Birth plans, c-section, premature birth etc.

I'm looking at writing a birth plan and getting it on file. The thing is
that this delivery WILL be a c-section, since my last delivery ended up
having to be a classical C, so I can't VBAC, and most of the examples I've
found don't deal with that. I would like to breastfeed/pump if at all
possible, but unless someone else is staying with me, I don't know about
having the baby room in for the first 24 hours or so because of recovery
pain (I've had abdominal surgery twice now-I have a good idea of how much
pain I'll be in right afterwards).

In addition, I have a 50% probability that this will end up being another
premature delivery. Therefore, I assume the birth plan will have to be
changed in that instance, and I don't know what is reasonable. If it's
another premature birth, I will probably be on pretty heavy medication
(since that would imply a recurrance of the HELLP), and I don't know if
breastfeeding would be reasonable or not.

Does anyone know of any examples online or have suggestions for birth plans
when you already know it isn't going to be a "perfect" delivery? There's so
much that I really can't control that I want to make sure that in areas
where I can make a choice, I get to do so.

Donna Metler wrote:
I'm looking at writing a birth plan and getting it on file. The
thing is that this delivery WILL be a c-section, since my last
delivery ended up having to be a classical C, so I can't VBAC, and
most of the examples I've found don't deal with that. I would like
to breastfeed/pump if at all possible, but unless someone else is
staying with me, I don't know about having the baby room in for the
first 24 hours or so because of recovery pain (I've had abdominal
surgery twice now-I have a good idea of how much pain I'll be in
right afterwards).

Is there a reason you think you won't be able to have someone stay with you
in the hospital? Because, as a general, I've found hospitals to be very open
to new mothers having a family member stay with them during their time in
the hospital. I had someone with me the entire time after each of my
births--my husband with #1 and #3 and my mother with #2. I'd had pretty
uncomplicated births each time, but I certainly wouldn't have wanted to try
to manage the whole thing on my own in the hospital, that's for sure.

In addition, I have a 50% probability that this will end up being
another premature delivery. Therefore, I assume the birth plan will
have to be changed in that instance, and I don't know what is
reasonable. If it's another premature birth, I will probably be on
pretty heavy medication (since that would imply a recurrance of the
HELLP), and I don't know if breastfeeding would be reasonable or
not.

I don't know what meds they give for HELLP, so I can't advise on their
compatibility with breastfeeding. However, if you *do* have a premature
infant, the benefits of breastmilk are significantly greater than for a
full-term infant, so I think it's something you should certainly find out.
(You need Dr. Thomas Hale's book _Medications and Mother's Milk_. No other
reference is as authoritative. The PDA and manufacturer's inserts are
useless.)

Depending on how prematurely you deliver (if you deliver prematurely at
all), you may not be able to breastfeed directly at all to begin with,
simply because baby won't have the necessary suck reflex. But whether you
pump and feed colostrum/breastmilk or feed formula and pump merely to
establish supply until any incompatible drugs clear your system, you should
specify that all feedings should be done either using a tube or a
finger-feeding device. If you want to have a chance of breastfeeding
successfully once your baby develops a good suck, you absolutely don't want
him/her to have been incorrectly trained by a bottle!

I think that about covers the contingencies on that score, anyway.
--
Be well, Barbara
Mom to Sin (Vernon, 2), Misery (Aurora, 5), and the Rising Son (Julian, 7)

This week's suggested Bush/Cheney campaign bumper sticker:
"Leave no child a dime."

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

In addition, I have a 50% probability that this will end up being another
premature delivery. Therefore, I assume the birth plan will have to be
changed in that instance, and I don't know what is reasonable. If it's
another premature birth, I will probably be on pretty heavy medication
(since that would imply a recurrance of the HELLP), and I don't know if
breastfeeding would be reasonable or not.

Do you know how breastfeeding-friendly your hospital is? If they are
good, maybe just put in a short birth plan that you'd like them to do
everything possible to help you breastfeed (like having them wake you to
pump, if you're able, and requesting BF-friendly medications)? I'm
guessing that a simple, "This is what I'd really really like, so please
help me in whatever ways you can to achieve this," and maybe some
possible suggestions, may get you the best results, since you can't
predict how things will be going.

Good luck! I hope the HELLP doesn't come back and that your birth goes
as smoothly as possible.

Mary S.

"Donna Metler" wrote in message ...
I'm looking at writing a birth plan and getting it on file. The thing is
that this delivery WILL be a c-section, since my last delivery ended up
having to be a classical C, so I can't VBAC, and most of the examples I've
found don't deal with that. I would like to breastfeed/pump if at all
possible, but unless someone else is staying with me, I don't know about
having the baby room in for the first 24 hours or so because of recovery
pain (I've had abdominal surgery twice now-I have a good idea of how much
pain I'll be in right afterwards).

My DH was able to stay in the room with me, and my mom came when he
wasn't able to be there. Of course, right after the section I was in
recovery for some time, and he spent that time in the NICU with DS.
Does your hospital not allow you to have someone else in the room with
you overnight?

