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What Can I Do?

post #1 of 13
Thread Starter 

I'm working on a birth plan, and I know a few things that I am going to put in, but my question is are there things that if my OB says I need to do, that I actually need to do? If I disagree with something(s), what situation(s) am I looking at?

 

A few examples are:

 

I had an US recently, where they said the baby has cord wrapped around the neck twice. I've been reading, and looking at what that means, and I've come across different scenarios of handling that WRT labor and delivery; some clamp and cut the cord, and some don't, and then there are a couple of different ways the ones that don't cut the cord handle the situation. I want to request it not be cut, and that they try one of the other methods of handling it. What are possible outcomes of my requesting that, if they don't want to do it that way?

 

Pretty much, the situation is, DF knows that I've done a lot of research into things, and that while I'm not formally educated, that I do have a pretty good idea of what I want and safety of different things and stuff like that, and he's a little worried that if I'm too determined/argue with too much stuff, we're going to get kicked out of the hospital or something.

post #2 of 13

I found that doctors don't argue very much. They'll let you know their opinion of what they suggest but leave everything up to you. I looked into delayed clamping while I was pregnant and decided that there were so many variables involved that there would be no way I could make an informed decision on the spot so I left everything up to the doctors. 

post #3 of 13
Do you mean what could happen to you or the baby if the cord needed to be cut and you refused? Or do you mean what might happen to your relationship with your OB if you refuse in advance and s/he doesn't like that?

To answer the first question, if the cord was very right and wrapped around several times it could tear or cause damage to structures in the baby's neck if delivery of his/her body was forced with the cord still in place. If the cord tore then the baby could experience some blood loss depending how quickly it could be clamped. This is very much a worst case scenario. My general rule is that if I can slip two fingers under the cord then there will be no problem sliding it over the shoulders/body. Unfortunately there's no way of knowing what will happen til your there.

I can't really answer the second question. I guess, if you are in the US, s/he could refuse to treat you if you didn't consent to early cord cutting if needed.
post #4 of 13
They can't kick laboring women out of the hospital in the US, so put that worry to bed.

I wanted to delay cord clamping when my ds was born, and my doctor didn't argue at all. But she was calling to have the cord clamped the second he was born, and when I protested, she looked me in the eye and said "you're hemorrhaging. "

I think my doctor did the right thing, but I wanted to point out, there's a lot of ways to not argue, and they don't all involve doing things the way you want them done when you talk it over before labor.

The situation you're talking about is one that's going to make doctprs nervous. They're going to look at your chart, and if the nuchal cord doesn't resolve, they're going to see "lawsuit". Some nuchal cord situations really are no big deal, and delayed clamping and cutting is fine, but if your baby's heartrate looks worrying on the monitors (they're really going to want to monitor) or the baby is born looking blue, they're going to prioritize doing whatever it takes to get your baby oxygen.
post #5 of 13
Thread Starter 
Quote:
Originally Posted by katelove View Post

Do you mean what could happen to you or the baby if the cord needed to be cut and you refused? Or do you mean what might happen to your relationship with your OB if you refuse in advance and s/he doesn't like that?

To answer the first question, if the cord was very right and wrapped around several times it could tear or cause damage to structures in the baby's neck if delivery of his/her body was forced with the cord still in place. If the cord tore then the baby could experience some blood loss depending how quickly it could be clamped. This is very much a worst case scenario. My general rule is that if I can slip two fingers under the cord then there will be no problem sliding it over the shoulders/body. Unfortunately there's no way of knowing what will happen til your there.

I can't really answer the second question. I guess, if you are in the US, s/he could refuse to treat you if you didn't consent to early cord cutting if needed.

 

That's what I was wondering about.

 

Quote:
Originally Posted by Escaping View Post

I found that doctors don't argue very much. They'll let you know their opinion of what they suggest but leave everything up to you. I looked into delayed clamping while I was pregnant and decided that there were so many variables involved that there would be no way I could make an informed decision on the spot so I left everything up to the doctors. 

