May 18, 2011

a cesarean birth plan

Yeah so April is over. And with it the deadlines I had for a few posts on c-sections. Meh, whatever. CAM might be over, but I'm still pretty aware of my c-sections regardless of the month, so I'll just bravely carry on.

When you're pregnant you hear kind of non-stop about birth plans. Some practitioners are in favor of it some, like my first midwife with Guthrie are superstitious about it - she said, "I think that whatever you write on it ends up happening" and some outright refuse to have anything to do with it.

Having written three birth plans - one for Guthrie, two for Laithe - I think they are useful for a number of reasons.
1. it forces you to think about (and prioritize) your preferences. Some believe that there is no such thing as a preference with a birth - you get the baby out. You hope it is healthy. You trust the Expert to do their job. Except that's not really how it is. Within the realm of a "normal, healthy birth" there are an astonishing array of decisions to be made.

2. it allows you space to discuss your preferences with your practitioner(s). You get to read their expression as they read your plan and frequently you learn a lot. A lot. The birth plan is an excellent tool to open a dialogue with those involved in your sacred experience. Because it is a sacred experience - regardless of method, of your level of consciousness, of who is present: when a person comes into this world it is sacred moment. Choose wisely and to the best of your ability who will be with you.

3. it gives you some insurance should your chosen practitioner not be there. Should someone get the flu. Should you get transferred to another care provider or location. I cannot say this enough - do not count on your chosen practitioner(s) to be your only advocate. It's just not good practice. In addition, I would even say do not count on yourself, spouse, partner, or family member to be your only advocate. Shit happens. You may be under general anesthesia and the pediatrician is wondering whether or not your baby gets a vitamin K shot and no one may be there to speak for you. Your own partner may forget you didn't want eye antibiotics because Oh My God he just became a father. It is good to have your desires known by those who will be giving you and your child care and it is good to have them be on a piece of paper.

And most of all because this is your first conscious act of parenting.

The birth plan we wrote for Guthrie was based on the belief that we would be in a hospital, that interventions would likely be suggested, and that we wanted a natural birth. The first birth plan we wrote for Laithe was based on the belief that we would be at home, that we would need people to know what pets we had, and that this would be a vbac. The second birth plan we wrote for Laithe was when we had a 24 hour window between scheduling a cesarean and actually having it.

Preparing for a non-emergent cesarean is a surreal experience - at least it was for me. Both times. Emergency c-sections are becoming more rare. The vast majority of people I speak with had a window between when they were told they would be having a c-section and when it occurred. Some have a few hours, some have a few days, some have years if they are told they will never have the option to birth vaginally.

Once we had the cesarean talk when I was laboring (or not) with Guthrie I believed I had no options; once I was in the operating room I was at the mercy of whoever else was in there - to this day I have no idea who delivered her. I even have my chart and the resident's name is not listed; only her supervisor's. (see why I feel strongly about #3?) I was wrong though.

You have options and a degree of control over:
- who will be with you - how many people can you invite to be there? With Guthrie both my mom and John were there, with Laithe, only John. The benefit to having two people was that my mom was able to stay with me after John went with Guthrie and the mass of peds. Both times we also brought in our camera which was good.

- what is going on in the background. There are frequently radios/cd players in operating rooms. Yeah, it is weird. I'll never forget listening to Taylor Swift while they were stitching me up from Laithe thinking, 'huh. Taylor Swift? really?' But trust me, I'll take Top 40 over the discussion that was going on between anesthesiologists during Guthrie's birth- the one about the MMC the resident was going to have to attend halfway through my surgery because he'd lost someone during surgery not long before. I was so doped up on meds that I couldn't get the words out to ask them to stop. That I was terrified and vulnerable and are you kidding me you're talking about this in front of an awake patient? A patient who's uterus is currently outside of her body? Really? We all watch TV; we all know about these meetings. It's really, really hard when you physically cannot be your own advocate.

- seeing and touching your baby. There are rumors that people have had their baby placed on their chest after a c-section. I was told both times that there wasn't enough room between my chin and the curtain. I did however, the second time know to request that one arm be untied (they velcro you down during surgery in a crucifix position. one arm has the IV in it, but the other is just velcroed.) Once they know how you will react to anesthesia, etc there's no reason you can't have the other arm undone so you can touch your baby. Being able to touch Laithe's little face was awesome.

- sharing the sex of your baby - We didn't find out the sex of either baby prior to birth, so one of our requests was that John announce the baby's sex. It was probably the best part of both births. You know, other than the actual baby.

- who goes with the baby - Once the baby is out s/he is taken to either the NICU, nursery, or your recovery room. As I said before we chose to have John go with the baby both times. It made me feel better that our child was in the care of his/her parent from the get-go. Taylor Swift kept me company. It was ok. On the other hand, I could certainly understand wanting your partner to stay with you because it is scary, there's no two ways about it.

There are other requests that we made that were not because I was having a c-section - like keeping my placenta (everyone asks questions about this one - and actually we forgot Laithe's at the hospital and John had to go back for it - it was really quite funny), having the baby receive cares in your room rather than the nursery, to not have the baby get nourishment from anywhere other than your breastmilk, to not circumcise, to not receive vitamin k or eye antibiotics.

Like I said before, this is one of your first conscious acts of parenting. And just because you know you're going to have a c-section, or know you're going to induced, or know you're going to have a homebirth doesn't mean you shouldn't write one. Because, not to be all doom and gloom, but we in fact do not know. Human life at its most basic, right?

And there was that one lady I met who was scheduled for a repeat c-section and went into labor early and bam had the baby within an hour - too quickly to even get the operating room set up -- and man was she pissed! What is that saying about grass being greener?

Go write your birth plan.

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