Birth Preferences Thoughts, Questions, etc.

[sdlaura]

So our board is pretty slow and I was thinking about things that might be fun or useful to talk about

Anyone want to share any of their birth/hospital preferences, ask questions, or discuss?

I don't know much about planning or what goes on with baby after a C-section, so those of you with experience there, feel free to chime in.

Some of our preferences include delaying eye ointment (so baby can see us better right after birth), no Hep B shot in the hospital (baby gets it at their first appointment - we don't see the point in adding any stress to baby's first foray into the world when the only way the baby would have gotten Hep B at that point is if I had it), and no bath in the hospital, just rubbing off with soft cloths (we think there's value in the baby's skin absorbing the vernix).  At least, we did all this stuff with our first two kids and hope to do it all again (fully acknowledging that we can change these preference if there are extraordinary circumstances - like if baby needed a blood transfusion for some reason we would obviously get the hep B shot right away).

Anyone want to discuss your preferences/plans?

[agm04]

I like this thread idea! we have most of the same preferences as you (though i think we did hep b in the hospital and probably will again, not that i disagree with your analysis), plus:

labor/delivery:
- delayed cord clamping
- placenta given to me
- immediate skin to skin, delayed weighing/checking etc until after bonding
- minimize vaginal exams/don't tell me how dilated i am unless i ask
- fluids by mouth
- no pain meds offered
- intermittent fetal monitoring
- heplock instead of IV
- pitocin post delivery only if necessary (i think it's standard procedure in many hospitals to control bleeding)

for baby:
- no bottles of milk/water/glucose/forumla
- no pacifiers (actually undecided about this. we didn't use one for the first 10 days or so with DD but this time i probably will...)
- with mom and dad at all times, not taken away for anything unless medically necessary

in case of medically necessary c-section:
- husband and doula present at all times
- transverse incision and double layer sutures
- baby given to me immediately after birth
- to breastfeed in OR
- no post-op drugs without prior discussion

we are obnoxious, but it's actually a single page and very easy to read.

[sdlaura]

agm04, we actually have all these exact same things on our one-page of birth preferences

Only real difference is we're fine with (and I actually hope baby will take) a pacifier.

I also decline all cervical checks from my OB at appointments before labor. I don't think they indicate much and can be uncomfortable and introduce bacteria. I also love when people ask toward the end if I'm dilated at all and I can say "I have no idea."

We also have in our preferences that if baby is taken away at all, even if medically necessary, that one parent accompanies baby (like for the hearing test, or whatever).

Oh, and I specifically request a heplock on my arm instead of hand so it's less intrusive.

So we are totally on the same page!

[agm04]

sdlaura same on cervical checks at appts! i think agree about the pacifier. it ended up being a god send for us, no matter how many times i had to go replace it for her during naps/night at 4-5 months, haha.

[cateyes]

Our preferences are:

Prior to and during Labor/Delivery:
-Med free vag delivery
-Free movement and walking until actual push time
-No IVs-use of hep lock
-No continuous monitoring
-Prefer external monitors over internal
-Prefer Doppler monitoring unless otherwise indicated
-Minimal interventions (only if medically necessary for baby and mam health)
-No counting during pushing, I will push for as long as my body dictates
-Deliver in whatever position is most comfortable
-Be able to drink fluids and eat light foods during labor
-Avoid stringent time constraints
-Keep the bag of waters intact until it breaks freely on its own
-Prior to using induction, I would like to try natural methods of progressing labor
-**Prefer no use of Cytotec**
-No episiotomy even if a tear is possible

-After Birth:
-No supplemental formula or nuks
-Skipping the Eye Ointment
-Heb B shot at 1 month check up
-Yes to Vitamin K shot birth leaving hospital
-Delayed vital checks until we have had skin to skin bonding for at least 2 hours
-Delayed cord clamping

In case of C-section:
-Please provide alternate options
-Use epidural for C-section
-Jeff present during C-section and cut cord
-Skin to Skin still with mom right after delivery
-If I am unable to hold/bond with our baby immediately after the delivery, Jeff is to be able to hold and bond directly after delivery

[sdlaura]

Great list, cateyes! Out of curiosity, is your doctor/midwife OK with you not doing eye ointment at all? Ours are only comfortable delaying it.

A little bit of a funny story about the bag of waters - with my son, the on call doctor said "I'm going to break your water now" and I said "no thank you - it states in our birth preferences that we want it to break on its own" and she seriously rolled her eyes at me. About two minutes later, right before crowning, my water breaks on its own and literally shoots like a flood of water across the room, such that the nurses jumped a bit With both of my kids, it broke right before they popped out.

