Birth plans!

knottieamusements

Bumping this since some of us are just getting around to actually doing it.  

purplegoldfish2

@tropical1982 What happens with ABO incompatibility? I have O and the hospital never checked my boys’ blood types. They said there was no reason to due to my blood type, but a friend with O mentioned an issue with her daughter because she was O and the baby was something else.  Is it something that is apparent immediately or can it show up later?

I didn’t have a birth plan last time because it was a planned c section and I didn’t realize there would be anything for me to put in it.  This time I’m hoping for a VBAC, so I will probably do one, but I am going to talk to the Dr and hospital before I start it.

jennybean80

@purplegoldfish2 ABO incompatibility is more likely in moms with O blood than A or B. It happens when the O mom naturally makes anti-A or anti-B antibodies (specifically IgG which can pass through the placenta). Those antibodies can attack baby’s red blood cells and cause anemia and jaundice in baby. 

purplegoldfish2

Thanks @jennybean80! Is it something that would be noticed right away or can it happen later?

jennybean80

@purplegoldfish2 it’s usually noticed within the first 3 days of life (that tends to be when jaundice peaks), but it can result in long term anemia that can last up to 12 weeks, and should NOT be treated with iron. 
Often they test a sample of the cord blood to look for antigens without you even realizing it. So they may have done that at delivery (we Type all our babies cord blood at delivery). 

mytrueloves

ODD had ABO incompatibility. They told me when they brought her back from the NICU (she went for 1 hour after birth for observation). They kept her for 48 hours for observation but she was totally fine. I'm O+

Any time I tell a health care provider that she had ABO incompatibility, they look at me like I'm making shit up. I even had a nurse at my OB's office ask me how that's possible. It drives me crazy.

chyvie

So if we have O blood type should the test be preformed? Can they test if mother's blood has the anti-A or anti-B antibodies (specifically IgG) before the baby comes to prepare for it? 
I'm O+ and DH is A-

eireyes

@mytrueloves my DD ended up with ABO incompatability related jaundice. I'm guessing DS's birth triggered my antibodies, and DD had to deal with them; she was super jaundiced. I fully expect this LO to have the same issue, so as much as I'd like to bail on the hospital ASAP, I know that in reality that probably won't be possible for us.

I can't believe the nurses question you on it - that's nuts!

tropical1982

Both my kids they tested within 24 hours and then we had they were both jaundiced.  My first had to be put under bili lights for a good 36-48 hours.  That was heartbreaking.  I know there are worse things but not being able to hold your child for more than 20-30 minute feedings is tough.  My second was a plump one (almost 10lbs) and he was able to get rid of the jaundice just through poop/pee and sun exposure. 

When we took them home they both had to go get retested for jaundice 24 hours after being home until the jaundice was gone.  For this reason alone, we will not be doing delayed cord clamping.  I know our history with ABO and I'd rather not deal with it if I don't have to.  Like @mytrueloves stated - I've had people totally dismiss it and look at me crazy, especially since its not as discussed as RH, but it's real and a PITA.

jennybean80

@chyvie testing mom typically isn’t done since it’s not a good indicator of which babies will have problems. I’d just confirm with your OB that they will do a Coomb’s test on baby’s cord blood. It’s a better identifier of problems. 

koala1107

I’m likely having a repeat c-section, VBAC doesn’t seem to be in our cards unless the stars align. I just want to provide some encouragement to those who may end up with csections though. My first was planned (she was breech from the start and I had a septate uterus so no chance of her flipping) so I had a lot of time to come to terms with it. My doctor was very accommodating and I still had a very good birthing experience. Here are some things I requested that really helped me not feel like I was missing out:
-my own music playing in the OR. We brought in a Bluetooth speaker that my husband set up near my head so baby was brought into the world to some jack Johnson 
-my husband was able to photograph the whole thing after the initial incision so I got to see the moment she was pulled out. I may request a clear drape this time.
-immediate skin to skin. They handed her to my husband first who then handed her to me and we had skin to skin while they stitched me up. 
-breastfeeding as soon as I was wheeled into recovery
-I was able to have the epidural and catheter removed within a few hours. Was up and walking by that evening. IV removed the next morning. Then went home the next day. Standard is 3 nights for a csection, but my doctor knew I was eager to get out and home so sped things along as much as possible for me. 

It might not seem like much, but getting to choose some things like that made a big difference in regaining perspective for me and not mourning the birth I lost. 

mytrueloves

I didn't even know delayed cord clamping could contribute to that problem! I'm glad I heard about it with enough time to research.

jennybean80

@mytrueloves it isn’t so much that delayed cord clamping worsens ABO issues, but it is associated with higher rates of jaundice in term infants, so you can be setting baby up for jaundice from two separate sources. 

mytrueloves

@jennybean80 makes sense! Thanks for clarifying.

mytrueloves

So this is the final updated version of my birth plan. Quite a few things were changed now and I'll give some of my reasoning. 
Here's the birth plan. Warning, it's in spoiler because it's huge lol

Since my birth plan is more for my partner than anyone else, I decided to remove everything that I don't need his help advocating for for me or that wasn't very important to me. I did this to keep my birth plan as clear and concise as possible.

Things that were removed because they weren't as important: 

• Keeping lights dim. (I can ask DF to turn lights on or off as needed)
• No pain medication. (He knows that I want a natural delivery and I can request pain medication as needed if I change my mind. For example, I know that if Pitocin is introduced that I'll want an epidural right away)
• No eye ointment. (I was neutral on this subject and decided I didn't want DF wasting energy or time advocating for this as if it was as important as everything else)

Other things were removed due to the policies of my delivering hospital. When I formulated my first draft, I wasn't certain which hospital I'd be delivering at so I put everything that was important on there to cover all my bases. 

What was changed due to policy:

• Immediate skin-to-skin. (This is already the policy of the hospital I'm delivering at. The nurse tells me that if I'm unable to do skin-to-skin, they'll have DF do it as per their policy)
• Delay newborn procedures. (I had this on there originally because I was concerned that doing the eye ointment / hep b / vitamin k immediately would delay skin-to-skin and breastfeeding. However, at my hospital they do all of that while baby is laying on mom / dad after delivery)
• Breastfeeding exclusively. (Hospital is pro-exclusive breastfeeding)
• Consult before food or meds. (Originally placed on my birth plan to prevent baby receiving formula but hospital is pro-exclusive breastfeeding)

Things that were changed for other reasons and why:

• Delay cord clamping. (See discussion above re: ABO incompatibility)
• No episiotomy. (I realized this was more of a wish than something I want to actively advocate for. While I want to avoid an episiotomy as much as possible, I realize that it might actually be necessary)
• Limit visitors. (The only person who knows where we're delivering is my sister who is my babysitter for ODD during the birth so anyone who wants to visit will have to ask where we are and we can limit visitors that way)