[mommyofatoz]

I am trying to prepare a birth plan for my doctor appointment tomorrow. While I am only 24 weeks, I want to take it in to my doctor to see exactly how he feels about everything to help me determine exactly how hard I will want to push Dh for a homebirth.

Anyway, so I'm preparing a birth plan, but have questions about some of my options...I will add more as I read, research, etc., but for starters, my first question is...

1. IF I am found to be Group B+ (I was with first two, but not with third), would I HAVE to recieve IV or can I just get a shot? What are your opinions or what have you found from your research? Is there pros/cons of either? Obviously the con of IV is being tied to a pole, but what else?

2. Food, can they deny me food? Should I bring in my own heathy snacks/soups, etc. to keep from feeling weak/dehydrated because I don't want an IV? I know in the past, I've only been allowed to chew ice chips...

3. I've had my water broken all three times, but that's after I am very dialated and the baby is engaged...is there still a reason I should not have this done? Is there a reason I should? I'm really not sure why they broke my water the last three times????

4. Suctioning the baby...I read somewhere that this can cause issues with breastfeeding? Tell me what you know! Can I tell them not to suction the baby?

5. Talk to me about eye drops and any other shots/test they give baby after delivery and why or why I shouldn't allow it.

6. How long do I HAVE to stay in the hospital? What are the risks/consequences of staying the recommended time vs. leaving ASAP?

With any of these questions, if you have resources that would be helpful to take to the doctor with me, please share!

Stay tuned...more to come!

 

[MegBoz]

Quote:

Originally Posted by mommyofatoz I want to take it in to my doctor to see exactly how he feels about everything to help me determine exactly how hard I will want to push Dh for a homebirth.

I HIGHLY recommend that if you really want to know how he feels about things, you ask open-ended Qs and don't reveal what YOU want. That way, it's totally impossible for him to "tell you want you want to hear." & He'll truly reveal how he typically practices.

While some OBs may be more medically-minded, but willing to bend to us crunchy Mamas-- personally, I'd rather have someone I don't have to argue with. Someone for whom it is the "default setting" to use evidence-based care & respect the natural process.

"1. IF I am found to be Group B+ (I was with first two, but not with third), would I HAVE to recieve IV or can I just get a shot? What are your opinions or what have you found from your research? Is there pros/cons of either? Obviously the con of IV is being tied to a pole, but what else?"

Well, the IV is the CDC recommendation, so a doc puts his neck on the line to deviate from that official rec. You're not totally tied to the pole - the infusions take 20 min to an hour (I think the 1st is a "loading dose" that takes the full hour, the subsequent doses every 4 hours are shorter.) & they can disconnect you after that.
Personally, I think the way they manage it in the UK makes more sense - antibiotics only if you have TWO or more risk factors (& GBS+ swab is just one factor) & that's what I'll chose for myself next time.

"2. Food, can they deny me food? "
Well, legally, they can't kick you out of the hospital for disobeying the idiotic "nothing-by-mouth" rule, nor can they tie your arms down to stop you from eating. HOWEVER... do you really want to have to argue with the nurses?!? I don't! & remember, even if your Doc is OK with it, nurses will be accomstomed to the standard hospital default policies... and if "NPO" (Non per os - Latin for "nothign by mouth") is the standard, the nurses aren't going to be comfortable.

"I'm really not sure why they broke my water the last three times????"
Perhaps so they didn't have to worry about getting it all over themselves when it broke as you pushed.

"4. Suctioning the baby...I read somewhere that this can cause issues with breastfeeding? Tell me what you know! Can I tell them not to suction the baby?"
I don't know about BFing.. just that it's not really necessary. Most babies can cough & clear out their sinuses & throat themselves. Sure, you could tell them not to suction, but if it's second-nature & they do it 100% of the time, they might forget.
OK, sorry to be so hospital negative! I gave birth in a hospital & it was great. BUT, I really think it's important to find a hospital/doc/nurses who are friendly to the natural process... rather than go into a bad one & try to fight with them the whole time. So that's why I'd urge you to find a mother/baby friendly hospital, rather than as "Can I refuse XYZ?"

