So here is my birth preferences for Womble. I wrote them with advice and support from head of delivery suite and my consultant. Who knows what will happen, I know that it may not get stuck too but heck it helps having it written down as a masterplan. Rereading it yesterday did make me a bit upset. I don’t think necessarily because of what is to come with birthing Womble but for the references to what passed with Munchkin. I suppose even though I think I am mentally in a million times better place than I was before- I will always feel a bit of sadness about how Munchkin entered the world. But that’s okay.
IMPORTANT: XXXX has suffered PTSD since extremely traumatic birth of her daughter 23months ago (Failed pain relief, forceps, episiotomy, oxygen starved 9.5lb large baby with pneumonia in NICU for a week and brain scan revealed hypoxic injury). It has taken a massive amount of work to get XXXX to stage of trying for a vaginal birth again (originally an Elective C-section was agreed). Please do everything possible to support XXXX and minimise the trauma.
***Very real risk of mental breakdown if another traumatic birth is experienced.***
The aim is to get the baby out with minimal trauma to baby or mother.
- Early Epidural If I go into spontaneous labour then I am willing to give it my best shot to give birth vaginally however the priority in labour needs to be keeping me feeling as calm and as safe as possible so I don’t end up with any further mental trauma so I want an epidural as soon as I am in established labour. Dear Anaesthetist please don’t leave me until you are positive the epidural has worked properly- last time my first epidural failed and I was left for another few hours in agony before another anaesthetist could be found to site a second epidural that did work.
- Monitoring the baby – any concerns at all with the baby- meconium or worrying oxygen levels etc then I want a CS unless there is a very good reason not to do that at that point in time. Please talk me and my husband through this. Our first daughter was extremely ill due to her labour and we are obviously very keen to avoid a repeat of that experience.
- No delay in the second stage – if pushing isn’t working for me again (baby is in 90th centile for head circumference!) and the baby is showing any signs of distress then I want intervention to expedite delivery- however I will absolutely refuse the use of the Keillands high rotational forceps. Obviously I am keen to avoid another forceps/episiostomy delivery but I do recognise that in some cases this is preferable to a CS where the baby has to be moved back up the birth canal. So please try and discuss my options with me as much as possible.
- Induction– Unless I have an epidural in I will refuse all forms of induction including prostin, ARM and syntocin drip. I have a further appointment at 40W+1 to discuss options if I do go overdue.
Panic- I am going to do everything I can not to panic and freak out and I have been using a hypnobirthing CD to try and stay in calm. You can help me by doing the following:
- Don’t leave me on my own (this is very important- my husband and I were left on our own a lot during previous labour). If you have to leave me- reassure me and tell me when you will be back and please be as quick as possible.
- Please be nice to me, reassure me, even hug me or stroke my arm or whatever. I respond very well to reassurance and touch. Tell me I am doing well.
- Help me with my breathing and visualisations to stay calm.
- Things that may help me stay calm:
- Focusing on my breathing- in through my nose out through my mouth
- Focus on parts of my body not in discomfort- eg my big toe!
- Visualising a large comfort dial and turning the pain down
- Reminding me that soon I will get to meet my baby and the pain will stop.
- Saying 3,2,1 Relax during contractions (part of hypnotbirthing)
- Supporting me to visualise my meadow safe space and my ladybird visualisation as part of that. (see additional sheet)
- Keep the environment calm- lights down low and soothing music- maybe even being in water.
I intend to come to the hospital as soon as I think I am in labour so I can hopefully get my early epidural.
• Alternate Pain relief choices- if for any reason I can’t get my epidural early enough.
– Early stages
- Willing to try Massage, TENS (have a pack in my birthbag), Birthing ball and staying as mobile and upright, warm water in early stages.
- Gas and air (Entonox) – this didn’t really work for me last time as I wasn’t shown how to use it properly and it made me a bit sick but I sort of got the hang of it towards the end- please support me with using it properly if I wanted it in early labour but I want an epidural for the pushing stage and would prefer not to use gas and air for the second stage really as I found it made me unable push effectively.
- Being in water
- Pethidine as an absolute last resort if there is no epidural available when I really need one then I am willing to try pethidine (but I really don’t want too because of impact on breastfeeding)
–Established Labour and delivery- I want and need an epidural!!!!!
My husband and I have agreed that it might be better if he wasn’t present for the pushing stage as I need to focus my energy on pushing and not worrying about what he is experiencing. However this may change on the day so we will see.
I am unwilling to delivery on my back with my legs in stirrups. Ideally I want to be as upright as possible maybe in some kind of supported squat or on all fours but I do recognise this may not be possible because of the epidural- in which case I’d like to try lying on my side.
Please give me as much advice as is necessary, particularly regarding when to push and when not to push. If I am unable to feel the contractions properly because of the epidural it maybe beneficial for me to watch the monitor so I know when to start pushing. Please don’t shout at me “push out a poo” as that is pretty much all I remember lots of people shouting from my daughter’s birth!
Please advise me if you think a different position may be beneficial. I am extremely concerned that I won’t be able to push another baby out but I did get my giant headed 9.5lb daughter to very almost out but her distress and my exhaustion meant she had to be assisted out, so I am hopeful that given my body has done it once before then I will be able to manage it this time- please be as positive as you can with me but if you are worried about the baby focus on getting her out.
• I did not get to hold my daughter properly until she was 24hours old. This was devastating. If all goes well this time I would like the baby to be wiped clean quickly before having skin-to-skin contact for at least an hour following the birth if medically possible to try to help establish breastfeeding.
• I would like the cord to have stopped pulsating before it is cut (obviously if medically possible.)
• I have no real preference between physiological rather than a managed third stage, whichever is best at the time.
• My skin scars very badly (Keloid scarring)- for any stitches please can you put your best sewer on the job!
• I would like to be able to breast feed as soon as possible after birth. I was able to predominantly breastfeed my daughter but it was an incredibly difficult struggle due to the a breast reduction, flat nipples, an extremely ill tube fed baby who lost 14% of body weight and also turned out to be tongue tied! Please can I see a breastfeeding counsellor post-natally especially to check this baby for tongue tie and for support in the early days.
- I have built up a supply of frozen colostrum for my baby- my husband can pop home and get it if needed for any reason.
• We would like our baby to receive a vitamin K injection.