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  • "Andypink" started this thread

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Thursday, July 27th 2006, 10:32am

Creating Birth Plan

I've just had a rough go at writing my birth plan - I want to keep it simple, but is there anything I may have missed off or isn't clear. I would appreciate any comments.
Andypink
x



Andrea’s Birth Plan
I am happy for my plan to be flexible – Baby’s & Mummy’s welfare is most important!!

Birth Partner: Andrew (husband)

Pain Relief: As little as I can get away with. Preferably just gas and air. Not keen on pethidine or epidural.

Water: Would like a water bath available to help me relax.

Syntometrine: fine

Cutting cord: Andrew

Delivering baby: Really keen to have skin on skin immediately. Should I not be able to for whatever reason Andrew to do it.

Feeding: Breastfeeding ASAP.

Vitamin K: Injection for baby fine.

Caesarean: Not keen. If necessary I want to be awake and Andrew with me at all times.
PCOS. Ovarian drilling October 2005
Amazing BFP January 2006!!!!!!!!!!
2nd BFP natural!!!! - due Dec 2008!


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Saz

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Thursday, July 27th 2006, 10:33am

Placenta, natural or injection.

Saz

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Thursday, July 27th 2006, 10:35am

Ignore that, just seen you have put it!!

  • "Andypink" started this thread

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Thursday, July 27th 2006, 10:52am

Are there any cons to having the injection for the placenta?
x
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2nd BFP natural!!!! - due Dec 2008!


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Saz

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Thursday, July 27th 2006, 10:54am

I don't think so, but don't hold me to that. At our parentcract classes, the mw who did them said that the only difference is the length of time. Naturally, I think she said it can take an hour or more before it comes, whereas its obviously much quicker with the injection.

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Thursday, July 27th 2006, 11:07am

Who do you want to cut the cord? DH or the midwife?

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Thursday, July 27th 2006, 11:34am

Hi HOn
THese are mine so far tho it is still very much a working document


Birth Plan Requirements


Attending Birth

•Husband– M

•Friend L – if available

•Consultant

•Midwives



Natural

•No induction if possible

•Birthing pool with M asap and alap

•No episiotomy unless bad tearing expected

•Drugs for birth fine but only if water birth not possible

•NO ventuese/forceps

•Placental delivery by injection



C Section

•Badder catheter to be inserted after the epidural or spinal is administered

•Muscles not cut

•Baby to be squeezed out rather than pulled out

•No earlier than week 39

•Epidural or spinal anesthesia

•Antibiotics at the time of the cesarean

•Uterus to be closed with two layers of stitching (double-layer uterine suturing

•Care after surgery to reduce the chance of blood clots as necessary

•If not a mobile epidural then narcotic (opioid) medication to be injected into the epidural tubing catheter at the end of the operation to ensure sufficient pain relief to allow me to feel comfortable enough to hold and breastfeed my baby in the first hours after the surgery.

•Baby and hubby to be with me in the recovery area

•Can I control my pain medication (PCA.





Post Birth

•M to cut cord

•Skin to skin asap

•Baby mum and dad left together as soon as poss in darkened room to allow bubs to try and find nipple and feed naturally

•NO formula for baby

•All examinations of baby to be done in my and Ms sight

•Baby not to be taken from room without M

•VIt K injection acceptable

•I would like the baby with me during the day but in the nursery at night for first couple of nights, but brought to me for breastfeeding.




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Thursday, July 27th 2006, 12:14pm

thats a really lovely plan... :D

Chilli

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Thursday, July 27th 2006, 1:23pm

i didn't write one as DD was early i just didn't get time, in a way I am glad i didn't as i didn't know what to expect so i had no hard and fast rules on what i wanted. Andy yours is very much the way I planned it in my head.

the only thing we did was have vitamin K orally I wish I hadn't bothered now and just had the injection to get it out of the way.

I also had the injection for the placenta but it didn't work for me so I had to have it manually removed on the plus side I didn't have much bleeding after the birth I stopped bleeding after 10 days.