 

I'm not necessarily talking about delaying it in the "traditional" sense of the word, so much as trying to use the "somersault trick" or otherwise remove the cord for baby to be completely born before the cord is cut, because (from what I've read) cutting the cord before baby has been fully delivered can pose extra risks that wouldn't (necessarily) be there if they waited.

 

Quote:
Originally Posted by MeepyCat View Post

They can't kick laboring women out of the hospital in the US, so put that worry to bed.

I wanted to delay cord clamping when my ds was born, and my doctor didn't argue at all. But she was calling to have the cord clamped the second he was born, and when I protested, she looked me in the eye and said "you're hemorrhaging. "

I think my doctor did the right thing, but I wanted to point out, there's a lot of ways to not argue, and they don't all involve doing things the way you want them done when you talk it over before labor.

The situation you're talking about is one that's going to make doctprs nervous. They're going to look at your chart, and if the nuchal cord doesn't resolve, they're going to see "lawsuit". Some nuchal cord situations really are no big deal, and delayed clamping and cutting is fine, but if your baby's heartrate looks worrying on the monitors (they're really going to want to monitor) or the baby is born looking blue, they're going to prioritize doing whatever it takes to get your baby oxygen.

 

Of course, I would let them do whatever is necessary to save/protect us from unnecessary emergencies or situations. I was more talking about how (some) providers routinely (from what I have read online, fwiw) cut nuchal cords without there being a medical reason, just because it's "what they do". That's what I was more wondering about, things that the hospital/specific OB do routinely, that aren't necessarily "necessary". If baby's heart rate is decelerating or baby is in distress or looking blue, or I'm hemorrhaging, of course do whatever it takes to ensure we all survive, and are reasonably healthy.

post #6 of 13

Sorry I misunderstood. I was in a similar situation, not exactly the same but I felt I was very much listened to and had a really great hospital birth. I've found that as long as you and your baby aren't in danger and there is time, they'll respect your wishes no matter what they are. With me they even brought my parents in, even though there was only supposed to be one support person in at a time because I said "I wish my parent were here" ... I had no idea they were in the hospital yet, it was cool smile.gif

I've found that doctors and hospital staff appreciate what a special time this is for families and they're really accommodating.

post #7 of 13

They can't refuse you care once you are in the hospital because you don't want something done a certain way.  But if you or baby are in danger, your preferences won't matter very much if they need to save you.  It sounds like you get this already.

 

I would be very clear and specific in your birth plan about what your wishes are, but also acknowledge that they are wishes and that circumstances may arise that do not allow them to happen that way.  I did this myself lin my plan ast time to avoid coming off as unrealistic or adversarial to the doctor/nurses.  Be as specific as possible, and detailed as possible.  Discuss your plan with your OB in advance of your due date so you can find out from her/him if there are any potential issues with your wishes.  Then you can find out why, discuss, argue or amend your plan as necessary.  Have several copies of your plan in your hospital bag so you can be sure that the doctor(s) on call get one as soon as you get there, as well as the nurse or nurses and tell them you want to know if they see any issues with the plan, and that you'd already been through it with your OB and he/she didn't have issues with it.  Have someone who can advocate for you if you can't do it for yourself if anything arises that is an issue WRT your plan (partner, doula, other support person).  It's important that they are informed about your plan and reasons behind choices etc. before you get to the hospital too. 

 

FWIW, I had absolutely no issues with my plan being acceptable last time.  It didn't have anything crazy in it, but did include delayed cord clamping, no antibiotic oitment on the eyes, extended second stage of labor if necessary, baby to be placed right on my chest as soon as born, etc. etc.  I think that how much of a fight you will have to put up depends on your provider and where you deliver.  I had care from a low risk clinic of MDs last time, and had my baby in Canada where they aren't quite as invervention happy as in the US.  So if I'd delivered at a US hospital with an OB I may have had a different experience.

