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help with triplet birth plan

1133 Views 15 Replies 11 Participants Last post by  LIZnCHAD
I'm trying to cut this down so that it will be more likely to be read. I just can't seem to cut more. Any tips? Thanks!

Birth Plan for Miriam and Ron's Triplets
Personal Wishes
•We request that the number of staff present be kept to the minimum necessary for an optimal outcome.
•We would like to photograph or record the babies' birth on videotape.
•My support team is Ron, my mother, Patti, my father, Gene , and my step-mother, Lorraine.
•I would prefer a regional anesthetic (epidural, spinal block, etc.). If general anesthesia is necessary, I would prefer the type and dosage be given in a way that allows me to regain consciousness as quickly as possible.
•I would prefer to be catheterized after receiving an anesthetic.
•I would like my husband present at all times for emotional support.
•I would like to see and touch each baby after an initial examination determines each is in stable condition.
•I prefer post-operative analgesic medication that allows me to remain alert and able to interact with my babies.
•I prefer that each baby remain with me in the recovery room, unless a particular baby requires special care due to its medical status. Should a baby (babies) require special care, Ron will accompany them and my mother, Patti will remain with me.
•I prefer a private room for the recovery period.

•I expect to breastfeed any stable, healthy triplet when the infant(s) exhibits feeding cues.
•If any or all babies require NICU care, I would like to initiate breast-milk expression within 3 hours of birth. We want our babies to receive as much of my colostrum and milk as possible. Further, I would like help to initiate breastfeeding as soon as any baby shows signs of interest or begins to coordinate sucking and swallowing.
•I would like the staff's help to breastfeed or pump within several hours of birth if I experience a complication that interferes with immediate breastfeeding or milk expression.
•We prefer no artificial infant formula, bottles of any kind or pacifiers be given to any baby, unless found medically necessary and after consultation with us.

•I expect to keep any stable, healthy triplet stay in my room with me as soon as possible. I understand that the degree of rooming-in depends on both the babies' and my conditions after birth.
•We prefer that any physical examinations, tests, etc. of the babies take place in my room.
•We will be abstaining from the antibiotic eye medication for the babies.
•I would like to have my husband or another support person remain in my room.
•I prefer medication options that allow me to remain clear-headed and able to interact with my babies and support persons.
•Should any of our girls turn out to be boys, we do not want him/them circumcised.
•We would like to initiate skin-to-skin "Kangaroo" care as soon as possible.
•If two or more of our babies require NICU care, we would like them to be co-bedded in a single crib as soon as two are medically stable.
•If co-bedding is not possible, we would like their cribs/isolettes to be placed side-by-side.

Ron and I understand that this is a high risk pregnancy and delivery and that our children face potential complications, including but not limited to, a NICU stay. We are flexible with our birth plan when the situation requires it, but expect to be part of any discussion of and give permission for any medical intervention being considered for our children. Should Ron or I be unavailable or unable to discuss any medical issues, we ask that Miriam's father, Gene, or Miriam's step-mother, Lorraine, be allowed to receive any medical information and make decisions on our behalf. We also request that the information given to other family members be kept to a minimum without our express consent.
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I really don't have any advice, just want to say this looks really great to me!

From my own experience with a c-section and preemies and my own complications, I'd say that your requests are very reasonable and most of them seem like the protocol done at my (Level III) hospital.

I really think the info about breastfeeding/pumping/rooming in is especially important, it was something I didn't think to discuss since the nurses at the hospital told me it was breastfeeding-friendly. Um, no. It's important to specify what you want done with the breastfeeding/pumping issues, and you've done that. You might also contact a hospital IBCLC before delivery and let her know you're going to be using her services. Even if you've breastfed before, each baby has her own nursing style and you'll be learning three nursing styles at once - alternatively, if there are preemie issues that keep one or more from nursing immediately, the LC will be able to help you with your pumping routine and so forth.

My own experience was that my care was quite focused while the babies were inside me but that the care became very fragmented afterwards. There was one set of people attending to the babies and another set of people attending to me, plus residents (you might want to add a comment about the participation of residents if this would be an issue for you - there is really no way you won't have a small city in your delivery room but perhaps if you can keep all the nosy residents/interns/med students who JUST HAVE TO SEE THE TRIPLETS BE BORN out, you can keep it from becoming a medium-sized city). The point is that there are lots of people only doing their own specialty after the birth, and you'll need to have a family member to focus on the combined care needed to acheive the best breastfeeding start. There is no medical specialty that cares for the mother/babies quadrangle, and it's quite a shock to discover this. Especially if you have complications, you will need someone else to advocate for you. It sounds like you've put this into place, but do expect to have to continually remind your caregivers about it.

Pain medication that keeps you alert is totally possible, I did best myself on plain old ibuprofen (in prescription strength of course). Being in pain is the most exhausting thing so keep working toward pain relief if it becomes an issue.

I wish I had had something like what you've written out, and I think the most important thing you did was to state which family members, and in what order, would be your companions and advocates. It is impossible to overstate the importance of having someone to advocate for you.

