New Prenatal Care Plans & Birth Plans

As I mentioned in my last post this week was full of appointments with health care professionals. We met with my OB, my midwife, my nutritionist, and my weight loss surgeon. During the ultrasound with my OB the placenta placement was questionable. I go back in 3 weeks to determine if placenta previa is an issue. If it's partially covering my cervix the odds of it moving enough for me to deliver vaginally are fair. That happened with my 2nd child. But if it's fully covering my cervix a caesarean will be likely. I'm trying not to worry much over any of this because I'm still early in pregnancy and things can change. Plus we do not know if this is even an issue at all yet. We will have a better idea on the 31st. 

Our next appointment was with my dietitian and weight loss surgeon. They both were comfortable with my weight loss and blood levels as far as protein, iron, calcium, b12, vitamin d, ect goes. I control those with a large amount of supplements because of the surgery. They did however express concern for the baby to be at risk of low birth weight simply because I can't physically consume what a pregnant women should. My stomach holds 4 oz at a time and I digest things very slowly now. I struggle to get in more than 600-700 calories a day. I live on supplements and they give us what we need but nothing more. This will have to be monitored with ultrasound scans through out the entire pregnancy. The farther along I get the harder it'll be for baby and I to get extras so that's specifically when it's the most important to monitor his/her's growth. Of course it is scary for me to think about but it also raised the question of how that changes my plans to switch fully to the birth center for my prenatal care. The birth center does not do ultrasounds. Obviously if I have placenta previa that's irrelevant because I will have to deliver in a hospital but placenta previa aside this news just left me unsure so I made an appointment with my midwife. 

Yesterday we met with our midwife at the birth center. We discussed everything that we've learned this week and came to the conclusion that I'd continue to see BOTH my OB and my midwife until we had solid answers or any reason that I was no longer adequate for midwife care. 

With this most likely being our last baby imagining that I will not get my dream birth is unfortunate but ultimately baby's health is what matters. I will proudly do what I have to to keep him/her safe. For now I will pray hard that everything goes perfectly but this news also lead me to reexamine and update my pregnancy and birth plans.

Prenatal Care Plans:

Originally I was going to stop seeing an OB after my anatomy ultrasound scan and switch fully to my midwife. However, now that the baby will need regular growth check up scans I feel that it is best to continue my care with the OB as well as recieve care from our midwife. I've began scheduling those appointments for the same day to simplify life. 

Birth Plans:

I've prepared for just about every outcome in detail. I am unsure of where I'll deliver and who will deliver me. In a perfect world my husband will deliver me under my midwife's care but it's possible that she will deliver me at the hospital in Rogers or that her partnering OB staff will deliver me via C Section. Either way I will be delivering in Rogers, AR. My birth plans with our other children were throughout but my wishes weren't respected at all so this time I hadn't put much thought into a birth plan. In my experience they are pointless but I believe that's not the case with most health care facilities. I know for sure that it's not the case with the birth center. They are all about mother lead birthing and you call the shots granted no emergencies arise. With multiple possibilities on the table for how things could go I put a lot of thought into my new plan. With the help of a birth plan template I covered all opinions in great detail plus added a few of my own. I will adjust the original plan as needed depending on further diagnoses but the basics of each outcome are addressed in the new plan.

Full name: Callee Jo'Ann Lane

Partner’s name: Brian Joe Lane

Midwife: Brittany & Brennan

Doctor: Subject to change 

Due date: July 8th, 2017

Baby's Gender: Unknown

Please note that I:

[ ] Have group B strep

[x] Am Rh incompatible with baby

[ ] Have gestational diabetes

My delivery is planned as:

[ ] Vaginal

[ ] C-section

[x] Water birth

[ ] VBAC

I’d like:

[x] Partner: Brian

[x] Parents: Le'Ann & Brenda

[x] Other children: Charlee, Andlee, & Hudson during labor only not present for birth

[x] Midwife: Brittany & Brennan

[x] Other: Family friend/photographer 

…to present before AND/OR during labor

During labor, I’d like:

[x] Music played (I will provide)

[x] The lights dimmed

[ ] The room as quiet as possible

[ ] As few interruptions as possible

[x] As few vaginal exams as possible

[x] Hospital staff limited to my own doctor and nurses (no students, residents or interns present)

[x] To wear my own clothes

[x] To wear my contact lens the entire time

[ ] My partner to film AND/OR take pictures

[x] My partner to be present the entire time

[ ] To stay hydrated with clear liquids and ice chips

[x] To eat and drink as approved by my doctor

I’d like to spend the first stage of labor:

[ ] Standing up

[ ] Lying down

[ ] Walking around

[ ] In the shower

[ ] In the bathtub

[x] All of the above

I'm not interested in:

[x] An enema

[x] A urinary catheter

[x] An IV, unless I’m dehydrated (and a heparin or saline lock IS/IS NOT ok)

I’d like fetal monitoring to be:

[ ] Continuous

[x] Intermittent

[ ] Internal

[x] External

[x] Performed only by Doppler

[x] Performed only if the baby is in distress

I’d like labor augmentation:

[x] Performed only if baby is in distress

[ ] First attempted by natural methods such as nipple stimulation

[ ] Performed by membrane stripping

[ ] Performed with prostaglandin gel

[ ] Performed with Pitocin

[ ] Performed by rupture of the membrane

[ ] Performed by stripping of the membrane

[x] Never to include an artificial rupture of the membrane

For pain relief, I’d like to use:

