Birth Questions

nda_roxybabe

Alright, last time we discussed these was way back when. Even though my plan is essentially a lot of "whatever my Dr. thinks is best", I still want to create one for my own peace of mind and just to make sure I've properly explored my options. I definitely don't want anything for nurses to roll their eyes at (though they shouldn't regardless), so I'm trying to keep it light.

I'm following @mdlorenz lovely template of sorts, but have some Q's and figured I am not the only one

What kinds of things should I note regarding a C section?
What does this mean? " IM (in your thigh muscle) pitocin - reduces your risk of postpartum hemorrhage (heavy blood loss) by 40% (this is a big deal - the WHO [World Health Organization] has recommended this as one of the biggest lifesavers of women after birth -- even homebirth midwives carry this)"

nda_roxybabe

and here's the "template" from MD:

Pain mgmt:  Unmedicated birth? IV meds? (can take the edge off but don't last long) Epidural? (and timing? right away per hospital/facility protocol? wait as long as possible?)

Baby bath:  Hospital or home (not required before you leave)

Baby meds:  Ok with vitamin K (prevents bleeding in new babies who have immature livers and can't vitamin K-dependent clotting factors fast enough without it), antibiotic eye ointment (to prevent badness from gonorrhea), Hep B vaccine (please just vaccinate your babies - oh wait, a totally *different* controversial topic we can wait for)

In case of c-section:  Who do you want with you in the OR?

Circumcision:  Yes/No

Placenta:  Keep? Toss? (just so your nurse/provider doesn't toss it prematurely - they clean things up as fast as possible after all the stitching is taken care of)

Some other things to think about:

[] If you want an unmedicated birth -- Consider asking nurse not to offer pain medication or epidural, and not ask you to rate your pain (you will definitely let them know if you change your mind, but having someone ask you all. the. time. whether you are in pain can get into your head)

[] IM (in your thigh muscle) pitocin - reduces your risk of postpartum hemorrhage (heavy blood loss) by 40% (this is a big deal - the WHO [World Health Organization] has recommended this as one of the biggest lifesavers of women after birth -- even homebirth midwives carry this)

[] Cord pulsing (standard in many hospitals) - leaving your baby's cord to pulse for at least 60 seconds will reduce the risk that your baby has anemia in the first year of life

[] Delay routine baby cares (standard in many hospitals) until after the first hour to facilitate bonding / first feed

[] Ask that your baby be given nothing but your breast - no pacifiers or bottles (unless you decide to do so)

[] Ask that your baby not be taken out of your presence - no nursery stays (unless you are having too much trouble resting - then please, by all means, get 2-3 hours of sleep)

[] Routines to be aware of: congential heart disease screen (pulse oximetry - not invasive), bilirubin level, hearing screen, newborn screen (for metabolic disorders)

hp_momma

I asked @mdlorenz about the IM Pitocin in the Randoms thread so I'll just copy/paste her answer because it explained it well! 

"IM Pit is nearly universal and standard of care in both hospitals I'm at. Some people refuse it and would rather rely on oxytocin during the first breastfeed --- which is an option if you are not separated from baby immediately postpartum. I'm a pretty firm believer in whatever the WHO (World Health Organization) thinks is essential for safe
birth, because they're thinking of both low- and high-resource settings and wouldn't recommend something in those lower-resource areas if it wasn't backed up by solid evidence. Most moms don't remember the shot and most providers don't really offer an alternative - it's just a given."


And @WombThereItIs said it's sometimes given in your IV, which I think is what I ended up having since I don't remember a shot after delivery (but there is also so much going on I could have totally missed that too!) 

jayandaplus

I used Earth Mama Angel Baby and Mama Natural's (pictogram) birth plans to create my own. I only mention that to point out it's obviously pretty crunchy. I, being in the medical field, do not like leaving it up to my healthcare professional to make a decision. As a HCP, I don't feel that it's fair to put that on them-- these are our decisions, and I prefer to own them.

That being said, I made two birth templates. One is all written out in text (EMAB), one is pictograms (MN). My birth plan is to give birth with my midwife and DH at a birth center, so the options are limited to begin with and the acceptance of "alternative" ways is wide. That being said, sh*t can happen. I work in an emergency department and know it's best to be prepared for anything and there's no way to over plan. So, I do mention preferences around a cesarean and more traditional birth practices, if it comes to that.

@nda_roxybabe I'd ask your OB if pitocin IM is their routine practice, or if they only give IV pitocin if you show signs of hemorrhage.

