Cover Letter for Birth Plan

I am giving you a copy of my birth plan, prior to seeing you for me next visit. I would greatly appreciate it if you would please read the following birth plan and letter before I see you at my next appointment on the 20th. I respect you as a Dr. and have had many positive recommendations of you from various people in the medical community, so I hope you can see why I feel it necessary to get my thoughts down regarding the rest of the pregnancy and labor, due to my complications. 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. That along with the fact, that my condition has been pretty much considered not an OB issue has raised some concern for me.As you know, 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. At the 34 week exam, you preformed a cervical check in which we used stirrups, this resulted in so much pain afterwards that for almost 48 hours walking was not a simple task. The information regarding SPD says to avoid stirrups, I should have reiterated that, but I didn’t and I take responsibility for that. As far as cervical checks go, at 32 weeks when the nurse practicioner did the cervical exam, she used the narrow gap technique and came at me from the side. I experienced only a little discomfort after this. This is something that I consider “good to know” and I am glad that we found out now.As you also know, I 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.We discussed two different induction dates. Either the 28th or the 1st. After seriously considering my last two inductions – I would like to try and schedule for the morning of the 28th. I feel that it is important that we try a morning induction, for a few reasons, but most of all – I need access to the PT on Staff at Southdale at the end of the labor. If we do the induction late in the day on the 1st – chances are we will deliver that night, and the PT will not be on staff. I am trying to be proactive to prepare for any outcome. Once pictocin was administered at both of my last labors, I went from not dilated to fully dilated within 5-6 hours out the outside. Hannah will be 37 weeks 4 days on the 28th. I understand that inductions are not normally scheduled until 38 weeks; however, as the pregnancy progressed and the weight on the joint intensifies, the damage is compounded each day. I personally do not consider this a voluntary induction by any means. If we need to do an amino to see if her lungs are ready, I am more than willing; however, I assume that at 37+ weeks that is not necessary. Let’s discuss….We also discussed the possibility of administering the cervical gel the evening before in the hospital. As I mentioned to you during our last visit, I would like to avoid this. I was given this with my 1st labor and it didn’t accomplish much, except for exhaust me for labor the next day. It is my understanding that this only start labor in less than 5% of women, but does aid in the softening of the cervix. If there are other options for that I would like to be made aware and have a discussion with you concerning these. I would also like to know what my bishop’s score was at my last appointment with my son. I did not need the gel and still my labor moved swiftly when the pictocin was started. (Under 5 hours) Let’s discuss….I want you to know that I appreciate your willingness to not have me deliver on back, that you understand that there are serious implications for me if I do. The plan as it is right now, is that my doula will bring a birthing stool. I have never used one, but after all the research on what positions would be the best, this seems to be an excellent option. Easier for me and hopefully easier for you, when the other options are hands and knees. I don’t think they are that common, and I don’t know if you have attended to a birth using a birthing stool, if not my doula does have further information on it, as well as a video to watch. Let’s discuss….