Birthing plan?

Are you pregnant again after having preeclampsia once already in a previous pregnancy? Post your thoughts/concerns here - there are others who share your feelings. This is also the home of our Bedrest Buddies Support group.
User avatar
caryn
Forum Moderator
Posts: 10203
Joined: Fri Jun 25, 2004 06:36 am

Re: Birthing plan?

Postby caryn » Mon Sep 19, 2011 07:56 am

Jaundice - and possibly the sort of placental insufficiency associated with PE - at certain gestational ages interferes with the bonding of a chemical called apatite to form dental enamel. Or this is what Oscar's pediatric dentist says. :ugeek: we apparently hit the jackpot because he needed 4 caps on the front top baby teeth and then the baby molars didn't close in the centers, which meant sealants and a root canal.

I find it useful to think about the odds of maternal survival - 1 in 150 die in childbirth without medical care - and neonatal survival - 1 in 30 die in childbirth without medical care - and the odds of Space Shuttle survival - which turned out to be right around 1 in 100, right in the middle and around the same order of magnitude. Uncomplicated birth, and soaring into space, are probably both pretty awesome, but taking precautions is still a reasonable thing to do. We don't get to choose to be uncomplicated, but we do very much need to acknowledge our preferences and see what can be done to increase our chances of having the sorts of births we want.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

steffthomas
Registered User
Posts: 79
Joined: Wed Jun 29, 2011 6:47 am

Re: Birthing plan?

Postby steffthomas » Mon Sep 19, 2011 06:37 am

Thanks ladies! I could have done all that research on my own BUT I knew that at least a few people here would have some knowledge on most of these things.
Most of the items listed I have no problem with, I may request that my doc does not do an episiotomy, mostly because obviously I'm not the only one who has read articles about natural tears healing quicker. Definitely something to think about in the upcoming weeks.
Caryn--What was that that you were talking about with jaundice and appetite/teeth? Our peanut had jaundice and now we're having tooth issues, unfortunately. Some dentists have blamed it on prematurity. Did the jaundice affect your sons tooth development? It would be nice to have some explanation as to why we have spent a few thousand dollars on dental bills in the last few years!

pryncesspez
Registered User
Posts: 17
Joined: Wed Sep 26, 2007 08:53 pm

Re: Birthing plan?

Postby pryncesspez » Sun Sep 18, 2011 09:59 pm

Just thought I'd put my 2 cents in. I am very much for natural childbirth for myself. I believe in the body's ability to birth naturally. And in a large portion of low risk births, there is a huge amount of unnecessary interventions in this country (really this applies for low-risk births though, PE puts someone in a high risk category and the interventions that you get may or may not be wanted, but are necessary). These are my thoughts as they apply to me, but this is just my personal opinion for myself, each woman has to decide what's best and important for them.

Constant fetal monitoring- if I don't become pre-eclamptic with this one, I plan on refusing it, they just get in the way and you can't move anywhere. Intermittent fetal monitoring can be just effective in low-risk births.
IVs, hep lock- if you don't see birth as a medical process then there is no need for an IV, but I don't mind them. I'll have one.
Episiotomy- everything I've read said tears heal faster so I wouldn't want one.
Clamping of cord before it stops pulsating- really not feasible in a hospital environment, as a hospital is a place of business and time is money and this would most likely not be listened to. It's going to take at least 20 minutes and really if that woman expects this one to actually happen, she needs to be in a birthing center or at home. EDITED: Scratch that I misread this, I thought it was discussing delayed cord clamping, which can take a while. I just assumed it because that's just one of those crunchy-granola things you read about and the birth plan looked pretty crunchy. I'm pretty sure it usually gets clamped pretty quickly and I'm not sure why this would be reiterated in a birth plan or why someone would specify before hand.
Pulling on placenta- not that it happens very frequently but uterine prolapse is a possibility, as well as the placenta coming off in multiple pieces and hemorrhaging out of a retained piece.
Vitamin K shots, Antibiotic eye ointment- I didn't have the ointment for my second child and don't plan on it for this one. I just don't see the need for it in OUR case. Vitamin K shots reduce the risk of infant bleeding in half, but do not completely eliminate the risk and some people don't feel that a 1 in 10,000 chance of newborn bleeding is worth a shot. There is also oral Vit K as an alternative but this is not as effective as an injection.
Minimal cervical exams during labor- this could be an issue depending on where you deliver. Let's say you deliver in a teaching hospital (where people need to learn what 5cm actually feels like). First the student nurse, then the nurse, then the medical student, then the intern, then the resident, then the attending. If it's a non-teaching hospital, it's only gonna be the nurse and the doctor and it wouldn't really be an issue.
Newborn screening tests- this I think is really important and each state's test is actually different. The one universal one they check for is PKU, but depending on the state you live in they can check for upwards of 50 different diseases. I remember talking to my husband though with our second child and telling him I wanted to refuse the Vitamin K shots and he thought I meant this. He told me it was awful watching his little girl bleed. I laughed (because I'm a registered nurse who works with hospitalized children [but not L&D or post-partum] and make children bleed on a regular basis). I imagine it does look pretty barbaric to those who have never seen it done and who don't understand what the test was actually for. Out of all the things people can refuse, this is one that I think is just plain a bad idea to refuse, it's a poke and a squeeze and you could save your child's life so very easily.

