Birth Plan for a C-Section???

[annasmom]

Kris' birth story has me thinking, I never even thought about having a birth plan for a c-section. But I am scheduled for a repeat c-section in September and I would LOVE to have some control or say over the situation.

Both of my previous c-sections were emergencies and I wasn't even conscious for my first. I am also having this c-section at a new hospital, so procedures may be a bit different than my last hospital. So I was hoping some c-section experienced mommas can tell me what they have included in their own birth plans, and/or some things that they have liked or really disliked about their experiences.

I know if I have to have another emergency c-section and another preemie, things will be out of my hands, but I am optimistic!!

TIA!!

[ellies mom]

I would ask to have the baby stay with you while in recovery. They can do the nursery stuff while you are being moved back to your room and the nurses are getting you settled. That is what they did with us, although we didn't know it was an option ahead of time, the nursery staff was just too busy at the moment. That meant that we could start trying to nurse while in recovery and I could cuddle her and such.

I know it is harder with other kids but if the hospital allows rooming in, I'd arrange it so someone can be with you at night. The hospital we used allowed rooming in for c-section patients as long as someone was there at night.

Ask to be able to start walking as soon as possible and do it. I took short walks several times a day, I think it really helped my recovery.

Good luck!

[kellyotn]

My first was planned for breech presentation. I just had my doc and then the nurse (from our tour) go over the steps with me. Where the baby would be (with DH), when DH would bring her to me in recovery (right after I was sewn up), when I'd be able to get out of bed, etc. I also asked which post-op pain meds they used as some make me throw up.

With my second, I just had my doc look at my chart from #1 and verify that all the drugs (from the surgery and recovery) would be the same. Everything went really well the first time, so I wanted to make sure it'd all be "the same".

I didn't really do a birth plan, just checked up on the stuff that I was most concerned about. The hospital we were in is wonderful, and most of what I'd have put in a birth plan regarding nursing, rooming-in, etc. is standard operation procedure there.

[tarahsolazy]

I think this is an important consideration, and its a great idea to think about it.

The first step would be to talk to the hospital about routine c-section procedures. I would call the L&D unit and ask to speak with the charge nurse about it. Docs often don't really know about the nursing protocols, so they may promise you things that sound reasonable to them, only to find later that they are "against policy" and you have to fight or accept something you don't want.

Decide what's important to you, things like: type of anesthesia and post-op pain control; arms restrained or not; who can be in the OR with you, can they take pictures.

Find out about: What happens to the baby after delivery: are they automatically removed from your presence, and if so, for how long and why?; Are they observed in a nursery somewhere for some arbitrary routine amount of time?; When are they bathed, etc.; Can c-section moms have baby room in?

Once you know these typical procedures, you can figure out how they fit with your idea of what you want. Certainly circumstances can intervene, like emergencies and preemies, but otherwise its not unreasonable to make some requests.

I have had a c-s, and if I require another, either in similar circumstances to my first (not emergency, but not scheduled), or scheduled, my birth plan will include these things, which are important to me.

No separation of mother and baby unless medically necessary
Dad to stay with baby if baby needs to be removed from mom's presence
No formula or pacifiers, donor human milk to be used if supplement needed (we have a milk bank)
No bath before baby has a chance to breastfeed
No eye ointment at all
Rooming in unless medically impossible
Spinal anesthesia, or epidural, but remove epi catheter shortly after (didn't like my epi-pca last time). No IV mood altering drugs during surgery if at all possible.

[californiagirl]

My hippie-style birthing class included a session on C-sections. My best friend's hospital-based one didn't. Guess who ended up with a C-section? And it was my class that meant we knew to ask if I could gown up and come into the OR to hold her hand after her DH went with the baby. They were surprised but willing, and it made a big difference to her. Only one person can be in the OR with you at a time, but you can switch. Or somebody else can go with the baby, if you'd prefer.

[justlearning]

After my c-section, I posted some tips from my experience. Here's that thread: http://tinyurl.com/gvzja

I didn't have a birth plan but did become upset the day before the scheduled c-section (due to baby being breeched) to learn that DH would be leaving me when they stiched me up to go with DS to the nursery. I was freaking out about it because I was a nervous wreck already and didn't want to be alone. We asked if we could have a friend come with me (who even happens to be a nurse), but the hospital completely refused to allow anyone else in the OR other than my husband (their rule was only ONE support person, no more). They did go ahead and accommodate me by saying that they would have an extra nurse come in at the end when DH left to be with me. (It worked OK because I was scheduled for 7:00AM so the hospital wasn't too busy then.) I was SO thankful that the nurse was there with me. She rubbed my shoulder (I was getting a painful gas bubble) and answered my questions when I was wondering why it was taking so long to sew me back up, why my husband was still gone, if DS was OK, etc. I would have felt awfully alone if everyone in the room were only those working on me down below.