 

Good luck!

post #8 of 13
I would talk to your OB about it now, ask what they typically do In the situation and then bring up trying to slip the cord over first if possible if they don't. Make it clear that you understand if it is too tight that of course you understand they may need to cut it. I think it is good to have many conversations with your OB like this ahead of time to make sure you are both on the same page.
post #9 of 13
I too think that having a conversation about this ahead of time with your OB is a good idea. Approach it from the standpoint of: "We know this might be an issue because of the ultrasound. Delaying cord clamping is important to me and also I'm concerned that if the cord is cut when the head is out and there is a delay in delivering the body, like shoulder dystocia, this puts the baby at higher risk for injury. How do you feel about trying to slip the cord over the head or body or trying the somersault maneuver before clamping and cutting?" That seems reasonable and non-offensive to me. However, it *is* kind of micromanaging the way a provider practices (not that you are not entitled to have them try whatever you'd like) and the problem with that is that in the moment, they may be stressed due to the circumstances and act on auto-pilot, doing whatever they normally would do in that situation (i.e. cutting the nuchal cord). It might be a good idea to have your partner remind your provider of your wishes during pushing so it's fresh it their mind.
post #10 of 13

I agree with the PPs.  My daughter's cord was wrapped twice around her neck and we had very worrisome heart rate variables and meconium in the amniotic fluid.  But we were still able to do delayed cord clamping.  I think having a discussion ahead of time in terms of how common your OB thinks it is to cut the cord early is important. 

 

I also think you might get more information if you asked, "Roughly what percentage of your patients require early cord clamping" rather than "What would you do in X scenario?"  Lots of docs say they are against routine C-sections, for example, but their numbers don't support that assertion.  So even if your doc says, "We would try to delay cord clamping if it's safe", it might be worth it to know what that means in actual percentages. 

post #11 of 13

And just as a word of reassurance, if your birth does end in a c-section, it isn't the worst thing in the world. Breastfeeding isn't impossible, your baby isn't taken away from you, your bond won't be compromised, they don't cut your through your abdominal muscles, etc. the worst thing about a c-section is that it hurts after. It hurts a lot but it gets better quickly. And because doctors are so scissor-happy, they're very good at it, they could probably do it blindfolded. 

I know some women have horror stories, but that isn't the majority. If you've done everything you can and there are no other options, don't feel for a second that you've failed or done your baby some irreparable harm. They're not as bad as some people want you to think hug2.gif

post #12 of 13
Thread Starter 

Thanks, everyone! Y'all have given me a lot of things to think about, and some really good ideas!

 

Quote:
Originally Posted by Escaping View Post

And just as a word of reassurance, if your birth does end in a c-section, it isn't the worst thing in the world. Breastfeeding isn't impossible, your baby isn't taken away from you, your bond won't be compromised, they don't cut your through your abdominal muscles, etc. the worst thing about a c-section is that it hurts after. It hurts a lot but it gets better quickly. And because doctors are so scissor-happy, they're very good at it, they could probably do it blindfolded. 

I know some women have horror stories, but that isn't the majority. If you've done everything you can and there are no other options, don't feel for a second that you've failed or done your baby some irreparable harm. They're not as bad as some people want you to think hug2.gif

 

I had a c-section with my first, and unfortunately was one of those people who have a horror story. I realize that one bad experience doesn't guarantee a repeat bad experience, so I'm (doing my best to) prepare for that, too, as a possibility, and convince myself that it isn't going to be the same. But honestly, I'm really afraid it will be the same. Just really, really hoping it's not.

post #13 of 13

A bit of advice for the delayed cord clamping: You might put in your birth plan when they may cut the cord. A lot of doctors read that moms want delayed cord clamping and wait 30 seconds before they cut the cord. But if you write in your birth plan: "Please do not clamp or cut the umbilical cord until ___ minutes have elapsed after baby's birth," it gives the doctors a number. And hospital staff like numbers.

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