LET’S TALK BIRTH PLAN

 

(Blue lettering is a link!)

We take pride at Cumberland Regional, that we have a very low C. Section rate!  Nova Scotia doctors are working hard to improve the quality of care given to women during pregnancy and delivery!

As you may know, the C. Section rate is alarmingly high–and efforts are being made, across the province–and country, to lower this.

Most first time C. Sections are done for “failure to progress”—don’t you LOVE that term, “FAILURE!!!”   Not a word that makes a woman feel good about her labor—she FAILED!!!    Many times, it is FAILURE to be patient!   We used to have this “rule” about only being allowed to push for 2 hours!  Now we know  we can go much longer, if the mom and baby are looking good!

Of course, C. Section can be life-saving–and can be a relief to a long dragged out labor, babies in trouble, or hours of pushing!  I had a C. Section for a 10 pound 9 ounce baby–after 5 hours of pushing!  100 years ago I probably would be a “died in labor” story.  I went on to have my third baby vaginally (Vaginal Birth after C. Section–VBAC).

The Canadian Society of Obstetricians and Gynecologists, along with provincial Reproductive Care Boards, are reviewing every hospital–looking at C. Sections, and looking to see what may be done to avoid that first C. Section, without harming the mother or the baby.

Article about delivery and C. Section rate

We have incorporated much of this into a birth plan—not just a generic plan you print off Google–a plan for Cumberland Regional.

SO–WHAT DO YOU BRING TO HOSPITAL?

Don’t bring your best nightdress, lots of cash or jewelry–leave it at home!

FOR MOM:   All lotions, deodorants etc. must be NON-SCENTED

Comfortable T shirts, sweat pants, outerwear–you’ll still be in loose clothes going home!  Bring 3 of each–you’ll be changing every day with the sweating, and bleeding etc.

sensible slippers/shoes, socks that you don’t mind chucking in garbage if soaked–NOT your special hand knitted ones!

LOTS OF UNDERWEAR (NOT THONGS–you’ll be wearing pretty bulky pads for a few days)!  GRANNY PANTIES ARE THE BEST!!

Nursing bras, if nursing–and breast pads, even if you are not nursing–your breasts will leak anyway!

Shampoo, conditioner, hairdryer (we have one!), hair brush, scrunchies–those big hair clips don’t work when you are lying down).  Toothbrush/paste, personal makeup stuff—just moisturizer and lip balm is enough.  DEODORANT–please!!!

games or books to pass time—labor can be a lot of waiting.

Phone, cameras, extra batteries and chargers

Snacks, any special foods (we have a fridge).

Music CDs

Glasses, case, contacts solution etc.

Sleep apnea machine if you use one

Glucose testing machine if you use one

Medications

social insurance number and health card–you’ll need you and partner to register baby

BABY

we have diapers and t shirts–but limited supply–please bring in a few “onesies”, and receiving blankets

PLEASE DO NOT TAKE OUR ONESIES/BLANKETS HOME AS SOUVENIRS–we will soon have to stop supplying!

a photo outfit–and a spare outfit, going home outfit, and blanket

LEAVE CARSEAT in the car until discharge day–also see if your local fire station will do a car seat check for you!  Have gifts delivered to your home!  Clean out your car–you will be going home with flowers, gifts–and a new baby!

Pacifier, if are planning to use one -we do discourage it with breast feeding

socks- and you can put socks on hands to stop fingernails scratches.

Baby book, if you want footprints etc.  You’ll have to bring the ink pad–we don’t do foot prints any more!

Leave baby stuff in a bag in the car, until you need it–we have all you need for baby while in hospital.

BIRTH PARTNER–may be with you for a few days!

Change of clothes, underwear and toiletries–toothbrush/paste, deodorant!

Camera, batteries, lists of numbers to call.

Those hand held fans can be nice!

Music

Massage oil

Food and drinks–the hospital doesn’t feed you–we have coffee and toast–but other than that, it’s snack machines and canteen–when open.  Make sure you eat!  We don’t need you keeled over from hunger or thirst!

You can store perishables in the fridge–just label the items–and clean it out before you leave!  You can bring a cooler, if you need to feed several people!

Here are some pics of our delivery rooms and unit:

This is our nurses station.  You have to register DOWNSTAIRS, then you are brought up here!

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This is our assessment room–you usually are in this room, until the decision is made to either admit you—-or send you home!

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This is a labor bed.  To the side you can see our monitor–this is one of those monitors that allows you to walk around and still keep track of the baby’s heartbeat–even in the tub!

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We have all the bells and whistles needed to resuscitate a baby if needed–and all of our family physicians, obstetricians, and nurses are certified in newborn resuscitation.

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This is our waiting area, at the end of the hall.  We use this during the day time.  At night time, there is a sitting area out by the elevators–we ask that you use this at night–so patients can sleep.  PLEASE TELL YOU FAMILY ABOUT THIS–we can’t have people waiting outside the room–there are other patients and confidentiality has to be maintained.  We sometimes need to make phone calls about a patient–and the family hanging around interferes with our ability to maintain privacy.

