Suggestions for "gentle cesarean" birth plan? Having my 4th c-section soon... - Mothering Forums

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#1 of 6 Old 08-14-2013, 11:41 AM - Thread Starter
 
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A little background: 

 

Though I am a huge prononent of natural, at home birth, I am scheduled for my 4th c-section next week, at 39 weeks, 1 day.  I am 42 years old and have a pretty large amount of amniotic fluid, causing my OB to panic a little and want that baby out. I am also a bit anemic (not sure of my hemaglobin count, forgot to ask, but I would guess 9 or 10, since I have been tested at that before).  I had my last child after 42 weeks 5 days of unassisted pregnancy, on purpose, and was hoping for a home water birth, but after 3 1/2 days of labour, found a doctor who would do my c-section that afternoon and off I went, whereupon I found out that baby was double footling breech.  This baby is still, as of last week, breech (not sure exactly which sort).  I feel great, and am tempted to push my c-section back a week (against my doctor's wishes) but due to my friend's availability (she will be watching our other 3 children during surgery and possibly during the days/nights) and my husband's work schedule (though he could reschedule his days off), I am hesitating.  I am also quite tired and ready for baby, in a way. 

 

Anyway, onto my questions... I have mentioned to my OBGYN and one of her partners (I have an appointment with her other partner tomorrow) that I want baby not bathed and brought to me as soon as baby is born, I don't want vitamin K or vaccines, no drops, no finger or heel pricks, nothing, just baby brought to me and put on my chest while I am being stitched up.  My husband will be beside me the entire time and will help hold baby on me, or take baby onto his chest for kangaroo care and cuddles.  I don't want baby taken to the nursery (where my 2 1/2 year old was born, and taken there for 45 minutes before being brought to me in recovery, and it was for no reason whatsoever, she was extremely healthy, and just cried much of that time in the heating incubator - awful!, with my husband only able to reach in and being told he could not remove her, so dumb!) at all.  When I went for a quick tour last week, I told two nurses there that, and they both seemed fairly amenable to it, but I know that sometimes, they will say "sure" but then not live up to that when the time comes.  I am certainly hoping to avoid that, but also to not annoy anyone. 

 

I do plan to bring a box or two of chocolates to give to the nurses' station when we arrive.  :)  I want as many good vibes going my way as is possible.

 

My OBGYN has said yes, generally, to all of the things I requested of her, but just to remind her the day of the c-section.  That makes me a bit nervous, as I don't want to forget anything and I don't want her to forget anything, so I am thinking a written birth plan would be prudent.  One thing that she didn't exactly say yes to was when I asked for the cord to be kept intact until it finished pulsating...to which she said she could cut it very long, both times that I asked.  That isn't exactly what I wanted though, right?  Is there benefit to keeping it long for the baby, or not? 

 

Do you think a written birth plan would be helpful?  Or will they all pretty much ignore it and go on with their plans, forgetting or avoiding reading it? 

 

I found this sample cesarean birth plan

 

http://birthwithoutfearblog.com/2012/09/18/a-family-centered-cesarean-birth-plan/

 

and this one

 

http://empoweredbirth.typepad.com/empowering_birth_blog/2007/06/cesarean_birth_.html

 

but I would love to hear other suggestions or see your c/s birth plan and figure out what to keep in and what to leave out. 

I am nervous that if it is too long, it won't be read or paid attention to, but I also don't want to miss anything important.  This is our 4th and last child and my last c-section birth, so I am hoping to not regret parts of it, if at all possible. 

 

Thank you so much for your input!

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#2 of 6 Old 08-14-2013, 12:50 PM
 
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I hate that mothers ever feel that they have to bribe the nurses with chocolate.  They should be doing well by you because it's their job.  That said, if you think chocolate will help, bring it.  If chocolate would get me or my sister better care, I'd go to Costco and bring a truckload.

 

On the cord - I think the "cut it long" thing is odd.  The point of not cutting the cord is that the baby can still be attached to the placenta.  If the cord doesn't end in the placenta, it doesn't matter how long it is.  There may be reasons to cut the cord quickly (I wound up with the cord immediately clamped and cut both times, once because of hemorrhage, and once because the baby was super premature and needed immediate breathing assistance), but cutting it long is not a substitute for leaving it attached.  It may be that your doctor is saying that she won't delay clamping or cutting the cord.  It would be nice if she'd present a logical argument for that.

