Yadda Yadda,

[geminigirl]

pregnancy stuff that I'm putting out in public cause I need more feedback than the filter would get. :)

First off, more recent fetus-photo...


More here

I'm fine. Heartbeat at 155. Referral to pulmonologist, and I called and they squeezed me in for tomorrow morning at 8:30. Which will make me a cranky woman because I'm not a big fan of morning and because it will involve rush hour traffic to get to this place for an 8:30 appointment. But if it means breathing better, so be it. The OB suggested the possibility of supplemental oxygen, but I'm really hoping I don't end up going that route. I'd be fine with nebulizer treatments or a long acting bronchodilator or something (can't do inhaled steroids, I end up with thrush and coughing blood every time I've tried.) We'll see what the respiratory therapist and NP have to say tomorrow.

I scheduled the rest of the OB appointments through my estimated due date today. This is overwhelming. And scary. And I feel totally unprepared. And I just hope that I'm good at the forthcoming job.

We started a registry this week (someone at Cayne's office asked, which means I assume a shower is in the works somewhere.) No you can't see it yet...it's not done and I'm not happy with it, I need to make more changes first. If you do want to see it leave a comment to that effect and I'll comment back when I'm more settled into what's on it. This is not a request for stuff. This is an "if you wanna look at it you can tell me cause it requires that I disclose my name to you. I do not expect stuff from anyone for this.

So, with today's OB appointment, I was cleared for delivery by whoever is on call, rather than whichever MD is on call. What that means is that assuming that everything continues to go smoothly, if it happens that a midwife gets to me first when I'm in labor then a midwife gets to deliver the baby. This is a very good thing. Which brings me to the public-reasoning for this post...we started talking very vaguely about birth plans at today's appointment. And the doctor asked what I wanted...and my answer was "as low intervention as we can." Dr. P is fine with that. I threw out examples like "no continuous fetal monitoring" to which he said "no problem, unless we've had to use Pitocin," and I'm apparently allowed to wander around as much as I want if I'm comfortable, whether or not my water's broken, and use the tub and so on and so forth. But, I'm looking for birth plans. If you've written one when you gave birth (or you've got a partner who has written one) please share it. Links here are fine, e-mail to username at livejournal is fine, and so on. But the more I can read actual real ones that people I like have written the more able I think I'll be to craft my own.

Here we go.

Comments

Off Topic, I'm sorry!

[jaclyn.livejournal.com]

I don't have a birth plan - though I'll certainly be making one when the time comes! But I just wanted to comment on one part.

I admit some feelings came up for me when your OB mentioned Pitocin after you had said you wanted low interventions. I'm sure you've read up on all of the downward spiral events of using Pitocin and how it often leads to a cascade of interventions and from what I've heard an overall harder and more painful child birth.

Just checking on that part - hope I'm not being intrusive.

Re: Off Topic, I'm sorry!

[geminigirl]

Not off topic at all, sweetie. It's entirely relevant to the post. And yes, I'm aware of the increased risk of other interventions with Pitocin, but thank you for the reminder and the opportunity to talk about it a little bit.

He's not pushing induction or anything like that at this point, but it's a reasonable thing to discuss in the sense of "it's something that you should be aware of as you think about things," if that makes sense. If I start to have complications later and we have to talk about getting the baby out, I may end up with the choice to try something like Pitocin or just schedule a C-section, and in that event, for example, I'll go for the Pitocin first, even if it does end up leading to other interventions. And the other side of that is the fact that if I go too far beyond my due date, that means at the very least a conversation about induction. It's worth at least mentally being prepared for the possibility, you know?

I know that Dr P knows that I'm the kind of person who is going to go home, sit down, do all the reading and research I can, and so on, and make educated decisions about what to do and what's next. Rather than encouraging it as an option, I think it was his suggestion that I include my feelings and thoughts on that in my plan and to understand that if that becomes an issue it may change the course of things and I need to be flexible, understanding and well informed about it.

Re: Off Topic, I'm sorry!

[jaclyn.livejournal.com]

That's totally fair and thank you for providing more insight into the situation. I'm also glad you didn't bite my head off! (grin) Everything you responded with completely makes sense to me. And thank you for approaching me kindly. :-)

Re: Off Topic, I'm sorry!

[geminigirl]

I wouldn't bite your head off for bringing up something reasonable and important to think about, in a thoughtful and informative way.

It's certainly something I've thought about, and Cayne's thought about, too. I'll share his IMs when we were talking about things to make sure to discuss with the doctor, in a post filtered to the pregnancy filter tomorrow or the day after depending on how tired I am.

Re: Off Topic, I'm sorry!

[jaclyn.livejournal.com]

Hugs to you, lady.

And I also wanna be on the baby registry list, please ktx.

:D

Re: Off Topic, I'm sorry!

