[LisaG]

Hello,

I'm putting the finishing touches on our c/s birth plan and would appreciate feedback. I've borrowed from various plans I've come across on MDC. Any suggestions for tweaking or additions are greatly appreciated!

As this is a planned Cesarean birth, my husband Dan and I are looking forward to a positive birth experience. We want to participate in this long awaited birth to the fullest. We have listed our preferences below; these decisions have been made after research, consultation, and thought. Your help in attaining these goals is very much appreciated.

•Lisa would like the catheter put in after anesthesia is administered.

•Lisa and Dan do not wish to have medical students present during our cesarean.

•No mind-altering drugs are to be administered without Lisa's expressed permission. She is aware that some hospitals routinely sedate the mom for the repair portion of the surgery. It is important to Lisa not to feel drugged or be unable to remember the events of the birth. Lisa would like to avoid having nausea medications administered unless absolutely necessary, Zofran is preferred if the need arises. She has had several surgical experiences and has no history of nausea from anesthesia.

•Lisa would like at least 1 arm/hand to remain free (unstrapped) during and after the surgery. She will respect the sterile surgical field.

•Lisa and Dan would like the option of viewing the birth either by lowering the screen or positioning a mirror.

•We would like to take photos of the birth as it occurs.

•If at all possible we would like that the baby's father, Dan, be able to cut the cord.

•Lisa would like to see the baby immediately after birth if at all possible. She would also like to hold the baby or have it held near her in the OR.

•Dan and Lisa request that the baby stay with them in the OR and recovery and not be taken to the nursery unless medical treatment is absolutely necessary.

•Lisa wishes to have the baby with her in recovery so that she can breastfeed immediately.

•If our baby requires medical treatment, Dan will accompany the baby at all times.

•NO EYE OINTMENT is to be administered to our baby at ANY TIME. Lisa, the baby's mother has been tested for all STDs and was negative and since this is a cesarean birth, our baby is at no risk of eye infection. This has been discussed prior to the birth with our baby's pediatrician.

•Vit K???

•All tests and procedures are to be done in the presence of one of the baby's parents, and with our expressed consent, barring no emergency situation.

•Please do not bathe our baby, we would like to give our baby his or her first bath.

•If our baby is a boy, do not circumcise.

•We have refused the Hepatitis B vaccine at this time.

•Our baby will be breastfed. Please do not give our baby pacifiers or bottles.

•We would like our baby to room in with us. Lisa will have someone with her at all times to assist her with the baby in any way.

 

[Asher]

I cannot give advice, but would like to thank you for posting this. I've been looking for a c/s birth plan and was honestly clueless what to include in it.

Best wishes!

 

[LisaG]

Thanks! I cross posted on our ddc too

 

[kltroy]

This is somewhat similar to the c-birth plan I made prior to my first birth, a scheduled c/s. (second was a VBAC!) You should talk through the plan with your doc/MW, because hospital policy may not allow for some of the things you ask for. This was the case for me and, since I was already crushed and disappointed by the whole thing, I found it very upsetting. Specifically, I wanted to have both my mom, a CNM (though not the one I was using for my healthcare), and my husband with me. They said I could only have one person with me due to space constraints. (I think this was legit - it was very tight in the OR). I had initially asked for a mirror or to see the birth, but decided later that I didn't want that because it was too weird.

One thing that we did, which I thought was nice, is that we did not know the sex of the baby. When my son was first born, the doctor immediately said, "Dennis, stand up and take a look at what you've got" instead of announcing "it's a boy!". He was able to cut the cord and stayed with the baby for weighing etc. Immediately after the cord was cut the doctor brought my son over, screaming, for me to see.

Actually, one of my favorite pictures from my son's birth was one the anaesthesiologist took of the three of us, with DH holding our son.

