The Birth Plan and the High Risk Pregnancy

by longtallyarn

I started working on my “birth plan” a couple weeks ago.  It is a document, recommended by our childbirth educator, which details for the labor and delivery team how you would prefer to have things procede once you are admitted to the hospital. 

Our hospital provides a form for expectant mothers to complete.  I have now read a few books on birth and have been generating an idea of how I hope things will unfold at the hospital.  I have never given birth before so I really have no concrete expectations of how it will be.  My idea is that I would like to have the most natural birth I can.  I will accept a Cesarian birth if the doctors determine that it is necessary, but I hope not to have to recover from a major abdominal surgery while adapting to the arrival of two new babies.  I have no preconceived notion that labor is easy; my mother says it’s difficult and that’s why they call it labor.  I have also heard many references to labor pain.  I am open to the idea of taking an epidural, but I am planning to see if I really need it and to wait as long as possible before I take any drugs.

Oso and I have been reading The Big Book of Birth, a good resource filled with suggestions for helping labor and delivery procede more efficiently, and have been noting numerous coping strategies.  (Things we will try before I choose to take narcotics or an epidural). 

I had a short discussion with our o.b. about the birth plan and the differences between between a singleton birth and a twin birth, with regard to Wake Med Hospital.  The most major difference is the likelihood of having a Cesarean birth.  If the babies are oriented vertically, and the lower baby is head down, the mother is allowed to try for a traditional birth.  If the babies are breech a Cesarean is required, of course.  Also, a Cesarean may also be required if, after the first baby is born, the second one begins to be distressed.  This makes the planned Cesarean more appealing to some people because of the risk of having to recover from both a vaginal birth and a Cesarean birth at the same time.

Our o.b. also recommends that a mother of twins go ahead and have the epidural catheter placed in her spine even if she hopes to have a natural birth.  This was a disappointment to me because the most appealing aspect of natural childbirth is that no one sticks a needle in your spine.  Apparently this does not make every woman nervous, but I really love my spine and everything that it does for me, and I don’t like the idea of anyone sticking a needle in it.  Even a trained professional. 

Another draw back to the whole needle-in-the-spine thing is that I bet they don’t let you soak in the bath tub once that catheter is in place.  And I really wanted to soak in the bath tub.

She did say that I could request of the attending physician that intermittant fetal monitoring be used unless continuous monitoring is medically necessary.  This would allow me to walk around the hospital if I wanted to do so.

Our o.b. also confirmed my suspicion that I would be required to give birth in the operating room.  She said that we would be happy to be there and save travel time in case the second baby had to be born by emergency Cesarean.  I’m sure she is right, because she has more experience with birth than I do.  But in my imagination, there I am, lying helplessly and passively on the operating table and being watched by a large crowd of medical professionals.  I don’t like having an audience, especially if I am doing something personal.  I also don’t like being passive.  I was also hoping to at least sit up while pushing, because I’ve read that any position is more efficient than lying on one’s back.  I’m hoping that in the operating room I may be allowed to sit up or move around while pushing if the epidural has not been administered and if the babies seem to be doing well but I forgot to ask if this may be a possibility.  

The birth plan is a very flexible document and I am going to be flexible as well.  It expresses only preferences.  It may be entirely set aside in case of an emergency and I fully understand this.  I hope for the best, that nothing unexpected occurs and that my wishes can be honored.  As recommended, I’m also planning to take some cookies for the nurses.