"5. Talk to me about eye drops and any other shots/test they give baby after delivery and why or why I shouldn't allow it."
Wouldn't this be a Q for your pedi?

"6. How long do I HAVE to stay in the hospital? What are the risks/consequences of staying the recommended time vs. leaving ASAP?"
Whoa! If you let your doc know you'd consider checking out "AMA" (Against Medical Advice) you are really setting yoruself up for abad relationship with this doc, IMO. In addition to using words like "allow" - this line of questioning would give the doc the impression you don't trust him at all & don't even really respect his opinion (i.e. you want to make all your own choices & just want to know how hard he's going to make life for you if your decision happens to go against his.)

While I highly recommend getting educated yourself so you ARE making your own decisions, again, I also think birthing mamas ought to choose a health care provider they CAN trust & DO respect as someone to advise them in the process of making decisions.

IMX, my CNMs were happy to check me out ASAP - but the Pedi's won't check out newborns as quickly. I was GBS+ & didn't get any antibiotics (by accident, I showed up pushing!) It's standard policy to keep baby 48 hours in that case, (that's a nation-wide recommendation) so I didn't expect them to be flexible on that.

As far as resources are concerned, I think the book, '"he Thinking Woman's Guide to a Better Birth" by Henci Goer is great! The chapters on "NPO" & EFM are fabulous.

 

[MangoMommy]

Great info! Thanks!

 

[JamieCatheryn]

1. IF I am found to be Group B+ (I was with first two, but not with third), would I HAVE to recieve IV or can I just get a shot? What are your opinions or what have you found from your research? Is there pros/cons of either? Obviously the con of IV is being tied to a pole, but what else?

You can't get a shot from what I've seen, it's IV or nothing. Antibiotics can wipe out all the bacteria, good and bad, which knocks down your immunity and your baby's and especially puts you and baby at risk for yeast. You could clear GBS with hibiclens solution as a vaginal rinse or with garlic and probiotics but the hospital would still count you as + without a culture to prove otherwise. IME If you refuse the IV they'll hound you and threaten about the risks and measures they'll want to take to observe the baby.

2. Food, can they deny me food? Should I bring in my own heathy snacks/soups, etc. to keep from feeling weak/dehydrated because I don't want an IV? I know in the past, I've only been allowed to chew ice chips...

Bring it in a bag and don't even ask if you can eat or drink it. They won't even be in the room most of the time.

3. I've had my water broken all three times, but that's after I am very dialated and the baby is engaged...is there still a reason I should not have this done? Is there a reason I should? I'm really not sure why they broke my water the last three times????

It's pretty neutral at that point, having the sac out of the way might make pushing slightly easier, and doesn't have much risk so late in the game. If you want to allow baby to be born in the caul if it goes that way say so, and have your husband and or doula on guard for the amniohook.

4. Suctioning the baby...I read somewhere that this can cause issues with breastfeeding? Tell me what you know! Can I tell them not to suction the baby?

Usually isn't needed, maybe if you had an episiotomy cut baby might need help clearing lungs, but it's just so routine they wouldn't think about not doing it. If you tell them no they could easily forget or laugh at the request...maybe if you called it a religious thing they'd lay off.

5. Talk to me about eye drops and any other shots/test they give baby after delivery and why or why I shouldn't allow it.

Eye drops are for sexually transmitted infections in case you had them and baby picked it up on the way out. State law usually tells them to use the goop. It's usually unneeded, and keeps baby from seeing well for a while. You can ask for a delay for bonding or refuse (AMA to cover their butts).

Vitamin K shot is an unnatural form and high dose at once, given in case baby has rare but serious clotting disorders due to typical low levels or in case of circumcision.

Hep B vaccine is given at the hospital routinely to make sure the population has it done, since they have baby there already. It has risks and the baby likely won't be exposed before you got to your pediatrician for it if you chose to get it later. Or never.