In addition, I have a 50% probability that this will end up being another
premature delivery. Therefore, I assume the birth plan will have to be
changed in that instance, and I don't know what is reasonable. If it's
another premature birth, I will probably be on pretty heavy medication
(since that would imply a recurrance of the HELLP), and I don't know if
breastfeeding would be reasonable or not.

I breastfed a premature baby after an emergent c-section at 34 weeks
for severe pre-eclampsia, and no one said anything at all about
breastfeeding being contraindicated because of it. They assumed I
would be breastfeeding and gave me meds compatible with it. I was on
the mag, blood pressure meds, and painkillers, fwiw.

Is the HELLP likely to recurr, or is it just (just!) that you're at
very high risk for PE? I thought HELLP had about a 5% recurrence rate
but made it more likely that you'd get severe PE -- that's why I'm
asking.

The sucking reflex kicks in at right around 34 weeks, so if your baby
is earlier than his or her sucking reflex you will have to pump. Be
prepared for the NICU to tell you that they do not believe in nipple
confusion -- heck, be prepared for the IBCLC to tell you that she does
not believe in it and to give the preemie a pacifier. There is
actually a new study saying pacifiers don't interfere with preemie
breastfeeding and they will want to provide what comfort they can and
you will not be able to be in NICU all of the time if they want you on
your left side with an IV. However, you can teach a nipple-confused
baby how to latch.

My 34 weeker was in NICU for a week. I found pumping very difficult
but you do not have to get very much at all at the very beginning
because they are so very small and do not eat much. There's also some
speculation that the milk comes in later for PE moms and some
confirmation that the milk comes in later for c-section moms. My
hospital provided Medela Lactinas to all women with babies in the NICU
while in the hospital and rented them to us at a nominal rate when we
were discharged, so you might find out if a protocol like that is
already in place.

It took several days to teach DS how to nurse as his suck reflex
developed and as he worked through the nipple confusion. Once he
learned how we all got way, way more sleep. If you have any questions
*at all* when your baby is born please email me or post and I will see
if I can be of any help!

Does anyone know of any examples online or have suggestions for birth plans
when you already know it isn't going to be a "perfect" delivery? There's so
much that I really can't control that I want to make sure that in areas
where I can make a choice, I get to do so.

I have seen some -- I'll poke around in my books and see what I turn
up.

Also, I have a scenario to bounce off of you. I've been asked to take
a strings position at the local middle school, which I am reluctant to
do because I will be moving in a year. It would set those students up
to have four teachers in four years. *But* they are having a great
deal of difficulty finding someone string-certified and it sounds like
if I *don't* take it, they're going to plug in a choir person with
nominal at best string experience. On top of that, it's a part time
position with a tour in April and three competitions, i.e. full-time
work, part-time pay. I wouldn't really be gaining experience I need
on a resume and I would have to juggle care for DS among three
different care providers (relatives) and school starts in a little
over a week. So I am leaning towards not taking it, and feeling
guilty because the students are going to be disappointed and set back.

--
C, mama to twenty-one month old nursling

wrote in message
m...
"Donna Metler" wrote in message
...
I'm looking at writing a birth plan and getting it on file. The thing is
that this delivery WILL be a c-section, since my last delivery ended up
having to be a classical C, so I can't VBAC, and most of the examples
I've
found don't deal with that. I would like to breastfeed/pump if at all
possible, but unless someone else is staying with me, I don't know about
having the baby room in for the first 24 hours or so because of recovery
pain (I've had abdominal surgery twice now-I have a good idea of how
much
pain I'll be in right afterwards).

My DH was able to stay in the room with me, and my mom came when he
wasn't able to be there. Of course, right after the section I was in
recovery for some time, and he spent that time in the NICU with DS.
Does your hospital not allow you to have someone else in the room with
you overnight?

They were friendly about him staying with me-I'm not sure whether he is
ready to take on care for a newborn right afterwards, though!
In addition, I have a 50% probability that this will end up being
another
premature delivery. Therefore, I assume the birth plan will have to be
changed in that instance, and I don't know what is reasonable. If it's
another premature birth, I will probably be on pretty heavy medication
(since that would imply a recurrance of the HELLP), and I don't know if
breastfeeding would be reasonable or not.

I breastfed a premature baby after an emergent c-section at 34 weeks
for severe pre-eclampsia, and no one said anything at all about
breastfeeding being contraindicated because of it. They assumed I
would be breastfeeding and gave me meds compatible with it. I was on
the mag, blood pressure meds, and painkillers, fwiw.

Is the HELLP likely to recurr, or is it just (just!) that you're at
very high risk for PE? I thought HELLP had about a 5% recurrence rate
but made it more likely that you'd get severe PE -- that's why I'm
asking.

