Musings of a Marfan Mom

My Birth & Postpartum Plans

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After last week’s miserable OB appointment, I had a lot more research to do. I want the healthiest birth possible for myself and Smudge. As of today, that’s a VBAC. That could change in the next few weeks (for instance, if he flips breaeh or if my aorta grows), but for now, I am set on a VBAC. I know that unnecessary interventions can create a cycle that will make a c-section much more likely, but I also don’t want to come into the hospital and immediately set up a barrier with the medical staff by fighting everything.

After talking with Mark and with our doula, I’ve come up with this birth plan (obviously subject to change with a change in circumstances, whether that be before or during the birth).

1) Due to the distance I live from the hospital in traffic, if I go into labor during the day I will head to the hospital sooner rather than later…probably when my contractions are coming about 5 minutes apart. If I go into labor at night, I’ll likely labor at home a little longer.
2) I’m not going to check into L&D right away. I’m going to walk around the hospital grounds, maybe grab a light bite to eat, and monitor my blood pressure with my personal monitor. When my BP starts to go high, or I get too uncomfortable, I’ll go upstairs and check in. With any luck, I won’t end up there till it’s about time for the epidural, this eliminating any discussion over early-labor monitoring.
3) I want periodic external monitoring, so that I can move around at least a little bit. My hospital does not offer wireless monitoring. I plan to very politely tell my nurse that I want to wait on continuous monitoring until I get my epidural and am bed bound.
4) I will not consent to internal monitoring without a cause. Having a VBAC is not cause enough. Internal monitoring means that my water will be broken and a screw inserted in my son’s scalp. It clearly brings a risk of infection, one that I’m not willing to take.
5) I’ll have the epidural between 3 and 5 cm, depending on how I’m feeling and how my blood pressure is. I need to have the epidural prior to full on active labor, which is why 5 cm is the upper limit. Only an attending or a fellow will be allowed to insert the epidural. Normally I’m cool with students practicing on me, but not with dural ectasia, not while I’m in labor and so much rests on this epidural working.
6) If I “stall out” I want to try having my water broken or use nipple stimulation before moving to pitocin.
7) Internal exams will be kept at a minimum after my epidural is inserted. I’ll decide how often. Internal exams increase the risk of infection and increase the risk of me being told I’m not progressing. I’d rather rely on how the baby and I are feeling to determine how well labor is progressing, because internal exams tell you VERY little.
8 ) As a rule, Mark knows to tell the medical professionals that we’re going to take a minute to discuss anything they want to do before consenting. I just want to be able to have that time to make a decision with a clear head so I don’t regret feeling pressured later. Whether I end up going with what they suggest or not, I’ll feel better being confident that it was my decision.
9) Apparently I’ll be allowed to push a little bit (?). This is not typically recommended but I have a really nice aorta so I might go along with it. I’m going to discuss it with my cardiologist at my next echo. Otherwise, forceps or vacuum will be used, whichever the doctor on call is most versed in.

If I need a c-section:
1) I want Mark & our doula in the room with me.
2) I want one of the doctors describing to me what they are doing, rather than just talking amongst themselves.
3) I’d like to be able to have my arms unbound so I may touch the baby before he’s cleaned.
4) Mark will go with the baby and our doula will stay with me. I want to be able to breastfeed in the recovery room.

Postpartum Plan:
1) Assuming baby & I are both ok, I want to hold him immediately, before he is cleaned.
2) I want to take an hour to allow him to nurse and us to bond before his bath and routine testing/weighing.
3) I’d like those tests done in our room and if they can’t be, then Mark will go with the baby.
4) No artificial nipples, sugar water, or formula
5) Smudge will room in with us (as opposed to staying in the nursery).

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14 Comments

  1. I love it. Smudge is already so loved. I’d just add a pulse ox at 24 hours. :)

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    marfmom Reply:

    Hahaha yes of COURSE! I’ve already told Mark that; I can’t believe I forgot to put it on the form!

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    Mike N. Reply:

    From what I recall from Maternity Nursing (six long, caffeine-addled years ago; don’t worry folks, my practice has nothing to do with pregnant women or infants) isn’t a pulse-ox at 24 hours a standard test?

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    marfmom Reply:

    Not at most hospitals unfortunately

  2. sounds like a well thought out plan…

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  3. Awesome plan. I’m especially fond of the part about having an attending do your epidural. I had a student and it was a DISASTER. Because I have a bone disorder that makes my bones fragile, she was being too gentle–as if a needle could break my back (I’m not that fragile!). Ended up taking way longer and had to be done twice.

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  4. I’m with Ellen, I completely agree with having an attending or fellow do the epidural, with my EDS, my spine is NOT in normal position most of the time, and pregnancy REALLY screwed my back up, so even with the CHIEF OF ANESTHESIA doing my epidural it still hurt like hell, and he had to do it twice because my spine was all screwed up and he didn’t place it correctly the first time…
    Congratulations, and I hope with all hopes that you are given your VBAC and as natural a birth process as you and your baby can handle, I figure if you can do it this time, then that means that I can do it too next time… GO VBACS!!!!

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  5. I’m praying that you’ll receive exactly what you’re hoping for – a smooth and beautiful delivery without unnecessary pressure. Either way, I know Smudge will be beautiful and loved. Good luck Maya. :)

    Kristi, Live and Love…Out Loud
    @TweetingMama

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  6. Sounds like a great plan! Your plan gives me some great hope that barring another breach baby, I too can have a VBAC! :)

    When they did my c-section, I was lucky to have the nicest anesthesiologist monitoring everything. She had to tie down one arm so she could put the IV in, but she was careful to keep one arm free so I could touch DG as soon as she was born. She even helped hubs put her on my chest so I could hold her for a few minutes before they did anything. That was worth everything to me!

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  7. Awesome plan. I pray it goes your way. Make several copies of this and keep one in the car, with Mark and any place else you think it needs to be. So while this is going on with Smudge—who is taking care of the big bro? Best of luck and I still think 12-11-10 at 9 would be cool.

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  8. Sounds like a great plan. With my csection, I asked for the curtain to be lowered as my baby was being born and that was such a special moment for me. With my other babies (3) the first time I saw them was when they were all bundled up. To see my baby emerge all goopy and messy and beautiful was AMAZING! Just something to think about adding-hopefully you won’t need it but it made a huge difference to me this time around.

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    marfmom Reply:

    That’s a great idea, thank you! I’ll have to ask if that’s something they allow at my hospital. :)

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  9. Fantastic! I actually asked for the chief anesthesiologist to administer my epidural. I had the films of my back with me, and sweetly (I hope?) explained that only he/she would be able to touch me, since the risk of paralysis was increased. I’d suggest that, just in case. Like you, I’m all about providing myself to the students, but not when my life could be so severely impacted.

    Love the plan! Can’t wait to hear the details!

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    marfmom Reply:

    I don’t blame you! I am bringing my films too and the anesthesiology fellow I spoke with also promised they’ll bring an ultrasound machine to check my spine again before placing the epidural.

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