Good luck with your c-section, hope these tips help...

[KBecks]

I don't know what I'd put in a birth plan.... but I will ask my doc a few questions about how it will go the 2nd time around.

For me, the worst part was getting the catheter in. I don't know why, but that hurt! (more than the epidural needle!!!) I imagine it was technique and I'm hoping for gentler treatment of that area this time.

I'm at a different hospital this time and I hope that these things are the same or similar as last time....

1. DH able to come in operating room

2. DH able to take photos in operating room (of baby!)

3. I got a popsicle in the recovery rooom -- AWESOME!!!! AWESOME!!! I NEED to know if this hospital has popsicles too, it was possibly the best part of my last c-section (aside from the baby, of course)

4. Able to try breastfeeding in recovery room. DS needed to spend some time under warmers too, but that was OK.

5. Got to hold DS right away after he was cleaned up in the OR.
Got to see DS constantly once he was born -- he was in my line of sight.

I think my c-section was very good, and nothing about it really bothered me. I think it's the *NURSES* who can make any experience good or not. And who knows if the people on duty that day will be nice and in a good mood or not. I love good nurses and wish I could pick my own 'dream team' -- yeah, right!

I'm just going to ask the doc if there are any weirdo hospital policies I should be aware of, as he delivers at both places all the time.

Curious to know what you would put in your birth plan -- it may inspire me to do something differently.

ETA: my arms weren't restrained and DS never left me, and so I will call to verify that my expectations from last time will be the same or similar this time too :)

[daniele_ut]

>No IV mood altering drugs during surgery if at all possible.

Tarah - I was given Ketamine during my c/s with Logan (I had general with Kiely) and I had a *really* freaky reaction to it. It felt as though I was floating above my body and I was sure that I was losing Logan and dying myself. I was apparently feeling more than I should have with just the spinal, though I don't remember any of it now. It scared me half to death, honestly, and I wasn't totally aware when Logan was born until after they cut the cord and gave me Versed. IS there anything that can be done to avoid that again?

[annasmom]

Daniele,

I don't know about ketamine, but I was curious as to whether they had you on morphine after your c-section with Kiely. I was on a morphine drip the entire day following my first c-section (also under general) and was really out of it.

[annasmom]

I wanted to thank everyone for your responses it gives me a lot to think about, and a lot of questions to ask my new hospital.

Even though it was an emergency, my second c-section was a pretty good experience and there are many things about it that I wouldn't mind to duplicate. My dh was with me the whole time, he took pictures of the baby, I was unrestrained, the pain medication was right on, I was lucid, and the atmosphere was pretty jovial afterwards. And while I didn't get to see Kieran right away because the neonatologist needed to check him out, they did show him to me in a minute or so, and my dh was with him the whole time.

However, my big stumbling block is whether I will be able to hold and/or room in with my new baby after he is born. I will definitely deliver at 36 weeks and I hope to make it that far. I have never been able to hold my babies immediately after they were born, and they were both brought straight to the NICU. So I guess my big question is if a 36 weeker is born healthy, does he automatically go to the NICU just because he is early.

[KrisM]

Most of mine were covered in my other post or by PPs here. I did find out that a lot of the stuff is determined by the anestesiologist, not the OB. For example, he didn't want my doula in there because of space considerations. It wasn't a big deal to me, though. It was he who said I could be unrestrained as well.

I asked that as many procedures be delayed as possible - eye drops, bathing, etc.

It was important to me to see the baby as soon as possible, even if for only 30 seconds. Because of the meconium, this wasn't possible, but if all had been perfect, it would have been.

I also wanted the catheter and IV removed as soon as possible. This was done in about 12 hours, which was overnight for me.

Most of my things came from my vaginal birth plan, just adapted a bit for a c/s.

In both hospitals, it was routine for the baby to stay in recovery with me, so find out what is typical where you'll be.

[daniele_ut]

Eileen,
I was on a morphine pump for about 24 hours both of my c-sections. I was a little out of it after Kiely, but it's hard to say what was contributing to that, grief or the meds. They didn't realize for quite a bit that my IV was clogged, so I was in a significant amount of pain for about an hour or more after.

