Follow Up To My Birth Plan
Thanks for all the positive comments regarding my birth plan! I'm glad it was well received and I especially appreciate the comments from those who said even though they made or plan to make different choices than me, they still respect me posting my plan.
So, now to answer your questions. A few of you mentioned that you didn't mean your questions in an offensive way and I just wanted to say that I didn't take any question as offensive. You don't know if you don't ask! Also, I'm no expert, so I'm just going to answer with what I've found in my research and with my own personal opinions. So don't take my word as the one and only truth! Here goes...
1) I'm confused on the internal monitoring, they could not see my contractions on the screen so they had to go internal and I guess that means internal FHR check too. How can you prevent that if they can't see your contractions?
First of all, monitoring FHR internally and monitoring contractions internally require two different tools. Internal FHR monitors consist of an electrode with a small screw/spring that is inserted into your cervix and screwed into the skin on the top of the baby's head. An internal contraction monitor is an interuterine catheter that measures pressure. So you can have one thing monitored internally and not the other. Also, external monitors are only able to measure the timing of contractions, not the intensity, while an internal monitor can measure both the timing and the intensity.
I really don't want internal monitoring for either FHR or contractions. The thing about having a natural birth is that I will know when I'm having a contraction. Even if the monitor isn't picking it up, I'll still know it. Because of that, it should be no problem to avoid internal monitoring unless there is some type of emergency situation.
2) What is "no directed pushing unless requested"? My doc told me when to push and she counted to 10, if she didn't do that I would have given up or taken longer breaks after awhile because I got so tired. Do you count your own pushes? How does this work?
Directed pushing mostly results from an epidural. If you have an epidural, you may not know when you are having a contraction and you probably won't feel the urge to push. However, that is definitely not the case if you haven't had any pain medications! Women who have natural births feel an intense urge to push, so I won't need anyone telling me when to push or for how long. I'll push when I need to push. Also, there is some belief that pushing when you feel the urge rather than pushing when you are directed decreases the chance of tearing because you are pushing as your body directs.
3) Does getting an epidural mean you stay awake for an emergency c-section? I had an epi and they still knocked me out for it.
No, sadly, it does not. In a true emergency situation, I would be put under general anesthesia. Or at least, that's what I was told in my birth class...
4) If you are under general anesthesia, do you not want Chad in the room for a c-section?
If you are under general anesthesia, no one is allowed in the room. So yes, I would like for Chad to be there, but he won't be allowed. This is truly my worst fear - being completely knocked out for a section and not having my husband there. But I'm just hoping that it doesn't happen.
5) I didn't see you include anything pertaining to getting an episiotomy during delivery, but you did note the stitching of your perineum.
I didn't mention it because my doctor doesn't cut episiotomies. He always allows his patients to tear naturally.
In that same vein, I also didn't specify that I want the cord to stop pulsing before they cut it, and again, that's because it is my doctor's regular procedure to do that.
Now, if I went to a large practice and had the potential to have any number of doctors deliver the baby, I would mention those two things anyway. But that's not the case for me - my doctor is the one who will deliver my baby, so there was just no need to reiterate something that is standard procedure for him.
6) What benefits do you achieve by having no internal monitoring and having a minimum amount of vaginal exams?
First, the monitoring - The biggest disadvantage to internal monitoring is that your bag of waters must be broken in order to use the monitor. So if my water hasn't broken on it's own, it would have to be done artificially. I'll talk more below about why I want to avoid that, but that is the main reason I don't want internal monitoring. Not to mention the fact that I hate the thought of that dang screw being shoved into Bug's head.
Second, vaginal exams - Each time you have an exam, you risk the possibility of infection. So fewer exams means less risk. Also, from what I've been told from women who have had a natural labor, you eventually reach a point where you tune everything out and get in a sort of zone to help you deal with the contractions. So I just want to avoid any unnecessary distractions once I'm in that zone, including vaginal exams.
7) When you write that you want to hydrate by mouth and not IV, is that option always available?
Whether or not it's available really depends on your doctor, I think. More traditional doctors may be less inclined to let you drink during labor. But my doctor is OK with me drinking water rather than getting my fluids through an IV, so that's what I'm doing.
8) When you say that you want the baby to be put to your breast even if you are unconscious after a c/s, is that really something they do? I never even knew that! Amazing! Did your doula provide all this information for you?
Yep, apparently it is something they really do! I didn't know it either, but my doula told me about it, so I added it to my birth plan. I want the baby to breastfeed ASAP, no matter the circumstances.
9) Can a person like me, who wants an epidural for sure, hire a doula for support before and after birth? Or is that just for people who are wanting a natural birth?
YES!! I feel like having a doula is the best decision I've made so far with this pregnancy and I haven't even had a labor yet. A doula is there for so much more than just support through a natural birth. Mine has talked me through all of my fears and has been an awesome source of information. Plus, she will be available to me after the baby is born for any questions I have. And even if you want an epidural, and doula can still be a great source of support during your labor.
10) I was just wondering if you feel strongly about AROM, as well as what you will do regarding the eye ointment and Vitamin K?
AROM (artificial rupture of membranes) - I don't want it done and yes, I feel very strongly about it. Mostly because once your water has broken, you are put on a time line at the hospital and if it's done artificially, it can increase your risk of surpassing that time line and being forced to use Pitocin or being taken to a c-section. So I definitely want to avoid it.
Eye ointment and Vitamin K - we are doing both, but I don't want either done immediately after birth. That is part of the reason why I specified that I want all the routine baby care procedures to be postponed until Bug has had a chance to breastfeed. Honestly, I'm completely torn as to if either are really necessary (um, I don't have chlamydia, thanks for asking. But at the same time, I don't want to risk infection and have the baby go blind...), so for now I've just decided to err on the side of caution. I think. The eye ointment is the one that really bugs me and in the end, I may change my mind. But for now, we plan to do both.
11) Do you know if the eye ointment is really required by law?
From what I understand, it is required by law in the state of Missouri, but you do have the option of signing a release stating that you do not want the eye ointment administered. I'm sure that's different in each state though.
12) Are you prepared to be flexible in your birth plan if needed?
Yes, I am. I've said this before and I'll say it again - I trust my doctor 100%. There is a reason I chose him and it's because his philosophies on birth line up with mine. If he says we need to do something against what I've specificied in my birth plan, I know it is because it is necessary. Like I said in the opening paragraph of the plan, the preferences I have are for a normal birth. I know that things can change.
13) My son took in a lot of fluid when he came out, while they did give him to me right away, he was breathing okay, they quickly had to remove him in order to suck the fluid out of his airways, will you be OK if something like that happens?
Of course! I mean, I want the baby put to breast immediately, but if he or she is having trouble breathing, I definitely want that taken care of first.
14) What will you do if your water breaks and it has been over 24 hours and you have little progress?? Will you still be allowed to refuse intervention? Will your doctor let you keep going past the standard 24 hour mark?
I am not comfortable going past the 24 hour mark once my water has broken, so no, I won't refuse intervention at that point. I'll do whatever has to be done to get the baby born.
15) If you cannot handle the pain will you be ok with yourself if you do ask for pain meds?
Honestly? No. I'll feel like I failed. So hopefully I can handle it... And that's not to say that I feel like other people who have used pain meds have 'failed'. I don't think that at all. But I've made a personal choice that I feel is the best choice for me and my baby and I really want to follow through with it.
I hope that answers everything!
