Archive for the ‘c-section-preparation’ Category

A Cesarean Plan

Wednesday, July 6th, 2011

Cesarean is often the last thing we want to think about during pregnancy. Most of us think it will not happen to us. Having a plan, an idea of what to ask for, to know there are ways to bridge the gap between Plan A and Plan C can be very beneficial to both mother and baby.

There is no way to make a cesarean just like a healthy vaginal birth, and frankly, that ought not be the goal. It can be however a much more family centered, family bonded, more respectful and humane experience.

Speak to your provider ahead of time about needs and desires. If you know you are having a cesarean ahead of time, meeting with the Nurse Manager and the anesthesiology department can be useful in obtaining what you want. Have the conversations, create partnerships.

Below is my latest version of a family centered cesarean plan  that can be used for a planned or unplanned cesarean delivery. All requests may not be feasible in all areas, but even small changes can be helpful.

It may be copied and pasted into your own document for personalization, however I do ask that you credit the source if you are an educator, doula or related professional using it as a sample.

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Name: Jane Doe

Estimated Due Date: January 1, 20XX

Care Provider: XXXXXX

We are seeking to make a cesarean delivery as special, low stress and family centered as possible.In the event a true emergency and general anesthesia is needed, I understand that some of my requests cannot be honored.

JUST PRIOR TO/DURING DELIVERY / RECOVERY –

  • I would like to meet each staff member in the OR by name who will be participating in the cesarean.
  • I may ask my _________ for aromatherapy to help with nausea, surgical smells and stress.
  • I ask that only essential conversation be allowed.
  • I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
  • I would like my ______________ to take photos and/or video of the birth of my baby.  I respect that the surgeon and anesthesiologist may not want the entire surgery on video, however I would like a record of my baby being born to make it as special and personal as possible.
  • Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
  • Please lower the drape so I may view my baby coming out of me and hold my baby up so I can see him/her at the moment of birth.
  • Request my arms not be strapped down so I may touch my baby freely.
  • I would like my baby to remain connected to the placenta after manual extraction, as the cord will continue to pulsate for some time. I would like my ___________ to cut the cord after 10 minutes post delivery or the cord has stopped pulsating near the umbilicus.
  • I would like my baby placed skin to skin on my chest immediately with basic assessments being done while on me. My husband (partner/family member can hold baby there with a warm blanket over my baby and help maintain the sterile field.
  • I would like to breastfeed in the OR or as soon as possible in recovery.
  • I would like for my ________________ and baby to stay in the OR with me while surgery is completed and remain in recovery with me.
  • If the baby needs medical assistance requiring leaving the OR, I’d like for another person (doula, friend or family member) to attend me in the OR while my ___________________ goes with the baby, so my baby nor I will have to be alone.
  • In the event baby needs to leave the OR, I would like the wipe down towel(s) to be placed against my chest skin and baby to be pressed on me for fluid and odor transfer.
  • Asking for a delay in eye ointment and Vitamin K until after the first hour of bonding time or I am waiving all immunizations and eye ointment.
  • In the event of a hysterectomy, please do not remove my ovaries or anything else that is not medically necessary

REGARDING BABY

  • In the event the baby requires medical attention beyond that of a healthy baby, please inform me (husband/partner/family member) verbally what is needed or will be needed so I can actively participate in choices made for my baby’s care.
  • In the event of  a need for separation of my baby from me:
    • Limit the number of persons who touch or attend my baby to only those on staff as needed and my _____________.
    • Request my baby not be bathed or fully dressed until I have the opportunity to smell, touch, cuddle, etc. with my baby and I am able to participate in the bathing.
    • I plan to breastfeed exclusively, so no pacifier, formula, sugar water should be given to my baby.
  • No tests shall be performed or medications administered, etc. without my ________________ consent & prior knowledge

Thank you for honoring my requests for me and my baby.

Preparing For Birth, LLC

All Rights Reserved 2011

Family Centered Cesarean Plan

Saturday, October 16th, 2010

Below is my version of a family centered cesarean plan – can be used for a planned or unplanned cesarean delivery.

Sample Cesarean Plan PDF

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We are trying to make a cesarean delivery as special and intimate as possible for us even though we did not have the desired vaginal birth.

DURING DELIVERY / RECOVERYIn the event a general anesthesia needs to be performed, I understand that some of my requests cannot be honored.