[geminigirl]

And hugs to you. I've been thinking of you a lot this week.

No worries about the registry list. I need to feel like I can sit down and deal with it, and that's not likely to happen until I can get my lungs settled down so I'm focused less on breathing and more on everything else that needs to happen. :)

Re: Off Topic, I'm sorry!

[jaclyn.livejournal.com]

OH TOTALLY! I wasn't pressuring for a list now, just saying count me in as one of the recipients of the information whenever the time comes. Lungs comes first holy cow of course!!!


xoxoxo

:-D

Re: Off Topic, I'm sorry!

[jennifer0246.livejournal.com]

E., I think your thoughts on this totally make sense here. Pitocin can be a not good thing, but when its the better of the things on the plate in front of you, it looks mighty appealing.

[vix.livejournal.com]

Baby registry here pls!

No birth plan yet, but maybe in a couple years. :)

[geminigirl]

Can't remember if I ever gave you the registry info-we're also encouraging people to deviate from it, especially for favorite childhood books. If I didn't give it to you, let me know. (I'm digging back at this post cause I needed to look at birth plan stuff again.)

[wolfden.livejournal.com]

Out of curiosity, did you brush your teeth and rinse with salt water when you used steroid inhaler before? That's what my mom had to do to be able to use it without getting thrush. She needed it to breathe so they were keen on finding a solution. She rinsed/gargled with salt water every time she used the inhaler. She may have even rinsed in between puffs. I'm not saying that's going to be your solution but wanted to put it out there for you as more information.

As to birth plans, I'll have to look for mine. I'm not sure I've saved it. My experience degenerated into "Birth Plan, what Birth Plan?" because of the pre-ecclampsia. I know we included things like no internal monitoring, no continuous monitoring, freedom to move around, mother's choice of position including birth position. Also, doula to be present, no pitocin after birth, no pain meds unless requested by us. No episiotomy (I had one stitch it was a minor upward tear). Seems like there was more though and I will look for it. I think the delayed Hep B shot for the baby was in the plan (as in not at the hospital) and nothing but breast milk and no pacifiers.

One thing I'd advise is having your wishes included for if things do go phlooey. Just be aware that when the interventions start they tend to compound. Hopefully, you'll have a complication free delivery.

I'll look around for the birth plan. It seems like something I should have saved.

[danger-chick.livejournal.com]

My mom got put on steroids this year and ended up with thrush, whereas I have been on them for 16 years or so without any problems. I was told to at least gargle some water afterwards, but I usually follow the doses with brushing my teeth. It's actually kind of useful, since I want to brush my teeth before I go to work and before bed so it's helped me to be more regular with my meds.

This does explain why you are not on the steroids, though. I had thought to ask you if it was pregnancy related, since some of them are class C and D drugs. But I forgot....

One other breathing thing. A friend of mine just had a baby about 5 months ago. She was out of breath a lot the last 3-4 months. She said it felt like the baby was sitting on her lungs. Maybe she was right, since it went away with giving birth. It was pretty weird, though. She would be sitting down and panting. Her husband is a lot taller than her and the baby came out really long.

[geminigirl]

It's likely a combination of two things-the guts squishing upwards as the uterus grows makes a lot of people short of breath-the only reason I was concerned is that it wasn't just short of breath, there was audible wheezing along with it.

The pulmonologist's NP suggested Pulmicort at the lower dose (though I can up the dose if I need to.) Pulmicort is apparently category B, and everything else seems to be category C or D. I'm willing to try just about anything at this point, so I filled the prescription for that, along with Singulair, Xopenex and Zyrtec. It seems to be working and I've incorporated it into the teeth brushing routine as you suggested, so we'll see how it works, and whether I end up with all the usual unpleasantness from the steroids. I do need to check on the whole breastfeeding issue though.

[danger-chick.livejournal.com]

Yeah, the wheezing is a bad sign. I hope the Pulmicort works and you don't get thrush again. I'd hate to have that happen to you. Tell me how well the Pulmicort works for you. You are the only asthmatic I know who's pregnant. I might need that information some day.

I haven't heard of Xopenex. I was on Zyrtec for awhile and hated it. You know how it says some people get sleepy? I was like a zombie. I had to switch off of it.

Birth plan

[puzzld1.livejournal.com]

I want a healthy baby please. The rest of this is secondary.

My big dream is to go, have a healthy baby, and go home, without any side trips to the NICU or the hospital at all. A lovely, vanilla experience, without drama would be wonderful.

Please avoid hyper-flexing my hips unless absolutely necessary. I had double THRs 3 years ago. Please remember I can’t really squat. Hips need to stay higher than knees.

Side lying for delivery last time worked great. Let’s see if it does again.

The only people other than Birth Center staff that should be around during the labor and birth are Chris, Samantha, Molly, Kim and Becca. My in-laws “dropped in” during labor last time. This didn’t make me happy.

