Birth plan question...

marrymemylove

OK I'm posting here because a) some of you know me better and b) you're a bit saner than the pre-first-child type boards :-)

I am normally one of those who thinks birth plans are either a waste of time or vanity. Generally I think if your requests are that complicated you should reassess your priorities.

BUT...here I am writing one...and for a 2nd child no less! So why?

Well. Because I had a bit of a bleeding scare last week and went to the hospital to get checked out (I was 37W 4d at the time, took the bag just in case). All turned out ok, they did the NST and said the bleeding was probably the beginning of something sometime but who knew when. Fair enough.

 BUT the conversation with the midwife really disturbed me. And now I'm stressed about how hard it is going to be to get what I want even though its so simple.

So I ended up writing the birth plan below. Some of it can probably be cut, as really it should happen anyway...but who knows?

 So the background is that last time my waters broke and I didn't feel any contractions at all but the OB told me I was contracting nicely on the NST and told me to walk round the corner to the hospital and get admitted. No problem there except DH had to go home for the labour bag, wish he'd been with me. 

I got admitted. I explained that I wanted an epidural in asap and that on my notes they would find that I needed antibiotics prior so could they please get that started. The nurse said "don't be silly you aren't even in pain yet, you shouldn't even be here" (this was admission on the OB's rec remember!). I tried to gently push the point but she simply walked out and disappeared for quite a while. Eventually she came back and I pushed the point. She dragged her feet at every step but eventually put the IV in...failed to get it which I don't blame her for but then continued to try 6 more times despite clearly having lost her nerve. Well that's the charitable interpretation, maybe she was just being mean. Eventually I insisted she let someone else try and an anesthesiology registrar got it first go. Then the pain started in earnest. This is after 2+ hours of faffing around...if she had done what I asked in the first place I'd have had the epidural placed by that point!

As I was 3cm when admitted she refused to check dilation for a while but after 30 mins or so of my screaming in constant pain for the epidural she checked and I was 8cm already. At that point the anesthesiology walked in and I love that man to this day. 10 mins later I was in bliss. And DS was born several hours later quite painlessly despite the silly midwife trying to turn down the epidural until I snapped at her.

OK...fast forwad to this pregnancy - given that my first was really quite quick, and that I didn't feel anything for ages until it was almost too late for an epidural, I DEFINITELY want the epi asap on admission this time.

So when discussing this with the midwife during the NST last week...

I said "so do you have policies that would normally limit when you can administer an epidural, just so I know?" 

and she says "why would you want one of those?".

And I replied "Well last time I didn't feel anything until I was almost in transition, so I'd like to know that I can get one asap".

She replied, "well so what? Then you get a baby without an epidural...even better!".

I replied "actually no, I'd like the epidural thanks."

She replied "I hope I'm not on your shift!"

I said under my breath "me too" but I don't think she heard me.

My OB said this particular midwife is always like that and just to yell until I get one. But it shouldn't be like that and I shouldn't have to be stressed about a simple request being complied with. So I wonder if its worth writing a birth plan. At least they can't claim confusion then.

Here it is - it is less than a page. WDYT?

People present:

XXX XXX, husband

Clinical staff as necessary
Pain relief
Epidural asap on admission

I want to order the epidural immediately and get the antibioticsstarted to minimize delays.
Transfer to the Park Hyatt List
I want to be put on the list asap requesting transfer to the (insert hotel they have an arrangement with) postpartum, unless this is contraindicated at the time.

Monitoring
Do all the monitoring you think necessary or appropriate. I find it reassuringto know the baby is doing well.

Interventions
I would like to avoid a caesarian on the advice of my [specialist], XXXX
I would particularly like to avoid forceps if possible and would rather labourdown if this is possible.

Other than that I am happy to have whatever intervention isadvised by my obstetrician in the circumstances.

I would like to avoid general anaesthesia if possible but ifnecessary please note I have had 30+ previously.
Delivery positions
Whatever is appropriate at the time.
Feeding
I would like to breastfeed as soon as possible after delivery, health statuspermitting.

