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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. |
#2
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you seem to have sensible questions, though I don't know enough to comment
at all about the needle, firstly they should be able to insert one fast and the need to insert one would unlikely to be without any warning, but if they really want you to be already set up, see if they can get a vein on the back of your arm, I would also hate to have one in my hand, but I've never had a problem with one in my arm, even when it's been there for days. Anne |
#3
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"Do I have to go through a formal process to organise a FAQ...or do I just
do a Todd?" --Ellen/Chookie, 2002 http://groups-beta.google.com/group/ misc.kids.pregnancy/msg/a45192dfb785c7ed Ellen/Chookie, You didn't mention birth position so - for the benefit of new readers - I will risk doing a Todd. : ) 1. Most women understandably do not wish to say to the OB or midwife: "Your standard delivery positions - semisitting and dorsal - close the birth canal up to 30%." Instead, women usually say diplomatically: "I want to push in positions which allow the birth canal to open maximally" - or words to that effect. 2. Most women also understandably do not wish to say to the OB: "Your standard procedure is to keep the birth canal closed the "extra" up to 30% - keep women semisitting or dorsal when babies get stuck - I don't want you to do that." Instead, women usually say diplomatically: "If you have to pull with hands, forceps or vacuum, please make sure I am in a position that allows my birth canal to open maximally." Point #2 in this Todd is rather new - I think it was inspired by Rivka. Todd PS One more note below###### "Chookie" wrote in message ... 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. ##### New readers. Immediate cord clamping temporarily asphyxiates the baby and robs him/her of up to 50% of his/her blood volume. It is wise not to explicitly call the OB or midwife's attention to this fact - but all women should know it. Saying "delay cord clamping until after pulsation ceases" is much more diplomatic. 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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Chookie wrote: 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. Ok--I had pre-eclampsia. Ended up with an OB for labor and delivery. The most annoying thing was that we had planned to do the birth plan that weekend (while taking our first labor class), but he arrived on Friday. So I didn't know the OB, she didn't know me, and our wishes weren't written down. So I was in the middle of labor and telling people what I did and didn't want..... I expect to need more emotional support than the average second-timer, particularly if I develop symptoms. I expect this next time around too. 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. FYI--an IV isn't a needle stuck in your hand and left there. The needle is used to gain access to the vein, a catheter inserted and left there, while the needle is then removed. I found that the forearm is a great place for a non-intrusive IV. The hand tend to be sensitive, and the anticube is positional if they have to administer fluids. I too would like to labor next time without an IV in place, but I would not be seriously opposed to a forearm saline lock for quick access. 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. FYI-The usual for after a 4 hour BP monitoring, is every 8 hours while remaining in hospital (once per shift if shift change is q8 hours). That would mean 3 checks in the second day versus 4 checks. "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? FYI--mine meant that twice a week I went in to have my BP measured until resolved (2 weeks post). Of course I was at the hospital all the time because my son was still admitted. Also--you could ask *how* they would plan to induce (I may have missed this question). The way my labor was started, I would *highly* recommend. They took a foley catheter and inserted it up past my cervix into the uterus without breaking my waters, and then inflating the balloon. With nothing more than mild cramping once in a while, I was 4-5 centimeters in 8 hours. It was when they started pitocin and performed AROM (without my permission) that things got ugly. I think the rest of your questions are excellent! Sharalyn mom to Alexander James (9/21/01) |
#5
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For me there is a difference in how I would want to be treated with and
without an epidural. Without an epidural, I cannot tolerate being strapped down, so that means no constant monitoring (and me preferring an internal monitor to an external monitor so I don't have to stay still for it to work) and no IV. If I get an epidural, I can't do anything except lay there, so then I don't really care if I have an IV or monitors strapped on. Just thought you might want to consider that. I have ITP, but my platelets have never been an issue to anything except getting an epidural. Two hospitals I went to would allow an epidural with a good bleeding time test, but my current hospital has simply said no epidural if platelets are under 100K, so you should look into the rules of your hospital. I personally came to the hospital late in my second labor knowing it would make it impossible for me to get an epidural, but preferring to labor without harassment in the earlier parts of labor. With this time an epidural being off the table for sure, I plan to again arrive in late labor. Good luck in not getting pre-e this time! Have you shown any symptoms of it yet? KC |