Also, on the drinks/snacks front - my plan with my first labor was also to eat and drink in case it was a long haul. But my body decided that it needs to completely clean itself out during labor. Like, on both ends So I wasn't able to keep anything down - even sips of water - while laboring. I'm glad I made it clear that I wanted to option, though, in case my body reacted differently or in case it was a long labor and I needed some sustenance. But I guess everything coming out first means that maybe I didn't poop on the table (not that anyone brought it up either time)!

[marshian]

cateyes - If we decline the eye ointment and/or vitamin K shot, the hospital policy is to call DCFS. You might want to check on your hospital policy just so you're aware.

[sdlaura]

Interesting, marshian. We actually declined Vitamin K for DD and nothing happened. We did get it for DS since he was being circumcised and we didn't want to risk any blood clotting issues.

[marshian]

These are great lists! We meet with our doula in a few weeks to discuss our birth plan/preferences and at my next appointment with the midwife she'll go over it as well, so my list is preliminary until I get more info on hospital policies and work through it with H and our doula.

All of this is with the huge caveat of everything going well and no risks to me or baby's life. End goal is healthy mom and baby. Optimal goal is no interventions, but I'm up for discussing them as needed at the time.

The really big thing for me is I want to be *asked* to do something, not *told* (unless it's a life-or-death issue). Like sdlaura's story: I don't want to be told they're breaking my water, ASK if I want it. H and I would much prefer to have a discussion about all the options.

For labor:
- Not come into L&D until fairly far along (doula's goal which she meets most of the time is 6-7cm dilated)
- No offering of pain medication/epidural (I have a code word to tell H if I want it)
- Minimal cervical checks
- Ability to move around (hospital does mobile monitoring so should be fine)
- Heplock if absolutely required by policy or from GBS+, otherwise no IV or heplock

Delivery:
- No episiotomy (my MW avoids at all costs)
- Push in alternate positions as my body wants (e.g. standing, squatting)
- Delayed cord clamping
- Immediate skin-to-skin

Baby Post-Delivery:
- Delayed newborn testing
- Debating on delayed eye ointment
- Delayed bath (H actually found studies on this so he brought this one up)
- No bottles
- No pacifier (we will give on our own if we want)
- Does not leave our sight unless true medical emergency

If c-section is absolutely necessary:
- Husband and doula present at all times
- Skin-to-skin in OR
- Baby stays in our sight

[marshian]

sdlaura - Yeah, we learned about it on our tour last week. H asked me if I wanted to start off on the wrong foot with DCFS since we are both skeptical about the eye ointment since there is no way at this point I'll have an STD to pass on to baby. But I think we'd rather avoid the confrontation.

[agm04]

marshian same situation here for the eye ointment.

in general, so many of my preferences dropped in importance because DD1 was breech...like i was so happy to have a TOL that the rest was secondary. i ended up with an episiotomy and 2nd degree tear, and i am sooooooooooooooooooo hopeful that i don't end up with an episiotomy this time. ugh the recovery. i know from my doula that my doctor tends to use episiotomies with breech babies - like not as a definite, but he's far more concerned about a quick pushing phase than avoiding them - but tries to avoid with normal/vertex deliveries. so, fingers crossed. i feel like there are SO few providers experienced with breech deliveries, and even fewer who are willing to take on the risk, so it was a trade i was totally willing to make (and would again). but not ideal!

[marshian]

agm04 - That makes sense about your TOL for your breech baby and having less cares about things on your plan. I asked, and apparently no doctor in my entire state will do a TOL for breech. At all. So right now I'm super thankful this babe is head-down and crossing everything it stays that way!

[agm04]

marshian yep, unfortunately that's the case almost everywhere. it's a real shame, but it's a CYA world. at DD's birth, there was a huge group of residents out there while i was laboring trying to get into the delivery room. my doctor would ask them questions, and if they got the right answer, they would get a spot in there. haha. he knew i was thrilled with the idea that residents were learning breech delivery techniques though, not at all bothered by it.

i think it's wonderful that he not only does it, but teaches it. he went to med school in costa rica, and it was just part of the deal to learn. he and i have discussed this at length: the reality is that no matter how willing or unwilling a provider/hospital is (or insurance company is to insure them), many will be in a situation where it has to happen - women come in pushing out breech babies sometimes. like either didn't have prenatal care and didn't know about positioning or that was their plan or whatever. so it's definitely safer if people know how to handle it! and it's super sad that women who are informed and want a TOL (not that women who do not seek a TOL are uninformed) are limited to home births (which are often illegal), where they are too far away from a hospital in a true emergency situation. sigh.

i guess that's probably enough of my tangential babbling...can you tell i have the feels about this?

