This is a copy of the birth plan that we have provided to the hospital's maternal unit. We will bring extra copies with us. The maternal care coordinator said there were two things that might be a problem: not getting the heparin lock (the inlet for an IV that they can place in your hand and it just stays there), and being allowed to eat or drink anything.
Susan and Tim – Birth Plan
We have written this birth plan with our ideal birthing situation in mind, knowing well that flexibility is an important factor in emergency situations. We are willing and eager to listen to opinions and discuss alternative options for the birth of a healthy baby should the need arise.
Our hope is to have a natural childbirth free of medications and interventions. Susan is planning to use the hypnobirthing method of relaxation during the birthing. She plans to spend the very early stages of labor at home with her family and her doula, Lynn Johnson. She then plans to be at St. Luke’s for the active stages and the birthing, accompanied by her husband, Tim, her doula, and her mother-in-law, Mary Anne Daily.
First Stage Labor
• Please do not offer me pain medications; I will ask for them if I want them.
• Intermittent monitoring via Doppler or external fetal monitoring is preferred.
• Please do not restrict my movement. I prefer to maintain mobility.
• Please do not administer an IV or heparin lock unless there is a clear medical indication that such is necessary.
• Please allow me to eat and drink to comfort if allowed.
Augmentation
• Please do not administer pitocin.
• Please do not artificially rupture membranes.
• Please allow first stage of prolonged length.
• I would prefer to walk to speed labor, and use other natural methods.
Second Stage (Pushing/Birth)
• Please do not perform an episiotomy; use compresses & positioning. I prefer to tear.
• Please delay cord clamping & cutting.
• We would prefer for Tim to cut the cord.
• We would like to bank the cord blood privately and will have the kit available.
• Please encourage me to begin pushing only when my body tells me to.
• Please do not restrict my choice of birthing position.
• Please provide squat bar for birthing bed and birthing ball for laboring.
• Please allow second stage of prolonged length.
• Please allow for Susan to eat immediately after birth if desired.
Baby Care:
• If baby is not in distress, please allow for immediate skin-to-skin contact and breastfeeding for 5 to 10 minutes; conduct newborn assessment on Susan’s chest if necessary.
• IV to be administered in baby on a warming bed rolled next to Susan.
• Please do not provide formula or glucose water; I would like to exclusively breastfeed. If tube, bottle or dropper-feeding required, please use Susan’s breastmilk.
• When baby is transported to another facility, please discharge Susan as soon as possible.
Unexpected Events
Cesarean Birth
• Spinal/epidural anesthesia
• Tim present
• Please allow Tim to hold baby as soon as possible
Stillbirth/Newborn Death
• Please allow Susan & Tim to see and hold baby as often and for as long as desired.
• We wish to obtain mementos such as photographs, locks of hair, footprints.
• Please allow Susan to recover in a room separate from postpartum unit and provide early discharge.
• Please offer spiritual and grief counseling.
• Please provide information regarding any support group.
Friday, November 21, 2008
Thursday, November 20, 2008
CHD Awareness video
Today, a friend passed on the link to the Kansas City CHD families web site, which I haven't looked at in quite a while: http://www.chdfamilies.org/. If you scroll down, you will see a video for "CHD awareness 08" that you can click on to play. It is a little under 14 minutes long. I hope you have time to view it. Even I learned a little more about congenital heart defects. It is a homemade presentation.
Today's consult with the neonatologist
I finally got to have my consult with a NICU pediatrician, aka neonatologist, at the hospital where I am delivering.
So I asked about what it was that they would need to do with baby immediately after birth, if they would be whisking baby away within a minute, and would baby be getting more than an IV. And the doc said oh no, it would be more than a few minutes, so that was good. And he said, the IV was the only thing they anticipate doing, and will have the IV drip on the floor, in anticipation of baby's birth. So I asked if I could hold baby while they put in the IV, and he looked horrified! He said it was a pretty tricky procedure, it goes into baby's hand or foot. They need a stable surface. So he said, but we can wheel over the warming bassinet right next to you, so you can stay in contact with baby while we put in the IV!!!!!!! I was so thrilled to hear this! (Otherwise, they planned to do it in the nursery.)