 

I am also not a fan of the system where you "remind" the doctor of what you want the day you have surgery.  I have only had one c-section, but in my overall experience with surgery, it is not always guaranteed that I see the doctor before the drugs kick in.  So I'd go ahead and print up more then one copy of a birth plan, to hand out as you see fit.  I agree that short is best, but I think it helps to have these things written down.

 

On the sample birth plans -

On the first, I don't see an upside to having the surgery performed slowly.  The longer you're open, the more you bleed.  Also, functionally, I suspect this is a point that doctors are likely to ignore. 

 

I think some of the points on the second one are hugely likely to get major pushback from staff.  Like never being separated from your partner, ever.  I don't know why there's the policy on having the patient solo when they're putting on surgical anesthesia, but there is, and they really do not budge on it.  On having your partner present even if you're under GA, I don't think you're going to get much wiggle room either.  The point of having a partner in the room is to support you.  If you're unconscious, that person in the room is an untrained observer, taking up space and potentially screwing up sterile technique.  (In my experience, ORs do not have a ton of extra space.)

 

The other one I think you're likely to be disappointed on is dictating the location if the baby needs deep suctioning.  There is no way for the baby to be suctioned in your arms if you're on an operating table, and the OR may or may not fit suctioning equipment at your side. 

 

The "I do not consent to any students, interns, etc. watching or participating," thing is vague.  Never use etcetera when you could say what you mean.  How do you feel about residents?

 

The point about asking the surgical team not to engage in incidental chatter seems draconian and possibly counterproductive to me.  This is going to be really a matter of personal preference.  It was my experience that silent doctors are doctors sitting on bad news, so it was reassuring to me to have them chatting about the weather and the ball game.

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#3 of 6 Old 08-14-2013, 01:45 PM
 
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I am sorry that I am not able to respond in detail to all your questions, but I just wanted to say that I agree that the shorter the birth plan the better. Pare it down to those items that are most important to you.  I would strongly encourage you to consider having music.  During my unscheduled c/s, I really appreciated that the OB offered to bring my player with me. It was really powerful to have a beautiful jazz song playing while my DS was born, and I definitely think it helped with the idle chatter. 

 

I will be writing up a cesarean birth plan in the next couple of months. My OB who supports and regularly practices gentle cesareans recommended that I watch this video to have a better understanding of the options:

http://www.jentlechildbirth.org.uk/?portfolios=the-natural-caesarean

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#4 of 6 Old 01-12-2014, 02:29 PM
 
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Thanks for posting this.  We are starting to plan the next baby, which will be a repeat C-Section (#4 after 3 attempted natural births).  I'm already stressing about this part, and we don't even want to actually ttc unitl this comming June!  It helps tremendously to talk with other mothers who are / have gone through the same / similar things.   Please keep posting to let us know what you decide & then how it goes over at the hospital.  We'd all really appreciate to hear the outcome, I'm sure.  :)


Wife to since '98; Homeschooling, working on my doctorate & becoming crunchier by the day; Mom to DSs: 06/10,12/05, & 1/99 & 1 on the way (3/15)
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#5 of 6 Old 06-09-2014, 09:20 PM
 
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Awesome idea!
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#6 of 6 Old 06-12-2014, 06:56 PM
 
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They don't let the partners in for anesthesia induction, whether it's a spinal or general, because it freaks some people out. Suddenly having two patients is really a problem. I'm sure a lot of surgeons would rather not have the partner in the room at all, but since that's kind of expected these days they relent to it.

Are you planning to have your baby at a teaching hospital? If so, you may not have a choice about residents. Surgery takes more people than just the surgeon, and in surgery those students, interns and residents do jobs - like hold retractors - that would at a private institution be handled by other types of employees. They may be able to accommodate you, but they may not.

It also may help to find out the hospital policies about what happens to newborns just born via C-section. At mine, Pediatrics was present for all C-section births and they got the baby first. THere, as soon as it's out, the baby is not the OB's responsibility, it's the ped's.
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