Here's the pictogram of what I'm doing:

saric83

I ended up with an emergency CS, and I honestly can't think of anything to note down if it's not a planned one. I did talk with my doc ahead of time about how it would be (my little human was pretty huge, so we were discussing potential risks with him getting stuck, so we were prepared if it happened)), but there were no decisions to make since it was just about getting him out safely at that point as quickly as possible, and it was a hospital policy to try to bring him to me immediately after he was out, so there was nothing to note there.  DH knew he did NOT want to cut the cord regardless, so I reminded the nurses as we went into the OR, but that was about it. 

KMD1106

C-section things to think about:
-If you are like me and really want to wear a bra during surgery, make sure it has no metal on it.
-Some of the meds can make you nauseous. They'll ask if you're ok with something like Zofran.
-Be prepared that meds can make you shaky.
-Plan who will be in the room with you. They'll ask this person if they want to see the delivery. Discuss that with that person. 
-Check on skin to skin right away.

mdlorenz

@jayandaplus I love the pictogram I'm crunchy too and take our local in-hospital birth practices for granted. That is, we: 1) practice delayed cord clamping with all babies unless baby needs meconium suctioned out immediately after birth, 2) our nurses are very protective of the "golden hour" (for mamas who want to breastfeed, removal of colostrum either by breastfeeding or hand expression has been associated with a stronger milk supply - plus, who wants to wait to hold their baby?! Most often, baby comes right up on moms tummy or chest and doesn't get weighed or burrito'd in a blanket until the first hour or so has passed), 3) episiotomies are incredibly rare - most often the reason they are performed is in the event of an "assisted" delivery with vacuum or forceps, and 4) "AROM" (artificial rupture of membranes, or breaking the water to get labor going or evaluate for meconium in the fluid of a baby who has appeared to be stressed-out on the (imperfect) fetal monitoring strip) is relatively common but not done without permission from mama. 

I wish that intermittent monitoring (having a nurse check baby's heart rate with a handheld Doppler every so often during a contraction) was more common. It's certainly more time intensive and the nurses are taking care of more than one patient so it's certainly more to ask of them. And hospital policy excludes *so* many women from intermittent monitoring so they get stuck having the fetal monitors strapped on during the whole labor. Thankfully, they can be used in the tub! 

Definitely run your plan / preferences by your provider prior to your labor. They can tell you what is standard practice and how your preferences jive with that or what circumstances would make them recommend something you aren't keen on. Early communication is key! (And of course, remembering to bring it with you to your birthing place when the time comes so everyone is on the same page)

WombThereItIs

I actually prefer my hospital's protcol to some of the crunchier requests that have gone mainstream. I don't anticipate having a plan but there are a few things I will want to bring up when I get to L&D:

I have 0 desire to do immediate skin to skin and plan on asking them to do a quick wipedown first. I can try the whole boob thing after baths and whatnot, that wait doesn't bother me. 

If I go the VBAC route I do plan to ask my doctor about their preferences for monitoring. Last time I spent more time in bed than I wanted to because the nurses made such a big deal out of taking the monitors on and off, I didn't realize that was their preference and not an actual medical issue in my case. 

Also I want to minimize any meds for anxiety during a cesarean. I didn't really get a heads up that they were pushing some stuff that was going to knock me on my ass. This time I want a heads up that they think it may be advisable and give me more of a chance to chill out or at least consent first. 

Other than that I don't want to see it or touch anything and give baby all the science and medicine current guidelines dictate. 

My regular doc will be gone by D-day so it will be a bit touch and go with a new provider but at the same time we will be leaving this hospital a couple months after birth so I am okay with speaking up a bit more and burning some bridges if need be. It felt like I was walking a line last time since I delivered where my husband worked and he regularly had work interactions with a lot of the staff including my doc. 

nda_roxybabe

Thank you guys!

Should I request intermittent monitoring if I can? I*think* I'd like the availability to walk around while I labor.

If it's a boy we're having him circumcised. Do they normally take the baby out of the room for that?

jayandaplus

@mdlorenz Remind me what you do in the hospital? Your hospital sounds great. And, honestly, I think the hospital I have to deliver at in case something goes wrong follows all of the steps you outlined. But, it's just my personality to have everything stated so I don't feel surprised or without voicing an opinion.

@WombThereItIs I'm sure delivering where DH worked was stressful! I think wanting to follow hospital and provider protocol will make your delivery smooth, because at the end of the day this is what they do all day.