There are advantages and disadvantages to every single intervention performed in all of medicine. Unfortunately it's difficult to find an unbiased discussion on individual interventions, especially in childbirth since there is so many emotions (and money) that go into it (take a look at regular hospital rooms compared to labor rooms, they spend more money on the things that make them more money). If someone plans on refusing interventions I think they should research both the pros and cons from both medical and natural view points. If you youTube birth plan you'll get these really funny videos making fun of natural childbirths plans. Where the woman is shown as crazy about the natural process even though they actually need the interventions. And there are definitely some crazy women who are that one sided that they can't see that they are harming their own baby. But then you can also google unnecesarean or birth rape and get a whole other side of why they may be like that.

This is not to say that every single person who has a low risk pregnancy needs a non-intervened, non-medicated birth. That may not be what she wants. She may want an epidural, she may want a c-section, she may want an early elective induction. If that's the case, go for it. To each her own. Having choices is awesome. I'd really like to have a long, boring, non-PE pregnancy where I have tons of choices.

Whew, that was longer than I intended! Congratulations if you made it to the end of my long ramblings!
Me 29, not overweight, non-smoker, no pre-existing or underlying conditions
DH 32
DD1 Born Dec 2005, severe PE and beginning stages of HELLP, emergency c/s at 39 weeks
DD2 Born Nov 2007, mild PE, induced VBAC at 39 weeks
DS1 Born Feb 2012, mild PE, induced VBAC at 39 weeks

alexis
Forum Moderator
Posts: 305
Joined: Tue Sep 23, 2008 01:22 am

Re: Birthing plan?

Postby alexis » Sun Sep 18, 2011 08:44 pm

Ah yes - I thought you meant in general! Aliza also got the beach vacation. Nothing serious, but with the same risk factors I wouldn't add to it.
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!

User avatar
caryn
Forum Moderator
Posts: 10203
Joined: Fri Jun 25, 2004 06:36 am

Re: Birthing plan?

Postby caryn » Sun Sep 18, 2011 08:41 pm

"Much" with our kids - sorry, that's not clear! PE babies are a whole lot more likely to end up with jaundice in the first place simply because they're preemies, and the more volume they have to process, the longer the jaundice persists because the more red blood cells there are to break down.

I have a strong dislike of jaundice because Oscar's was timed precisely to mess with the apatite formation on his baby teeth, which then involved a couple grand in outlay. So yeah. :D
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

laughinggirl127
Registered User
Posts: 75
Joined: Fri May 27, 2011 1:24 am

Re: Birthing plan?

Postby laughinggirl127 » Sun Sep 18, 2011 08:13 pm

I keep seeing these baby shows were the woman gets up there and goes on about not having their birthing plans. And some of the stuff that they insist on is just bizarre.

Constant fetal monitoring (Would there be an issue with this? I find it reassuring?)
I didnt like to hear th loud thumping after awhile and the monitor being strapped to my belly was kind of irritating but it just takes a few minutes for your baby to be in destress and something bad happens. Seriously why wouldn't you have this?

IVs, hep lock (REALLY not understanding this??)
I can understand not having fluids running but it's just a little stick and when, in an emergency every second counts wouldn't you feel stupid that you didn't let them start one to begin with?

Episiotomy (Had read an article once before that says tearing naturally actually heals quicker--I didn't tear/have an episotomy, any opinions here?)
I would have preferred not to have on also. But then again I have had two emergency surgeries with a baby that ended up spending a month in the NICU. Think I would take that episiotomy over the emergency section and going blind for three weeks but thats just me.

Clamping of cord before it stops pulsating (And again, never even thought about this!?)
Hace heard of this and don't see the problem. Current thinking is that it helps the baby while they transistion just for a little boost.

Pulling on placenta (It has to come out, obviously. Issues here?)
Just keeps you from having more contracts. every once in awhile they can pull and only have comes out but it is kinda rare. Iffy on this one.