I'm sure others will have actual concrete ideas, just wanted to give my random thoughts. You rock!
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Originally Posted by mimid
Should Ron or I be unavailable or unable to discuss any medical issues, we ask that Miriam's father, Gene, or Miriam's step-mother, Lorraine, be allowed to receive any medical information and make decisions on our behalf. We also request that the information given to other family members be kept to a minimum without our express consent.
You may need to discuss this part with your doctor, since privacy laws are so strict you may need to word the document in a specific way. There may also be a patient advocate office at the hospital where you will deliver - that might be a place to call to get info on this issue. Good luck.
I might have missed it, but I didn't see anything regarding the hepB vax. In my state they give it to newborns as standard procedure, and you really don't want that injected into your little ones.
Just a there some reason you have to have a c-section? After my unwanted twin c-section it would seriously have to be life or death(and not just the bull$%#! the OBs tell us all) for me to have another. I read several accounts of vag triplet births when I was researching multiple birth stories. Anyway, just wondering your thoughts on that.
The plan sounds good!

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PS -- the c-section recovery was the worst ever for took 3 months to really recover and I know I will never be right again.
Are you having a c-section? I don't have any real advice but just wanted to wish you the best!
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I might also add whether it is necessary for the Vitamin K injection (to enable the blood to colagulate sooner). If a baby looks as if it might be headed to the NICU, then it might be warranted. Otherwise, if the baby(ies) are healthy it should not be needed.

Just my two cents.
Thanks all! My dad and step-mom are nurses (step-mom is an NICU nurse) and I'm getting all my medical questions ready to ask them about. My dad especially is pretty hands-off medically and is always telling me what I don't need. That's also why I have them down as getting the information since dh's family get easily confused with the English medical jargon.

For the c/s, there have been off and on concerns about B and C. Right now things are looking good but it seems like every so often things change so I'm going for the "give up my want of a natural birth to make sure my babies are okay" route.
Looks good to me . . . two thoughts:

I wish I had thought of the catheter AFTER anesthesia - will they really do that?

Also, you might want to have your own personal lactation consultant or LLL leader on call to assist with breastfeeding, and perhaps to be your advocate in the hospital. I delivered at a hospital with a decent reputation for supporting breastfeeding and one of the nurses first comments was: "Don't worry if the nursing thing doesn't work out for you hon; you have twins." Duh. Way to offer encouragement.

Like AmyY said, pain meds that keep you alert after surgery are totally doable. I used ibuprofen for a couple of weeks; that's it. (I was still in pain, but it was managable after that.) However, make sure you are taking anything you need to in the first weeks to manage your pain (don't try and tough it out too soon.) Being without pain is essential to recovery, rest, and nursing your babies comfortably.
Wow! You are a complete hero, mimid!!!! Your babes are lucky to have you and the rest of your family advocating for them. I'm not a mother of multiples but just happened to come upon this thread. We are a two mom family and our lawyer drew up a "fancy permission slip" that gave me permission to make medical decisions for DS until he was officially adopted by me. It was easy, quick, and cheap. You might want to consider something like that to give your father and step-mother legal rights to make medical decisions, just in case the hospital gets nit-picky about your birthplan and what can be official and what can't. Not that it seems that there's any reason why you and your husband couldn't make the decisions.....Just wanted to put that option out there to you.

Best of luck!

Royaloakmi~I got the part about the catheter from a birth plan for multiples on Karen Gromada's site. I'm sure hoping they will!

I will add that to my list of things to ask about, Megin. I really just wanted to CMA if there is some reason I'm out of it and dh is not sure what is happenning because it is moving so fast.

Originally Posted by mimid
Royaloakmi~I got the part about the catheter from a birth plan for multiples on Karen Gromada's site. I'm sure hoping they will!
Don't let them cath you before the epidural/block, they aren't going to do it first if you say no. At my hospital, cathing after the block was standard procedure.
I think your plan looks great. Not too long at all. I struggled to shorten mine and in the end I had a long and a short version. I took the long version to an OB appointment and went over it in detail with my OB. I planned to take the short version to the hospital. I think my short version was still longer than yours. If I had ended up transferring, I would have had a very natural birth frendly OB, but in a very conservative hospital, so I felt I had to be pretty explicit.

It sounds like you're doing great! Will they let you go into labor, or are you scheduling the section? I'm really getting excited for your girls to arrive!!
Check your wording in the last paragraph, about who's allowed and not allowed to get medical updates. With HIPAA in place, the hospital will want that very, very clear. My birth plan specifically states "we authorize you to discuss our medical care with ____ fully" just to keep the lawyers happy. "Kept to a minimum" is probably not going to fly well.

Originally Posted by twins10705
Don't let them cath you before the epidural/block, they aren't going to do it first if you say no. At my hospital, cathing after the block was standard procedure.
It was SOP at my hospital too, so no problem.
Your birth plan sounds very similar to what mine was (except I had 1 baby). The wording is exactly how it needs to be. Polite but firm and letting them know you won't accept anything less barring medical conditions of course. Good Luck to you mama!

If you are wanting to attempt a vaginal, I would divide the c-section and vaginal birth into different categories. So I had Vaginal Birth, C-section Birth, Recovery, Infant Care. And then listed my wants underneath those so if things didn't go exactly how I wanted, I could at least make sure that I got what I wanted if I had to have a c-section.

I don't think it's too long at all. You will have different teams for each part of your care. So the team responsible for your babies, will only have to look at that part, the team for the actual birth, ect. Your doctor will be the only one who needs to look at all of it, but he/she will have a chance at one of your check ups.
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