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birth plan help - pain relif and intervention


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  #1  
July 20th, 2012, 10:15 PM
NewGurl's Avatar Mega Super Mommy
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so Im trying to make a birth plan or at least get the idea of one and also make sure its one my hospital will be able to provide and Im kind of stuck. I want to at least try a natural birth or as close to one as my situation allows when the time comes but I wanted to have medical preferences chosen encase I need them. except even with research I dont feel strongly inclined to any options being the "best". also how do I actually know when its time to say ok guys I need some help here.

Im pretty sure my hospital gives all the standard options but ill list them just in case. for pain relief these are the non "natural means" choices my hospital provides..............

Pain relievers, such as meperidine (Demerol), fentanyl , or nubain
An epidural
Spinal anesthesia
Nerve blocks *normaly a pudendal block*

the hospitals site explains them and gives Pretty good pros and cons for each but I still have no Idea which one to chose if i decide I cant handle it. Is this something you should really just leave it up to the doctor because they will know which is best? or should you have some pretty concrete steps set out? Just looking for opinions, experiences, or medical standpoint here. what have you used, what will you use, whats safest ect.


Intervention wise Im slightly confused as to how to know when to say yes Induce me ( if its aplicable) I hear alot of ppl say doctors pressure to induce or augment to stay on schedule even though its not necessary but some times it is necessary so how do I know If im being an idiot by telling them to Back off? I mean how long do you wait for "true contractions" after your water breaks? How far past due Is to far? what blood pressure is actually to high? how long is laboring to long? I dont mean to be annoying but Google seriously does not answer these questions the answers out there are so far apart its ridicules. And Iv heard some tru horor stories about hospital births Im hopeing I have a great doctor/ nurses whos judgment calls I can trust but I really want to be at least simi comfortably knowledgeable. I dont want to be distraught through the whole thing being jerked around becuse they dont care and I dont know whats even going on.

Also I wanted to get your opinions On fetal heart monitoring I was thinking Intermittent external monitoring for just in case. But apparently I can chose to have no monitoring*srry mis typed no tether monitoring* or continual although I see no reason for continual Unless something is wrong Perhaps theres something I dont know about.

sorry I just brain farted my questions all over you guys I just feel like the more I try to learn the less I actually know.
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Last edited by NewGurl; July 21st, 2012 at 02:52 AM.
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  #2  
July 21st, 2012, 12:44 AM
Irene.C's Avatar Veteran
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The concerns you have are a lot of the ones I think about too. The babycenter.com has a great info section that addresses a lot of this in a summerized form. Birth plan worksheet | BabyCenter scroll down a little and there are links to individual concerns. From what I have read from the Bradley method there is never really a necessary time to induce unless you have pre eclampsia or something like that where you are in danger if you carry the baby longer. If you do induce you pretty much need an epidural since the contractions are so much more painful.
Does the hospital offer Nitrous Oxide gas? That would be the best pain management option but few hospitals have it. It lessens pain with out interfering with you mentally or physically. From what I have researched on opiate derivatives, demerol, phentanyl, ect they dont really help much with labor pain and just kind of drug you out. My plan is that if I need pain management I will go to epidural.
As far as time deadlines go I was in the thinking that I am gonna just say no when they say its been too long or that I have been pushing too long to be forced an intervention. Well then I was talking to some ladies that have had natural births and the one was saying that the dr said he had to try vacuum or forceps or c section cause she had been pushing for 3.5 hours. Well I guess it wasnt the fact it had been 3.5 hours it was that she was exhausted and was not able to do any sort of effective pushing at that point. It was her husband that said to her you are exhausted and cant do it yourself anymore. She got the vacuum and it worked. So I guess you want the dr to not make decisions based on time but on how you are presenting. Also I think your birth partner needs to be very informed on what you want and know you very well so they can help with those decisions.
For my birth plan I have an itemized one that is for my husband but for the one I give the hospital is going to be more of a statement saying something like I plan to have the most natural birth possible few the fewest interventions and I would like your help in achieving this.
This is my first baby so really I am not an expert in any of this advice I thought I would just share some of my thoughts on the matter.
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  #3  
July 21st, 2012, 02:09 AM
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I'm not making a birth plan. Whatever happens when the time comes will happen. I have already decided to accept pain relief and the epidural. Typically the nurses know when to give those, same with the doctor and the epidural. If they decide to induce, I'll let the doctor make that call. They've been doing this a lot longer than I have! I suppose you can say my "plan" is to go with the flow. The only thing I don't want is a vacuum assist.

