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Calling for Birth Plan Thoughts!
I'm heading in to my delivery hospital to discuss labour management this
Friday. I'm particularly interested to hear from people who had pre-eclampsia, ITP or a similar condition on what practices suited them or annoyed them etc, but all comments are welcome. I want a relaxed normal delivery with as few interventions as possible during labour, and to delay cord clamping until after pulsation ceases. DH would like to cut the cord and say a prayer. I want to put the baby to the breast immediately. My idea of a Bad Time is arguing with an intervention-happy obstetrician between contractions, and I'm planning to enlist the aid of the midwives to prevent this (they run the show unless something goes wrong). So far, my enquiries include: I expect to need more emotional support than the average second-timer, particularly if I develop symptoms. I think staff should have a look at the relevant section of my labour notes from DS's birth, so they know what went wrong last time and how fast. Do you want me to come in fairly early in labour for blood tests or other baseline measurements? (ASSHP suggest a repeat full blood count, serum uric acid, creatinine and liver function tests, together with assessment of urinary protein at 33-36 weeks gestation in symptomatic PE.) Under what circumstances would induction/augmentation be considered? Or Caesarean? My obstetrician suggested an IV be put in "just in case". How about we hold off on that until I develop symptoms? I don't want to labour with a needle stuck in my hand. I want CFM only at the onset of serious symptoms (ie, inability to control blood pressure despite adequate hypertensive therapy; deteriorating liver function; deteriorating renal function; progressive thrombocytopenia or neurological complications or imminent eclampsia) or heavy-duty medication. Do you use magnesium sulphate for convulsion prophylaxis? What cutoff should we use for BP? (ASSHP suggest 170 systolic and/or 110 diastolic, but I am not sure my numbers got that high until I actually seized). What would you do if my BP did get too high? Frequency of BP monitoring -- half-hourly and at delivery of placenta if symptomatic -- how often will it be done beforehand? Is there any point to anaesthetic assessment prior to labour if I am asymptomatic? Platelet count prior to epidural -- how long does it take and how much could my platelets fall in the intervening period? No ergometrine/syntometrine for third stage -- use oxytocin (they probably do this anyway). My ob suggested 4-hourly BP monitoring for 24 hours post-partum. I would like 6-hourly BP monitoring for the succeeding 24 hours as well. "Careful clinical monitoring should detect premonitory signs of convulsions (eclampsia) such as hyperreflexia with clonus, retinal vasospasm, visual obscurations and persistent headaches." How do we do this in labour? "All of the features of pre-eclampsia will resolve postpartum but clinicians should remain alert for new maternal complications for at least a week after delivery." What will this involve? "Eclampsia is a well recognised complication of the puerperium, especially when the guard of regular observations has been dropped. Some abnormalities, particularly thrombocytopenia and platelet function defects, will often get worse during the first 2-3 days after delivery" -- how will this possibility be handled? -- Chookie -- Sydney, Australia (Replace "foulspambegone" with "optushome" to reply) "In Melbourne there is plenty of vigour and eagerness, but there is nothing worth being eager or vigorous about." Francis Adams, The Australians, 1893. |
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