Birth Intentions – Draft numero uno

7 Mar

I’ve been working on my birth intentions.  I’m a bit of a procrastinator – I tend to pretend it’s because I want everything perfect, but honestly, I think I just wait too long and get overwhelmed into producing inferior results.

Anyway, I spent several hours Saturday looking for recommended plans/hospital scenarios for diabetic women and found very little.  (I did find some a couple of small journal articles on prenatal care for pregnant diabetics that I hope to share here soon!)  It was a nice reminder about how little our unique situation is overlooked, even as it becomes more and more common.  No one wants to be a diabetic, no one wants to be a diabetic mom; but until the health situation changes in America, and we seriously ALL start changing our lifestyles, the numbers of pregnant diabetics (type 1, 2 and 3/GD) is only going to rise.

Without further ado, here is my one-pager for my primary birth intentions (notes in italics):

Through-out labor and delivery:

  • Please introduce yourself to me by name and reason for entering the room. – I think it’s rude of medical personnel in non-emergency situations to forget that you are more than the part they are treating… also working at a certain, large coffee chain for 3.5 years leaves a certain impression about sharing names.
  • I want dim room lighting. Please tell me if you need to turn on lights.
  • I will wear my own clothing, including socks, gown and glasses.
  • I will labor in many different positions and try many different comfort techniques. – why not?
  • I would like to eat and drink as I feel necessary and tolerable until pushing. – My husband would rather that I avoid food, but I figure if I push this with my doctor, she won’t NPO (nil per os – no food!) me unless necessary, but if I don’t say anything, she might not stick up for my right to eat like laboring women have done for millennia.  Basically, I’m going extreme in hopes that I can meet a compromise on this one.
  • Minimal vaginal exams. – I don’t think anyone goes into labor thinking, I hope they check my hoohah every hour, on the hour, but still, it needs to get said.
    • Absolutely no exams without one of my support people in the room – not even “triage”.
    • Refrain from phrasing such as, “just relax,” and “it just takes a second”.  – Because “just relax” is kinda condescending – who can relax on demand?
  • I understand that my blood glucose will be checked _____________________ [rate] (1/hr?).  – I just want the doc to confirm how often this will happen.  I don’t care how often as long as they’re respectful about it – see next item.
    • I would like to prick my own finger. – some people are friggin vampires! They just grab your hand and jab it without warning.  Not cool.
    • If my blood glucose levels are between _________ and ________, I would prefer to continue to manage my levels by eating and drinking, with the help of IV insulin. – I still get the feeling that I won’t have much of a say on eating and drinking, but if I try to put it in there, at least I reiterate that it’s important to me to have that option open.
  • IV:
    • I understand that intravenous insulin throughout my labor is ideal– The big pump is actually pretty efficient and submitting to it means one less thing I’d have to worry about.  They probably wouldn’t let me do my own shots anyway.  Besides, after all the work of labor and delivery and then the absence of the baby, my body may need different dosages – the pump can help regulate those changes hourly instead of receiving a big bolus shot that will take a long while to take effect and can’t be “taken back” (pumps are set to divide a large dose equally over a long period, and if negative changes are being seen (dip in B.G.), the staff can dial back the dose, to take effect immediately).
    • I would prefer to hydrate by drinking water and beverages pre-approved by my doctor. – Basically, I’m saying, hey doc, I want to drink during labor – what would you recommend to me?
    • I would prefer not to receive glucose through I.V. – because I’d rather be able to eat if I feel like it.  I get the feeling this one will be nixed, but it’s worth pushing.
    • If changes are to be made to my I.V., please tell me.  – Don’t try to be sneaky!  Don’t change my insulin without telling me, don’t try to add hanging or bolus medicines without telling me.
  • Intermittent fetal heart monitoring. – Those straps are not comfortable and the constant checking of a strip and pinging will only make me more anxious.
    • I will only consent to continuous/internal EFM upon direct consultation with an ob. – I just want them to actually bring in a doctor so I can go through B.R.A.N. with the doc directly and not through a nurse who may or may not be a good source for information on why they might recommend a change in monitoring for my labor.
  • Do not offer pain medications to me. I will ask for pain relief if I feel need it. – I’m a wimp, but don’t treat me like one.