Vitamin K shots, Antibiotic eye ointment (Side effects I should be aware of?)
Well it was developed after a long history of negative pt outcomes. The vitamin k is to promote blood clottting so the wee one who is born with none doesn't bleed to death and the abx oint is to fight any bateria that they would have been exposed to in the birth canal and prevent blindness. I have heard of vitamin K oral drops if they don't want their baby to have a shot. Really if you want your baby to be blind or bleed to death possibly then more power to you.

Minimal cervical exams during labor (They really didn't check me much anyhow, every couple of hours?)
Ok I'll give her this one cause really who likes this part but if they don't monitor you how are they or you supposed to know if there is a problem. and i didn't get checked hardly at all for my first labor.

Newborn screening tests. (What tests are done with a healthy baby?? I don't see my self refusing!)
Well they do the hearing screen and the heel stick test that runs a bunch of tests like PKU. Why wouldn't you want to give your baby the best start? If there was something that wasn't overtly obvious but could be caught so you could start treatment and give them the best possible life....um really is it bad to want that for your child?


You are in fact not a total moron. I get the impression that She was uneducated about why we do those things for you in labor and after delivery. Yes women gave birth at home for thousands of years with no interventions. But the mortality rate of mother and child was about 50%. I'm pretty sure no one on this forum would be for those stats given the reason why we are all here. We already have tumultuos pregnancies and birth. What any of us wouldn't give to be able to whine about some antibiotic ointment after a completely heathy, normal pregnancy and delivery.

As the post go it seems that most of us all want extra monitoring and interventions to give our children the best possible outcome that we can. They should really do more pt education. I feel if you are educated about the reason and possible effects of not doing interventions you will make better decisions.
DS born 2003- 39 weeks preeclampsia, 6LBS 7oz
DD born 2009-32 weeks preeclampsia, 3LBS 1oz
DD born 2012-38 weeks, PIH, IUGR 5lbs 4oz- no pree

alexis
Forum Moderator
Posts: 305
Joined: Tue Sep 23, 2008 01:22 am

Re: Birthing plan?

Postby alexis » Sun Sep 18, 2011 08:13 pm

My understanding was that it makes jaundice somewhat more likely, but I don't know about "much." Delayed clamping is pretty widely practiced in some countries. I do hear crazy excuses being given for why not to, which doesn't help anyone (no, the extra blood is not going to poison the baby; no, getting the blood to the baby does not depend on gravity). If you give silly reasons, people won't listen to your conclusions.

Speaking personally, as a woman with a history of PPH and a first baby with ABO jaundice (I'm O+, DH is AB-, what a pair!) I'm fine with active management and quick clamping. In another scenario, I might make another choice. It's definitely not one of the clear cut ones.
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!

alexis
Forum Moderator
Posts: 305
Joined: Tue Sep 23, 2008 01:22 am

Re: Birthing plan?

Postby alexis » Sun Sep 18, 2011 08:10 pm

Ok, these are all pretty standard "crunchy" birth plan points, I'll go through them one at a time from what I've read:

Constant fetal monitoring (Would there be an issue with this? I find it reassuring?)
- Not proven to improve outcomes for low risk labors and increases the CS rate. Hospitals do it because of all the CP cases and because it's easier if they run a central monitoring station (ie, need fewer nurses, one sits at the station and reads all the strips; with intermittent ascultation, the nurse needs to do more work). VBACs are the exception: EFM has been demonstrated to show signs of uterine rupture earlier. You can see the pattern on the strip, you can't hear it on a Doppler. Again, this is for low risk labors. If anything is wrong, you want continuous monitoring.

IVs, hep lock (REALLY not understanding this??)
- Having the IV in all the time is uncomfortable. Frankly, I'm fine with a lock, I don't want to be an emergency stick.... but I can understand why people hate having a saline lock in. It's really uncomfortable.

Episiotomy (Had read an article once before that says tearing naturally actually heals quicker--I didn't tear/have an episotomy, any opinions here?)
- Routine episiotomy is on the way out. Good hospitals don't do it. A natural tear heals more quickly, and an episiotomy may tear even more (like making a small cut in a piece of paper, and then ripping, versus trying to rip an uncut page). You may still need to do one sometimes, but I've seen rates (NYS reports them) and the big teaching hospitals have seen a huge decline in episiotomy rates. The problem with not requesting it is that ultimately, it's up to the OB, and if they're still a dinosaur who thinks everyone needs a cut, they're going to justify that decision.

Clamping of cord before it stops pulsating (And again, never even thought about this!?)
- May reduce anemia in babies.

Pulling on placenta (It has to come out, obviously. Issues here?)
- THis is part of a package known as "active management of third stage": quick clamping, controlled cord traction and a shot of pitocin as the shoulders are delivered. The package has been shown to reduce the incidence of significant PPH. The placenta will normally deliver on its own within 30 minutes without the traction. I am not sure they've quantified how much each element contributes to the reduced rate. In some countries, they do the pit shot without tugging on the placenta. Some people prefer a physiological (unmanaged) 3rd stage. I imagine that cord traction might be uncomfortable if you haven't had an epidural, and apparently it is possible (but rare!) to invert the uterus or break the umbilical cord.