The main thing is you are as comfortable as poss and you are both safe xx

  • "Andypink" started this thread

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Thursday, July 27th 2006, 5:05pm

Tinkerbell - how do you know so much about c-sections?
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Thursday, July 27th 2006, 5:53pm

Researcher by nature and nurture hon......I alway info gather before I make any decision..that way I feel secure that my deciisoin is the best I can make ensuring I dont blame myslef if it all goes pete!!!!




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Thursday, July 27th 2006, 6:02pm

Andy, you plan looks good to me, there are no real disavantages to having an injection to allow the placenta to come away, my friend didn't with her 3rd child and said it was worse than the delivery!!

I haven't done mine properly yet, just not organised this time, but finished work today :)) so will have more time and energy to sort things out, the only thing I would really add to my plan is that I want the cord to stop pulseating before it is cut, to allow an extra 250mls of blood into baby's system, which is quite a lot of blood for a baby.

Tinkerbell, you have really done your homework on c- sections!!!


Karenxx













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Thursday, July 27th 2006, 6:19pm

positioning- Do you want to stay as mobile as possible?

eating and drinking in labour?

Are you happy for student midwives to assist with the birth?

Make sure you tell the midwife in charge of helping you birth your baby that your birth plan is there to be read- sometimes they are easily forgotten!

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Thursday, July 27th 2006, 6:21pm

oh and another pro to syntometrine is that it reduces the risk of post partum haemorrhage, however dont be rushed into delivering it as a physiological 3 stage is also nice and natural

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Thursday, July 27th 2006, 8:00pm

Andy I'm really impressed with your plan, its nice and flexible but its easy for a midwife to read in a hurry. I've a nasty feeling mine might run to several pages!!!

Does anyone know if its OK for me to have 3 birthing partners? I want DH, MIL and a student midwife who's been following my pregnancy throughout. It might get a bit crowded!





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Thursday, July 27th 2006, 8:05pm

We were told we could onlyhave 1 but when i got there they were fine with 2 and the girl next door had 5! I would of felt crowded 2 was enough for me.

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Thursday, July 27th 2006, 9:32pm

HAve still not made my mind up which birth im going for...but want to make sure that whichever I opt for Ive thought about it long and hard and understand my options.............even if I didnt havent the chioce I would still have researched cesers as I think that its better to have prepped myself for a contingency situation...I understand an emergency c section can be quite distressing.....by having some control, however limited, in such a situation may help reduce that stress and at least give a feeling of the excercising of some choice.

I know Im a sad bunny but Id rather cover all bases and know in most situations what the major decisions are and have thought about them in advance with the luxury of time and discussion with those I love and respect.

Really interested in the umbilical pulsating....havent come across that yet so will look into that now too!!



This post has been edited 1 times, last edit by "tinkerbell" (Jul 27th 2006, 9:35pm)


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Thursday, July 27th 2006, 9:34pm

Good tinking Tink. I had also looked into C- Sections ''just in case'' and was so glad I did. I know everybody always says stay positive etc, but I also think it is better to be prepared.

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Thursday, July 27th 2006, 9:37pm

Saz


You were clearly a VERY good girl guide!!!!!!!




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Thursday, July 27th 2006, 9:39pm

I think you were better than me!!! We had a rough 'back up' birth plan, but not as detailed as yours!!

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Thursday, July 27th 2006, 9:49pm

I had a detailed one but it did only run to 2 sides (ie 1 sheet of paper) - they haven't really got time to read reams of stuff, they did read it all though which I was impressed with. I remember I put things in like - I have a high pain threshold so when I ask for pain relief I want it NOW! that was a really useful thing to have in!

Yours is great Andy - Only thing I'd add is - lights on/off/dimmed. Any music you would like to have on/bring? Episiotomy or tearing and whether you would like to go for natural healing if a small tear rather than stiching - as by that stage you will be too busy smiling at you little one to give clear instructions :D



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Thursday, July 27th 2006, 10:29pm

Syntomentrine is a mixture of two drugs, syntocinin to make your uterus contract strongly and ergometrine to keep it contracted. It's usually quicker and you lose less blood 'at the beginning'.

If you are having syntometrine then you can not wait until the cord has stopped pulsating as the baby would receive a massive rush of blood through the placenta due to the drug. This means that the baby will miss out on that extra, oxygen rich blood.