[marshian]

agm04 - My MW has many feelings and opinions about the one study which keeps everyone from doing a TOL and seriously, that study was crap. But oh my gosh, some babies didn't do well, so that's it! Never do it! She hopes in the future it will become more commonplace. I hope so too, for all the reasons you mentioned.

[agm04]

marshian me too. unfortunately the providers who are trained/experienced are going to die off unless something changes soon, and then it'll be even harder.

[mreve]

In my province, the eye ointment is required by law.

I know there are differences between American and Canadian hospitals, but I don't know what is due to that or being in a small/rural hospital setting. Either way, my experience was that everyone there wanted as few interventions as possible and would only offer them if it was thought necessary. I had no birth plan and ended up with a med free vaginal delivery with only one cervical check, no fetal monitoring, and no iv. I did show up at the hospital fully dilated, so that probably influenced a number of factors as well. I had a second degree tear and when they asked if I wanted to hold DS while they stitched it I said no because I felt so weak and tired and was scared I would drop him. So they did the newborn tests and DH got to hold him first, and I didn't until about an hour after he was born.
DS and I never had any problems with "bonding", so I'm not too concerned about getting the baby instantly.

My labour progressed quickly last time and I'm assuming (ha, I know!) that it will be the same this time and that I will stay at home again as long as possible. I pushed for nearly two hours on my back with DS and that was by far the worst part of the whole experience, so my plan this time is to ask if I can try pushing in other positions and hope that it's better. Also that it doesn't take as long. I really think that's the only thing I will try to do differently this time.

[starsandshamrocks123]

Things I wish I had thought about beforehand last time:
Course of action if baby is sunny side up and 2+ hours of pushing with no progress means intervention is inevitable

What I learned: in an emergency situation where baby's life is at risk, they aren't going to wait on anything to take that baby out, even if it means your H isn't present!

[agm04]

starsandshamrocks123 true! and thankfully so.

[sdlaura]

mreve unfortunately we seem to love our interventions in the US, and that's why writing this stuff out is necessary. I do totally agree that showing up at the hospital as close to fully dilated as possible is the best way to cut down on interventions. It's super common here for hospitals to admit women at like 3 cm and put them on a strict timetable and administer drugs to move things along, and if they don't progress on the set timetable, c section it is.

Based on my experience and that of my friends, if you had a quick labor the first time, I'd highly recommend heading to the hospital this time as soon as you realize you're in labor

[mreve]

Apr 26, 2017 15:47:24 GMT -5 sdlaura said:

mreve unfortunately we seem to love our interventions in the US, and that's why writing this stuff out is necessary. I do totally agree that showing up at the hospital as close to fully dilated as possible is the best way to cut down on interventions. It's super common here for hospitals to admit women at like 3 cm and put them on a strict timetable and administer drugs to move things along, drugs and if they don't progress on the set timetable, c section it is.

Based on my experience and that of my friends, if you had a quick labor the first time, I'd highly recommend heading to the hospital this time as soon as you realize you're in labor

Yeah, I hear more stories of people being sent home because they aren't dilated enough, and didn't want that to be me. And your advice is the same as my mom's, whose second baby was almost born in the car (her birth story includes a police tail because my dad was driving very fast)!

[sdlaura]

starsandshamrocks123 was baby in distress from being sunny side up and that's why they had to rush and do something without your H there? Just wondering in case baby is not in a good position this time!

[marshian]

mreve - Basically what sdlaura said. The c-section rate in the US is very high, higher than it needs to be. And interestingly, so also is the maternal mortality rate. The main reason I chose a midwife over an OB was the midwives prefer to avoid interventions and are more open to trying everything. Mine won't rush you, either, though they do encourage you to labor at home as long as possible to avoid getting caught up feeling rushed at the hospital.

[starsandshamrocks123]

sdlaura the 2+ hours of pushing was getting me nowhere (and I honestly didn't have a lot more to give.. it was 24 hours after induction due to high blood pressure issues). Progression had stalled- and I think his shoulder couldn't get past my pelvis (?) They were talking about vacuum or forceps or c-section all of which I was strongly against. The other option was to manually reposition/turn him which seemed like a reasonable choice. Well, his umbilical cord prolapsed. So that was an immediate emergency as he would essentially cut off his own oxygen supply. Luckily they were able to keep his head off the cord for those 5 mins.