Yiggle09

@nda_roxybabe IM stands for intra muscular could be a shot in your thigh butt arm but I received the pit or oxytocin via my iv after birth. 

WombThereItIs

@nda_roxybabe baby does leave the room for a circ. It is quick though.

mdlorenz

@nda_roxybabe You can usually still walk around regardless of whether the monitors are on (depending on whether your birth place has wireless monitors, that is). Having the option to be upright and mobile is important even if you're a person who wants an epidural ASAP because protocol might keep you from getting one until you are in active labor (at least 5-6 cm with regular, frequent contractions depending on who you ask). That being said, I'd definitely ask for intermittent if you have a choice. 

P.S. "IM" means intramuscular (a shot) and Pitocin is synthetic oxytocin - the hormone that causes lovey feelings ... and uterine contractions. Were there specific details otherwise about that point that need clarification?

@jayandaplus I totally did the same (stating all my preferences explicitly) and think it's best to lay it out for your provider. I practice Family Medicine with OB so easier to be crunchy than an OB/Gyn. 

jayandaplus

@nda_roxybabe It's all about preference, but I personally want intermittent monitoring. In addition to being able to move around, I feel constant monitoring is too medicalized for me, and would add stress. I don't want that constant feedback, it'll freak me out after a while I'm sure.

Yes, baby does leave the room for a circumcision. But they don't typically do that right away. And it's very quick in my opinion, from what I've seen in hospitals.

Yiggle09

I've been hooked up to the contraction monitor and the baby hb monitor since 7 30 today it's bringing back lovely memories of ds birth
Eta that they said in labor the use wireless ones!

nda_roxybabe

Awesome, I'll request it then. @MDlorenz,  your answer to @hp_momma was perfect. I'm going to ask what their normal protocol is.
It might sound bad, but I'm glad they take baby boy out for that as I do not want to witness.
I figure it's best to have my thoughts/ preferences laid out as well. I have my preference listed and then I have the "unless Dr. feels otherwise".

NotAPlaya-JustCrushAlot

I didn't have much of a birth plan the first time and likely won't this time.  I did have a few things I mentioned to DH to serve as my advocate in case they came up such as: avoid episiotomy, skin to skin immediately, and in the case of a baby emergency during birth, DH should go with baby. Other things I'd note:

1.  I'm pretty sure I got pit in my IV.  I'd already been on it that day for my induction.
2.  Once I got the pit, they started constant monitoring, which I think I prefer.  At one point, DD's heart rate dropped quickly and there was a bit of an emergency to get it back.  We might not have noticed as quickly if we monitored only intermittently.  Maybe constant monitoring is required once you are on pit?
3.  DD also had meconium in her fluid, which we noticed when my waters were ruptured.  It was nice to have that heads up and get the NICU team ready.  
4.  As a FTM, I preferred the bath in the hospital.  It gave me some time to get use to my baby without the terrifying experience of bathing her shortly after going home.  It can be a bit nerve-wracking. Now that I know they are not as breakable as they seem, maybe I'd choose differently.  But DD hated bathes at first so maybe i'll still let the nurse take that one.

So basically, if I'd had a birth plan, most of it would have gone out the window.  I think it's a good idea to have an outline of your & DH's preferences.  And I know all of us know to be flexible. I just wanted to share the flipside of some of these.

nda_roxybabe

Can I request they hold off on the bath for a bit?
@NotAPlaya-JustCrushAlot So it sounds like you'd recommend have your water broken, yea? I wasn't sure what's "best" there.

hp_momma

My birth plan alligns very closely with @WombThereItIs and @NotAPlaya-JustCrushAlot But I'm pretty much a "go with the flow" kind of patient. I feel educated enough (I do my own research) to make the decisions or follow along with my doctors suggestions. 

The only thing I am pretty adamant on is an epidural as soon as possible (which I've always been told would not be until I was in active labor). My labors progress very quickly and both times have almost been too close to the end to get the epidural. 

nda_roxybabe

I haven't made an epidural decision and I'm not planning on (making the decision). I'm just going to....see how it goes? I'm cool either way and imagine I'll probably get one because hey!

