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).