Birth Plans

catem07 · February 2017

It seems like the only reason not to do it is if you are saving or donating cord blood.

pammasu0909 · February 2017

@mrsstuessy I had GD with DD and they do heel pricks to check the baby's glucose before they eat the first few hours after being born (at least in my hospital).

rachelgreene-2 · February 2017

@schef070911 my hospital does delayed cord clamping for a minute. You can request them to delay it even further until the cord collapses and the placenta stops pulsating. My midwife said it's only an additional minute.

Magheeta · February 2017

I'm enjoying reading through these. I was very flexible the first time around, so I didn't write down a formal plan. I knew things could change and didn't want to get my heart set on something only to have it change on me. However, this time around, I am more comfortable asking to have things done that seem reasonable to me based off my previous experience. I will deliver in the same hospital, so assuming they're abiding by the same practices, I know what my limits on requests are.

One thing I will add is to limit our family visitors to 15 minute increments while I'm in labor, assuming I'm comfortable allowing them in in the first place. Our families will be traveling from out of town, so they don't really have anything to do except wait. We ended up having the nurse shoo them out last time because they were just lingering and starting to make me stress out, so it was something that stuck out in my mind this time around.

mrsstuessy · February 2017

@pammasu0909 Thanks! Good to know. I should definitely know about that as a birth professional. I am definitely going to do more research. Babies are getting such a minuscule amount of food that I wouldn't have guessed they would have to test baby. But, I'm sure they have reasons and I am off to read about it now.

MWoodside · February 2017

We delay cord clamping until the cord stops pulsing. It was definitely at least five or more min both times. You really want all that blood to circulate back into baby unless you are saving the cord blood for banking.

yes, I did skin to skin both times immediately with the cord still attached. Unless the cord was abnormally short this shouldn't be an issue.

ebloom3 · February 2017

My plan is have a baby. That's it. Preferably in a hospital room. Preferably vaginally. After birth baby will be breastfed. That's it.

mrsstuessy · February 2017

@schef070911 I think the other ladies answered this for you. But, most hospitals are moving towards delayed clamping. But, that might only mean 30 seconds to some doctors/midwives. Most of the blood will get back to baby in the first 30-60 seconds, but it typically takes longer than that for the cord to completely collapse. I have seen a cord pulse for 15 minutes before. It was pretty cool. So, I will be asking my midwife to wait at least 5 minutes if possible. Most cords are long enough that you can have baby on your chest while still attached to the cord. Sometimes they might only reach your belly, or barely even that. (fun fact: DD1's cord was MEGA long. Like, all the doctors and nurses were totally astounded) Baby will be fine and taken care of for a few minutes if that is the case.

MrsBakes · February 2017

I know this sounds dumb, but my only plan is to come out of that hospital with a healthy baby. I didn't have a plan with #1 and I'm glad I just said I'd simply roll with the flow. I had wishes such as trying to progress on my own, avoid epidural etc. but complications came about so I had to be helped along with pitocin and I also needed an epidural because my body was so stressed out from constant contractions that I wouldn't progress even with pitocin.
So this time around I know there is no such thing as a plan really, but rather wishes and goals. My one thing I did ask for first time around and will do again this time is NO episiotomy. I did push for over 3 hours but I had less than a 1st degree tear, It was totally superficial and i'm glad I didn't let them cut me. Everything else, we'll just see how it goes.

After delivery, i'm glad my clinic supports and lets you keep the cord intact until it stops pulsating. Then they give you the baby for skin to skin and we try to nurse within the first hour. Then they do their usual bath, vit K shot, eye stuff etc.

BecNJake · February 2017

I had a traumatic birth experience that ended in a C-section with DS 1. This go around we are going to a birthing center, so I am not too concerned about a birth plan. I will have one made up in case a complication arises and we have to go to the hospital. The hospital I go to did things that made me so mad last time. Here are a few things I will have on my birth/hospital stay list:

- no episiotomy
- no internal checks (or very minimal)
- intermittent monitoring
- no shots or eye cream
- baby does not leave me or DH at any time
- absolutely nobody unnecessary in my labor or recovery room (we had nurses and hospital reps coming to our room a few times a day to "rate service" and promote their lactation clinic last time. It was such an unnecessary distraction!)
- do not push formula. I can and will breastfeed. If I need it, I will have my own preferred brand.
- do not bathe my baby.
-no students in my room

in case of C-section:
- as previously explained I will also follow protocol for a gentle cesarean
-no unnecessary conversation in the OR. My baby and I will be the focus. If you talk, talk about us. (2 doctors who did my c-section with DS 1 were talking like they were out to coffee- I was so pissed. This was the most important moment of my life and they were talking about their vacation plans).