NotAPlaya-JustCrushAlot

@nda_roxybabe  I wouldn't say I "recommend" it.  But I'd consult with the doctor or nurse at the time to see why it's being offered.  Mine was broken because I was very dilated, had an epidural, and they thought it'd speed things along.  It did and I didn't feel any of the usual pain that comes with it (because epi).  I don't think I'd do it if I didn't have the epidural yet, but, again, I'd want to know why they wanted to do it and if that made sense, I would. So basically, more of my "go with the flow" attitude. (Not to be confused with a calmness, because I'm not calm )

mamatowildones

My birth plan with my first was whatever they threw at me during my induction. I didn't know any different and wouldn't have felt comfortable enough to ask for different things. My second I waited until 6cm to get my epi because I felt like I wanted to try to go without As long as I could stand it. By 6 I was ready. I opted out of potocin with him when they offered it at 7cm since I was stuck there for so long. Sugar worked, but also made me puke with every push. 
This time I may try to go the full labor without meds but if I can't handle it, bring on the epi. Delaying bath this time which also happens to be hospital policy anyways. Immediate skin to skin and golden hour. 

KMD1106

Has anyone here had a VBAC? What questions/considerations are unique to that? 

hp_momma

@nda_roxybabe For the circumcision, your DH should be able to go with (if he wants) or if your more comfortable (and your insurance covers it) you can have your pediatrician do it in the office. I need to ask my OB about circumcision at our hospital, I'm assuming it's done in the hospital and our pediatricians don't do it, but it's all in the same building anyways. 

bubsalicious

My hospital gave me a great template for this and they specify the degree to which you want to go for something. Like if you want an epidural, there are 4 choices: Absolutely not, I'd prefer not but will be open to it if need be, I'd like one but want to hold off as long as possible, Give it to me now. Same with feeding: bottle only, breastfeeding only, breastfeeding but supplement if needed. The sad thing is I guess they had to recently add in "supplement if needed" because they were getting too pushy and refusing to give formula to people who were really struggling to breastfeed when they checked the breastfeed only box? Another thing they have on there are methods you want to use during labor like water, essential oils, walking, the mirror....

bacorrea

hp_momma said:

@nda_roxybabe For the circumcision, your DH should be able to go with (if he wants) or if your more comfortable (and your insurance covers it) you can have your pediatrician do it in the office. I need to ask my OB about circumcision at our hospital, I'm assuming it's done in the hospital and our pediatricians don't do it, but it's all in the same building anyways. 

I think Tricare only covers circ if you do it in the hospital. Double check though I could have misread. @hp_momma

mdlorenz

@nda_roxybabe AROM is not necessarily a helpful or safe intervention in all cases. If baby's head is not deep in the pelvis and pressed up tight against the cervix, there's a risk of the cord or a hand coming down ahead of the head when the sac is ruptured. 

WombThereItIs

bacorrea said:

hp_momma said:

@nda_roxybabe For the circumcision, your DH should be able to go with (if he wants) or if your more comfortable (and your insurance covers it) you can have your pediatrician do it in the office. I need to ask my OB about circumcision at our hospital, I'm assuming it's done in the hospital and our pediatricians don't do it, but it's all in the same building anyways. 

I think Tricare only covers circ if you do it in the hospital. Double check though I could have misread. @hp_momma

I don't think thats true. My husband does them in clinic but not everyone does. Check with your provider. 

hp_momma

@bacorrea I know when we had DD1 and DD2 (before we knew they were girls) and we had Standard and Prime Remote, our civilian pediatrician could do them in office and it was covered by Tricare. 
@WombThereItIs I'm assuming it's up to the hospital/OB? If I choose to do it at the hospital is it done by urology or pediatrician? This is definitely on my list to ask my OB what the policy is! 

I just found out my pediatrician is retiring, ughhh. Now I have to figure out who we are assigned to at the clinic (we are seen at the AF side for pediatrics) or if I want to get switched over to the Army/main hospital pediatrician clinic... Nothing like adding more to my to do list! 

pshaortao

Questions regarding birth plan. I plan to ask about this at my next appointment as well. I was given a template by Kaiser during my first pregnancy so it was nice to have a template with check boxes and they kept a copy on file so they had it when I came to L&D and they pretty much honored it.

For places that don't give you a template, how does one go about making a birth plan and making sure your needs are met? Do you just give it to the OB in advance or give it to the hospital the day you go into labor or what? Mine is a very short list since I'm very go with the flow, however I care more about the immediate stuff following the birth.

vrj0522

With DS I had a pretty intricate birth plan that we created as an activity during our birthing class. I took it to my provider and we discussed what was hospital/practice standard and what were some of the things that they needed to know from me.