And as far as fetal monitoring... I'm pretty sure if you're in bed, you'll be hooked up to the fetal and contraction monitor. They need to track the contractions, as well as they babies heart rate during those contractions. Its important to know if your baby is having decelerations. Those aren't good. So, there is a need for it... its not something they typically do just for fun.

A high blood pressure is anything over 140/90, or what your doctor decides is high for you. For example, I usually run 90/60 or in that area. So, if I'm up in the 130's, it'll probably concern my doctor.

As far as doctors inducing to fit into a schedule... those are typically the doctors who you'll notice in your office visits that rush thru things. You can always ask your doctor what his/her opinion is on things like induction and c-sections. That'll be a good tell as well.
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  #4  
July 21st, 2012, 03:12 AM
fancypants27's Avatar Mega Super Mommy
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Just to mention you should also include whether you prefer to have an episiotomy or to tear naturally if it comes down to it...

If you plan on breast feeding, you can put no bottles / cup only (if baby has to leave your side for whatever reason).

In terms of meds, my hospital does not give you a choice. It's either epi or no epi. (Of course you can change your mind if you say no epi and then decide to have one)
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  #5  
July 21st, 2012, 05:42 AM
Katie81's Avatar Platinum Supermommy
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I've been induced twice, the first was at 41 weeks, the second at 38.5 weeks. I was already 3cm and 80% effaced with the second pregnancy and wanted the baby delivered by my OB.

As far as pain relief, no one forces anything on you. If you ask for it they will provide it. With my first I started with Stadol IV and then asked for an epidural. The nurses and doctors will give you advice on timing.

For monitoring, my choice is to be monitored at much as possible. The only way to know if the baby is in distress is to monitor. My first baby had the cord wrapped around her neck and her heart rate dropped majorly. She had to be emergently vaccumed out.
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  #6  
July 21st, 2012, 06:31 AM
LindsayGriff
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For pain relief, I would go with the epidural but sometimes you wait too long before you decide on it and then it not an option. If you go with the drugs, they can sometimes then get to the baby and cause decreased breathing for the baby. I had stadol last time but it was after delivery when I was still hemorrhaging and they had me on 3 different meds to make my uterus contract down so I felt like I was still in full labor. At the time I was so druged up from it that I didn't know where my hands were in space, I was just floating. At the time I really didn't care because I had been going like that for about 8 hrs before they finally gave me the drug and I was so sick of being in pain I just wanted any relief. I would not have wanted to feel like that during delivery because then I wouldn't have been able to hold the baby right after delivery as I had no sense of control of my arms. The spinal is really only used during c.sections. It gives a set amount of time for pain relief. If you got a spinal during vaginal delivery, it could wear off before you actually deliver, the epidural leaves a catheter in your spine that can continue to deliver the pain meds.

As for being monitored, the general rule is anytime you are back in bed they will monitor you. It helps keep an eye on the baby and if the baby is in distress from your contractions. I would choose to be monitored if you are in bed because there is really not a reason not to. You can have the monitor off if you are up and walking around but if you get the epidural then you are bound to the bed after that anyway so you might as well be monitored.

As far as blood pressure, high blood pressure is considered >140/90 but they can treat this with medications if you are still early and not ready for delivery. What they really monitor when your blood pressure rises is whether you are developing protein in your urine. That could be a sign of pre-eclampsia and then if you are developing pre-eclampsia then you need to deliver as that is the only treatment. Failure to deliver when you have pre-eclampsia can lead to full eclampsia which leads to seizures

Finally as far as inducing, most places will let you go to 42 wks before they induce you. If your water breaks naturally then you do need to deliver within 24hrs of your water breaking, otherwise you risk developing infection so if you are showing no progress after about 18 hrs of your water breaking then they will probably start talking induction.
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  #7  
July 21st, 2012, 06:35 AM
kristiemarie518's Avatar Mega Super Mommy
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IMO, you won't be saying much at all during labor. Lol. But seriously, once you get that far your reasoning and what not generally go out the window so it's important to know ahead of time what ou want and have an advocate present (hubby, bf, mother, etc) to execute your wishes. Being in a hospital setting changes a lot. It's hard to ask about medical intervention decisions because at this time, you can't say anything about the actual condition. In theory and in reality are very different and every situation is different. What is an emergency for you may not be for me. I know that i came pretty close to a c section (they had prepped the or) but my doctor wanted to try several other options first before resorting to surgery to get her out. But we had literally minutes to decide so any birth plan I had was forgotten pretty quickly.