Postpartum/neonatal care

I would like to stay with my husband and baby if at allpossible. Should separation be necessary I would like my husband to be able tostay with the baby if she or I need separate care.

Vaccinations
I would like the baby to receive both vitamin K and Hep B vaccination. I wouldlike to be informed when this is to be done and be present. If any othertreatment is advised I would like to be consulted prior unless there is anemergency.

veloelle

Most of what you have is part of their hospital policy. I'd stick with your epi issue. Nothing else. And WTF hospital do you get discharged to a hotel?

marrymemylove

LOL very common here. Basically funding beds is expensive, and rather than throw you out after 2 days like they do in the States (though given the nurses I met there when DS was born I was glad to get out)...they transfer some mums to a hotel they have a deal with for the next 2-3 days. So you still get the 4-5 day stay you normally would in Australia, but only 1-2 days of it is in a hospital setting (depending on when the bub is born).

Not usually available to first time mothers or c section mums though or anyone with complications (mum or baby).

At the hotel they have a dedicated floor with 5-6 rooms and a nurses station with a couple of nurses and a visiting LC but not as intensive as at the hospital. Private health insurance treats it the same as a hospital bed and you pay the same daily excess but no more.

It should be good, but I haven't tried it yet. Personally the idea of not having to clean up, getting meals delivered and having a nurse around the place but not in my face AND a comfy bed make it very appealing.  

ridesbuttons

Good luck with your birth plan.  I hope it works out for you.

Just wanted to add that I hoped and planned to go natural with my second (excellent experience with my first and did have a late epi as well).  As it turned out, my labour was sooo fast the second time around, I wouldn't have been able to get an epi even if I wanted one.

So, just consider that might happen.  There was 15 minutes of pure hell, I won't lie to you, but overall it was totally ok.

Good luck either way!  And very nice about the hotel aspect!

MamaPosh

Lucky you, wish I could relax at the Hyatt after!  Birth plan sounds a lot like mine, apparently they need a blueprint at the hospital so why not spell it out for 'em! Food for thought:  what if you get the epidural TOO early and by the time the extreme pain comes, epi wears off, and is too late for another?  Good Luck!

marrymemylove

MamaPosh sorry but there's no such thing as an epi "wearing off". The whole point is you can have it for as long as the labour takes. As long as they keep that bag full it will keep flowing. If it appears to stop working that means either a) the catheter has slipped and needs to be re-done, or b) the biotch midwife just turned it down on you!

Spinal anesthesia for c sections is a 1-off injection in a slightly different place, and that DOES wear off.

Yes I'm aware nature may conspire against me. I don't need an uppity midwife to be in on it. If nature is the reason I don't get an epidural I'll wear that. If SHE is the reason she'll be wearing a black eye methinks. And if a labouring woman hasn't got a defence who does? 

4Speedy

I had a fairly short first labor and I was 3 cm dilated with #2 at my 36 week appmt.  I got to the hospital about 2 hours after the very first hint that I was in labor and I was already at 8cm when I was checked.  They called for the epi before I left triage and the anestheologist walked through the door to my room at about the same time I rolled in (and they were running me from triage to the laboring suite).  I was strep B + with DC #1 so I automatically got the antibiotics with #2.  I got the IV placed in about a minute and a half and the epi immediately following--I would bet it was less than 15 minutes after I walked through the front door of the hospital.  The reason they jumped on it so quickly was because of my history of quick labors--my OB was hoping the epi would actually slow down my labor or at least make it tolerable so that I could get at least one bag of antibiotics into me before my son was delivered.

I would think you might be able to use this to persuade your OB and or the nurses to order the epi quickly.  With your history of quick labors and being strep b+, you would be in the same situation as me.

EMT

Can you ask for someone else if she is there? I hope you get your epi in time! That's not cool...noone should be pushed into a non-medicated birth if that is not what they want.

championmama

I couldn't read all of that - but congrats!  I didn't know you were expecting.  Sounds like we're due about the same time!  good luck!