The chance of retained placent is higher. The uterus is caused to contract sometimes before the placenta has been delivered. In this case you will have to have your placenta manually extracted.

A physiological third stage can (not always) take a little longer and you will have to push the placenta out but believe me, after pushing a baby out it's very easy to push something soft, slippery and maliable out. Personally I found that it wasn't difficult at all and certainly not worse than delivery!!!

It has to come out and synto doesn't make it any less painfull, it just speeds it up. Bleeding will be heavier 'at first' but you've just had a baby... blood is expected and for a first baby who is to know how much blood you 'would've' lost?

There is also some unpublished research which suggests that syntometrine can cause 'shearing' of the internal blood vessels of the uterus which can cause problems in later life. One consulant in gynae problems could tell if a woman had had syntometrine from her case notes purely by symptoms of cramping, bleeding, bloating, constipation and pelvic pain which were typical in women of menopausal age.

If you start to bleed then you will be given synto, they're not going to leave you to bleed.

In my opinion, why give a woman a drug to speed her up and why give a drug because someone 'might' PPH? Hospital policy is why!





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Thursday, July 27th 2006, 10:49pm

Also, episiotomies are only done when they're needed. If you need one then you'll have one... if you don't then you won't. I understand that nobody actually wants one but if it's a choice between tearing through your perineum to your anus then you'll get one whether it's in your birth plan or not.

Sections too, if you're booked for a normal delivery and you need a section then you will have one whether you want one or not. You may have no choice on whether you are awake or not.

Someone mentioned no ventouse or forceps. If they need to use them then they will do whether you want them to or not. If you DON'T want them to be used then you need to be mobile, upright, be able to feel baby coming down, be able to change position and reduce pressure. Be able to feel the baby and your contractions and be able to go with your body and push the baby out. Lying on your back, strapped to a monitor with an epidural is one way to improve the chaces of having an instrumental delivery.

I would suggest that all the things that you're not keen on, not sure of or don't really want will be overlooked because ..... well.... because it's a bit wishy washy (eeek, sorry!) If you feel REALLY strongly about things then you are more likely to be able to argue your corner when faced with 'hospital policy' but if you've shown that you're apathetic then chances are that your opinion will be second to whoever's looking after you.


Most midwives will be really open to strong feelings and beliefs if they feel that they are backed with an informed choice. Being able to explain WHY you want some things and WHY you don't want other things is better than stating that you do or don't want them.





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Thursday, July 27th 2006, 11:41pm

My advice would be to have an idea and write down yoru preferences, but do have in mind that what will be will be and if something has to be done then it has to be done.

For example, I didnt want epidural cos of the increased risk of ventouse or forceps. I didnt want episiotomy, I didnt want forceps or ventouse, I wanted to stand when giving birth.

I ended up having an epidural as I could not cope at all, I ended up having to go to theatre for an episiotomy as baby was too big and was not coming down as she had to be turned, it was either a forceps delivery or c section if she could not be turned.

I ended up with spinal block, episiotomy and a 3rd degree tear with a forceps delivery.

I was open minded but did have things i would rather and rather not do and have, but you just have to go with it on the day.

If you have any really strong ideas then make that clear verbally x



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Friday, July 28th 2006, 7:21am

I am lucky as my choices will be exercised within reason (ie medical necessity) I can choose to have a ce setion in advance if the labour is proving to be difficult and indications are that what I DONT want id likely to happen..........I have already had a number of discussions with my consultant who will spend some time with me inadvance going through my birth plan...as will the midwives.....discussing what is and isnt feasible and what stage choices become limited. THe plan will then ammended accordingly in case for aome reason I dont make it to London and have to go locally

Bells..my local NHS hospital is known to have a higher than average epesiotomy rate.......but is also known to do everything they can to help towards the achievement of birth plans....

'I would suggest that all the things that you're not keen on, not sure of or don't really want will be overlooked because ..... well.... because it's a bit wishy washy (eeek, sorry!)'.....
I am suprised to read this as I understood a birth plan was there to help represent what you really do and really dont want so that they can strive to help you achieve it. Also IM sure your do birth partner can reinforce your wants and needs as placed in the birth plan.