After the birth, if anyone else comes to see us, I’d like advanced warning before they come in the room. Again, my in-laws managed to get in through the fire door while I was trying to breast feed. Not cool!

Kim and Becca are Molly’s support people. Molly should be supported in being present or not as she is comfortable. Her wishes are to be honored. Kim and Becca can help her with this. Molly is a smart and insightful kid and deserves trust.

Please do not keep Molly away from me if she wants or needs me.

Let Molly tell me the gender if she’s there.

Let Chris/Molly cut the cord.

I do not want to see the placenta. Once was enough for a life time.

I want to try to labor at home for as long as reasonable before going to the Birth Center.

No pictures during labor and delivery. Period.

I would love to avoid an episiotomy. Double for c-section.

Forgive all cussin’ please.

Gently encourage me to moan instead of scream.

Remind me that while it hurts, I am not being harmed so there is nothing to be afraid of.

I can get snippy about being touched too much under normal circumstances. I’m like a cat, sometimes it’s very good, sometimes it’s not. Please ask me, or ay least warn me before touching me Please respect my wishes without offense if I ask for personal space.

Last time I barfed a lot. I also crapped on the floor while pushing. While I understand this may be part of the “miracle of life” I was very embarrassed. If it happens clean up it up quick and reassure me that it’s no big deal.

I get hot easily. Hot leads to cranky. Please help me stay as cool as possible, especially by keeping my hair out of my face and off my neck.

The birthing stool worked really well last time for pushing!

Jacuzzi was good too.

With Molly, she went into respiratory distress a few hours after birth and went to the NICU. I am unreasonably anxious about this happening again. If this baby is breathing fine, please keep telling me this. If he/she isn’t- please tell me honestly.

I was born with bilateral hip dislocation. Please let me know if the baby’s hips check out OK.

[wait.livejournal.com]

We didn't have a written birth plan, but we gave a rundown to our midwife who just nodded and smiled.

In general, we wanted to have our medical professionals do occasional monitoring and to catch the baby. Unless there was fetal distress, we didn't want to be put on a time table. I refused an IV with a heplock that they could use "just in case." Any nurse worth a dime can get one started ASAP -- and it was much more comfortable not to have any wires attached to me for mobility. Every hour you can stand and walk during labor will reduce your time by 2 hours.

If you have pit, you most likely will want an epidural. Pit makes the contractions much worse. Epidurals keep you from moving around. So if they suggest pitocin, be sure you want it.

We found it really helpful to have my mom there, plus J. It meant I was never left alone and they were able to get a break.

If you want to talk, you know where to find me. :)

[entirelysonja.livejournal.com]

I refused an IV with a heplock that they could use "just in case." Any nurse worth a dime can get one started ASAP -- and it was much more comfortable not to have any wires attached to me for mobility.

Seriously, it depends on the person. I have difficult veins, and it literally took 30 minutes and 4 nurses to get a hep lock in for my second birth. Since I know I have difficult veins, I have no problem with having a hep lock in situations like this -- whereas I do have a problem with having an IV "just in case".

[rivka.livejournal.com]

Here's (http://rivka.livejournal.com/235016.html) my birth plan. We did wind up deciding to accept artificial rupture of membranes even though the birth plan said no.

There were some things I didn't have to put on my birth plan because I knew how my midwives operate. For example, I didn't have to worry about being on a "labor clock" (must dilate 1cm per hour or get interventions) because they don't believe in set schedules.

I'd like to see the registry when you put it together.

[rivka.livejournal.com]

One thing I notice in retrospect is that my plan didn't say anything about pushing positions. I think that was because I was confident that it wouldn't be an issue with my midwives. If at all possible, you want to avoid trying to push while you're flat on your back, or trying to deliver while you're lying down or sitting. Essentially, any pushing position that puts pressure on your tailbone is going to narrow the birth canal. I delivered on my hands and knees, and it was awesome.

[entirelysonja.livejournal.com]

Honestly, delivering my (9 pound, 12 ounce) son on my back was my own preference. And considering how quickly the pushing stage went, faster would definitely not have been better!

By which I don't mean to suggest that women shouldn't be free to adopt different pushing positions, and that various geometric configurations of the baby and mother don't call for different positions -- I just thought I'd throw out there that "on your back" isn't necessarily a bad thing.

[entirelysonja.livejournal.com]

Here's my birth plan:

Birth Plan for (my name)

General

I believe in remaining flexible during labor and considering various options as the situation warrants. To that end, it is important to me to have an opportunity to discuss various recommended procedures with my doctor so that I understand their advantages and disadvantages as fully as possible under the circumstances, and am able to make informed choices.

