Is this birth plan reasonable

racing-mom4, BSN, RN · Mar 12, 2008

i would like to have the baby placed on my stomach/chest immediately after delivery. this will be done, as long as baby is ok.
i would prefer that the umbilical cord stop pulsating before it is cut. i dont know about this---i do know that if the blood from the cord flows back into the baby, the baby will be jaundiced like no other.
i would like to hold the baby while i deliver the placenta and any tissue repairs are made. i for one had to push really hard to get the placenta out, it felt like i was having another baby. i dont think i could have held a baby and pushed at the same time.
i would like to hold the baby for fifteen minutes before he/she is weighed and measured. i would also prefer the evaluation of the baby be done with the baby on my abdomen. if baby is good this should not be a problem, but 15 min is a long time, wouldnt you feel much better knowing that the baby is getting a complete head to toe with in the 1st few minutes of life? you will have a life time to hold your baby.
i plan to breastfeed the baby and would like to begin nursing shortly after birth. good luck with this, i too nursed my babies, but they really are not hungry after delivery so dont be disappointed, it takes practice and time for both mom and baby. and no matter what they professionals tell you. it hurts.
i do not wish to have any bottles given to my baby. if supplements are needed i would prefer syringe or finger feeding. all 4 of my babies used bottles as needed, if their blood sugar gets low, you would want them to get some glucose water and quickly. they wont get nipple confusion. they know their mama.
while i would like minimal interventions, the health of my baby (first) and i (second) are the priorities. thank you for being here and helping us achieve these goals. your babies best gift in life is you as a mother. trust the drs and nurses to know how to prioritize the needs of both their patients.

let me guess? 1st baby? as the mother of the 4 best kids in the world ( who knew they all belonged to me!! lol ) it doesnt matter what your birth plan is, it will change. no matter how it changes, you will love your little one like no other, and they will turn out just as good as had the birth plan had worked to a t. they wont remember the erythromycin ointment in their eyes and they will still bond with you just the same.

i hope you dont think i am coming across as sarcastic---really i love the idea of a mom who cares so much for her baby that she is making these plans. mother hood is full of plans changing, that is rule #1 you need to modify, adjust and role with it.

best of luck!!!!

wulfbourne · Mar 12, 2008

Let me guess? 1st baby? As the mother of the 4 best kids in the world ( who knew they all belonged to me!! lol ) it doesnt matter what your birth plan is, it will change. No matter how it changes, you will love your little one like no other, and they will turn out just as good as had the birth plan had worked to a T. They wont remember the erythromycin ointment in their eyes and they will still bond with you just the same.
I hope you dont think I am coming across as sarcastic---really I love the idea of a mom who cares so much for her baby that she is making these plans. Mother hood is full of plans changing, That is rule #1 you need to modify, adjust and role with it.
Best of luck!!!!

Actually this is my second baby. My first one I had steady contractions (5-7 min apart) for 3 days with no progress. My midwife had me come in, they gave me nubain to let me sleep and induced me the next morning. Almost as soon as they started the pit I got my epi and my husband started playing video games until the birth. It wasn't a horrible experience and my baby came out perfect, but I do wonder sometimes if I missed something. My placenta came out on its own last time just from the force of the contractions.

With the cord clamping, I've all the studies I've looked at all say that delaying cord clamping leads to less of a chance of infant anemia and longer durations of early breastfeeding. Could you provide me some resources about the negatives, they are hard to find.

I know nothing ever goes according to 'plan', but I also know that if you have no plan then you are more likely to have more interventions. Ultimately it's all about getting a healthy baby and all of those 'plans' are thrown out the window if there is even a hint of anything is wrong with the baby, but if it's possible I am looking for the 'experience' I hear so many women talk about.

allnurses Guide · Mar 12, 2008

I don't see anything wrong with your plan.

Just be ready for plans to change and don't be upset if they do.

At my facility - we do put the baby on your chest right away and do an assessment there. We also let you nurse right away. Just getting baby to latch and suck a bit is a good thing and makes for a wonderful birth experience. It can hurt though - to have the baby on your tummy as the doc delivers the placenta so don't feel bad if you ask the nurse to take the baby temporarily.

We always wait to do the Vit K shot and the eye ointment - no big deal. And the weight and measurements don't get done until we take the baby to the nursery.

If something is really wrong and your baby needs nutrition - don't feel bad about a bottle. None of my kids had nipple confusion and I nursed them into toddlerhood.

I wish you the best!

steph

Jolie, BSN · Mar 12, 2008

Congratulations on your upcoming delivery!

I'd like to ofer a few suggestions for your birth plan.

As long as baby appears vigorous and stable, it is perfectly reasonable to ask that s/he be placed immediately on your chest, and that the APGAR and first set of v.s. be done from that perspective. At some time in the first hour of life, the baby will need a complete assessment, which is not practical to do on mom's belly. (Measurements, complete physical evaluation, possibly a blood sugar, depending on size and condition.) This can be done in a warmer at your bedside so that you and Dad can watch and learn. Vit. K and erythromycin can be delayed for a time to allow boding, as well. I like to do the erythromycin as the baby slips into a deep sleep, typically within a few hours of birth.