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Bring some CDs to play!

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Our “birthing ball” and “squat bar”

BIRTH BAR, Birthing Ball, Mirror

Here is one of our after-delivery (post partum) rooms:

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This is the PRIVATE room you get after you have delivered.  that red chair folds out to a sleeping bed for your partner.  You have your own bathroom—lots of privacy!

Image result for picture of mother and baby

 

Let’s see  what you think of our ROUTINE care:

ROUTINE means that it is done for all births, and is not considered a “special request” that needs to be asked for.  This plan is for the average pregnant woman–who is being cared for by family practice, in the low risk clinic.   Many women being cared for in the high risk clinic can have all of this too.  Very few literally cannot get all the routine things(for instance–dangerously high blood pressure at risk for seizures,  bleeding more than expected during labor, worries about if the baby will tolerate labor due to some problem with the placenta–things that require close monitoring).  Even in these high risk cases, position changes, skin-to-skin, partner cutting cord etc can usually be done.

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All low risk women are allowed to walk around–we encourage it!  You don’t have to change into a flimsy Johnny coat/hospital gown.  If you want to wear your own long shirt–bring it!  Bring non-slippery comfortable shoes or slippers.  Want a shower?  Want a bath?   FINE!!!

YOU NOW MUST BRING YOUR OWN UNDERWEAR TO THE HOSPITAL!!!   BRING A FEW PAIRS!!!

THE HOSPITAL  PROVIDES 2 PAIRS OF MESH PANITIES!!  Wash one–wear one–rotate!

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We encourage you to drink!  It is best to drink clear liquids, if in real labor.  If you keep up with fluids, you will not need an IV!  We have water, apple juice and generic popsicles.  If you want something like Gatorade, or ginger-ale, or 7-up, you can bring it in with you–mark it with your name, and put it in the fridge provided.

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You CAN eat light snacks, such as soup, toast, fruit, if you are in EARLY labor, or if you are NOT in established labor.

You may also choose to bring snacks or meals in, and keep them in the fridge–or your drinks in a cooler—meals are NOT provided for your partner or support people–so think of snacks, and meals for the big day!

If you CHOOSE to get an epidural, THEN I’m afraid you won’t be able to eat when in labour–but you can still drink.  That is an ANESTHESIA issue.

 

PAIN RELIEF

If you choose NOT to use pain meds, that is fine! This is YOUR labour!

You will have one on one nursing care, and walking, position changes, warm baths/showers, sitting on the toilet, sitting on the birthing ball, massage, etc  can all help.

You can have a DOULA  (click here for info)http://assets.howtobecome.com/assets/images/2014/03/Doula.png(a support person who is trained to be a help to the mother in labor).  You would have to hire–and pay–for the services of a doula.  There are doulas in Nova Scotia, but most in Amherst will use  doulas out of Sackville area.

You can have up to three people in room with you for birth—talk it over with us if you want more—no hard rules!!

We have the big bouncy labor balls that you can use!

We also have birth bars you can use to help with pushing.

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You don’t have to deliver on your back!

 

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A nice tub bath or a shower is also great when you are in labour!

Every woman has a different labour–this is NOT a competition.  A woman who starts labour after a good nights rest, and has a 6 hour labor, and goes “all natural” should not gloat it over a woman who slogs it out through a 36 hour labour!   Do what you need, or want, to have YOUR birth experience–but let’s not put down our fellow woman/mother by belittling her choice to use pain medication.

I always cringe when I hear partners on the phone after delivery:  PARTNER:  “We had a little girl”  other side:  bwa bwa bwa bwa PARTNER:  “No–she took the epidural!”   The other side typically asking “Did she have it natural??”    The next response is “Ooohh–”     OK!   Listen up!  DON’T ASK A WOMAN WHO HAS JUST HAD A BABY WHETHER SHE WENT ‘au natural’.

You are setting her up to feel like a failure on a very special day in her life–just say you are happy, and ‘congratulations’, and ‘good job’—the details that matter—she doesn’t need that disappointed “Oh…”

WHAT HAPPENS IN THE DELIVERY ROOM STAYS IN THE DELIVERY ROOM—so DAD!   Friends/family privileged to be there—NOBODY POOPS DURING LABOR–got it!!!!???  If she asks if she pooped–the answer is NO!!!!!!

You can use relaxation, self-hypnotism, warm shower/bath, massage, position changes, and a doula to help you with labour.

If you CHOOSE to use something medicinal for pain, there are options available:

IV medication.  We use Fentanyl–it is short acting, so can repeat every 15-30 minutes–that is often enough to get you through–especially if this is not your first baby.

ENTONOX (nitrous oxide/oxygen mix–laughing gas)

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This is available to you, and can be very helpful for short tem–to get through late stage labor, to use while waiting for an epidural.  It is not really meant to be used for long hours of labor.

It takes about 15-20 seconds to work, so you need to start using it the second you feel a contraction coming on.