LIke everything tho a plan is only ever a guide...flexibility must always be recognised as necessity given the unpredictable nature of birthing...better to have a plan and deviate than no plan at all tho.....is my philosophy...........safety of baby and mum must always come first.




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Friday, July 28th 2006, 8:02am

I totally agree with Vicki!

I only wrote my birth plan the day before proper labour started cos I thought I would be at home the whole way. In the end we were in such a muddle going to the hospital & the midwife had picked up my notes but not the file they were in so the birth plan got left behind.

In the end the only thing I didn't have was a c-section although I was told that at midnight they would do one & DS came at 11.48pm. They were going to do an episiotomy as I had foreceps but DS came very quickly & I tore (2nd degree).

TBH with the problems we had with DS's heartbeat & the fact they were concerned about him I was just glad he arrived safe & sound. At the end of the day that is all that matter, not how the arrival happens although in an ideal world that would go according to the birh plan.

Best advice - don't rule anything out or beat yourself up afterwards if it doesn't go to plan!

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Friday, July 28th 2006, 8:22am

Yes Gill and Vicki you are right. I wanted a homew birth and really did have this romanitc notion in my head it never happened I had an epidural after having DD which really got me down as I had done everything naturally but no regrets at all, what will be wil be.

Tinkerbell you are right to write everything down and cover every aspect and as you say birth is unpredictable so keep your mind open.

I really do believe if you have it set in stone how you want it to go it never happens the more open minded you are the better it will be.

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Friday, July 28th 2006, 8:35am

Bells, I have a question. I read something you posted a while ago about mum, dad and baby being left on there own after delivery so that baby can find the breast on its own rather than being slapped on immediatly after delivery. But I've also read that BF can stimulate contractions so help deliver the placenta. I'd like to avoid syntometrine if at all possible, if I'm left with my baby so he/she can BF at leisure, will my placenta be left in until the contractions stimulated by BF push it out, or will it have to be delivered first manually?

Also a really thick question for anyone, can I wear a TENS machine in the birthing pool? I know its electric, but can I be in the pool with the stickies on and DH hold the machine bit outside the water?





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Friday, July 28th 2006, 8:36am

Mrs J - unfortunatley you can't use TENS in the water but you can have gas & air :D

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Friday, July 28th 2006, 9:05am

Mrs J- you should be free to help baby bf at leisure to assist with the delivery of the placenta. A physiological 3rd stage "can" take up to anhour so there should be no need to step in for a manual removal before then.

Tinkerbell- can i just ask you about your reason why you do not want an instrumental delivery.
Thistypeof delivery (as you know)is carriied ounin the 2nd stage, to assist mum if she is exhausted, to deliver baby quickly if the hr is showing signs of distress, or if the 2nd stage is prolonged and there is no progress despite adequate pushing from mum.
All of these above factors cannot usually be predicted, and i'm just wondering how you would fell in this situaution?
Would you rather go through an em cs, which IMO is more emtionally and physically stressful, not to mention traumatic and potentially dangerous than a "quick" instrumental del?




This post has been edited 1 times, last edit by "Rose" (Jul 28th 2006, 9:05am)


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Friday, July 28th 2006, 9:54am

Quoted

Originally posted by Andypink
Are there any cons to having the injection for the placenta?
x


Haven't read through this whole thread so don't know if anyone has replied to this particular question but my personal experience of delivering placenta was this:

Birth went really well, one puff of gas and air which I hated so gave up on it. Wanted physiological third stage, to ensure Plum got every last bit of goodness from the placenta, so went ahead with it. after only 20 mins my MW actually said "well this is all very well but its a bit boring"!!! she then went off and fetched the Ob and together they pretty much frightened me into having the injection.

It was administered and at this point they told me that if the placenta wasn't out in 7 mins my uterus would shut down and I'd have to have it manually removed. The contraction like pains returned and got much worse than before the injection, really very painful.

The placenta didn't make an appearance and so I was wheeled off to surgery where they gave me a spinal injection and I had a James Herriot experience. In the meantime Little Plum was missing out on skin to skin and BF - they gave her formula in my absence and without permission!