#6
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#7
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I'm trying to read between the lines here to clarify what some of your
concerns are. 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. You seem to be saying here that you don't want fetal monitoring unless you have severe pre-eclampsia. Am I getting that right? Of course all these decisions are up to you, but I personally would want my wife to have fetal monitoring if she had any pre-eclampsia (including mild). Fetal compromise is one of the criteria that defines severe disease - if you aren't looking for that, you won't know. The clinical findings you list above are part of the definition of severe pre-eclampsia. Once you get to this point - and I hope you don't - fetal monitoring isn't really an issue any more because if you get this sick, you need an expedited delivery (hopefully vaginal if you are far enough along in labor, c-section if you are not). The additional finding of fetal distress really wouldn't add much to the decision. In other words, if you get this sick, you need to be delivered quickly no matter what the fetal monitor says. Do you use magnesium sulphate for convulsion prophylaxis? What are your concerns here? Perhaps a better question would be, "under what circumstances would you use mgso4 for seizure 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? Cut off for what? For the diagnosis of severe disease? For needing antihypertensive medication? "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? If you develop critical thrombocytopenia, you may be advised to have a platelet transfusion. |
#8
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In article .com,
"alath" wrote: You seem to be saying here that you don't want fetal monitoring unless you have severe pre-eclampsia. Am I getting that right? Of course all these decisions are up to you, but I personally would want my wife to have fetal monitoring if she had any pre-eclampsia (including mild). Fetal compromise is one of the criteria that defines severe disease - if you aren't looking for that, you won't know. Last time, I had severe disease without any fetal problems. I am one of the 44% of eclamptics who suffer it post-partum. DS was delivered at 41 wks and weighed 8 lb 5 oz. This baby isn't showing any signs of trouble either -- in fact, it's more active than DS was -- so I'm treating myself as a time bomb and not worrying too much about the baby. My symptoms were high BP -- seizure, haemolysis, the standard liver & kidney problems, and thrombocytopenia/DIC. The only symptom in labour was severe headache, and the seizure occurred about 5 minutes pp. The clinical findings you list above are part of the definition of severe pre-eclampsia. Once you get to this point - and I hope you don't - fetal monitoring isn't really an issue any more because if you get this sick, you need an expedited delivery (hopefully vaginal if you are far enough along in labor, c-section if you are not). The additional finding of fetal distress really wouldn't add much to the decision. In other words, if you get this sick, you need to be delivered quickly no matter what the fetal monitor says. I don't want CFM *unless* augmentation of labour is indicated. Do you use magnesium sulphate for convulsion prophylaxis? What are your concerns here? Perhaps a better question would be, "under what circumstances would you use mgso4 for seizure prophylaxis?" I heard that a large-scale trial of MgSO4 was taking place to see if it was useful for preventing seizures in the first place -- it's definitely the drug of choice for preventing *further* seizures. If anyone knows anythign about this trial, I'm keen to hear about it -- couldn't spot it yet on Pubmed. 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? Cut off for what? For the diagnosis of severe disease? For needing antihypertensive medication? Either. "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? If you develop critical thrombocytopenia, you may be advised to have a platelet transfusion. Fortunately, my platelet function normalised rapidly last time, but I'd like to see it monitored because of the rule of thumb about PE occurring later in subsequent pregnancies. IIRC, I had 2 units of *PRBCs* transfused, and as it still took 18 months for my haemoglobin to return to normal, I assume the haemolysis was severe (I only lost about 850 ml of blood). Thanks for helping me clarify my thoughts! -- 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. |
#9
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Chookie, I don't know how much hlep this is going to be, but here is a copy of Monika's birth plan. since it is written "bullet" style, maybe you will find silver one among them. :-) I am Monkia Finkenstaedt McMahan, and this is the birth plan for the delivery of my child. This plan should govern my medical treatment if I am transferred to a hospital for labor and/or delivery. I expect each item on which hospital policy differs from my stated wishes to be discussed with me and my husband, and explicit consent be obtained from me before undertaking any action that is contrary to the wishes stated in this birth plan. General Procedures and Procedures Specific to the Mother -------------------------------------------------------- I do not want to be shaved. I do not want to have an enema. I want to labor in my own clothing. I want the option to give birth nude. I do not want to have my membranes stripped. I do not want to have my waters broken without my prior consent. I want to eat light food and drink juices or water of my choice at any time during the labor. I do not want to be placed in the lathroscopic position (on my back) for exams or at any other time during labor or delivery. I want remain ambulatory and labor in any position of my choice. I want to give birth in the position of my choice, including, but not limited to standing, squatting, or all-fours. I do not want an episiotomy. I would rather risk a natural tear. I want my husband Larry N. McMahan and my midwife H P to be with me during the entire labor and delivery. If I am incapacitated so that I am not able to give medical consent, I want medical concent to be obtained from my husband, Larry N McMahan before undertaking any medical procedure. I do not consent to EFM (electronic fetel monitoring) at any time during labor and delivery, except for cause and with consent. All routine monitoring should be done with fetoscope or doptone. I do now want to have routine vaginal exams to monitor progress. Exams will be for cause and with consent only. I do not want to be prepped for IV (heparin lock inserted) unless there is a medical necessity. This will be done for cause and with consent only. Pain relief medication will be administered with consent only. If I want any I will ask. Please don't suggest it to me. Absent other medical indications failure to progress will not be considered a cause to induce labor. Induction will be done for cause and with consent only. I do not want forceps or vacuum extraction to be used for delivery unless there is a medical necessity. If necessary, then consent must be obtained at the time. I do not wish for cord traction to be used for removal of the placenta. I also do not wish to have any drugs administered without my permission in order to deliver the placenta. I wish to use nipple stiumlation, primarily by breastfeeding to encourage the placenta to detach and spontaneously deliver. Any change to this point must be done only for cause and with consent must be obtained at the time. If a Complication Requires a C-Section -------------------------------------- I want my husband, Larry N. McMahan, and midwife H P to remain with me in the operating and recovery room before, during and after the procedure. I want the procedure to be done using a local anesthetic only, no general anesthetic. I do not want to have a screen placed so I cannot see the birth. I want to hold the baby, and if possible attempt to breastfeed the baby immediatly after the birth. I want the baby to be seperated from me the minimum time possible. Procedures Regarding the Baby ----------------------------- I want either myself, my husband, or the midwife to remain with the baby at all times after the birth. Absent medical complications, I want my baby to be examined and his Apgar evaluated while he lies on my stomach. Absent medical complications, I do not want my baby placed in an isolette or on a warming table. I want my baby to be held by myself or a family member at all times. If my baby is a boy I do not want him circumsized. I do not want the baby to be fed formula, glucose water, or to be given a pacifier at any time after the birth. I do not want my baby to receive a vitamin K injection. It may be given orally. I do not want my baby to receive silver nitrate eyedrops. Erithromycin ointment may be given, but only after the first two hours. I do not wish to have my baby's airway routinely suctioned. It will be done for cause and with consent only. I do not want the baby's cord to be clamped before it has stopped pulsating. Absent medical necessity, I do not want the cord clamped or cut until after the placenta delivers. If complications require the baby's hospitalization, I want to breastfeed or express breastmilk to feed the baby. I do not want supplemental feeding without consent. If complications require the baby's hospitalization, I want to visit or stay with the baby at any time. If complications require the baby's hospitilization, I do not want the baby to be fed by bottle. The baby may be fed by gavage, cup, or syringe. |
#10
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Larry McMahan wrote in news:4264c525