I don't know what I would have done differently, odds of a cord prolapse are so so small. But maybe should I have kept pushing? Should I have researched more about forceps or vacuum beforehand? Those options terrified me in the moment but perhaps it would have been safer in my situation? I I was determined to avoid a c-section, but in hindsight that might have been the safest as same exact situation for my coworkers wife and she did the unplanned c-section and all was well. I guess I just wished I had considered these possibilities beforehand and talked with DH about it. I assumed I would push and DS would make his way out!

[lulu783]

Apr 26, 2017 15:39:14 GMT -5 starsandshamrocks123 said:

Things I wish I had thought about beforehand last time:
Course of action if baby is sunny side up and 2+ hours of pushing with no progress means intervention is inevitable

What I learned: in an emergency situation where baby's life is at risk, they aren't going to wait on anything to take that baby out, even if it means your H isn't present!

This.

DD was like the perfect storm - huge and sunny side up. My hospital let me push for 6.5 hours before intervening. I was given the option of trying 2 pushes with vacuum assist before moving onto a c section, or going straight to a c section.

I got her out on my final push with the vacuum but not before I got an episiotomy (after a tear).

ETA: I realize the 6.5 hours of pushing is way outside the realm of normal. I did elect to have midwives at a pretty "earthy crunchy" hospital, so that's my only explanation as to why they let me go that long. Its also my OB's explanation. IDK. I'm on the fence if I will let that happen again if I find myself in the same situation.

[sdlaura]

Thank you starsandshamrocks123 and lulu783- and geez I hope this baby is not sunny side up - that sounds terrible! starsandshamrocks123 the emergency situation totally makes sense with the cord prolapse - I was just hoping it wasn't only the position that made for an emergency.

With a sunny side up baby, did your bodies tell you to start pushing, or did the staff tell you to start pushing? Again just interested in how things work with that position...Oh, and could the staff tell you your babies were in that position when you arrived in labor?

[starsandshamrocks123]

lulu783 omg I'm so impressed you hung in there for 6.5 hours!!! You are one strong mama. I'm so glad you got her out on the final push, you must have been so relieved. *sigh* I'm totally avoiding the same scenario, but doing the RCS. So ironic how opposite I feel this time

[starsandshamrocks123]

sdlaura I had a ultrasound the day before induction to make sure he was far enough along and he was supposedly in perfect position. My only explanation is that he must have changed when I was transitioning (I went from like 2cm to 8 in what felt like 5 minutes and I got the epidural then) I still don't get it.

I couldn't feel much after the epidural but my contractions were close together and they let me know when it was time to push. I will say that I mostly experienced back labor. I didn't know that was going on at the time. I would literally do anything I could to get my lower back to chill out and I couldn't. I don't remember strong contractions in the front as labor progressed, only at the beginning. So maybe that was an indication. I was wondering how they could NOT have known but I guess it happens to a lot of people.

[lulu783]

Apr 26, 2017 18:40:45 GMT -5 starsandshamrocks123 said:

lulu783 omg I'm so impressed you hung in there for 6.5 hours!!! You are one strong mama. I'm so glad you got her out on the final push, you must have been so relieved. *sigh* I'm totally avoiding the same scenario, but doing the RCS. So ironic how opposite I feel this time

Trust me it was first time mom 'ignorance is bliss'. I had an epi so it wasn't so much painful as it was mentally frustrating.

I did not know she was sunny side up until I was laboring, at least that is what I remember. At some point during a check the midwife could tell I think? I can remember googling it while I was laboring down, so I must have known before I was fully dilated.

[lulu783]

Also I wish I did some reading up on 'stork bites' before labor. My daughter was born with pretty severe stork bites on her face and it was shocking to me. They have all faded and disappeared (by 18 months they were gone) by now but it still made me feel panicked when I first saw her.

[lindsay]

Not putting together a birth plan at this point, mainly because I believe there are a lot more unknowns with having twins, so I'm trying to be flexible and trust my doctors best judgement. I do plan to ask for delayed cord clamping and skin to skin/to the breast as soon as possible. And if it's a vaginal birth, I want to labor naturally as long as possible with movement, massage, and shower. Then get an epidural. With DD, I had to be monitored internally pretty early on so I wasn't allowed to move about, and had to get the epidural sooner than I wanted bc it was so painful to labor in bed. Slow things way down!

One thing We plan on doing is not inviting family to wait during L&D. Instead we will call them once I've had a chance to do plenty of skin to skin, as I want to ensure we can get off to a good start BFing as much as possible. I want to soak up all the time with them and DH, and allowed myself to "recover" from delivery/c section for an hour or two before having family there.