Planning what you can't plan

The birth of our babies is the biggest, most important day of our lives. Dare I say even more important and special than our wedding day. We spend months planning our weddings. Down to how every minute will go. It is kind of the same with birth. Like a wedding, you pay professionals thousands of dollars, or more throughout your pregnancy to get ready for the big day. You research everything under the sun, and find just the right people to be part of your big day. But here's the weird thing. You don't get to plan the date! It is so mind numbing to me to be preparing for this event so thoroughly but still be in the dark about when it will actually happen! I mean can you imagine approaching your wedding day that way? We would all be a complete wreck! So maybe this is why it is so hard to wrap my head around what is about to take place. I know something huge is coming. I know who will be there, where it will be, roughly how it will go. Heck I even have a lovely blue gown picked out! I know it will be a very painful, probably long, very intense day. I will need to use all the planning I did to get through. And in the end I will be meeting one of the most important people to me. The person I will love most for the rest of my life. But I don't know when it will be. It could start 10 minutes from now or 5 weeks from now. Man does that make for a bundle of nerves!

36 week appointment

I am 36 weeks and 4 days today. I had my doctor appointment this morning. I was really worried that baby was breech because I've been feeling all her hiccups up high instead of low. And I just felt like I couldn't make any progress towards labor that way. Not to mention it would be a challenge to get to do a breech delivery in the hospital. My doctor listened to her heartbeat and palpated my stomach and he is pretty sure she is head down. I really hope he is right! I'm measuring at 37 weeks and he figures she is about 6 or 7 pounds. I so hope she comes somewhat early and stays small! I have enough newborn sleepers to clothe twins and I want a chance to use at least some of them. I think Aimee maybe wore one newborn thing before going on to 0-3 month stuff. As I was leaving the office I realized I hadn't heard the results of my GBS test from 2 weeks ago. So I poked my head back in and asked. The nurse looked it up and I'm negative! I'm so happy about that. I did not want to have to deal with a battle over it or figure out what to do. My doctor said "so you can just come in and pop out a baby whenever you feel like it". I like this doctor so much better than the one I had with Aimee!

Now I just need to get my mind around the fact that I am actually having a baby and wait for labor to start. I can't believe it has gone by so fast.

My birth plan

Due date: 9/12/2011

Patient: Amanda Andrews (Mandy)


Patient of: Dr. Shumate

Delivering at: Samaritan Pacific Communities Hospital

I know that things change, but unless there is a genuine medical need I would like to stick to this plan as closely as possible. If a change needs to be made it should be discussed with me in full before proceeding.

Sincerely,

Mandy

Labor/delivery coaches: Husband-Joe and Mom-Dana . All other persons should be directed to the waiting room.

Labor/vaginal delivery

-         No IV, my doctor has given the ok for a hep lock.

-         Limited vaginal exams

-         Fluids and light foods by mouth throughout labor

-         Free to move, walk, and change positions throughout labor including birthing ball and tub use

-         No internal monitoring

-         No artificial rupture of membrane 

-         Wear my contact lenses or glasses throughout labor/delivery

-         I do not want to be offered any pain medications. If I want something I will ask.

-         Absolutely no pitocin

-         NO EPISIOTOMY, I will tear if necessary.

-         Would like the perineum supported while pushing to avoid tearing

-         Should I tear I would like a local for the repairs

-         Allowed to choose the position I deliver in.

-         A mirror to view baby's head crowning.

-         Do not want coached pushing.

-         Baby placed directly on my chest immediately after delivery

-         Hold baby during delivery of placenta and all initial exams performed on my chest.

-         All exams/bathing in my presence. Baby does not leave our sight. In the case of an emergency her Father must be with her.