I asked about arterial umbilical lines that another CHD mom had mentioned and he said they do not anticipate putting those in unless baby is VERY sick. He said it carries a high level of risk that they prefer not to put baby through unnecessarily. (They use the arterial line to measure blood gasses to make sure the baby is getting enough oxygen, not retaining too much CO2, not becoming acidotic from poor heart function, check electrolyte balances, etc.)
He did say this, though: the number one and worst side effect of prostaglandins (which is what the IV is for) is Apnea. Apnea is difficulty or cessation of breathing. He said if that does happen, then they will need to bring the baby to the NICU to intubate. He said that many babies don't have a problem with the prostaglandins, however.
So then I asked if baby didn't need the intubation, would they still intubate the baby prior to the children's hospital team taking baby by ambulance to their hospital, as I had heard that. And he said, no, they would not intubate a baby that didn't need it. So this was another huge thing to hear.
I did ask about keeping baby connected to the umbilical cord, if that would help baby to continue getting oxygen. He said I had to be careful with that. If baby is placed above the placenta, then blood will drain down out of baby, possibly leaving baby anemic. And if baby is below the placenta, baby could face being overwhelmed with blood, not a good thing. So I am thinking maybe about lying on my side after birth, so baby is about even with the placenta. I don't know, though. Since we are doing the cord blood thing, we will probably just go ahead and clamp the cord after the last pulses, and then I can do chest to chest (hoping) with baby.
I am just so happy to have had this talk. He said he would update the medical orders to indicate the IV placement in the OR. And I said I would update my birth plan to indicate this, too. We both agreed that if the situation is not ideal/healthy for baby, that all these plans get thrown out, and I can live with that.
In addition to the consult, I had my weekly prenatal office visit, fluid check, and biweekly NST. Unfortunately, I have not progressed much since last week, still just 50% effaced, and only fingertip dilated. She did say the cervix was a little softer. Baby is still doing well, passed the NST (which showed two contractions I had thought were baby stretching) with a heart rate of about 135 BPM, and the fluid level was 17.3 centimeters. My blood pressure was 109/65. One interesting thing the nurse practitioner showed us (Mary Anne was with me) was something floating in the amniotic fluid around baby. She said it was the baby's vernex, which is that white moisturizing/insulating layer found on all babies, which slowly disappears as baby gets closer to birth. It looked like snow floating in a snow globe.
My next prenatal appointment will be Monday, since the office is closed Thursday for the Thanksgiving holiday. If I still need one, I have another prenatal scheduled for December 1, and at that point I will be four days past my due date. Let's hope I have long since had the baby by then; the sooner baby is born, the sooner baby will be home for Christmas.
So I asked about what it was that they would need to do with baby immediately after birth, if they would be whisking baby away within a minute, and would baby be getting more than an IV. And the doc said oh no, it would be more than a few minutes, so that was good. And he said, the IV was the only thing they anticipate doing, and will have the IV drip on the floor, in anticipation of baby's birth. So I asked if I could hold baby while they put in the IV, and he looked horrified! He said it was a pretty tricky procedure, it goes into baby's hand or foot. They need a stable surface. So he said, but we can wheel over the warming bassinet right next to you, so you can stay in contact with baby while we put in the IV!!!!!!! I was so thrilled to hear this! (Otherwise, they planned to do it in the nursery.)
I asked about arterial umbilical lines that another CHD mom had mentioned and he said they do not anticipate putting those in unless baby is VERY sick. He said it carries a high level of risk that they prefer not to put baby through unnecessarily. (They use the arterial line to measure blood gasses to make sure the baby is getting enough oxygen, not retaining too much CO2, not becoming acidotic from poor heart function, check electrolyte balances, etc.)