So trusting your doctor is really more important than any birth plan. I'd talk to you Ob and lay this plan out with him. He will know better how to direct you in making what plans you can make and in what order to make those decisions. (natural birth first w/ no episiotomy, natural with episiotomy second, forcepts if necessary third... Etc)
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  #8  
July 21st, 2012, 08:11 AM
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I had a completely natural birth with my son, but with DD I was having contractions less than 5 minutes apart and not feeling them at all - additionally, my water had a pinhole leak and we had no way to know how long it had been that way, so inducing was the best option to make sure she didn't get an infection. With her I had IV pain meds... With both of them I had constant monitoring & good thing because my daughter was having decels which required a change in position to fix- had she not been monitored, I don't want to think of what could have happened.

I am so scared of having anything near my spine that I would never do an epidural or spinal, so I'd pick IV drugs over either of those options, but that is a personal choice.

As far as inducing, I would hope you'd feel comfortable enough with your Dr's advice on the subject. Maybe letting them know you'd like to avoid, but to advise when they feel it would be necessary. Trusting your dr is very important.

I think I expressed my feeling on the fetal monitoring, but a lot of that can depend on whether you are still mobil or not, so it might be a case where you can be unmonitored until your in active labor so you can move about prior.

There are so many other things you have to decide on too, whether if necessary they can use forceps, vacuum, episiotomy...

With all of my births, I never had a plan going in, but knew basically what I wanted. All throughout, they gave me options & I am just going to do it the same way this time. I never felt pressured to choose one way or the other, but I also trusted my Dr's advice, so if it sounded like what I wanted, I went with it...
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  #9  
July 21st, 2012, 09:18 AM
Think4Yourself's Avatar Mega Super Mommy
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Oh man, I just typed out a lot and then pressed the back button! Darnit! lol

Well anyway. Does your hospital have birthing classes at all? Most of them offer them, and I know mine was wonderful. They explained everything about medications, induction, laboring positions, hospital policies, etc etc etc. It was great! They were a bit pricey for us at the time and they let us pay what we could.

IMO there is a difference between going with the flow, and being uninformed. Knowledge is power and it's always a good idea to know what is going on and what your choices are, and it sounds like that's what you are trying to do, which is great! It does take some time to learn everything, so try not to get overwhelmed with all the information.. also a lot of it depends on specific cases.

With ds, I didn't make a birth plan, but went in with an idea of what I wanted. The nurses asked me upon admission what my pain management plan was and I told them I wanted to try natural but if I needed pain meds I want IV meds and I will ask for them. They never brought it up again until I asked for medication. Now, personally, I hated them. This will vary from person to person b/c everyone is different, but I am sensitive to pain medication and while it did nothing for the pain passed the first 15 mins of working, it made me dizzy, tired, out of focus and confused. I don't remember my son being born now because I was so out of it.. and I think it actually made the pain worse because I could no longer focus through the contractions. Of course, this experience will vary depending on the individual but this was my experience with fentanyl (I got my birth records to see what I got so I can avoid it like crazy this time). I have read others' similar experiences with this and other narcotics while in labor. I think it just depends how sensitive you are to that stuff. Also there are side effects as it does pass to the baby, and because my son was born quickly he experienced some of them. He had a hard time regulating his temperature after birth which is a side effect, and needed the heat lamps for a bit.

Epidural is really the only other COMMON choice during regular labor. Like with the narcotics it's pretty case by case and depends on the individual and labor. It can slow down and stall labor, could only work halfway or barely at all, or they can use too much where it makes it harder to push the baby out b/c of lost feeling, etc etc. Can cause your blood pressure to drop, causing issues, and overall it increases the risk for other interventions such as forcepts, pitocin, and c-section. You will be numb after birth and sometimes itchy as it wears off. But this is not always the case and some women have no issues with the epi.. and unlike the narcotics it WON'T affect your mind in any way.. no cloudiness or loopiness like with the narcotics.