Please be flexible regarding your plans to hold the baby while delivering the placenta and undergoing suturing (if necessary). Some moms manage this just fine. Others are simply just too uncomfortable, and rely on Dad to take the baby during this time. (He won't want to watch this part, anyway:)

If supplementation with glucose water or formula is necessary to stabilize the baby's blood sugar and you don't wish to use a bottle, please be prepared for your husband or yourself to finger feed the baby. Educate yourselves on the procedure beforehand, so that if it is necessary, you will be prepared. Feeding a baby with hypoglycemia is an urgent need, and unfortunately, the nursing staff doesn't have the luxury of time to spend on finger-feeding, or teaching parents to finger-feed.

Best wishes for a safe and happy delivery!

allnurses Guide · Mar 12, 2008

Just want to agree with Jolie - we do need to do a complete assessment that can't be done with you holding the baby. So within an hour, as she mentioned, the nurse will need to take the baby.

Our facility is small - we don't have the scale in the delivery room, it is in the nursery. So at some point I do take the baby out of the room. This is a good time for you and your hubby to kiss and hug though

steph

wulfbourne · Mar 12, 2008

Just want to agree with Jolie - we do need to do a complete assessment that can't be done with you holding the baby. So within an hour, as she mentioned, the nurse will need to take the baby.
Our facility is small - we don't have the scale in the delivery room, it is in the nursery. So at some point I do take the baby out of the room. This is a good time for you and your hubby to kiss and hug though
steph

Oh, I know that even if everything is good you guys still need to take the baby for a full assessment. I figured 15 minutes was a reasonable time. It would give me a chance to appreciate what I worked for and just hold him/her for a few minutes without interfering too much.

kythe, LPN · Mar 12, 2008

You may be better off talking with staff at the hospital itself as well as anyone you know who gave birth there about your real chances of your wishes becoming a reality. What hospitals say they allow and what they actually do when the time comes can be different.

I don't think any of your wishes would be fulfilled at either of the hospitals where I had clinicals. Both of our hospitals tend to be very authoritarian about doing things a certain way, and I don't think anything on your list fits their standards of care. No matter how much they deviate from your birth plan, they will always have some medical reason for it and will tell you that you should be accepting of this since it was for your own good or the good of your baby.

I had my babies in a free-standing birth center and my wishes (which were very similar to yours) were respected without question. Apgars were always done with the baby on my chest, and a more complete assessment was done with the baby still in the room a couple of hours later.

You may also consider hiring an independent doula, a professional birth attendant, for your birth. An experienced doula will have worked in several hospitals with different doctors and may have better skills at negotiating the kind of birth you want.

cmonkey · Mar 12, 2008

Remember that the Vit. K and eyedrops are NOT mandated in most (any?) states and if you want to refuse them, you can. They cannot force you to accept them. It was easy for me since I had DS at home. But it's still a consent issue afaik, and you can refuse. Of course, if there's compelling reason to accept, I would. My $.02

Re: cord clamping, if the baby is above the level of the placenta, backflow shouldn't be an issue. I know that there have been studies wrt early clamping and clotting issues, and it looks like letting the baby get most of the cord blood lowers bleeding problems by a lot, maybe even obviating the need for Vit. K. Also, you can administer oral K, though I think it's several doses over time.

Congratulations! Good for you for looking out for yourself and your baby. I hope it's fast and easy.

klone, MSN, RN · Mar 12, 2008

I disagree that the first assessment has to be done within the first hour. Maybe it's policy at some hospitals, but not at all hospitals, and it's certainly not NECESSARY.

Also, I disagree with another poster that most babies are not hungry right away after birth. Most alert, healthy babies DO have a strong instinct to nurse within that first hour after birth, if left undisturbed with the mother. And other than some transient discomfort at latch on that should go away within the first 30 seconds, breastfeeding should NOT hurt or cause nipple damage. But as this is your second baby, I'm sure you know that. :)

As a lactation consultant, I personally do not recommend oral Vitamin K if you're planning on exclusively breastfeeding, as anything else by mouth can affect the baby's "pristine gut." As someone else mentioned, the Vitamin K and erythromycin ointment are both medications that you DO have the right to refuse. I'm due in a week or two, and am planning on declining both, except under extenuating circumstances for the Vitamin K.

cmonkey · Mar 12, 2008

I didn't know that about oral K. Thanks!

racing-mom4, BSN, RN · Mar 12, 2008

Also, I disagree with another poster that most babies are not hungry right away after birth. Most alert, healthy babies DO have a strong instinct to nurse within that first hour after birth, if left undisturbed with the mother. And other than some transient discomfort at latch on that should go away within the first 30 seconds, breastfeeding should NOT hurt or cause nipple damage. But as this is your second baby, I'm sure you know that. :)
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I was told so many times by the nurses and the lactation consultant that if I am breast feeding correctly it should not hurt. Well it did, then it stressed me out that I was doing it wrong. Finally~~ God bless her the cleaning lady came in and saw that I was struggling, she came over and told me to put my feet up, to bring the baby to my chest and other useful tips. Then she told me the best tip ever. "Oh girl--it does hurt doesnt it-- dont worry hon, you will get used to it, and it will pass"

I had 4 healthy babies. The 1st few weeks of nursing them were torture. I would shudder when I would see their little mouths come towards me. But knowing i would get use to it and it would pass made it doable. I tell every new mom that it hurt me. I would rather them expect the worst and stick it out, then think they are doing it wrong and quit.