He did say this, though: the number one and worst side effect of prostaglandins (which is what the IV is for) is Apnea. Apnea is difficulty or cessation of breathing. He said if that does happen, then they will need to bring the baby to the NICU to intubate. He said that many babies don't have a problem with the prostaglandins, however.
So then I asked if baby didn't need the intubation, would they still intubate the baby prior to the children's hospital team taking baby by ambulance to their hospital, as I had heard that. And he said, no, they would not intubate a baby that didn't need it. So this was another huge thing to hear.
I did ask about keeping baby connected to the umbilical cord, if that would help baby to continue getting oxygen. He said I had to be careful with that. If baby is placed above the placenta, then blood will drain down out of baby, possibly leaving baby anemic. And if baby is below the placenta, baby could face being overwhelmed with blood, not a good thing. So I am thinking maybe about lying on my side after birth, so baby is about even with the placenta. I don't know, though. Since we are doing the cord blood thing, we will probably just go ahead and clamp the cord after the last pulses, and then I can do chest to chest (hoping) with baby.
I am just so happy to have had this talk. He said he would update the medical orders to indicate the IV placement in the OR. And I said I would update my birth plan to indicate this, too. We both agreed that if the situation is not ideal/healthy for baby, that all these plans get thrown out, and I can live with that.
In addition to the consult, I had my weekly prenatal office visit, fluid check, and biweekly NST. Unfortunately, I have not progressed much since last week, still just 50% effaced, and only fingertip dilated. She did say the cervix was a little softer. Baby is still doing well, passed the NST (which showed two contractions I had thought were baby stretching) with a heart rate of about 135 BPM, and the fluid level was 17.3 centimeters. My blood pressure was 109/65. One interesting thing the nurse practitioner showed us (Mary Anne was with me) was something floating in the amniotic fluid around baby. She said it was the baby's vernex, which is that white moisturizing/insulating layer found on all babies, which slowly disappears as baby gets closer to birth. It looked like snow floating in a snow globe.
My next prenatal appointment will be Monday, since the office is closed Thursday for the Thanksgiving holiday. If I still need one, I have another prenatal scheduled for December 1, and at that point I will be four days past my due date. Let's hope I have long since had the baby by then; the sooner baby is born, the sooner baby will be home for Christmas.
Saturday, November 15, 2008
38 weeks - Prenatal appointment
On Thursday, November 13, I went in for my weekly prenatal appointment. My blood pressure was 104/74. Baby's fluid level was 13.9, so still a very good amount. Heartbeat was about 140 BPM. (Babies' heart rates are much faster than adults', and remain so for about the first year.) Baby was nice and active, and passed the nonstress test. I was offered an optional internal exam if I wanted to know how far along I have progressed, so I said yes. Nurse said I was 50% effaced, which is the measurement for the thinning of the cervix, and barely a fingertip dilated. She massaged the cervix to release prostaglandins to continue the progress of dilation. (Cervix will eventually dilate to 10 cm to allow baby's head to pass out of the uterus.) Baby's head is at -1 station, which is just above entering the birth canal. (Click on picture below to enlarge.)
I'm not sleeping as well these days, I get odd cramps in my knees, or I wake up and can't fall back asleep, thinking about my long to-do list! I did put a towel and piece of plastic under the sheet to protect the mattress in case my water breaks at night! So the plastic is a little warm, and that doesn't help either.
So the full moon came and went Thursday, and I didn't go into labor! But today, Tim's mom arrives for two and a half weeks, so I've had a little chat with baby that the middle of next week would be a great time to arrive! We are still waiting for delivery of the crib and dresser, and need to start organzing all the gifts we have received. In the past month, baby has received three lovely homemade gifts by mail: a cozy yellow flannel patchwork quilt from baby's paternal grandfather's cousin, a wonderful scalloped edged yellow and white crocheted blanket from baby's paternal grandmother's sister-in-law, and a beautiful cream knitted blanket from baby's maternal grandmother's cousin.