In Case of Cesarean:

Unless absolutely necessary, I would like to avoid a Cesarean

-         To be fully informed and involved in decision making

-         husband present at all times

-         A spinal

-         Please help me stay calm by explaining what is about to happen and what I am feeling during surgery

-         If she is not in distress she should be put on my chest

-         Baby should always be in our sight

-          If baby has to be taken away due to an emergency, the Father must be with her

Baby care postpartum:

-      Baby laid on my chest right away

-      All cleaning and checking to be done in my presence

-      Baby is not to leave the room unless in an emergency, if this occurs, her Father must be with her at all times

 -     No Hep B shot 

-      Would like to try using a supplemental nursing system 

Feeling so removed

I am 36 weeks 3 days pregnant. With Aimee I couldn't wait to go into labor. I looked forward to the challenge and wanted her out! This time I still can't wrap my head around the pregnancy. Two of my friends' wives were in labor today and it occurred to me that holy cow, I'm next! But I don't feel like I should be next. I don't feel anything like I did when I was getting ready to have Aimee. When I'm going to bed at night and have a few contractions all I can think is, I don't want to go to the hospital or have to spend all that time in labor right now. It just isn't convenient. Or I start to feel sick and nervous. 

My house is all ready for baby. My family is ready and wating. And I feel like this isn't really happening. I don't know what to do or how to wrap my head around this!

I had the best doctor appointment today!

To start with, I was kind of nervous for my appointment because I wanted to go over my birth plan and a few other things. I was nervous that I would be in for a fight because I want things as natural as possible. Well my doctor was in emergency surgery so they sent the nurse in charge of labor and delivery and the nurse who teaches the child birth classes in to do my appointment instead. 

I am 34 weeks 4 days so they did the GBS test. I also have been having some strange discharge so they swabbed me for that. And I have been contracting pretty good so they went ahead and checked my cervix which I am totally ok with at this point. It was nice to have women doing it instead of my new, youngish, male doctor. I know it doesn't mean much, but I was almost 2 cm and 25% effaced with my cervix forward. I was only 1cm when I went into labor with my first daughter so I'm just happy to be making progress already.

I told them I would just wait and go over my birth plan and questions with my doctor at the next appointment. They said they had plenty of time and would be happy to go over it. Well it turns out I talked to the 2 best people! My doctor is new to this hospital so he wouldn't have been able to answer half my questions. They went down my whole birth plan and it sounds like this hospital is a lot more natural friendly than most. They told me just about everything on my list would be easy to accomodate. Such a relief! They also were able to go over some of the things I still wasn't sure about and answer a lot of questions. And because they are both Mom's and one of them is pregnant again, they were able to tell me all about the pediatricians in town. We are new to the area and I still had know idea who we would use. I've also had trouble getting my older daughter in to a doctor here because they are all full. Well I found out there is a PA that works in the office who is also a lactation consultant and specializes in feeding issues. She has plenty of room for new patients and both the nurses love having her for their kids.

This is where the lactation consultant part comes in. I had a breast reduction with nipple grafts almost a year ago so I'm not supposed to be able to breastfeed. I want to try though. The one nurse said she was unable to breastfeed her first due to being on chemo at the time. She said the hospital will set me up to try supplemental nutritian. Where I can have the baby eat at my breast through a tube but still suck on my nipples. This way I can breastfeed if there is any chance. This was the best thing I have heard in a long time! I have had such emotional trouble not being able to breastfeed and this is exactly what I need. That way even if my milk ducts don't work, I can still get the bonding and experience of breastfeeding. And I can get the help I need if my baby has issues with formula! It was also great getting to talk to a Mom who has been through the same thing and hearing how she felt and dealt with it.

I know this is getting really long, almost done. I was also able to get a few formula samples. I've asked for some before but always asked the wrong people because they were new to the office. Anyway I am so happy! All my questions were answered and my fears were put at ease. Now I am ready to do this whole birthing thing! 