As for not allowing med students to be scrubbed in... can I ask why not? (This is the professor in me talking now.) I think that, as women, we can be amazing teachers by example to the doctors of tomorrow. I know it comes down to a personal preference, but if it were me, I would put a note in the birth plan reminding everyone involved that while they see many births each day, this is your child's birth that you have been awaiting for 9 months, and is very sacred and special to you, so they should be respectful. And then I would personally invite the students in. But that's just me. As an anecdote, for my VBAC I had a similar note about being happy to have residents/med students in the room so long as they were respectful of my privacy. The med student who worked with my doctor got to do most of the "work", under his supervision. My VBAC was the first - and probably only - unmedicated birth that she ever saw. It was a unique experience for her and I would like to think that because of it she will be a better proponent and better able to support women in natural labor in the future.

2 other things I did before my scheduled c/s were:
1. Shave about the top 1 inch of pubic hair the night before the birth (have your partner do this since it's darn near impossible to see). I promise he'll do a nicer job than the nurses will.

2. Have a talk with your baby beforehand. Let him know it is his birthday and to get ready to be born. I think especially when you don't labor ahead of time it's good to have this talk.

I wish you a peaceful and joyous birth!

 

[nashvillemidwife]

This is a very good birth plan. It sounds reasonable and polite and I think would be well-received by the hospital. You might want to take out a few of the more obvious things to make it shorter; the longer a plan is the less likely they are to read it. Issues like circumcision and rooming in are things no one really cares about until after the birth. There will be plenty of time to tell them about it then. When they go to put the catether in ask them if they can wait for the epidural; no need to write that on the plan.

Quote:

Originally Posted by LisaG •No mind-altering drugs are to be administered without Lisa's expressed permission.

I wouldn't use that terminology. "Pain medication" or "medication that may affect her mental state or memory" would be better choices. "Mind altering", though a literally correct term, has connations that are going to result in some eye rolling. You want them to take you seriously.

Quote:

•We would like to take photos of the birth as it occurs.

I don't know of any hospital that will let you take photos until after the baby has been born. Right after, yes. As it occurs, no.

Quote:

•If at all possible we would like that the baby's father, Dan, be able to cut the cord.

Be prepared for them to deny this request as they may feel it is contaminating the sterile field they've created around your open adomen with your guts exposed.

Quote:

•Dan and Lisa request that the baby stay with them in the OR and recovery and not be taken to the nursery unless medical treatment is absolutely necessary.

This usually depends on whether they have enough newborn nurses to spare one to remain in your room with you. They may not have the personnel to accomodate this request.

Quote:

•If our baby requires medical treatment, Dan will accompany the baby at all times.

This will depend on hospital policy, but in many hospitals only staff are allowed inside the nursery.

 

[LiLStar]

Quote:

Originally Posted by nashvillemidwife This usually depends on whether they have enough newborn nurses to spare one to remain in your room with you. They may not have the personnel to accomodate this request.

This doesn't make sense to me at all.. why would a newborn nurse need to be present? My dd stayed with me in recovery and there was only one nurse in there, and she definitely wasn't a baby nurse. It was my post op nurse. The only personnel necessary to accommodate the request of a perfectly healthy baby rooming in.. is that baby's parents.

 

[LisaG]

Quote:

Originally Posted by kltroy As for not allowing med students to be scrubbed in... can I ask why not? (This is the professor in me talking now.) I think that, as women, we can be amazing teachers by example to the doctors of tomorrow.

Hmm, good question. I can't say I've had any bad experiences with med students and I understand what you're saying about the importance of teaching the doctors of tomorrow. I think it has more to do with the desire to limit the number of people present and that I'm really, really tired of being medically "special" over the past 5 years. It's been a long, exhausting, gut wrenching journey, filled with too many "surprises" and I feel like I've clocked my time educating docs and I'd like to have a break from being a teacher and an example and maybe, just once, get to be somewhat, relatively "normal". Or as "normal" as a scheduled c/s after a uterine reconstruction with myomectomy can be

Quote:

Originally Posted by kltroy They said I could only have one person with me due to space constraints.

I asked my doc about having more than 1 person in the OR and he says if it was up to him, we could have as many as we wanted. According to him, it's the anesthesiologist that has the final say. Not sure how to plan for this, because I'd really like to have 1 other person present to take pictures if we're allowed. I don't really want to put the burden of picture taking on dh in case he gets understandably squeamish seeing his wife cut open.