On a very sad note, Thursday was also the one year anniversary of the birth day of Josephine, my cousin's stillborn daughter. This has been on my mind a little bit, I still feel such grief for her parents.
I'm not sleeping as well these days, I get odd cramps in my knees, or I wake up and can't fall back asleep, thinking about my long to-do list! I did put a towel and piece of plastic under the sheet to protect the mattress in case my water breaks at night! So the plastic is a little warm, and that doesn't help either.So the full moon came and went Thursday, and I didn't go into labor! But today, Tim's mom arrives for two and a half weeks, so I've had a little chat with baby that the middle of next week would be a great time to arrive! We are still waiting for delivery of the crib and dresser, and need to start organzing all the gifts we have received. In the past month, baby has received three lovely homemade gifts by mail: a cozy yellow flannel patchwork quilt from baby's paternal grandfather's cousin, a wonderful scalloped edged yellow and white crocheted blanket from baby's paternal grandmother's sister-in-law, and a beautiful cream knitted blanket from baby's maternal grandmother's cousin.
On a very sad note, Thursday was also the one year anniversary of the birth day of Josephine, my cousin's stillborn daughter. This has been on my mind a little bit, I still feel such grief for her parents.
Wednesday, November 12, 2008
Baby has dropped...
At my appointment last Thursday, November 6, my nurse practioner told me that baby's head appeared to be engaged. (This means baby's head is now within the pelvic bones.) On Monday night, Jodi, our hypnobirthing specialist, and Tim both agreed that it looked like baby had dropped down in position. I have noticed that my heartburn is much reduced, so there must indeed be less pressure up at the top. I am also feeling lots more cramping in the lower abdomen, more lower back discomfort, and odd pelvic twinges. On Sunday, I felt like my pelvic bones were so loose that I was hobbling around the house for a few hours! Last night, for fun, I timed my Braxton Hicks contractions, and they were averaging about seven minutes apart, but still very irregular. I do sometimes wonder if the full moon tomorrow will start up my labor! But I'm hoping baby waits until my mother-in-law, Mary Anne, arrives Saturday, and until Lynn, my doula, gets over her new cold!
Nurse also mentioned that baby appears to by laying in an optimal position, Right Occiput Anterior, where baby's back is on my right side. Here is a neat website showing baby's head in the pelvis (scroll down): Fetal Position within the Birth Canal. [Other info from the appointment: blood pressure nice and low at 104/66, I passed the Strep B test, so no need for antibiotics at birth, baby passed the NST as usual, and fluid level was 13.8.]
So I suddenly feel like the end is near! The book, What to Expect When You Are Expecting, says that in first time moms, labor usually follows about two to four weeks after baby drops. I would love for baby to arrive on November 19th! In the meantime, Tim and I are practicing my relaxation techniques, I sit on my yoga ball instead of a desk chair all day (to open up the pelvis and strengthen my legs), continue my prenatal yoga, and drink my pregnancy tea, all in an effort to have a very smooth delivery. Here's hoping!
Nurse also mentioned that baby appears to by laying in an optimal position, Right Occiput Anterior, where baby's back is on my right side. Here is a neat website showing baby's head in the pelvis (scroll down): Fetal Position within the Birth Canal. [Other info from the appointment: blood pressure nice and low at 104/66, I passed the Strep B test, so no need for antibiotics at birth, baby passed the NST as usual, and fluid level was 13.8.]So I suddenly feel like the end is near! The book, What to Expect When You Are Expecting, says that in first time moms, labor usually follows about two to four weeks after baby drops. I would love for baby to arrive on November 19th! In the meantime, Tim and I are practicing my relaxation techniques, I sit on my yoga ball instead of a desk chair all day (to open up the pelvis and strengthen my legs), continue my prenatal yoga, and drink my pregnancy tea, all in an effort to have a very smooth delivery. Here's hoping!
Ilona's baby has arrived!