As for induction, there are multiple ways to start this but most will use pitocin. Pitocin will cause your body to contract, normally stronger contractions than you will have naturally. A lot of doctors will offer induction early. My doctor said if I didn't go into labor by my due date, she would induce me if I wanted a day before 40 weeks. This is common. The important thing to remember is sometimes body and baby are not ready at the due date.. it's supposed to be just an estimate. So therefore getting an elective early induction can increase the need for other interventions, including c-section for failure to progress b/c the body wasn't ready. It also will give you harsher contractions, with the result being more likely to need other medications which can in addition to the early induction put you at risk for even more interventions. Normally induction is not *needed* until a couple weeks after that due date, and if you choose to decline induction you will be monitored to make sure the baby is still doing okay passed the due date.

As far as when to go in, you will know . After my water broke, I had hard contractions right away, but this isn't always the case, sometimes it takes time. Hospitals have policies on how long they will let you labor after water breaking, due to the increased risk of infection being introduced. But real labor contractions are much stronger than the braxton hicks, or "fake" ones and normally you will be able to time them and tell when it's time to go in.

As far as monitoring, they will have a thing around your belly that will monitor the baby during labor. If you choose to go into the shower/tub or walk around, etc, they will let you get off of it usually to go do those things, and come back to check intermittently. As long as there are no complications that's pretty much how I always hear it done.

I think that was all your questions lol. If you have any more just ask! The only way we can learn more is to ask and read, read read. See if your library has any birth/labor books.. those helped me learn a lot too.
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Last edited by Think4Yourself; July 21st, 2012 at 09:23 AM.
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  #10  
July 21st, 2012, 10:24 AM
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I am not good with pain, so I elected for the epi. With my DS though, i went pretty quick so I didn't have time for to get it, so if you do decide to go with the epi, make sure you ask in plenty of time for the anstesiaologist to get to you. With my first, i had gotten to much and did have a hard time pushing her out but the nurses were able to "help" by pushing on my stomache, but she was fine. I never had any issues with any of the epidurals so i will be getting one this time too...

DH has some older daughters and both went completely natural. We were there for one of them and she went into the tub alot and it seemed to help but she was still in a lot of pain towards the end and got some nubain for her IV and that seemed to have helped her tremendously and allowed her to relax enough to help her progress more... I don't have any 1st hand knowledge though because i always got the epi....
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  #11  
July 21st, 2012, 10:40 AM
mollymalone's Avatar Mega Super Mommy
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Thanks for asking these questions... and for all of your answers! Everything makes so much more sense when you hear 1st hand experiences, rather than reading dry, technical info on the web. Sometimes the information is just overwhelming!
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  #12  
July 21st, 2012, 03:16 PM
Cocoa Sashimi's Avatar Usually Lurking
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1) If your hospital offers one, take a birth class. Our instructor covered all the standard major birthing scenarios and equipment we could possibly see at our hospital.

2) Make sure you have open lines of communication with your doctor AND your nurse/nurses. Those nurses will keep track of your birth plans.

3) If you bring in a written birth plan, don't bring in pages upon pages. The nurses and doctor don't have time to read it. Itemize it on paper or on index cards (pain management, induction, etc.).

4) Your partner needs to be aware of what you want. Once again, keep it simple for him.

5) Be prepared for the possibility that your birth plan may get thrown out the window if complications arise.
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  #13  
July 21st, 2012, 04:10 PM
mrs.wagner.10's Avatar Mega Super Mommy
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No pregnancy is text book. No pregnancy is also going to go the way you have planned. My birth plan is to go with out a epi DH thinks its a bad idea and all of my family is against it and saying im going to get the drugs. We shall see. Johnathon finally said that he was ok with it but if at any point he thought it was to bad for me to handle and I was just being a stubborn ***** to prove a point he would then make me get one. This is if I dont have to have a C. At the same time I know there is other meds that you can get that you don't have to have in your back. My ob already knows how I feel about labor and what I want and he is all for natural child birth if women want it. Just keep in mind things may not go the way you want them too! Dont be so dead set on something that if something comes up your upset that you didnt have it your way.
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