Obviously I cannot say that if I'd been encouraged to continue with the physiological 3rd stage that the placenta would have delivered but I do feel that 20 mins is ridiculous - I distinctly got the impression that they wanted / needed my room for the next delivery. Who knows!

Saying all that I've recovered fine but should I ever be lucky enough to have number two I will stick to my guns about a homebirth. I'm sure that in 9 cases out of ten the injection works like a dream but I didn't like it.






This post has been edited 1 times, last edit by "Rivka" (Jul 28th 2006, 10:01am)


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Friday, July 28th 2006, 10:32am

I just need to say that although I generally come across as a 'stick to your guns' kind of gal and I do think that birthplans are jolly handy as a guide .....and I wasn't suggesting that they are overlooked nor are they strictly adhered to, which is fine. All I was saying is that it's better to focus on the things you REALLY DO want and the things that you REALLY DON'T want and why. Of course it can all change but if you have an uneventful delivery then you have made your wishes known.

Remember that lots of women are happy to go into hospital, lie down and have their babies 'delivered'. The may have preferences but are not really bothered either way as long as baby is out and healthy. Nothing wrong with that but if you feel that you want to be upright, mobile and you want to avoid an instrumental delivery at all costs then state it clearly and state why you feel like that. Tinks, as you're private and have a good relationship with your doc, your wishes are likely to be taken into account more than the average bod ;)

I wish that I could make my tone of voice come over, I'm not saying that you should do a plan and expect it to be followed to the letter, I'm saying that if you do feel very strongly about things then put them down. Yes things change but if you feel very strongly about something then there is more of a chance of your midwife going an extra mile to help you get what you want. If you come across as not really bothered then she may think you won't mind too much if you deviate from your plan...... does that make sense?

I had stated in big letters that I didn't want syntometrine and why. Of course if I was bleeding out I would've been goven it without a second thought and that was accepted and appreciated but it was important to me that my wishes weren't overlooked that no one should mistakenly give me the drug as a matter of course as often happens when shifts change etc... As it happens the midwife clamped and cut the cord before it had stopped pulsating because she was used to giving syntometrine. It was the ONE thing that I hadn't put on my birthplan and to be honest, I was a bit cross (not at the time, later). She wasn't to know that it was important to me but it will bug me forever! :D


Mrs J, Nikki's already answered your question re placenta etc. You might have a midwife quietly mooching around your room but if you feel strongly about it, even if you have the syntometrine then I would write in bold at the bottom of your birthplan that you wish to be left alone, with lights down as quickly as possible after birth to initiate feeding. Baby can be left on your chest to find his/her own way to your nipple. Your midwife might stay with you and help you when baby does latch on, she may need to quietly do a few bits in your room but it won't affect the outcome and you probably won't even notice her.





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Friday, July 28th 2006, 11:06am

Hi Nicki......forceps and venteuse would be more distressing and traumatic for me than a c section..........whilsts the risks are greater for a c section than a natural birth it would appear that it is emergency c sections and those given to mums who had their heart set on a natural birth that seem to suffer distress and trauma........anecdotally those who elect or have time to prepare dont seem to find it overly distressing or traumatic......interestingly Ive found more women who have been distressed through natural childbirth (and have had more complications) than elective c sections. I guess everyone is different in what they want and how things affect them personally.

I am not wedded to a natural birth the way many women are.....though ideally I would like a water birth most important to me is that I am not stressed whatever route I take/have to take ..........I truly beleive that a stressed mum will affect the baby.......having done lots of research in to c sections I am equally not against them.....my consultant has a very balanced view of all approaches though she personally favours natural. TOgether we will come to a decision that is the correct one for me....but as she says closer to the time.........interestingly she fully understood why I would find instrumental delivery both distressing and traumatic but has warned me that once you get to that stage theres no other option.


Bells that must have been very distressing for you it must have been so disappointing because even tho you hadnt stated it in your plan there was obviously a reason for you wanting to deliver the placenta naturally and she should have checked, its so wrong to assume.......and thats why its so good having FZ cos its improves our awareness of all these issues and possible pitfalls and allows us to look at all different angles to ensure we can be as comfortable as we can be with whatever choices are available to us ultimately. Like you say it can only ever be a guide and we really do have to remain as openminded and flexible as possible but equally our preferences should be implemented wherever possible too and where choice exists it should be offered up with no assumptions made...oh to live in an ideal world!!!!!!