My neighbor Ilona had her baby on Sunday morning, on my mother's birthday! Edward Constantine was born at 4:40 a.m., weighing 8 lbs. 1 oz., and was 21 inches long. Ilona was in labor for 12 hours, with 2 hours of active pushing at the end. Mother and baby are healthy, and should be home as of today.
Tim and I had shown Ilona and her mother our nursery on Friday night, and I touched her belly and said, "This might be the last time I see you pregnant!" I was supposed to go over on Saturday afternoon to see their nursery, but she must have left for the hospital around the same time!
Congratulations to Ilona and George on the birth of their first son! (I checked the web nursery at St. Lukes online but they don't have any pictures of baby posted: Web Nursery.)
Tim and I had shown Ilona and her mother our nursery on Friday night, and I touched her belly and said, "This might be the last time I see you pregnant!" I was supposed to go over on Saturday afternoon to see their nursery, but she must have left for the hospital around the same time!
Congratulations to Ilona and George on the birth of their first son! (I checked the web nursery at St. Lukes online but they don't have any pictures of baby posted: Web Nursery.)
Tuesday, November 4, 2008
Baby shower in Missouri
On October 4, my friend and ninth cousin (!) Beverly Land cohosted a baby shower for us at her home in Parkville. Kimberly Mensch, a good friend from my golf club who had long ago offered to host a shower if we ever fostered a child, was the cohost. (Bev and I both do genealogy which is how we figured out our relationship. She is technically my only family who lives locally!)
The invitation list included my neighbors (and former one who flew in from New York!) and golfing friends. Quite a few who could not attend sent gifts. I was taken aback by everyone's generocity and thoughtfulness! Tim enjoyed looking at the gifts after I brought them home. I did bring in my mother-in-law's bassinet to use as a backdrop and gift holder, which worked out quite well. 
The lovely gifts included Two handmade small quilts, Four boxed photo albums, Polka dotted sage crib skirt and sheets; Giraffe baby blankie, Sweet pea boppy, baby sign language set, breastmilk storage bags, breast flow bottles, "Guess How Much I Love You" book and soft matching rabbit, Chenille pastel baby blanket, "squeeze me" onesie, Irish pastel wool blanket, rosary beads, moo bib, peace signs onesie, silver feeding spoon, Wedgewood Beatrix Potter china set (bowl, plate, cup), Bathtub super scooper, sassy bath toys in bag, travel size Baby Johnson products, BRU gift card, Cowboys NFL bib autographed by Tony Romo, Jacksonville NFL bib autographed by Derrick Harvey, Peter Rabbit baby book, Beatrix Potter "wallies" cutouts, Hand woven pastel baby blanket (very soft and washable), 3-packs: bibs (I love grandma), too cute onesies, best of friends onesies, Gerber t-shirts; hat and sock set, playtex bottle liners, foam bath mat, Evenflo bottles, Bathtub, rubber ducky heat sensor, nasal aspirator, nail clipper with magnifying glass, and a High chair.
They served these absolutely delicious frosted sugar cookies -- and let me take home the extra! We also played a few games. The first one was to guess how many diapers were in a sturdy plastic case. Having purchased a few boxes of them over the past few weeks, I was closest at 150, which was probably an unfair advantage! In addition to getting to take this home as a gift, as a little prize Bev also gave me a "baby's first Christmas" ornament, the only one we've received! A second game was to match baby pictures to names, some of celebrities but mostly of the ladies present. 
One of the guests was my next-door-neighbor, Ilona, who is due about three weeks before me. We did a belly comparison photo! At the time this photo was taken, I was at 32w2d, and Ilona was 35w0d.I brought home with me a poster that Bev made that looked like a page from a November calendar. On it, the guests wrote their guesses for the baby's delivery date. So far, the guesses include November 11, 12, 14, 17, 22, 26 and 28. We shall see!
All in all, it was a wonderful shower filled with lots of beautiful blessings.
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