I'm not sure-I've been told that I have a 50% probability of recurrance, but
I'm not sure if that's the HELLP or just the severe PE. If we can avoid the
HELLP symptoms, that would avoid a lot of problems during and after
delivery.
The sucking reflex kicks in at right around 34 weeks, so if your baby
is earlier than his or her sucking reflex you will have to pump. Be
prepared for the NICU to tell you that they do not believe in nipple
confusion -- heck, be prepared for the IBCLC to tell you that she does
not believe in it and to give the preemie a pacifier. There is
actually a new study saying pacifiers don't interfere with preemie
breastfeeding and they will want to provide what comfort they can and
you will not be able to be in NICU all of the time if they want you on
your left side with an IV. However, you can teach a nipple-confused
baby how to latch.

My 34 weeker was in NICU for a week. I found pumping very difficult
but you do not have to get very much at all at the very beginning
because they are so very small and do not eat much. There's also some
speculation that the milk comes in later for PE moms and some
confirmation that the milk comes in later for c-section moms. My
hospital provided Medela Lactinas to all women with babies in the NICU
while in the hospital and rented them to us at a nominal rate when we
were discharged, so you might find out if a protocol like that is
already in place.

It took several days to teach DS how to nurse as his suck reflex
developed and as he worked through the nipple confusion. Once he
learned how we all got way, way more sleep. If you have any questions
*at all* when your baby is born please email me or post and I will see
if I can be of any help!

Based on what the CNM said at my appointment, the hospital I'm delivering in
is pretty breastfeeding friendly, especially for preemies, and that they'd
probably avoid using medications which would interfere and if they did,
would try to maintain my milk supply (don't know on their views on nipple
confusion, though). She suggested that I go ahead and take the breastfeeding
class the hospital offers now, even though it's usually not done until much
later since I have a probability of premature delivery and/or ending up on
more restrictive bedrest later on-and that taking the class would probably
help relieve some of my fears in this area.

They also supposedly have support groups for nursing moms, including preemie
moms after delivery, which should help.
Does anyone know of any examples online or have suggestions for birth
plans
when you already know it isn't going to be a "perfect" delivery? There's
so
much that I really can't control that I want to make sure that in areas
where I can make a choice, I get to do so.

I have seen some -- I'll poke around in my books and see what I turn
up.

Also, I have a scenario to bounce off of you. I've been asked to take
a strings position at the local middle school, which I am reluctant to
do because I will be moving in a year. It would set those students up
to have four teachers in four years. *But* they are having a great
deal of difficulty finding someone string-certified and it sounds like
if I *don't* take it, they're going to plug in a choir person with
nominal at best string experience. On top of that, it's a part time
position with a tour in April and three competitions, i.e. full-time
work, part-time pay. I wouldn't really be gaining experience I need
on a resume and I would have to juggle care for DS among three
different care providers (relatives) and school starts in a little
over a week. So I am leaning towards not taking it, and feeling
guilty because the students are going to be disappointed and set back.

I tend to lean to not taking the position-I know what instrumental music
positions tend to do as far as time, and they're not at all stable (the
strings program has been targeted for cutbacks repeatedly in my district,
and I lost my 1/2 time co-teacher last year, which meant that while band was
still on the schedule, I wasn't really being paid to teach it-just expected
to do so along with a full-time general music position).

While I know it stinks to think about someone not qualified teaching those
kids (I have the same fears since I'm on medical leave for this pregnancy
and won't be going back AT LEAST until fall of 2005), sometimes you have to
think of yourself and your child. Especially since your son was a preemie, I
don't think bringing all the assorted germs, bugs and beasties that live in
a school home is a good thing. (I still feel that teaching had to contribute
to my complications in my first pregnancy-it can't be coincidence that I
ended up hospitalized very shortly after the winter concert season!).

Donna


--
C, mama to twenty-one month old nursling

Donna Metler wrote:
wrote in message
m...
Does your hospital not allow you to have someone else in the room
with you overnight?

They were friendly about him staying with me-I'm not sure whether
he is ready to take on care for a newborn right afterwards, though!

If your newborn is anything like two of my three as newborns, there won't be
a whole lot to do. My second and third babies slept most of their first
48-72 hours of life outside the womb (#1 was another story, but let's not go
there g!). My impression is that this is pretty common.

Anyway, the main things that will need to be done by your husband if you're
rooming in are to change the baby's diaper, swaddle her after changes, and
bring the baby to you when she (I *knew* you were having a girl--I almost
wrote "she" in a post and then came back later to change it to "he/she")
wants feeding (which will be pretty much whenever she's awake, IME). If he's
a little uncertain about diaper changes and swaddling, you can ring a nurse
to come and help the first few times until he gets the hang of it. (Newborns
tend to dislike being changed fairly intensely, BTW; they often scream their
heads off so you think you're killing them, but you're really not hurting
them--promise!). But there's really not a lot more to it in the very early
going.

So, at least on this score, you probably don't have too much to worry about.
--
Be well, Barbara
Mom to Sin (Vernon, 2), Misery (Aurora, 5), and the Rising Son (Julian, 7)

This week's suggested Bush/Cheney campaign bumper sticker:
"Leave no child a dime."

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman