Need help w/BIRTH PLAN (Birth center vs hosp vs poss ER trans)

[mama2be]

I am in need of advice in doing my birth plan. As some of you know if all goes as planned I am delivering at a Birthing Center (no doctors, just mid wives)...no epidurals etc...there (they are not at a hospital so don't have this technology)...they have insisted on a birth plan which is simple to do because just by choosing them I feel like that is 90% of the "birth plan"...I have completed my Birth Center birth plan.

BUT the chances are 20% that I am going to be transferred to UNC from there...I want what ever is best for baby so I in no way will feel cheated by this at all...but this is where I am having trouble with my plan. Infact the birth center never even mentioned touring UNC but I have decided to because with all of this preparation in the event I get transferred I have never even stepped foot into that hospital, won't know the Drs etc...but the midwives do escort me and stay with me...

IN all honesty it is the watching of TLC and witnessing some of these births and the residents comments that are scaring me the most. I am in no way anti technology and welcome it fully in the event the baby needs it. But these shows show these women having people count to them loudly while they are pushing which I don't think I would want...or they whisk the baby away to weigh etc...

I'm really needing steering on how to write it in the event I have a c-section. I just watched TLC and they barely showed the baby to mom, it was a quick glance from a far after delivering the baby this way...can I ask if healthy etc...for baby to come to me in this circumstance...what are your choices in this situation. Can your hands not be free, or atleast one of them. I was prepared to ask my MW most of these questions but they cancelled my appt today due to a few inches of snow on the ground.

Any advice would be greatly appreciated...or plans to share!!! I have searched the web for plans and find to many of them too specific and alittle "bossy" to the medical profession and that is not what I am striving for, jsut that a nice atmosphere is achieved and weighing etc...postponed if possible...

Anyway sorry long...but any guidance would be greatly aprpeciated...

[blnony]

This isn't really in response to your entire post, but one really big piece of advice if you do end up delivering at a teaching hospital, be it Duke or UNC, specify that you don't want interns or med. students as part of your care. ( I know some teaching hospitals where you do have this option if you are an insured patient) I say this, just because I had a good friend deliver at a teaching hospital, and things got so carried away that her husband had to demand all the people leave her alone. I'm sure after working in a hospital you are familar with this, but it panics me everytime I hear someone planning on using a teaching hospital.
I delivered at Rex in Raleigh, and I was very happy with everything. I think the quality of medical care in this area is outstanding. I think you should put everything down in writing that concerns you about a C Section delivery or hospital delivery and go over it with your husband so he can express your wishes as well. Sometimes I think Doctors respond better to the one not in pain!:)

[mama2be]

Great advice!!! I normally don't mind the "youngsters" (interns etc...) learning at my expense but I do know that I don't want them involved in the birth of my pregnancy. I have heard great things about REX and my OB goes there (DR Fortier) but the birthing center sends you to UNC...if I am so much in labor and heading to the birthing center and suspect they'll send me to UNC I think I'm heading straight for Rex isntead. I do love Dr Fortier, just have imagined the birthing center/water experience...

[gour0]

I too am planning on giving birth at a birth center so I didn't do a plan. It seemed to me that everything I wanted to avoid involved being transfered to L&D so why bother? I can see your point about having a backup plan, but am hoping that having my doula with me will be enough. She knows what I'm looking for and will stick up for me if anything starts to get out of control. Do you think I am being too naive?

[cara1]

I wish folks didn't fear teaching hospitals as much as they do. If there is ever anything wrong with your baby, you want him/her at a tertiary care center with an experienced NICU and expert neonatologists. That means a teaching hospital. Same goes for your own care, should you need it. You will never have a student/intern/resident deliver your child (vaginally or c/s) without the direct supervision of an attending physician. Most of the time, additional people (students/residents) provide even more care for the patient since the attending physician is not always available. In a smaller community hospital, you may end up laboring with the nurse at your side, only for the attending to come in periodically and help you deliver in the end. In a teaching hospital, there are nurses, residents, and students to help you every step of the way.

Regarding your other concerns, I guess I'm a bit biased because I never would have considered delivering outside of a hospital. By the time DS came out, I barely even noticed that they wisked him away for agressive suctioning, weighing, etc. I was so beat myself, and then I had to deliver the placenta. I got DS on my chest a few minutes later, but I was able to collect myself in between. I breastfed him immediately. The delay was fine. Furthermore, since he had a nucchal cord and had aspirated some meconium, I was happy to have all the attention he deserved. HTH.