PKU is a heel stick test for a bunch of rare but serious diseases, not much harm in doing it. It's not entirely accurate before your milk comes in though.

Hearing test isn't harmful

Bilirubin testing over the first 5 days could lead to a freak-out over mild normal jaundice, levels have to get very high or complications happen like extreme lethargy or not eating happen to be an issue.

6. How long do I HAVE to stay in the hospital? What are the risks/consequences of staying the recommended time vs. leaving ASAP?

Ask your doctor what the minimum stay he or she recommends is. Usually 24 hours, sometimes 48 but negotiable to 24. If you left earlier your insurance might not cover the birth.

 

[mommyofatoz]

Okay, so I have put together a list of questions to ask the doctor tomorrow, and part of that is on this subject. I figured I would address the questions by saying that "I would like to fill out a birth plan, but wanted to get your opinions first so I can make informed decisions as to how to fill it out. Like..."

1.How do you feel about working with a doula?
2.Would I have to have an IV? Or can I hydrate (or even eat) in other ways? What if I am group b+, can I just get a shot? Explain.
3.Do I have to be strapped to anything (monitors) or can they just monitor with Doppler?
4.When would you choose to break the water, if it doesn't break on it's own?
5.What positions do you recommend for delivery?
6.Do you like to directed pushing, or do you mind leaving it up to when the woman feels like pushing? Are there time-limits to pushing if the baby is fine?
7.When would an episiotomy be needed? Is it better to tear or have one?
8.What is your opinion on delayed cord-cutting?
9.If all is well, would I be able to hold the baby immediately after birth and postpone procedures until later (or do them on my belly)?
10. How soon would it be acceptable for the baby and I to leave the hospital?

What do you think? Should any wording be different? Of course all of these questions, I know the answer to, and know how I feel about them, but you are right, asking this way would make him feel like he is giving his input, rather than me just telling him "this is how it is...doc!"

 

[PaigeC]

You got awesome answers already. I just wanted to add two things.

I personally didn't do the open ended questions thing. I understand the logic behind it but I wanted her to know off the bat (I was only 10 weeks) that I wanted a certain type of experience or I was going to go elsewhere. It worked really well, she very nicely referred me to a midwife! (i hadn't known that was an option with my insurance - I honestly think she is listed as my OB). And the hand off wasn't rude at all - she said "you seem like you would really like midwife care."

The other thing: I know that the ped is in charge of the baby after delivery by I WOULD put that stuff in the birth plan since the same nurses will be in charge. Also, if you don't want vit K, eye drops, hep B, PKU I would recommend rooming - in or sending your DH with the baby if they have to leave. My portion of my birth plan relating to the baby's care:

•We will be rooming-in with our baby
We would like baby check ups to take place in our room.
•If the baby has any problems, I would like my partner to be present with the baby at all times, if possible.
•Please do not administer eye drops to my baby.
•Please do not administer vitamin K to my baby.
•Please do not administer any vaccinations to my baby.
oI am willing to sign a waiver for any of the above items
•My baby will be exclusively breastfed.

I also add at the bottom of the page:
Informed consent is very important to us. Please explain all procedures and medications to us prior to administration.

 

[mommyofatoz]

Well, I may have more time to think about my approach...all our roads are icy and I have two kids sick with the flu, so I think I may be rescheduling for another day...

 

[Materfamilias]

Great answers already, so I will just add support for the idea of laying your wants out there. Our OB was obviously not comfortable with many of my desires, so I went with a CNM, who was.
For a nice, gently-worded, short and to-the-point plan, check out Peggy O'Mara's Natural Family Living book.

 

[womenswisdom]

You might also want to ask about when is "too long" to be pregnant & when/with what induction would be recommended.

 

[*MamaJen*]

Have you thought about interviewing midwives? It does sound like you'd vastly prefer midwife care.

 

[mommyofatoz]

We have one midwife in our area, and I actually started out under her care, but the staff was horrible and I left. I was very sad to have to leave, because yes I very much would prefer a midwife. Unfortunately, I have limited options in my area.