  • I would like to meet each staff member in the OR who will be participating in the cesarean.
  • I may use aromatherapy to help with nausea, surgical smells and stress.
  • I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
  • Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
  • I would like for my husband (partner/family member) and baby to stay in the OR with me while surgery is completed and remain in recovery with me.
  • If the baby needs medical assistance requiring leaving the OR I’d like for another person (doula, friend or family member) to attend me in the OR while my husband (partner/family member) goes with the baby so I won’t have to be alone.
  • I would like to take photos and video of the birth of my baby.  I respect that the surgeon and anesthesiologist may not want the entire surgery on video, however I would like a record of my baby being born to make it as special and personal as possible.
  • Please lower the curtain and hold my baby up so I can see him/her at the moment of birth.
  • Request my arms not be strapped down so I may touch my baby freely.
  • I would like my baby to remain connected to the placenta after manual extraction, as the cord will continue to pulsate for some time. I would like my ___________ to cut the cord after 10 minutes post delivery or the cord has stopped pulsating near the umbilicus.
  • I would like my baby placed skin to skin on my chest immediately after basic assessments while in the OR. My husband (partner/family member can hold baby there with a warm blanket over my baby.
  • In the event of a hysterectomy, please do not remove my ovaries or anything else that isn’t medically necessary.
  • I would like to breastfeed my baby as soon as possible in recovery.

REGARDING BABY

  • In the event the baby requires medical attention beyond that of a healthy baby, please inform me (husband/partner/family member) verbally what is needed or will be needed so I can actively participate in choices made for my baby’s care.
  • Limit the number of persons who touch or attend my baby to only those on staff as needed and my husband (partner/family member).
  • Request my baby not be bathed or fully dressed until I have the opportunity to smell, touch, cuddle, etc. with my baby and I am able to participate in the bathing.
  • Delaying immunizations, even eye ointment and vitamin K.
  • I plan to breastfeed exclusively, so no pacifier, formula, sugar water should be given to my baby.
  • No tests shall be performed or medications administered, etc. without my (husband/partner/family member) consent & prior knowledge

Thank you for honoring my requests for me and my baby.

Preparing For Birth – A sample low-intervention birth plan

Thursday, August 13th, 2009

A birth plan is a tool to express your desires and needs for birth and initial postpartum, as well as, to make sure that you and your provider are on the same page.  Your birth plan should be brief (no more than one page) and only have the bullet point information that is specific to your care and desire or not usually done by your care provider or birth location.

Discuss with your care provider prior to labor and bring a copy with you to your birth location.  Remember it is not a legal document that your location of delivery or care provider must adhere to.

Here is a sample plan for an out of the home birth:

Birth Needs and Desires for: _______________________. Care Provider:____________________________________.

Estimated Due Date: ____________________________.

Labor

I am planning on a no to low-intervention natural birth.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

  • I plan on wearing my own clothing. I will ask for a gown if I change my mind.
  • I would like a saline lock in lieu of an IV
  • In the event of an induction and/or augmentation is medically necessitated-
    • Ripening – Foley Catheter instead of Cytotec (misoprostol)
    • Pitocin – A very slowly increased dosage
    • AROM – will only consent to if an internal fetal monitor is a must.
  • Delayed cord clamping for at least 5 minutes (baby can receive oxygen or other helps while still attached to me).

Postpartum and Baby Care

  • Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
  • Delayed bathing
  • Delaying vaccinations including eye ointment and vitamin k.
  • Exclusive breastfeeding, no pacifiers, sugar water, or formula
  • No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

  • Only essential lighting
  • Only essential conversation related to the surgery and delivery
  • Lower sterile drape or have a mirror present so I may see my baby emerge
  • Only one arm strapped down so I may touch my baby
  • Pictures and video
  • Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
  • Baby to stay with me continuously in OR and recovery
  • If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
  • Breastfeed in OR and/or recovery
  • Delayed immunizations
  • Delayed washing and dressing of baby
  • No separation from me except what is absolutely medically necessary

Preparing for a medically necessary labor induction

Wednesday, August 12th, 2009

Labor induction is increasingly on the rise, however, even ACOG has a limited statement on what is a defines medically necessitated labor induction.  This is generally defined as gestation or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy (postterm dates are defined generally after 42 weeks gestation though protocols and practice style is often after 41 weeks).  There are varying opinions in the birth world of what is truly medically necessary so always research your options and need.

Induction is not a panacea, it only sometimes works, is more challenging than naturally occurring labor and is often long.  I hope my suggestions and information can help you be more well equipped when it is the best solution for you and your baby.

So you do need to be medically induced, how can you prepare?  Do you need cervical ripening prior to the induction as well ?

Start with the type of induction you need.

Ripening is for a cervix that is not ready for using pitocin for induction purposes (see Bishop’s score below). Ask your care provider what your score is.  If he or she does not use the Bishop scoring ask for the particulars of each of the five categories then you can use the table yourself.  The position category denotes the position of your cervix.

Are you a good candidate for induction? Do you need ripening too?

Are you a good candidate for induction? Do you need ripening too?

If you need a ripener prior to the induction, you have two common options (Cytotec or Foley Catheter) though there are more available (Cervidil or Prepadil), they are not widely used any longer.