Vitamin K shots, Antibiotic eye ointment (Side effects I should be aware of?)
- There was a discredited study linking IM Vitamin K to childhood leukemia. There's also the "natural" argument... if all babies are born with "low" Vitamin K, maybe there's a reason? to which I say, Mother Nature has never demanded a 100% success rate, as every preeclamptic knows! The Vitamin K shot has really reduced rates of Vitamin K disease of the newborn. Oral Vitamin K is less effective at preventing late-onset disease. The eye ointment issue seems to revolve around unnecessary antibiotics and "I know neither of us has an STD!"

Minimal cervical exams during labor (They really didn't check me much anyhow, every couple of hours?)
- Uncomfortable, and then some providers start talking "failure to progress" too quickly. I know women who have refused cervical exams until ready to push (to make sure they were really complete). I've never seen any actual risks listed for refusing exams... you just don't know how quickly you're progressing.

Newborn screening tests. (What tests are done with a healthy baby?? I don't see my self refusing!)
- Screening for inherited metabolic disorders--the heel prick test. I have yet to see a compelling reason not to do these tests and I know of several babies who were saved from complications because the screening revealed that they had such disorders. There is a little argument to be had over timing--doing it too early can result in incorrect results. But after you know a baby who was saved from brain damage because they were diagnosed with PKU... such a big payoff and so very little risk.
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!

User avatar
caryn
Forum Moderator
Posts: 10203
Joined: Fri Jun 25, 2004 06:36 am

Re: Birthing plan?

Postby caryn » Sun Sep 18, 2011 07:49 pm

That's a "natural birth" list of preferences. Long story short, there's an argument to be made that monitoring or heplocks or cervical checks are unnecessary in a low-risk birth. (Of course, the point that a birth can become complicated very quickly, even if it's low-risk, and so there might be a benefit to checking for complications and planning for easy resolution of the most likely ones, can also be made. :D) Some people don't buy the argument from public health for antibiotic ointment or vitamin K or newborn screening - I do, and if you're a nurse you probably do too. Some people argue that the cord is pulsating because it's transferring blood to the baby that the baby needs (although as I understand it this makes jaundice *much* more likely, which is why they clamp, especially with our kids who are more prone to jaundice.) Some people argue that the placenta will come out on its own. (Well, maybe not if you've got a history of weird placentas!)

I think this view relies a whole lot on what I'd call a Platonic ideal of birth. It assumes that births will tend ideal unless proven otherwise. Here's the thing, though: a very large number of births turn out to be *not ideal*, which is why obstetrics has adopted these interventions. I'd really recommend the article linked here called "How Childbirth Went Industrial", by Atul Gawande, for more on this.

In any case, you're not a low-risk birth, because of your history. So most of 'em are considered necessary precautions in your case.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

steffthomas
Registered User
Posts: 79
Joined: Wed Jun 29, 2011 6:47 am

Birthing plan?

Postby steffthomas » Sun Sep 18, 2011 05:27 pm

So, I was doing a little research the other day concerning Department of Defense policy and procedure for medical care (and even though I didn't find even close to what I was looking for), I stumbled on an interesting posting about a girl who was concerned that because her husband was in the army she wouldn't be able to have her birth plan the way she wanted.

Because my little one was born early--any birth plan that I had even remotely been thinking about was basically tossed out the window. So, in this posting the girl had some, what I thought, seemed to be really strange idea's concerning labor/delivery/afterward, and I was wondering what you ladies thought.

Some things she wants to refuse:
Constant fetal monitoring (Would there be an issue with this? I find it reassuring?)
IVs, hep lock (REALLY not understanding this??)
Episiotomy (Had read an article once before that says tearing naturally actually heals quicker--I didn't tear/have an episotomy, any opinions here?)
Clamping of cord before it stops pulsating (And again, never even thought about this!?)
Pulling on placenta (It has to come out, obviously. Issues here?)
Vitamin K shots, Antibiotic eye ointment (Side effects I should be aware of?)
Minimal cervical exams during labor (They really didn't check me much anyhow, every couple of hours?)
Newborn screening tests. (What tests are done with a healthy baby?? I don't see my self refusing!)

So I feel like a total moron. I haven't practiced nursing in about 5 years, but never had it in my head that any of these things were bad.. except maybe the episotomy but who even knows!

I need opinions here! Sorry for a million questions!


Return to “Pregnant Again?”

Who is online

Users browsing this forum: No registered users and 16 guests