EPIDURAL–click here for video

We have 24 hour epidural availability.  You have to be IN LABOR to get an epidural.  Labor means that your cervix is opening up.  So–it you came in, and you were 2 cm, and now you are 3 cm, and having contractions, you could get an epidural, if you wished.

If you come in and you are 9 cm, and feeling an urge to push—and they are calling the doctor to come in –and we are driving, and hoping to MAKE it to your delivery–well—sorry—–only way now is pushing—too late for epidural.

You’ll see videos of epidurals, where they put a little bandaid on the epidural catheter that is left in(it is VERY soft catheter–NOT a needle).  I have NEVER seen just a bandaid used!

Every place I have worked really tapes the catheter down well–so you can move around in labor–because THIS is what it usually looks like at the end of labour–what with the moving, turning, sweating etc.  A BANDAID????    –just won’t do!!

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We have “walking epidurals”–so you can still get up, and go to the bathroom.  Not all woman can walk though–most CHOOSE not to get out of bed—they may feel “funny ” in the legs, or tired, or their blood pressure is low–but most DO get up and move about!

EPISIOTOMY—-NOT ROUTINELY DONE

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We do NOT do “routine episiotomy”.  Now, I know you are going to hear from your relatives/friends that you are”not going to just let it TEAR down there!!!”  “Make sure they give you a cut!”   What can I say–old thinking dies hard!

HERE is some information about episiotomy

DELAYED CORD CLAMPING/CUTTING THE CORD

We do delay cord clamping if baby is fine–which they typically are.

HERE IS INFO

For an uncomplicated birth, we lay your baby on your tummy—skin-to-skin, and stimulate the baby there.  If all is well, we wait for the cord to stop beating (usually 1-3 minutes), before clamping, and having your partner cut the cord.

If your baby is not responsive (not crying, limp), and needs some resuscitation, the cord will be cut, so we can get baby to the crib, and help your baby to breathe etc.

The cord will be cut long enough, that your partner can still “cut the cord”, after your baby is crying, and doing well.

SKIN TO SKIN

This routinely done–you would have to TELL us if you DON’T want your baby laid on your tummy/chest.

WHY IS SKIN-TO-SKIN iMPORTANT? click here

and also here!

CESARIAN BIRTH

Sometimes, you end up with a C. Section for various reasons–sometimes you have had a previous C. Section, and prefer to have a repeat Cesarian instead of attempting a vaginal birth (VBAC–another post!).

We do try to make your C. Section experience a decent one!  If you  have a spinal, or epidural for your C. Section, so you are awake, then we do welcome your partner, or other support person to be by your side during the operation.

Unfortunately, not everybody gets the required pain relief to do a C. Section while awake—we check before we start surgery!  In this case–the anesthetist may offer you another attempt at spinal/epidural–OR—may decide that you need to be “put to sleep”.    Because you will be asleep, you will not be allowed to have your partner beside you—your partner can wait outside the OR, and accompany your baby to the nursery.

If you ARE awake, we keep you with your baby (unless problems), and your partner stays with you too!

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Look at that head of hair—beautiful baby!!!

As soon as you are stable, you are back to your room to show off your new arrival to the family!!

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HOW LONG DO I STAY IN THE HOSPITAL?

For first time moms, you will typically be here for two-three days.  If you are breast feeding, we want to make sure that this is going well–we don’t want to have you leave when you are still getting the hang of it—you need help to build up confidence.

I’ll cover breast feeding in another post–but we are a breast-feeding friendly hospital.  If you CHOOSE not to breast feed, we will help you with child care tips, and make sure all is well before you go home.

If this is not your first child, we have sent women home in less than 24 hours, if they wish—just discuss with the doctor looking after your baby.

When you DO go home, you can call us (24/7) at the hospital if you have a breast feeding, or other question during your 6 week recovery period.  We can get you in touch with a physician if needed.   902-667-5400—ext 6144.

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Oh–and we know you might be sore “down there”, but in 4 weeks you may be feeling a bit frisky.  You can have another egg ready to fertilize in 2-4 weeks–so don’t think you can’t get pregnant before your 6 week check up!

I HAD to share a link to my absolute favorite lullaby by Connie Kaldor—sang it to all my children—TIMELESS!!   Think about what is really important!

LINK TO CONNIE KALDOR–with the lyrics!

give it a sec—it should go to song!

See the post on contraception.

 

 

 

 

 

 

3 Replies to “LET’S TALK BIRTH PLAN”

  1. Willy Ramil says:

    Thank you so much for your effort in writing this post.

  2. Feeley says:

    Was just pointed to this website today, and wish I had read this post for my first pregnancy. I love the honesty of these posts!! Makes me smile, and it’s so refreshing to hear it like it is, instead of the “my experience is perfect, my pregnancy was amazing I loved every minute of it” Thank you for this Web site and thank you for taking the time to share your knowledge. OMG!!!! that Lullaby brought me to tears!!! Can’t wait to sing it to my baby boy!!

  3. Ashley Hickey says:

    I love this … thanks for writing this in such a human way 🙂

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