[ ] Acupressure

[ ] Acupuncture

[x] Breathing techniques

[ ] Cold therapy

[ ] Demerol

[x] Distraction

[ ] Hot therapy

[ ] Hypnosis

[ ] Massage

[x] Meditation

[ ] Reflexology

[ ] Standard epidural

[ ] TENS

[ ] Walking epidural

[ ] Nothing

[x] Only what I request at the time

[ ] Whatever is suggested at the time

During delivery, I would like to:

[ ] Squat

[ ] Semi-reline

[ ] Lie on my side

[ ] Be on my hands and knees

[ ] Stand

[ ] Lean on my partner

[ ] Use people for leg support

[ ] Use foot pedals for support

[ ] Use a birth bar for support

[ ] Use a birthing stool

[x] Be in a birthing tub

[ ] Be in the shower

I will bring a:

[ ] Birthing stool

[ ] Birthing chair

[ ] Squatting bar

[ ] Birthing tub

As the baby is delivered, I would like to:

[ ] Push spontaneously

[ ] Push as directed

[x] Push as I feel urged to as long as the baby and I are not at risk

[ ] Use a mirror to see the baby crown

[x] Touch the head as it crowns

[ ] Let the epidural wear off while pushing

[ ] Have a full dose of epidural

[x] Avoid forceps usage

[x] Avoid vacuum extraction

(I do not permit either forceps or vaccum to be used)

[ ] Use whatever methods my doctor deems necessary

[x] Help catch the baby

[x] Let my partner catch the baby

[ ] Let my partner suction the baby

I would like an episiotomy:

[ ] Used only after perineal massage, warm compresses and positioning

[ ] Rather than risk a tear

[x] Not performed, even if it means risking a tear (I do not permit an episiotomy)

[ ] Performed only as a last resort

[ ] Performed as my doctor deems necessary

[ ] Performed with local anesthesia

[ ] Performed by pressure, without local anesthesia

[ ] Followed by local anesthesia for the repair

Immediately after delivery, I would like:

[ ] My partner to cut the umbilical cord

[x] The umbilical cord to be cut only after it stops pulsating

[ ] To bank the cord blood

[ ] To donate the cord blood

[ ] To deliver the placenta spontaneously and without assistance

[ ] To see the placenta before it is discarded

[ ] Not to be given Pitocin/oxytocin

[x] To preserve the placenta for encapsulation

If a C-section is necessary, I would like:

[x] A second opinion

[x] To make sure all other options have been exhausted

[x] To stay conscious

[x] My partner to remain with me the entire time

[x] The screen lowered so I can watch baby come out

[x] My hands left free so I can touch the baby

[ ] The surgery explained as it happens

[x] An epidural for anesthesia

[x] My partner or I to hold the baby as soon as possible

[x] My partner to go with the baby to the nursery right away

[x] To breastfeed in the recovery room

I would like to hold baby:

[x] Immediately after delivery

[ ] After suctioning

[ ] After weighing

[ ] After being wiped clean and swaddled

[x] Before eye drops/ointment are given

I would like to breastfeed:

[x] As soon as possible after delivery

[ ] Before eye drops/ointment are given

[ ] Later

[ ] Never

I’d like my family members:

[x] To join me and baby immediately after delivery

[ ] To join me and baby in the room later

[ ] Only to see baby in the nursery

[ ] To have unlimited visiting after birth

I’d like baby’s medical exam and procedures:

[x] Given in my presence

[x] Given only after we’ve bonded

[ ] Given in my partner’s presence

[x] To include a heel stick for screening tests beyond the PKU

[x] To include a hearing screening test

[x] To include a hepatitis B vaccine

Please don’t give baby:

[ ] Vitamin K

[] Antibiotic eye treatment

[x] Sugar water

[x] Formula

[x] A pacifier

I’d like baby’s first bath given:

[ ] In my presence

[ ] In my partner’s presence

[x] By me

[ ] By my partner

I’d like to feed baby:

[x] Only with breastmilk

[ ] Only with formula

[ ] On demand

[ ] On schedule

[ ] With the help of a lactation specialist

I’d like baby to stay in my room:

[x] All the time

[ ] During the day

[ ] Only when I’m awake

[ ] Only for feeding

[ ] Only when I request

I’d like my partner:

[x] To have unlimited visiting

[x] To sleep in my room

If we have a boy, circumcision should:

[ ] Be performed

[x] Not be performed

[ ] Be performed later

[ ] Be performed with anesthesia

[ ] Be performed in the presence of me AND/OR my partner

As needed post-delivery, please give me:

[ ] Extra-strength acetaminophen

[ ] Percoset

[ ] Stool softener

[ ] Laxative

After birth, I’d like to stay in the hospital:

[ ] As long as possible

[ ] As briefly as possible

[x] As long as needed to properly monitor baby and I

If baby is not well, I’d like:

[x] My partner and I to accompany baby to the NICU or another facility

[x] To breastfeed or provide pumped breastmilk

[x] To hold him or her whenever possible

These are just the basics. If anything happens and I have to have a planned c-section I will readjust the birth plan to be geared around that outcome but for now I will continue to plan for a water birth at the birth center. If you're working on your birth plan my advice would be to consider everything in detail. Anything can happen and we must prepare ourselves for that. 

Wow, this week has been a lot to process and very stressful. I haven't slept in days. My mind has ran constantly. Between the baby situation and being extremely annoyed that we haven't closed on our farm yet, it's just been rough. Momma needs a drink ha.