity to decide whether to view the birth/drop the drape if possible

[McGucks]

These are great suggestions, one and all.  I wish I had access to some ideas like this when I was pregnant. 

Do most people who have these kinds of birth plans know the person who will be doing the procedure?  My OB did my c-section, which I guess means I was kind of lucky that she was the one on call...she actually has been my OB/GYN for over two decades and assured me she'd do everything she could to be with me.  DH & I took a lot of comfort in her kindness and familiarity.  She knew some of my preferences beforehand, but I wonder what would have happened if it'd been someone else in her practice. 

[MsDolphin]

Originally Posted by caedenmomma 

Do most people who have these kinds of birth plans know the person who will be doing the procedure?  My OB did my c-section, which I guess means I was kind of lucky that she was the one on call.... 

I did not, I couldn't tell you the name of the doctor that did mine to save my life.  I was in L&D so long, I went through 3 shifts of doctors and nurses before I finally delivered.

[WaitingForKiddos]

We did much of the same that has been mentioned...

-no talking in the OR
-mom to be given no drugs that have a possibility of making her drowsy or otherwise not mentally present. She would rather be in pain then not able to focus on these moments. 
-mom to have free hand(s) to touch baby
-catheter to be placed after spinal is administered
-mom to be reunited with baby in recovery as soon as baby and mom are stable
-baby to only be weighed while in observation
-baby to be GENTLY cleaned with towel/blanket, please leave vernex if present
-if baby is breathing well, do not suction deeply or at all
-do not swaddle baby but instead cover loosely with blankets 
-no eye medication
-no vit K




I'd add this if I were to do it over..
-dad to diaper baby while in recovery
-baby to be weighed when mom is present and out of surgery
-baby to remain in mom's view while in the OR

 

[hildare]

Originally Posted by caedenmomma 

These are great suggestions, one and all.  I wish I had access to some ideas like this when I was pregnant. 

Do most people who have these kinds of birth plans know the person who will be doing the procedure?  My OB did my c-section, which I guess means I was kind of lucky that she was the one on call...she actually has been my OB/GYN for over two decades and assured me she'd do everything she could to be with me.  DH & I took a lot of comfort in her kindness and familiarity.  She knew some of my preferences beforehand, but I wonder what would have happened if it'd been someone else in her practice. 

yes, and i love this ob... but.. you never know, especially if you are attempting a vbac, whether that person will be on call or available.  exactly why it's good to have it for someone else if needed!

[APToddlerMama]

Thanks for all the ideas everyone! I am so happy mdc opened this forum.

[cameragirl]

I think that a lot of these are similar to what we'd like if I do have to have an RCS. While we're planning a VBAC, I realize an RCS is a possibility. This needs to be organized, but this is a quick list of what I'd like:

Surgery:
-I would like to view the birth. Please drop the cloth or provide a mirror.
-I would like baby placed on my chest immediately if possible. I will not reach into the operating field and will wait for a nurse to assist me with this.
-I would like to breastfeed as soon as possible. Please help me with this if I am unable to hold the baby.
-Please keep discussion in the OR about the birth.
-I do not mind music in the OR, but please check with me before if possible.
-Please close my uterus with a two layers of sutures, and please close my skin with sutures or a combination of internal sutures and glue.
-I would prefer PCA for pain relief.
-I have a severe dermatitis reaction to adhesives. Please use hypoallergenic adhesives, and remove as soon as possible. (Reacts to tape, electrodes, bandages, etc.) Tegaderm is OK.

Recovery/Postpartum:
-I would like baby with me in recovery.
-We do not want eye ointment. I am STD free and will sign a waiver.
-We will not be circumcising baby. Do not circumcise or retract the foreskin.
-Please help me breastfeed if needed. I would like to see a lactation consultant as soon as possible.
-Please do not supplement with formula.
-Please do not bathe the baby.
-Dad will go with the baby to the nursery for any needed testing.