I am a little crunchy and extremely picky, but this list stems from a traumatic birth and terrible 5 day stay at our hospital with the birth of our first in 2015.

ebloom3 · February 2017

Just a heads up for the episiotomy-- with DD I was in danger of tearing clitoris. The OB talked me through my options-- she doesn't routinely do episiotomies, but because of the way the baby was presenting it was either an episiotomy or my clitoris would have torn. She said, in her experience, when the clitoris tears it is really hard to repair, so the episiotomy would resolve a potentially torn clitoris. I didn't even think about tearing in that direction, so it is something to think about and consider when it comes to a birth plan.

MWoodside · February 2017

@ebloom3, so did you have an upward episiotomy?

pammasu0909 · February 2017

@BecNJake I'm curious - why no students? I deliver in a "learning hospital" so there's always students around, even in my regular prenatal appointments. They always ask before bringing one in, but I've never been bothered because they usually just observe in a corner.

Omie_Wise · February 2017

We are doing our birth plan with our doula after our birth classes end in March. Some of what we want our hospital already does (delayed cord clamping, immediate skin to skin, no bath, etc.) because they are baby friendly, which is a relief. We are also planning on writing a plan for a c-section. Has anyone asked their provider about seeding post c-section?

mrsstuessy · February 2017

@Omie_Wise I did actually ask my midwife about it. She was not really the best person to ask, because if I did end up needing a c-section I would obviously have an OB do that. She said in my hospital it depends on the OB, but most are willing to do it for a planned c-section. I would need to talk to them about that beforehand. She said during an emergency c-section it is less likely to happen, but if there is time I can talk to the OB before hand and ask about it and many will give it a try. So, that was encouraging. I think if a c-section happens I will try and have that conversation.

BecNJake · February 2017

@pammasu0909 if the student would have stood in the corner to observe at my hospital I may not have even noticed them. Unfortunately, without realizing it, I agreed to let them do internal checks before my doctor. That meant every time I was checked to see how far I had dilated, it was by 2 pairs of hands- one rough and inexperienced. Because I would definitely deliver at the same hospital if I needed to be in a hospital, that would be a hard no for me this go around. My catheter hurt really bad going in and out with the student, and I ended up getting an infection likely from so many internal checks. I have always agreed to let students help with my care- in fact I think it's really important! However childbirth is an exception for me. Likely because of my bad experience, but also now that I understand the intimate nature of labor and delivery. I think the fewer the amount of bodies in the room the easier it will be for me to relax and open up. This is just based on the opposite happening during my first labor.

certainly would not be the case for everyone or even in a different hospital!

Magheeta · February 2017

Talking about delayed cord clamping - I've been reading up on the recent recommendations in the ACOG from last month (https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth) and am interested in presenting this to my OB. However, the mention of an increase in jaundice has me concerned because of the Rh incompatibility factor. The articles I've found so far only mention a slight increase in term births, and as long as you have access to resources in the hospital to treat jaundice (lights/bili blanket) it isn't a big deal. Well, with DS, his bilirubin levels were so high after birth (with immediate cord clamping), he was under the light and on the blanket our whole stay. We almost didn't get to take him home the day I was discharged because he was so bad.

I had planned on asking my OB about this at my appointment yesterday, but had to reschedule since DS was sick, so I won't be able to ask about it until Monday, but have any of y'all experienced something similar? Or do you guys know of any resources that could help me understand it all a little better? How would you guys feel if you were in my situation?

catem07 · February 2017

I took a L&D class last night and was relieved to discover that many of the things I thought weren't standard practice have become so, at least in my city (delayed cord clamping, skin-to-skin and feeding before weighing and shots, etc.).

catem07 · February 2017

@Magheeta I don't know that much about this, but it seems to me like it's a balance between the long-term benefits of delayed cord clamping and the long-term harm of jaundice. Is there long-term harm in jaundice, provided your hospital has the means to treat it? I don't know the answer to that question. Also, what's the likelihood that because your first child had severe jaundice your second will?

HGRich · February 2017

@Magheeta I agree with @catem07--I don't know what the chances are of a little one with jaundice after having had one already, but that may be a factor to at least discuss with your doctor. Delayed cord clamping is standard at my birthing center so I'm fairly sure they have everything in place to help with jaundice anyway. But if your DS being jaundiced has no effect on whether this LO will be too, then I guess it's all up to you and whether you want to take a shot with the same percentage of all other babies with delayed cord clamping. At least that's how I would feel, in your situation. But again, if it is likely this one will be jaundiced too, then you'll have to ask your doctor about the benefits and risks of both sides.