About the NICU, Logan was born at 36 weeks, but had Respiratory Distress Syndrome, so he ended up in the NICU regardless, but they were planning to allow him to stay with me in recovery and room in if he was healthy.

Edited for typo

[tarahsolazy]

I remember my c-section, at least most of it. I had an epi, and they did a huge bolus of fentanyl in the epi before the surgery, which I think was why I felt very odd during a lot of it. I may have received Versed or something else as well, I never asked.

They left the epi in for pain control, and I had a continuous infusion of hydromorphone, which made it very difficult to stay awake, and made me itchy. I just kept asking for it to be turned down, and removed.

If I need another one, I'll take IV pain meds for as short a time as possible, switching to oral as soon as I can eat.

You can discuss with the anesthesia doc what your past experiences were, and that you'd like to avoid them if possible.

[tarahsolazy]

In most places, a 36 weeker that is healthy and breathing well does not come to the NICU at all. I'm a neonatologist, and the places I've worked have all had newborn nursery cut-offs of 35 weeks or more, and at least 2250 grams birthweight.

You could ask your OB if he can refer you for a neonatology consult before you deliver, or just have the neo call you. Then you can ask the neo what the routine for a 36 weeker is in the hospital you plan to deliver in. IME, if the hospital has a higher level NICU that cares for more critically ill babies, they are less likely to require a big baby to come to the NICU just because. Hospitals with no NICU or a lower level one may have more restrictive policies.

[KBecks]

I think one of the risks at 36 weeks is lung maturity. I'm having an amnio to check lung maturity and delivering at just over 36 weeks.

From what I understand as a patient, the lungs should be ready to go, but once in a while they are not quite ready, and that would mean a NICU stay. Of course, other conditions may require NICU too, but my impression is that 36 weeks is generally A-OK.

Alek was delivered at 36 weeks (after the amnio test) and did not go to the NICU.

But that's just my one experience w/it.

[annasmom]

Thanks again. That is a great idea about the neo consult Tarah, thanks so much for that suggestion, I will definitely talk to my OB about it. Kieran was born at 33 and didn't have any lung maturity issues at all (had to go to NICU just to keep warm, grow and learn to eat), so I am keeping my fingers crossed. Kbecks - I am going to pm you about the 36 week amnio.

ETA: Just wanted to add that the hospital that I am delivering at has a Level III NICU (one of the reasons I am delivering there), so here's hoping my very healthy baby doesn't have to stay there!

[kimbe]

Thank you for this thread. I didn't realize that you could have a birth plan for a c-section! Hopefully, I will get to be at the same hospital -- they did a wonderful job in every aspect of my ordeal. However, if I have to go somewhere else, thank you for showing me that I have rights!!!!

Some of the things I liked :
-saw the baby right away
-Dr. talked to me the entire operation
-I could have watched the operation if I wanted to (they had the curtain down on one side. However, I DID NOT and held the side up myself while DH watched over it!! LOL -- everyone in the OR thought that was funny.
-Very pro BF hospital so I didn't have to worry about that at all
-Walked around 12 hours after c/s
-roomed in with baby, however trusted the nurses enough to take DD at night so I could sleep. (One nurse even held her on her lap while she did paperwork so I could sleep.)
-after I came out of recovery, I wasn't even in bed before they started helping me BF DD. I was still a little out of it still, but the nurses paid no attention to me and got DD latched and nursing.

Didn't like:
-didn't have the baby while I was in recovery, however, I was pretty out of it from the demerol and DH got to be with her which was pretty special for him

HTH

[LucyG]

I had a c-section birth plan for what ended up being my VBAC, but I'll share the highlights from it with you.

- I asked for someone to PLEASE narrate what was happening with the surgery! (When my first DD was born by c-section, I really wished later that I'd asked the midwife or OB to tell me what they were doing behind that screen!)

- I asked to be shown the baby immediately, even if only for a few seconds, after the delivery. When DD #1 was born, they whisked her over to the side to dry her off and weigh her before I saw her and DH held her, and those two minutes or so were an eternity to me. I could hear my baby crying, but hadn't yet seen her.

- I asked for permission to have DH or a nurse photograph the surgery/birth (fine by hospital policy).

- I asked for a mirror so I could watch the birth.

- I asked for Duramorph (long-acting morphine) in my spinal after the birth. This kept me comfortable for about 24 hours after my first DD was born.

- Spinal rather than epidural so as to leave no catheter in the back.

- Nurse/hold baby as soon as possible.

- Arms unrestrained if possible.

DD #1 (2/03)
DD #2 (3/06)