Quote:

Originally Posted by kltroy 2 other things I did before my scheduled c/s were: 1. Shave about the top 1 inch of pubic hair the night before the birth (have your partner do this since it's darn near impossible to see). I promise he'll do a nicer job than the nurses will. 2. Have a talk with your baby beforehand. Let him know it is his birthday and to get ready to be born. I think especially when you don't labor ahead of time it's good to have this talk.

I asked the doc about shaving and he said they use clippers vs. a razor so it's not as irritating to the skin. Hopefully that means it doesn't itch like crazy when it's growing back in.

Thanks for the reminder to talk to the baby ahead of time. I love that idea.

 

[LisaG]

Thanks for the tips nashvillemidwife.

We're actually lucky that our doc will let us take pics of the birth. I know not all are willing to do that.

Having dh cut the cord isn't critical to either one of us. I'd say my biggest desire is to avoid having baby go to the nursery if at all possible. At one of the hospitals we toured, this was routine after mom was done in the OR and went to recovery. At the other, unless there was a problem, baby could stay with mom and dad. I'll double check with the nurse staff ahead of time.

And yes, we've been told that due to HIPPA, no one is allowed inside the nursery, but can watch from outside.

 

[phrogger]

Quote:

Originally Posted by LisaG I asked my doc about having more than 1 person in the OR and he says if it was up to him, we could have as many as we wanted. According to him, it's the anesthesiologist that has the final say. Not sure how to plan for this, because I'd really like to have 1 other person present to take pictures if we're allowed. I don't really want to put the burden of picture taking on dh in case he gets understandably squeamish seeing his wife cut open.

See if you can find out who the anesthesiologist will be. My OB knew a few weeks ahead of time who was on for the day of my last c-section. I also would say talk to him ahead of time and see if he/she will take the pictures. My second c-section the OB told me to hand my camera to the anesthesiologist and he would take the pictures for me. It wasn't hospital policy for no pictures, my OB said they usually do not allow them because of the risk of someone passing out while taking pictures from all the blood/guts etc. My OB however knew I wanted to see it all and I got some really awesome/graphic pictures from the anesthesiologist. My OB even posed the baby as he was pulling her out and saying "ok, take this picture, OH look at this, OH wait, hurry up and take this picture". Anyway, can't hurt to ask right? I know I will make sure I have two cameras in the OR this time.

I am probably going to borrow your list for my own

.

 

[LisaG]

Quote:

Originally Posted by phrogger I know I will make sure I have two cameras in the OR this time. I am probably going to borrow your list for my own .

Borrow away

Why do you want to have 2 cameras in the OR?

 

[cileag]

I'm an L and D nurse and your preference list looks just fine save for the cord cutting (I agree with Nashvillemidwife--although your husband can probably trim it afterwards), and the use of the phrase 'mind altering". Just ask that they check in with you about pain meds/anti anxiety/nausea meds and that should cover it.

We allow our babies to remain in with the mother if she prefers, the only issue is the OR is quite cold, and so if baby is borderline small, or transitioning not as well, I could see them preferring to have baby in another room.

 

[Norasmomma]

I also am going to borrow some ideas. Thanks.

 

[wombatclay]

You may have checked them out, but just for other mamas reading the thread too

...

There are a number of c/s birth plans and ideas in the Natural Family Living Cesarean Resource Thread.

The only other thing I'd suggest in terms of your birth plan would be to find out what standard practices are at the facility you'll be using. For example, the hospital where I had my unplanned c/s always inserted the cath after the spinal was in place. There was no need to request it. So if there are policies already in place that speak directly to some of your needs then those can either be left off your list or negotiated more directly with the staff if it's a change in their routine.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Staffing and "where the babe is"- there are three hospitals in my general area. One of them allows the babe to stay with mama in the OR assuming the babe is ok. The other two take the babe to the nursery and while the partner can go with the babe, reuniting the babe with mama really is a staffing issue for them. At one hospital it isn't a big concern since the mama recovers on the maternity floor... so the labor/delivery/post partum nurses are sort of doing double-duty. They "recover" the post-op mama as well as keep an eye on the new baby (for health as well as security reasons).