[mama2be]

Actually I worked at one of the largest teaching hospitals in the country and did so for 15 years!!!!...and residents all of the time delivered babies!!!! They talked to moms on the phone, and many times I over heard them saying, "I told you not to call me till your contractions are _____ apart". they don't have the bond with these women that a practice has, or the income to lose if a mom gets mad and leaves a practice. So I am pretty familiar with teaching hospitals...hence I say I am always up for supporting them to learn and having them look over shoulders etc...BUT I do not want my birth a standing room only event.

They can be there for my future hip replacements, Tristans suturing, my death, my organs being harvested etc.. etc......BUT I (just me...my opinion) do not want them at my birth. In fact don't really want many people there at all...

The great news about it is we all have choices (for the most part) which is why we do birth plans because each of us have different visions. I can't stress enough that if I am transferred to UNC that I know I will be in the best of hands. Just don't know how exctly to word my birth plan which is a requiremnt at my birth center...

[mama2be]

You might want to do a simple birth plan just because so many couples have different visions. Choosing a birth center is pretty much a "birth plan"...but some couples want privacy and to be left alone, some want the MWs to be there as a team...

Some women might be modest and not want massages...some do...so little things like that can help them with your vision. My birth center requires me to do one...If you email me I can show you what I've done thus far...but it's no masterpiece by any stretch of the imagination. Tammy just sent me hers that is geared for that environment too and hers is great!!!

I got the birth center one down...jsut not the if I go tot he hospital one done...

My email is [email protected]

[Melanie]

My advice for the hospital part of the birth plan is make it short because they probably won't even read it. I was in the exact same place as you, but ended up at the hospital with my 4-page plan. I was SO VERY LUCKY that a doctor my midwife thought I would like was actually at a very good hospital doing a c-section (yikes!)at the time. He had midwives in his practice, so she thought he might actually look at my plan. Of course he was barely there, but he was there when it counted to tell the nurse I didn't need a c-section when she was starting to say I might.

So, my other advice is that if you really think you might end up at the hospital, ask your midwife in advance what doctors fit your criteria, then go and see them, so that if you deliver you would get them (unless of course they do the group on-call thing).

Also, check out the hospitals, find one with a PRIVATE room. This was a Godsend. My baby stayed with us the entire time. It was just luck of the draw I ended up at the hospital I did, b/c usually that doctor was at a different one which is really old and you have to share a room. The L&D nurse I had was great. She had only two patients and answered an hour worth of our questions when we got there. She had no qualms about doing the massage so I didn't rip. In my situation, the decision to go to the hospital basically ate up most of my plan and Ds' amniotic meconium ate up the rest (no cutting of the cord right away, let me hold the baby and don't take him away for anything). However, I did have a positive experience by LUCK of the draw. The doctor even let ME deliver Ds, so I was the first to touch him on the outside, even if it was only for a couple of seconds.

Oh yeah, other advice, make sure your hubby never leaves your baby's side. If baby goes to NICU, Hubby goes. That way there's no shoving of the sugar water via rubber nipple needlessly ruining your BF relationship. I've heard many go astray this way. Ds did go to NICU for 1 hour and hubby went with. Nothing was given/done to Ds that we didn't want.

Good Luck! You probably won't even need any of this, but it's good to Hope for Best and Plan for Worst.


Mommy to Jonah

edited for clarity

[Melanie]

BTW, I made my plan from a mix of the ones at these sites:

http://birthplan.com/
http://www.mjbovo.com/BirthPlan.htm
http://www.childbirth.org/articles/birthplan.html


Mommy to Jonah

[mama2be]

Melanie thank you so much for sharing...I think these mid wives at the birthing center are partnered with a practice of OBs so I think I'd get one of them. I'm just starting to realize how little I know...if my appt wasn't canceled today from our little snow storm I probably would have gotten a lot of answers, but stuck inside and no place to go today my mind just started traveling and I so wanted to get the plan done which is why the sudden "panic"...:)

I'm imagining the Doctors I've worked with before (mind you ER not L&D which I know nothing about)...woudl never have taken the time to look over a plan...I guess I'd hope that the mid wives that escort would help. But in the end I just want a healthy baby...and that is all that matters. I have said all along I wouldn't be crushed if anything happens as long as he is healthy.

I'll look over those sites...thanks again!!!