Upon arrival at the hospital

I understand that I will be required to have intermittent fetal monitoring for 20 minutes out of every hour. I do not wish to have continuous fetal monitoring without speaking with my doctor about its medical necessity.

I do not wish to have an IV without consulting with my doctor. I understand that I will be required to have a heparin lock.

During labor

I would like to be free to move around and adopt whatever labor positions seem appropriate. It is important to me not to be required to adopt positions I find uncomfortable for more than a few minutes at a time, unless there is an important medical need.

I would like to be permitted to drink clear liquids and suck on ice chips and hard candy as desired.

Pushing and delivery

I would like to push at my own pace, particularly during the early stages of pushing.

I prefer to avoid an episiotomy.

If a cesarean section becomes necessary, I would prefer to remain awake for the procedure.

After birth

As I am planning to breastfeed, I would like to have the opportunity to nurse my baby within the first 30 minutes after birth. I do not want my baby to receive formula or pacifiers without my specific consent.

Doctor’s Signature, Date

This birth plan reflects the policies of my doctor's office, some of which differ from the policies at the hospital where I delivered, so my main objective in a birth plan was to write something that I could show the nurses at the hospital if they wanted to do something different from what I wanted when my doctor wasn't around. Plus of course having my doctor approve the birth plan ensured that we understood each other.

I didn't write anything specific about drugs or amniotomy because it falls under the general umbrella of wanting to stay flexible and make decisions together with my doctor in the moment -- it's not like my doctor was going to shoot me up with narcotics or break the amniotic sac without my consent! I didn't write anything about not wanting the baby to be taken away because it's standard hospital policy where I delivered to do all the "newborn stuff" in the labor & delivery room.

[therealocelot.livejournal.com]

I'm sending mine via email. It's kind of particular to the hospital I delivered at - I would have written it differently if I had been delivering elsewhere. I didn't end up actually showing it to anyone at the hospital, and things went fine anyways, but I found it useful for sorting out my own feelings - trying to distill it down to one page that hospital staff will be more likely to pay attention to helped to sort out what aspects are most important to me.

Personally, I prefer the term "birth preferences" to "birth plan".

One thing I'd encourage - get specifics on what the standard low-intervention procedures are, and how far these can be modified without a fight. For example, does "No continuous monitoring" mean "monitoring 20 minutes out of every hour" (which is common, and can feel like more trouble than it's worth to get in and out of the bed/straps/etc.) or "check the heart tones briefly with a doppler every so often". It sounds in your case like it's the latter, what with being allowed to wander around and all.

[meepkitty.livejournal.com]

FWIW, I think you will be a wonderful mom. You have so much vitality and love - any young'un will be lucky to be yours. :)

[aliki.livejournal.com]

Aawwwww!!!

P.S. Since I already know your last name (*grin*) why dont you just tell us where you're registered. :P

[aliki.livejournal.com]

Also, thank you for your card, it's lovely!!

[geminigirl]

Babies R Us. And please don't feel like you need to send anything.

[baratron.livejournal.com]

Do you know ailbhe? She had a birth plan for her second child based on the trauma experienced during the birth of her first. She admins plan_survive which is a community you might be interested in anyway.

[fairion.livejournal.com]

I am glad you and the baby are doing well. Reaching the birth plan stage is exciting. We created a birth plan which ofcourse got thrown right out the window. I think more important than creating an ideal plan is talking with your partner and any birth assistants you will have about what interventions you will allow and under what circumstances.

For example, Hiranu knew that I did not want an epidural or a c-section unless it was a matter of life or death for either me or the froggy. I wanted as low an intervention level as possible but would accept other interventions above those.

I ended up with pitocin because my water broke but froggy knew it wasnt time yet. Pitocin definately cascades the interventions (ie fetal monitoring and limits to position/movement thereby causing a need for pain meds frequently) But even if you need intervention you can create a priority or reason list so everyone knows what is acceptable and when.

Does that make sense?

And count us in on those who want to see the registry when it is available

and on a seperate note I need you snail mail addy. can you email it to me
dolfin at lionden dot org

[geminigirl]

The registry is at Babies R Us-the registry number is 69990408 or you can find it by name. Please feel no desire to send anything unless you want to, but do know that I trust most of my friends who are smart, and who beautiful and creative things to go well outside the registry if they so choose.

We had a discussion about pitocin and interventions with the doula the other day, which helped. And as long as everyone knows the priorities-healthy Mom, healthy baby come first, and avoiding a c-section is second. C-section rates are horrible down here and VBAC is virtually legislated out of existence because of the malpractice laws, and my OB knows I don't want one, and the people who are my support team know, and so on. If we're talking "fetal distress" it's one thing. If we're talking "failure to progress" that's different entirely. The longer I can labor at home the better, of course, and so we'll do everything we can to make it work.

I'll e-mail you in a moment with current contact information.