For me the birth is purely a means to an end and is only one day... the overriding thing for me is the need to breastfeed and I will go ape if they give pip formula for any reason other than I cant produce milk and then I expect them to clear it with me first. So heres hoping.



PS Edit - Bells just read your edit...........I think you are so right in what you say...if we appear indifferent they WILL make assumptions and decisions on our behalf....your tone of voice and advice is always , constructive and well received.......at least by me but Im sure by all of us.....I hope!!! My decisions always benefit from your input and you always help me with covering the different angles effectively.....I truly fnd that invaluable. And yes I am so lucky to be in the situation Im in because I have the luxury of the personal attention...I dont ever take it for granted and will be forever grateful to my DH for making this whole process as easy and stress free as possible for me.



This post has been edited 1 times, last edit by "tinkerbell" (Jul 28th 2006, 11:16am)


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Friday, July 28th 2006, 1:37pm


TOgether we will come to a decision that is the correct one for me....but as she says closer to the time.........interestingly she fully understood why I would find instrumental delivery both distressing and traumatic but has warned me that once you get to that stage theres no other option.


Tinkerbell- this was my point. I probably didn't put it accross very well as ever, but i'm trying to say that once you get to fully dilated and the head is deeply engaged, then there is often no alternative but to carry out a ventouse delivery, a cs at this point WOULD be very traumatic, particularly for the baby as the head is very low in the pelvis.

I'm not being deliberatly controversial, and i know yuo've looked in to this, but i'm just trying to understand your reasoning.

xx





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35

Friday, July 28th 2006, 1:40pm

Why do I need to but eating & drinking in birthplan - what do I need to put?

I think I am more confused about syntometrine now!! Not sure what is the right thing to do.
PCOS. Ovarian drilling October 2005
Amazing BFP January 2006!!!!!!!!!!
2nd BFP natural!!!! - due Dec 2008!


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Rose

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36

Friday, July 28th 2006, 1:49pm

many hospitals have an ancient outdated policy of "banning" women form eating in labour. There was thinking that "if" a mum needed an aneasthttic in labour then she might vomit and choke whilst under GA.
However this is has been dissproven and there is evidence to the contrary, which sugggests thats mums in labour need the calories and energy to keep them going. Labour has been compared to running a marathon, and you wouldn't run a marathon whilst starved would you?
Check at the hospital Andy, and see what the policy is. Some will "let" you suck boild sweets- whoo hooo...

Another reason for having a home birth........you can eat what you like!




This post has been edited 1 times, last edit by "Rose" (Jul 28th 2006, 1:50pm)


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37

Friday, July 28th 2006, 2:23pm

I'm not being deliberatly controversial, and i know yuo've looked in to this, but i'm just trying to understand your reasoning.

Reasoning for what?


Reasoning for not wanting a venteuse or forceps....would have thought nobody wants one!!!!



This post has been edited 1 times, last edit by "tinkerbell" (Jul 28th 2006, 2:24pm)


Rose

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38

Friday, July 28th 2006, 2:28pm

your reasoning behind not wanting to have a cs rather than instrumantal delivery if you are fully dialted- as you said often there is no other choice but to do an instrumental if complications arise.

Obviously nobody WANTS one, but situations do arise and they do have a place.





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39

Friday, July 28th 2006, 2:54pm

As I understand it its not possible to have a CS once bubs is in the canal.....no choice but to have instrumental delivery if there are problems......well according to my cons..

She basically said to avoid an instrumental delivery the judgement would have be taken earlier on in labour as to how the birth was goin and if she felt it there was a strong chance it would go in that direction then a cs would be possible........no guarantees that even with a good labour once in the canal problems dont arrive and instrumental is nec but often there are indications earleir that a delivery could be difficult..I guess thats when the decision can be made to go to C section.

I wouldnt go for a planned elective to avoid instrumental but I may choose to have one at the time if indications arent good.....the issue I face with the journey to the hospital is a much more key to the decision process whether to go for natural/elective c section







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