What to take to the hospital

For me:

nursing bra

2 sports bras

2 loose comfy outfits, shorts and t-shirt that can be ruined

short sleeve robe

going home outfit

socks

underwear

Food:

Gatorade

fruit cups

applesauce

granola bars

cliff bars for Joe

crackers

Travel sized toiletries:

chap stick

Vaseline for a dry nose

shampoo

conditioner

loufa

body wash

face wash

lotion

face moisturizer

tooth brush

toothpaste

contact case

contact solution

eye drops

glasses

deodorant

brush

hair ties

head band

makeup

Last minute things:

laptop, charger

phone charger

boppy

birth ball

camera, charger

carseat

For the baby:

going home outfit

a few onesies 

2 sleepers 

2 hats

 a picture outfit

2 baby blankets

2 burp rags

For Joe:

toothbrush

deodorant
3 pairs of comfy clothes
shorts and t shirt for sleeping
going home outfit
swim trunks


3 copies of birth plan
certificates to get free formula
bag to put goodies in

Everything that comes next

I just came across this and am so sad that I forgot to finish it at the time. I would try to finish writing it now but I just don't remember it very clearly. So I will at least post what I have. Maybe sometime I will come back and try to add to it.

Amelia Dannielle Andrews was born at 10:11pm on December 18th, 2008 after 35 minutes of pushing. She weighed 9lbs, 10.8oz.and was 21 inches long with thick dark hair. I guess she had such a conehead at first that my Mom was worried about her. I was too busy being in awe to notice. She got an APGAR score of  8 the first time and 9 after 5 minutes.


After holding Aimee for a few minutes I passed her off to the nurses to clean and measure. At this point the doctor started stitching me up. I was torn as far both ways as I think is physically possible. It took over an hour of constant stitching before he was done. I asked how many stitches I had and the doctor told me he had stopped counting. This whole time my legs were in the stirups and they were starting to go numb. Just when I thought I couldn't take any more, he was done. I was so hungry after all that work. The nurses brought me a tray of sandwiches, fruit, cookies, and who knows what else. Right about that time the new nurses came on duty for the night. One of them was so sweet , she even made me a chocolate milkshake! I can't remember ever being that hungry and happy.


Somewhere during all this I got to nurse for the first time. Aimee latched on right away.

Hibiclens for GBS

I have been looking into treating GBS with hibiclens. Below are the links I was given to research. Of course the most useful one to me is the Hibiclens flush protocol. I will be doing this before my test this week in hopes that I come back negative and can avoid the whole antibiotics dilemma all together.

Hibiclens Vaginal Wash as an Alternative Treatment to Antibiotics in Labor

Some research has demonstrated the effectiveness of using a Chlorhexidine (Hibiclens) vaginal flush to prevent newborn GBS infection. Hibiclens is an over- the-counter, medical grade antiseptic and antimicrobial soap.

Hibiclens Flush Protocol

Studies on Hibiclens for GBS:

J Matern Fetal Neonatal Med. 2002 Feb;11(2):84-8. Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. Facchinetti F, Piccinini F, Mordini B, Volpe A.

Lancet. 1992 Jul 11;340(8811):65-9.Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. The Swedish Chlorhexidine Study Group. Burman LG, Christensen P, Christensen K, Fryklund B, Helgesson AM, Svenningsen NW, Tullus K.
 

Eur J Obstet Gynecol Reprod Biol. 1995 Aug;61(2):135-41. Randomized study of vaginal chlorhexidine disinfection during labor to prevent vertical transmission of group B streptococci. Adriaanse AH, Kollee LA, Muytjens HL, Nijhuis JG, de Haan AF, Eskes TK.

Obstet. Gynecol., November 1, 2007; 110(5): 977 – 985. Chlorhexidine Vaginal and Neonatal Wipes in Home Births in Pakistan: A Randomized Controlled Trial S. Saleem, T. Reza, E. M. McClure, O. Pasha, N. Moss, D. J. Rouse, J. Bartz, and R. L. Goldenberg

Pros and Cons of 11 common labor positions by Paulina G. Perex, RN, BSN, CD, Lcce, Facce

Pros and Cons of 11 Common Labor Positions

Posted on July 27th, 2011 by Lamaze International | Find Out More About Lamaze International

By Paulina G. Perez, RN, BSN, CD, LCCE, FACCE
Movement and positioning in labor work magic. Movement enhances comfort by stimulating the receptors in the brain that decrease pain perception. The result is that you are able to tolerate increasingly strong contractions. When contractions become very strong, endorphins are released and pain perception decreases even more. Ultimately, your movement in response to your contractions decreases pain and facilitates labor – a win-win. Movement also helps the baby move through the pelvis, and some positions enlarge pelvic diameters.
The positions shown here facilitate the normal, natural process of labor. What position should you use? Follow your body. Move freely in response to what you feel. Your body will let you know just what position is best at every point in your labor.