But in the other (smaller) hospital the recovery rooms are not within the maternity section and not "covered" by the maternity section security measures. So in order for the babe to be with mama in the recovery room they need a nurse from the maternity section to stay with the babe. If a maternity nurse isn't available to stay with the babe "off the maternity floor", then the babe can't go and they wait for the mom to be brought back to the maternity floor.

This usually isn't a concern for larger hospitals where there is enough double-duty staff and/or recovery rooms within the maternity ward, but since you asked why staffing could play a role in where the babe is (and it's a question that is asked a lot in my ICAN group by mamas who used this smaller hospital and were apart from their babes for 2-3 hours post partum), that's the info I was given.

 

[Comtessa]

One thing I've seen recommended in other C/S birth plans is a request for double-layer suturing of the incision... but I think that's only if you plan to VBAC in the future, since it reduces risk. If that's not an option open to you, it probably doesn't matter. Or does it? I don't know much about it, but I know that's something I've seen elsewhere.

 

[Italiamom]

If you don't find anything about double layer suturing on the boards or the internet (for some reason), I know that "Ina May's Guide to Childbirth" has a pretty detailed section on it, as well as some resources.

Basically, while a single layer suture will shorten healing time, a double layer uterine suture will heal stronger. Even if every subsequent child will be a cesarean delivery, and even if no VBACs will be attempted, the uterus will heal more strongly and be less prone to complications in the future with double layer suturing. I've told DH that no matter what doesn't happen on the birth plan, the double layer sutures are the most important to me. I'd have a look into it at the very least.

Aside from that, your birth plan seems fair, well researched, and very reasonable. Good luck giving birth!

 

[kltroy]

Quote:

Originally Posted by Comtessa One thing I've seen recommended in other C/S birth plans is a request for double-layer suturing of the incision... but I think that's only if you plan to VBAC in the future, since it reduces risk. If that's not an option open to you, it probably doesn't matter. Or does it? I don't know much about it, but I know that's something I've seen elsewhere.

I asked about this and staples vs sutures when I had my c/s and was basically told "the doctor will do what he will do". Still, it doesnt hurt to ask if you have a preference.

 

[leigh09]

your birth plan seems completely fair to me. i have had two c/s, each in a different hospital.

my second baby was a planned c/s and we had discussed her birth with my ob beforehand - she would have even let us videotape the birth if we wanted to (i had no desire) but we have plenty of pictures of her birth. our anesthesiologist also took lots of pictures for us so we have pictures of the three of us in the operating room. my dh was also allowed to literally watch her come out of me and cut her cord. there is no nursery in that hospital, she was wrapped up and had her apgars done on a warming bed right beside my head so i could watch her. she wasn't weighed until later that night and bathed the next day. she was nursing about 20 minutes later, when i was sewn up and we were back in our room. the entire hospital is babies rooming in with their moms. her birth was absolutely beautiful.

every hospital and doctor has different policies, it never hurts to ask. good luck with your amazing birth.

 

[accountclosed3]

i think that the spirit and beauty of the birth and your desires as parents really shine through.

but, i would take all of the "would likes" and put in a more strong word: "Lisa will have one arm free during and after the surgery." sometimes, just putting forth the right language often helps things come to pass.

also, speak with your OB long before the surgery about what is standard procedure, what they usually will allow, and ask for exactly what you want.

i think you'll get it and have a great birth!

 

[auntieM]

I love the idea of "cheek to cheek." Your partner or someone in the OR staff can hold the baby's cheek up to your cheek while the surgery is finished (or even just briefly). You may or may not want to include this in your written plan. I've seen an image of the father holding a swaddled newborn up to his wife's cheek. Even a brief contact like that would have made a huge difference to me in my daughter's birth.

 

[mamatolevi]

pls see my next post. this got all wonky in editing. sorry.