[Rachels]

Neve, I never actually wrote a birth plan, figuring that being at the birth center would take care of things, and that if I went to a hospital, my plan was pretty much shot. But I did feel comfortable knowing that the midwives would stay with me in the event of a transfer. I think that helps a lot in terms of advocacy and not being separated from your baby when he's born. In my experience, most hospitals won't take the time to read a written plan if you're transferred. Your best bet is to tell your midwives and doula what you really care about-- stuff like not being coached on when to push (the World Health Organization recommends against that, anyway), not having the baby taken from you after birth, etc. Then they can make sure the hospital staff cooperates. Your doula is a fabulous resource for this kind of thing. I'd be sure to talk to her about it at length. But just keep in mind that your chances are EXCELLENT of not needing to transfer, so in all likelihood, you'll get to have the birth you want in the setting you want.

-Rachel
Mom to Abigail Rose
5/18/02

[egoldber]

Neve, to be honest, your choices are fairly limited. Many things that people put in their birth plans are determined by hospital policy (as I think you probably know). While you can, of course, REFUSE any treatment you don't want, in all likelihood this will lead to a very adverserial relationship with your caregivers.

If I were you, I would try to learn all you can about UNC policies. Take the tour. Ask questions. Talk to people who have delivered there. Learn what you CAN influence and concentrate on those things.

If you do end up with a C section, then I think that MOST hospitals try to make this as positive an experience for the mother as possible. Mine was generally a very positive experience. I did not hold Sarah immediately afterwards because I was actually reacting strangely to the anesthesia. (My oxygen levels kept dipping very low and I kept lapsing into brief periods of unconsciousness.) So even though many hospitals let you hold the baby in the OR, I couldn't. BUT they brought her over to me right away so I could see her and kiss her. If I had felt up to it, I could have held her.

Fortunately, DH had a video camera and he filmed all that was happening so that I could watch it later and feel like I hadn't missed anything. I was able to hold Sarah as soon as I got into recovery and nurse her there. So your individual experience may vary despite what hospital policies allow you to do. Personally, I think you are better off talking to the folks at the time about what you would like to do if possible rather than presenting a "plan". Getting on the good side of your L&D nurse, the OB on call and the anesthesiologist (if you need one) is probably more effective.

HTH,

[gour0]

The birth center had a form to fill out with your preferences. I also have discussed things with my midwife, dh, and doula so I feel ok. Like Rachel said, if I have to go to L&D my 'plans' are pretty much shot. So, I guess I can't see writing a back-up. At that point I feel that my support people are going to be more effective than a piece of paper, but that's just my feeling. I'm going to keep positive and assume that we're going to be able to stay in the birthing unit. Power of positive thinking and all...

[Melanie]

Oh, a midwife escort would be such a good thing! I asked my midwife about this in our interview with her, but when it came down to it, with another woman heading in, in labor, I got no offers. =(

Mommy to Jonah

[mama2be]

Evidently this group of midwives had to get actual "privledges" (in other words "permission to treat")at UNC to participate in the manner in which they do at UNC. That would be an investigation of sorts to make certain they are insured etc...I know it took them awhile. There was a time they did not have the privledges and I think were not privi to the operating rooms etc incase of c-section. Now they are...

But that might be where your midwife is being held up...When I worked in a hospital we would get memos every once inwhile granting "temp privledges" to a certin doctor for a certain patient...I have no idea what that involved. But if you contacted "patient relations" at your hospital they might beable to be an advocate for you on that front...

[mama2be]

Thanks ladies...

I really imagined the situation last night and like Cara and Beth said if I am having a c-section chances are I won't be up for much else than they do for those first few minutes post -op...we are just going to try to keep Steve with the baby....:)

Thanks again everyone!!!

[mamahill]

For some reason I just got so excited reading over these posts - you're having a BABY! It still astounds me. Honestly, I don't know how Ainsleigh got here. Well, actually I do. I had a birth plan, but it all went out the window shortly after arriving at the hospital. I agree that a tour would be good to familiarize you with the surroundings. That way, should you have to be transferred, it won't be as traumatic an experience. A couple weeks ago, a friend of mine ended up with a c-section after preparing with a MW. She says now that although it was was completely NOT what she wanted, when she was in the moment, she really didn't care. I felt the same way when they said they were going to have to use the vacuum (and after various other interventions that I thought I was opposed to. If the vacuum hadn't worked, it was off to the OR with me). I think one thing to remember is that there is no shame in childbirth. But you'll be just fine at the birthing center!