STANDING SUPPORTED SQUAT

Pros
 Realigns your pelvis to increase the opening by up to 15 percent
 Allows you to be supported by your standing or sitting partner, the wall or a squat bar
 Takes advantage of gravity
 Makes contractions feel less painful and more productive
 Lengthens your trunk and helps your baby line up with the angle of your pelvis
 Movement causes changes in your pelvic joints, helping your baby through the birth canal
 May increase your urge to push in the second stage of labor
Cons
 Requires a strong partner
 May be tiring for both of you

SITTING ON TOILET

Pros
 Helps relax perineum
 You get used to an open-leg position and pelvic pressure
 Uses gravity
Cons
 Pressure from toilet seat may be uncomfortable

SITTING

Pros
 Good for resting
 Uses gravity
 Can be used with continuous electronic fetal monitoring

Cons
 May not be possible if you have high blood pressure

SQUATTING

Pros
 Encourages rapid descent
 Uses gravity
 May increase rotation of baby
 Allows freedom to shift your weight for comfort
 Allows excellent perineal access
 Excellent for fetal circulation
 May increase pelvis diameter by as much as 2 centimeters
 Requires less bearing-down effort
 Descent is encouraged by the position
 Your thighs keep baby well aligned

Cons
 Often tiring
 Sometimes hard for health-care provider to hear fetal heart tones
 May be hard for you to assist in birth if you wish to do so

SIDE-LYING

Pros
 Helps get oxygen to the baby
 Good resting position
 Helpful if you have elevated blood pressure
 Fine with epidural
 Can make contractions more effective
 Easier for you to relax between contractions during the second stage
 Can slow a birth that’s moving too fast
 Your partner can assist in the birth by supporting your legs
 Lowers chances of tearing or the need for episiotomy
 Good access to perineum
Cons
 May be hard for health-care provider to access fetal heart tones
 No help from gravity
 If no one can hold your legs, you must support them on your own
 You may feel too passive in this position

WALKING

Pros
 Uses gravity
 Contractions are often less painful
 Baby is well aligned in your pelvis
 May speed labor
 Reduces backache
 Encourages descent
Cons
 Not recommended if you have high blood pressure
 Cannot be used with continuous electronic fetal monitoring

STANDING

Pros
 Uses gravity
 Helps get oxygen to the baby
 Contractions are more effective and less painful
 May speed labor
 Helps create a pushing urge
Cons
 Poor control at birth
 Hard for health-care provider to see the baby

LEANING OR KNEELING FORWARD WITH SUPPORT

Pros
 Can help shift the baby if needed
 Uses gravity
 Birth ball can be used
 Contractions are often less painful and more productive
 Baby is well aligned in your pelvis
 Relieves backache
 Easier for your partner to help relieve your back pain
 May be more restful than standing
 Good for pelvic rocking
 Less strain on your wrists and arms
Cons
 Hard for health-care provider to help with birth

KNEE-CHEST

Pros
 Good for back labor
 Assists with rotation of baby, if needed
 Takes pressure off hemorrhoids
 Good position to avoid tearing or episiotomy
 Good delivery position for large baby
 Helpful if fetal heart tones are low
Cons
 Hard for your support team to maintain eye contact with you
 Hard for you to see what’s going on

SEMI-SITTING

Pros
 Comfortable
 Good use of gravity
 Good resting position
 Works well in hospital beds
 Good visibility at birth for your support team
 Easy access to fetal heart tones for your health-care provider
Cons
 Access to your perineum can be poor
 Mobility of your coccyx is impaired
 Puts some stress on your perineum but less than when lying on your back

ON BACK WITH LEGS RAISED

Cons
 Works against gravity
 Compresses all major vessels
 Tearing or need for an episiotomy is more likely
 No use of gravity to aid in birth