Foley Catheter ripening is a mechanical ripening method that requires no medicine therefore has very little negative consequence related to the usage. The catheter is inserted in the cervix, then filled with saline to fill the end of the bulb and mechanically opens the cervix up to approximately 4 cm’s while the foley is in place. The mother will go home until the catheter falls out or will remain in the hospital overnight.  The pressure from the foley catheter promotes continual prostaglandin release that encourages the effacement and works in conjunction with the mechanical dilation to open the cervix.  When the catheter falls out, unless it prematurely dislodges the cervix is ripe and ready for induction (pitocin usage). Sometimes the mother is already in early labor and may not require pitocin or require less.   For more information and studies regarding foley cather ripening view my blog page http://prepforbirth.com/2009/07/20/foley-catheter-ripening-versus-medication-studies.html.

The most common yet riskier method of cervial ripening is the use of Cytotec (Misoprostol).  Cytotec is used in an off label manner for ripening the cervix. ACOG has this to say in the revised new guidelines that include seven recommendations based on “good and consistent scientific evidence” — considered the highest evidence level — including one that sanctions 25 mcg of misoprostol as “the initial dose for cervical ripening and labor induction.” The recommended frequency is “not more than every 3-6 hours.”  Though this drug has been shown to be successful for ripening it is not without concern, consequence, risk or controversy.  Please do your research ahead of time prior to allowing this drug to be used on you and your baby.

Here are some helpful links:

http://www.aafp.org/afp/20060201/fpin.html

http://www.petitiononline.com/cytotec/petition.html

http://www.medscape.com/viewarticle/458959

http://www.thefreelibrary.com/Making+an+informed+choice:+Cytotec%5BR%5D+for+induction-a0128063329

Your cervix is ripe for induction

The most common next step is the use of Pitocin to induce labor contractions. What to expect: an IV with fluids running, continuous monitoring, and limited mobility. The increased pain and stronger than usual contractions over a longer period of time associated with Pitocin use often leads women to ask for epidural anesthesia. There are varying protocols, but the low-dose protocol is most often used today.  Induction is not fail safe, you may or may not respond to “tricking” your body into labor.  Your baby also may not respond favorably.  In the event the induction fails or causes maternal or fetal distress or host of other complications, a cesarean delivery is the next step.

Here are some helpful links regarding Pitocin.

http://www.rxlist.com/pitocin-drug.htm

http://www.corninghospital.com/Educate/Pit.htm

http://pregnancy.about.com/od/induction/a/pitocindiffers.htm

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4975#section-4

Rethink how you pack your birth bag

Considering the length of time that you will be at the hospital  considering adding the following items to your birth bag.

  • Movies (make sure your hospital provides DVD players or you will want to bring one of your own)
  • Puzzles of all types
  • Cards
  • Games
  • Books
  • Laptop Computer
  • Extra changes of clothing
  • Extra food for husband, partner or labor support
  • Extra cash
  • Ear plugs and eye covering to make sleeping easier
  • More comforts from home to be soothing

Points to think about

  • You are having a baby and need to do the work of labor completely at the hospital. ONLY allow those who can help you keep the chaos and interruption to a minimum.  This is not a party.
  • Turn of cell phones.
  • Keep room comfortable, peaceful,  and stress-free.
  • Having your water broken artificially does not mimic it naturally breaking.
  • Use the space provided and get on the birth ball, stand near the bed and sway, use rocking chair, have equipment moved closer to bathroom so you may sit on the toilet, use as many positions as possible to help baby negotiate and to help dissuade a mal-position.
  • Induction increases the risk of a cesarean delivery becoming necessary whether from the induction failing (fooling a body into labor isn’t as easy as it sounds), maternal/fetal distress or another complication may arise.  Here is a sample cesarean delivery plan in the event it becomes necessary.  sample-cesarean-plan

My closing thought to you is take a deep breath and know when medically necessary an induction is a reasonable step.

My hope is for you to be well informed, be confident to ask questions, be strong to make your own decisions, and thrive to a successful birth even when Plan A isn’t an option anymore.

Cesarean Awareness Month

Wednesday, April 2nd, 2008
April is Cesarean Awareness Month http://www.ican-online.org/

What is Cesarean Awareness Month?
An internationally recognized month of awareness about the impact of cesarean sections on mothers, babies, and families worldwide. It’s about educating yourself to the pros and cons of major abdominal surgery and the possibilities for healthy birth afterwards as well as educating yourself for prevention of cesarean section. Cesarean awareness is for mothers who are expecting or who might choose to be in the future. It’s for daughters who don’t realize what choices are being taken away from them. It’s for scientists studying the effects of cesareans and how birth impacts our lives. It’s for grandmothers who won’t be having more children but are questioning the abdominal pains and adhesions causing damage 30 years after their cesareans.CESAREANS are serious. There is no need for a ‘catchy phrase’ to tell us that this is a mainstream problem. It affects everyone. One in three American women every year have surgery to bring their babies into the world. These women have lifelong health effects, impacting the families that are helping them in their healing, impacting other families through healthcare costs and policies, and bringing back those same lifelong health effects to the children they bring into this world.
Be aware. Read. Learn. Ask questions. Get informed consent. Be your own advocate for the information you need to know.
Visit your local ICAN chapter or go to http://www.ican-online.org/