Birth Preferences

Let's see how this copies... but here is the birth plan

Birth Preferences for
Due Date: 8/14/05, induction on 8/1/05 or 7/28/05
Patient of
Scheduled to deliver at

7/8/05
To Whom It May Concern:
Please read the following birth plan. I understand that Dr’s and Nurses of today have many complications to learn about, that some of the lesser known or rarer complications are just that – lesser known. I have written the following birth plan to aid both Dr. and O/B nurses and any other labor assistants to understand the specific complications that I am going into the hospital with.
I have a condition called Symphysis Pubis Dysfunction (SPD) I have been diagnosed with both a pubic shear (at the worst point, the sheer was 2 ½ inches – where the left and right sides were vertically apart 2 & 1/2 inches). The pubic symphysis separation is an abnormal gap in the symphysis joint. The implication of the wider gap (while extremely painful and potentially disabling in pregnancy) is that a full separation could occur in labor and lead to a more serious disability. My goal is to avoid any further damage if at all possible.
I also have an issue where the bone is curved at the end. Please refer to any notations Dr. may have written in my records at *** regarding my last two births. Due to this curvature and the complications surrounding my first birth, Dr.*** previously decided that in order to be able to deliver vaginally, we would need to induced early make sure and not have a larger baby. My 2nd child was induced at 38 weeks, with little complications.
Due to these issue there specific things that I must be careful of and I ask that you also take them seriously:
1. I have to be extremely careful of birth positioning. Certain positions are better than others. Avoid stirrups!
2. I need to be sure that all labor assistants and Dr’s know all about SPD, what movements can hurt or damage me further, and what my comfortable range of motion is. We will use a 'narrow gap' between the legs for any routine procedures that can't be avoided
3. My goal is to avoid an epidural if at all possible, as this often is associated with more severe damage – I was induced with my 2nd birth and understand the intensity of a pictocin induced labor without an epidural. My goal is to be able to not have any pain medication in order to protect myself.
4. I have hired a birth attendant that is familiar with and can help resolve baby malpositions, which are common in women with SPD. She is also familiar with what positions are acceptable for me to labor and deliver in that should minimize any further damage to the joint. I ask that you give her the respect that she deserves in positioning me to the best of her ability if complications arrive.
5. My goal is to be induced in the morning, so that if I do have any issues after labor I want to be seen by a PT on staff almost immediately to determine if the joint has sheared. The PT can help put the sheered joint back into place and help with the separation if there is a fair amount. If the joint completely separates, I understand that surgery may be the only “fix” for this; however, that is what I am trying to avoid.
6. If you have any questions, please, please do not hesitate to ask. I do understand assisting in a labor like this will be out of the comfort zone of many professionals; however, I trust that together, we can make this work and hopefully the end result will be one healthy baby girl who has a mom that can still walk!

Sincerely,



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Labor
I would like to be free to walk around during labor. I wish to be able to move around and change position at will throughout labor.
I would like the lights in the room to be kept low during my labor, unless it is natural sunlight.
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Cervical Exams

I would prefer to keep the number of vaginal exams to a minimum, if they must be done, Use a 'narrow gap' only – come at me from the side of my legs – not the bottom.
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Monitoring

I understand that I will need to be hooked up to monitors with the pictocin; however, I do not intend to be confined to a bed. If there is a point where the contractions slow enough, I would like the ability to walk to halls a little to relive the stress on the joint.

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Labor Augmentation/Induction

I would like to avoid the use of the cervical gel the evening before in the hospital. If there is another way to administer this and not have to spend the night in the hospital, I would like to be informed of all my options. I did not need the gel with my son’s induction at 38 weeks and still my labor moved swiftly when the pictocin was started. (Under 5 hours)

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Anesthesia/Pain Medication

Please do not offer the epidural – I realize there are many medications available; however, my goal is to avoid an epidural if at all possible, as this often is associated with more severe damage – I was induced with my 2nd birth and understand the intensity of a pictocin induced labor without an epidural. My goal is to be able to not have any pain medication in order to protect myself.
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Cesarean

Unless absolutely necessary, I would like to avoid a Cesarean. If my Dr determines that a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process. I would like Husband, Ed, present at all times if Hannah requires a Cesarean delivery.
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Episiotomy

I would prefer not to have an episiotomy; however I would prefer an episiotomy rather than a tear.
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Delivery
• Use 'alternative' birth positions - These include standing, kneeling, and all fours in particular. Crowning and birth of the shoulders is the most critical time for prevent pubic symphysis damage, so it is important to 'let' a me be in whatever position feels best for birth. If I must be in a more 'traditional' position because of other concerns, we will try side-lying as this takes the pressure off of the pubic symphysis and allows the coccyx and sacrum to move somewhat. Otherwise, all-fours or leaning back over a birth ball or using the birthing stool will be best
o Avoid giving birth on my back - Many cases of pubic symphysis injury occur in this position
o Avoid giving birth semi-sitting/squatting position - This tends to force the baby's head against the pubic symphysis, putting pressure on it to 'give' more. It also prevents the coccyx/tailbone and sacrum from moving out of the way during birth, and thus the only joint available with any 'give' to it would be the pubic symphysis, which puts it at greater risk for damage
o Avoid use of stirrups - This widens the gap between the legs and strains the pubic symphysis
• Please know that I need to listen to my body – Hopefully I will know what position I need to take in order to help baby out while avoiding damage to the joint. My doula, Marla, has 5 pages of different positions that are acceptable for me. We have crossed out any that could cause further damage. Please refer to this if you have questions. This may be contrary to what you are used to, but please give preference to the positions that feel the best for me. My ultimate goal is to deliver my healthy baby and avoid further damage to myself.
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Immediately After Delivery

I would like to have my husband, Ed cut the cord. As long as she is fine - I would like to hold Hannah while I deliver the placenta and any tissue repairs are made. If Hannah must be taken from me to receive medical treatment, my husband Ed will accompany Hannah at all times.
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Postpartum

I would like to have Hannah 'room in' after I have had some time to recover, unless I have more server damage that needs to be assessed at the time. I would like Hannah with me during the day but have the option to have her in the nursery at night. I want her brought to me for breastfeeding. (Note: Be sure to check the breastfeeding preferences below)

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Breastfeeding

I plan to breastfeed Hannah and would like to begin nursing very shortly after birth. Please do not offer her a bottle. As long as she is nursing well, and has a good latch, I do not have a problem using a pacifier.
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Other

My support people:
My husband, Ed; my doula, Marla and my mother, Maureen -- I would like them to be present during labor and/or delivery.

I have included information on SPD for anyone who wants to learn more about this.