@usenet01.boi.hp.com: Chookie, I don't know how much hlep this is going to be, but here is a copy of Monika's birth plan. since it is written "bullet" style, maybe you will find silver one among them. :-) I am Monkia Finkenstaedt McMahan, and this is the birth plan for the delivery of my child. This plan should govern my medical treatment if I am transferred to a hospital for labor and/or delivery. I expect each item on which hospital policy differs from my stated wishes to be discussed with me and my husband, and explicit consent be obtained from me before undertaking any action that is contrary to the wishes stated in this birth plan. General Procedures and Procedures Specific to the Mother -------------------------------------------------------- I do not want to be shaved. I do not want to have an enema. I want to labor in my own clothing. I want the option to give birth nude. I do not want to have my membranes stripped. I do not want to have my waters broken without my prior consent. I want to eat light food and drink juices or water of my choice at any time during the labor. I do not want to be placed in the lathroscopic position (on my back) for exams or at any other time during labor or delivery. I want remain ambulatory and labor in any position of my choice. I want to give birth in the position of my choice, including, but not limited to standing, squatting, or all-fours. I do not want an episiotomy. I would rather risk a natural tear. I want my husband Larry N. McMahan and my midwife H P to be with me during the entire labor and delivery. If I am incapacitated so that I am not able to give medical consent, I want medical concent to be obtained from my husband, Larry N McMahan before undertaking any medical procedure. I do not consent to EFM (electronic fetel monitoring) at any time during labor and delivery, except for cause and with consent. All routine monitoring should be done with fetoscope or doptone. I do now want to have routine vaginal exams to monitor progress. Exams will be for cause and with consent only. I do not want to be prepped for IV (heparin lock inserted) unless there is a medical necessity. This will be done for cause and with consent only. Pain relief medication will be administered with consent only. If I want any I will ask. Please don't suggest it to me. Absent other medical indications failure to progress will not be considered a cause to induce labor. Induction will be done for cause and with consent only. I do not want forceps or vacuum extraction to be used for delivery unless there is a medical necessity. If necessary, then consent must be obtained at the time. I do not wish for cord traction to be used for removal of the placenta. I also do not wish to have any drugs administered without my permission in order to deliver the placenta. I wish to use nipple stiumlation, primarily by breastfeeding to encourage the placenta to detach and spontaneously deliver. Any change to this point must be done only for cause and with consent must be obtained at the time. If a Complication Requires a C-Section -------------------------------------- I want my husband, Larry N. McMahan, and midwife H P to remain with me in the operating and recovery room before, during and after the procedure. I want the procedure to be done using a local anesthetic only, no general anesthetic. I do not want to have a screen placed so I cannot see the birth. I want to hold the baby, and if possible attempt to breastfeed the baby immediatly after the birth. I want the baby to be seperated from me the minimum time possible. Procedures Regarding the Baby ----------------------------- I want either myself, my husband, or the midwife to remain with the baby at all times after the birth. Absent medical complications, I want my baby to be examined and his Apgar evaluated while he lies on my stomach. Absent medical complications, I do not want my baby placed in an isolette or on a warming table. I want my baby to be held by myself or a family member at all times. If my baby is a boy I do not want him circumsized. I do not want the baby to be fed formula, glucose water, or to be given a pacifier at any time after the birth. I do not want my baby to receive a vitamin K injection. It may be given orally. I do not want my baby to receive silver nitrate eyedrops. Erithromycin ointment may be given, but only after the first two hours. I do not wish to have my baby's airway routinely suctioned. It will be done for cause and with consent only. I do not want the baby's cord to be clamped before it has stopped pulsating. Absent medical necessity, I do not want the cord clamped or cut until after the placenta delivers. If complications require the baby's hospitalization, I want to breastfeed or express breastmilk to feed the baby. I do not want supplemental feeding without consent. If complications require the baby's hospitalization, I want to visit or stay with the baby at any time. If complications require the baby's hospitilization, I do not want the baby to be fed by bottle. The baby may be fed by gavage, cup, or syringe. Wow... Talk about being prepared.. ;-) -- http://www.BirthClubForums.com The online community for new and expected parents. $50 Contest going on NOW! |
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