During delivery:

  • Even if I am fully dilated, if I do not yet feel the urge to push, I would like to try to wait  and “labor down” .
  • No directed pushing.  – I will slap and/or kick the first person to tell me to hold my breath and push while he/she counts.  I believe that, at least to begin with, women should be given the chance to use their body’s natural signals to push… that and counting is so infantilizing.
  • I will choose the position in which I deliver my daughter, including squatting, side-lying, or hands and knees.  – Notice the language: this is not about pushing, but doing the last bit of work to deliver this bundle of joy.  I am the person doing the work, so I should get to choose how to approach it.
  • My husband, my doula, and/or my mother will support me as I deliver. – No random nurses touching my legs, thank you very much.
  • No episiotomy. – No, just no.
  • I would like to have my baby placed on my stomach/chest immediately after delivery. – It’s not just about the breast feeding, or just about keeping her warm, but also about just being able to be the first one to hold her.
    • Evaluations can be performed while baby is on my chest, unless the baby is in need of immediate medical intervention.
    • If my baby needs medical attention, my husband will go with her.
  • I would prefer to delay cord clamping until the cord stops pulsing. – Why not?
  • I would prefer to deliver the placenta unaided (“natural”/unmanaged 3rd stage – no cord traction, no pitocin). – Why should I have to be pumped full or more drugs or have a doctor tug on babies cord stump if I don’t need it?
  • Baby will be breast-fed only! No pacifiers or bottles! – Breast feeding is important to me for many reasons – one being that it can reduce the child’s chances of obesity and diabetes!
    • I would like to meet with a lactation consultant.

One of the troubles I was having with developing a set of birth intentions was coming to grips with the fact that I absolutely need to be prepared with a set of intentions just in case of cesarean.  I want to keep them separate from my main “plan” but at the same time, I have to give them the same consideration.  I feel that cesarean delivery is a very real (though I’m trying to keep it small) likelihood for my baby’s birth and I’m okay with that.  Sure, I’d like to avoid having major abdominal surgery and I’d prefer to do things naturally because I get nervous when lots of people are involved and I’m not “in control”, but at the end of the day, cesareans are relatively safe and are not “inferior” to vaginal deliveries.  They’re just different, with their own set of drawbacks and risks.

I’m still working on that “set” mostly because I spent the majority of “research” time that I did this weekend reading on “natural“/”family-centered”/”woman-centered” cesarean and figuring out if the technique was worth specifically pursuing, if I found myself having a cesarean.  I’m also working on a set with intentions for the baby.  In all, I plan to have three different one-page sets of birth intentions: one page for labor and vaginal delivery, one for cesarean delivery (mostly stuff that only applies in non-emergency c-sections, but still, it is mentally calming to prepare such a list), and a separate one with notes on care for the baby (which will go straight into the “warmer” for a not-so-subtle reminder to the nurses and pediatrician).  I’ll try to post those tomorrow night.


5 Responses to “Birth Intentions – Draft numero uno”

  1. Cris March 11, 2011 at 6:47 pm #

    “If changes are to be made to my I.V., please tell me. – Don’t try to be sneaky! Don’t change my insulin without telling me, don’t try to add hanging or bolus medicines without telling me.”

    As a veteran of several surgeries, I must add the internet term of agreement, “THIS.” And even if they tell you, I would ask why and if it’s expressly necessary. When I was still in the ICU recovering from back surgery (and on morphine), a doctor added Benadryl to my IV. (I can’t remember why; I was 9 at the time.) The result was hallucinations and stuff. >.< Always wanna make sure there won't be any crazy drug interactions…

    Other than that, eeeee! This is so exciting! ^^; I can't believe there's only 13 weeks left. o_____o;;

    • andapinchofsalt March 13, 2011 at 7:44 pm #

      yikes! I’ve only had the one extended hospital stay for the insulin infusion a few months back, and it really struck me that the nursing staff takes a lot for granted. It scares me a little, but I’m just mentally prepping and getting ready to ask a LOT of “why?” in the style of a 3 year old.

      Me: Miss Nurse, whatcha doin?
      Miss Nurse: giving you some more IV medicine.
      Me: whyyyyyyyyyyyyyyyy?

      I think you see where this one is going.

      • Cris March 14, 2011 at 11:56 am #

        As is within your right as an informed patient to do so!

  2. Sheridan March 15, 2011 at 7:43 pm #

    This looks like a great birth plan. I can understand having a desire for a cesarean birth plan. I suggest making one, putting it in your bag and know you are prepared if it comes up. Then focus on what you WANT! 🙂

    • andapinchofsalt March 15, 2011 at 9:43 pm #

      Thanks! I actually decided this weekend that I’m going to wait a little bit on my cesarean “plan” because I have to have the confidence that I’m not going to have one and if I do, chances are that I just have to trust that everyone will respect me as a person, (which is what I was hoping to convey in my birth plan/intentions) because they may not have time to read a plan.

      I’ll be talking more with my doula about that situation, that she can help me mentally prepare and then put those thoughts on paper.

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