Magheeta · February 2017

@catem07 & @HGRich I could be totally off in thinking this one will have an issue with jaundice this time, too. I think DS issue was due to our blood type incompatibility (he's O+ and I'm O-) so I'm a little worried it could be the same thing this time around, so I'll definitely ask what the odds are that it happens again.

mrsstuessy · February 2017

@Magheeta I am also rh incompatible with my child. I am A- and DD1 is O+(like her daddy). Was your immune system sensitized with your son? The only way that the rh negative becomes a factor is if he blood was somehow passed into your blood system, which is pretty abnormal. I know they tested my blood with this pregnancy to see if I had built up an immune response to positive blood. I have not, which means DD's blood never crossed into mine, nor has this new baby's blood. I would definitely ask your doctor if they have done that test. If there was never a crossing of blood his jaundice would have nothing to do with that and was just random or caused by something else and there is a good chance this baby will be fine. I plan on doing delayed clamping with this baby.

MWoodside · February 2017

We did delayed cord claiming until pulsating stopped and both my girls had jaundice. We didn't need the bili lights but it took about a month to resolve both times and we needed several heel prick blood draws. We are still going to be doing delayed clamping this time bc of the benefits.

Magheeta · February 2017

@mrsstuessy - great question. If they did test me for it, I don't remember.

Y'all are giving me some good questions to ask! Thank you.

Omie_Wise · February 2017

@Magheeta I don't know the answer to your question but I do remember reading about this in Expecting Better by Emily Oster.

MWoodside · February 2017

Another thought, I am pretty sure that the reason my babies take a while to overcome jaundice is b/c I have a MTHFR mutation (so they do, too, since it's genetic). And it takes our bodies longer to detox everything. So they would likely have jaundice regardless of whether or not I delayed cord clamping. Plus I nurse exclusively so that is another contributing factor.

cafedisco · February 2017

@Magheeta I have never heard of a connection between jaundice and cord clamping - that's interesting and gives me something to read up on. My first had jaundice too but we were able to have a billi bed at home. It was scary at the time though and definitely interfered with breastfeeding getting a good start (although pics of glowy alien baby are pretty cute). I'll be asking my midwives about this as well.

NurseLaLa · February 2017

My first was clamped right away and had jaundice; my second was delayed clamping and didn't have much at all. I'll be delaying again. Physiological jaundice is relatively normal and one of the reasons that colostrum acts as a laxative for babies.

No student nurses. I know them all... And given my situation, the end result might not be positive, so I need the experience to be kept personal/intimate.
No suctioning if mec present unless baby needs resc.
No touching baby until I bring him or her out of me (hands off!)
Intermittent monitoring only
Pitocin only as a last resort for the induction (I'd like to try a membrane sweep, cervical ripening agents, and/or foley bulb first)
Father to announce gender
I want to get up to pee as soon as the placenta is delivered, then I can get checked for need of stitches, etc.
Skin-to-skin ASAP. Baby can be assessed while I hold him or her.
In the event of emergency surgery, please sever these tubes. I can't handle another pregnancy lol

Mama5181 · February 2017

NurseLaLa said:

My first was clamped right away and had jaundice; my second was delayed clamping and didn't have much at all. I'll be delaying again. Physiological jaundice is relatively normal and one of the reasons that colostrum acts as a laxative for babies.

No student nurses. I know them all... And given my situation, the end result might not be positive, so I need the experience to be kept personal/intimate.
No suctioning if mec present unless baby needs resc.
No touching baby until I bring him or her out of me (hands off!)
Intermittent monitoring only
Pitocin only as a last resort for the induction (I'd like to try a membrane sweep, cervical ripening agents, and/or foley bulb first)
Father to announce gender
I want to get up to pee as soon as the placenta is delivered, then I can get checked for need of stitches, etc.
Skin-to-skin ASAP. Baby can be assessed while I hold him or her.
In the event of emergency surgery, please sever these tubes. I can't handle another pregnancy lol

I have a few questions if that's ok. Why do you want to pee before stitches? And by no touching do you mean you're going to grab the baby on the final push and deliver yourself? That would be super mom awesome!!

MWoodside · February 2017

You can definitely deliver your own baby! The ob attending my second daughter's birth told me to reach down and deliver her myself. It was awesome!

cafedisco · February 2017

I caught my first baby. Plan was for DH to do it but I had to move quickly and he couldn't.

schef070911 · February 2017

cafedisco said:

I caught my first baby. Plan was for DH to do it but I had to move quickly and he couldn't.

I had no idea this was a thing!! Cool!!

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