What I included:
1)Delayed cord clamping
2)When you want the epidural (or whatever meds your are using or if you don't include that). My plan asked that they wouldn't offer pain meds unless I asked for them. With DS, I was able to go until I was 8 cm dilated but with DD I had to have it at about 5 cm because labor was moving faster. The big issue with doing it too soon is that it could stall progress.
3)I asked for intermittent monitoring so I could walk around before the epidural was given
4)I asked for no episiotomy if possible. With DS, I had one but only after 1.5 hrs of pushing and because I was starting to weaken. 
5)DH did not want to cut the cord
6)Immediate skin to skin
7)Opting in for a bath, vitamin k and eye ointment and all immunizations according to normal procedures
8)No pacifiers or artificial nipples (this was with DS, we changed our tune with DD)
9)In case of an emergency for baby or even for both of us, DH goes with the baby
10)We wanted DS circumcised (this actually didn't happen until the day we went home, to allow the baby to recover from the birth).
11) If c-section became necessary, I asked to be allowed to breastfeed the baby immediately after the birth if possible.

As far as circumcision being covered, our current provider only covers it if it's done during the hospital stay as part of the birthing procedures. Otherwise it's out of pocket if we choose to have it done after the fact. 

WombThereItIs

@hp_momma ask your OB provider because I think it varies by MTF. Here I think pediatrics does it in the hospital although my doc is family med and he did my son's. At our last hospital though I don't think it was always peds because the family docs that rotated on L&D and mother baby would also do them. 

bacorrea

Yes sorry I was wrong. Has to be done in 30 days.

https://tricare.mil/CoveredServices/IsItCovered/CircumcisionNewborn

Kipperoo

hp_momma said:

My birth plan alligns very closely with @WombThereItIs and @NotAPlaya-JustCrushAlot But I'm pretty much a "go with the flow" kind of patient. I feel educated enough (I do my own research) to make the decisions or follow along with my doctors suggestions. 

The only thing I am pretty adamant on is an epidural as soon as possible (which I've always been told would not be until I was in active labor). My labors progress very quickly and both times have almost been too close to the end to get the epidural. 

Samesies...I'm a go with the flow patient and I totally trust my doctors to guide me and give me the information that I need to make my own decisions, if necessary. And the epidural will happen ASAP...with my first, the pain came on so quickly and strongly that I still have nightmares about it. 

nda_roxybabe

@vrj0522 Thats looks pretty much exactly what I'd like. 

erinh2005

Another monitoring tidbit I don't think anyone mentioned is to consider that all the pressure and discomfort is basically happening around your midsection and the first thing they do is strap two wide belts tightly around that area and they don't come off until delivery. So although I opted for the mobile one where I wasn't confined to the bed my discomfort was still greatly increased by having the belts on. This time I will opt for intermittent monitoring if my OB agrees that I'm a good candidate since I believe it's done by hand in that case? I also didn't opt for pain management aside from breathing exercises and apparently squeezing the hell out of the bed rails for 5 hours. 

bacorrea

I had to be induced due to pre-e with DD and was basically hooked up the whole time because of the blood pressure cuff.

I am just super go with the flow. I got the cervadil, Foley bulb, and pit before getting the epi last time. I am hoping for no epi this time around, but who knows.

nda_roxybabe

IV/ Catheter: What's standard for these?

achays11

Last time I had a "go with the flow" plan. It worked pretty well at the time, but ending up with an unplanned c-section made me ask questions like "can I get immediate skin-to-skin?" if I end up with another c-section. MH and I also had discussed that he would stay with baby in case of emergency and 

**possible TW** 
We discussed that if for some reason it came down to saving one of us, that he would choose the baby. This was a very hard conversation for him and he was very against it in the beginning. I made sure that my mom was also aware of my wishes. 
**end TW**

Other than that, I'm pretty go with the flow this time and still haven't decided on CD or VBAC. 

ETA: missing words. 

KMD1106

*tw*

@achays11, that's such a tough conversation. DH and I should probably have it too. Although I don't know the answer. With DD I would have said the same as you, but now I don't know if I could be ok with leaving her without a mother. Gosh...this has me thinking. 

NotAPlaya-JustCrushAlot

I can't find a way to word this without sounding like I'm critical.  So please just know that I'm not trying to be critical or snarky.

In what situation would DH need to make a decision between me and his child? In my head, I'm only coming up with Grey's Anatomy type of scenarios.  I assume if there was such a scenario, the medical team would be able to provide some sort of analysis, advice, or prognosis to DH and it wouldn't come down to a 50/50 thing.  I fully expect that I'm wrong here.  I'm just trying to think about how this might occur.