I am now 38 weeks and 4 days pregnant and baby Lauren is expected to arrive any day. Placenta is 'mature' and baby is well grown - very active and making sucking and breathing movements. I am asked to walk as much as possible now to encourage labor to start.
This is my second diabetic pregnancy and was much harder to manage than my first. However, I know so much more now than I did then. I was able to manage it with mostly low carb eating and increasingly huge amounts of insulin....... And I am happy and proud to say that I have managed it very well. My latest A1C is 5.3. Higher than the 4.9 at the end of my last pregnancy, but still very respectable - and it has taken a lot of work. I've only gained 6 kg the whole pregnancy - without starving! Again proof of the benefits of low carbing and a very strict management plan.
I saw my Obe yesterday and we discussed my birth plan. She agrees with everything, had some good input to add to my ideas, and I am so happy that for this birth I will have a chance of having a good experience.
For my first daughter the birth was treated as a medical procedure (even though it was a vaginal delivery) and I was left feeling disempowered, violated, and very upset with the whole process. No family or companion allowed. No cell phone and no way to contact my friends / family to let them know what was happening. Imagine they did episiotomy without asking me or even telling me what they were doing.... There were all these residents pushing on my tummy and telling me to push. I wanted to yell at them to leave me alone, stop touching me, and let me do it by myself. I am sorry that I didn't.... it all happened too fast...
I wasn't allowed to move around or eat or drink for a labor that failed to progess until they used high doses of oxytocin, finally and relucantly on my side an epidural, and it still ended up taking more than 24 hours.
After the delivery they left me by myself in a recovery room, without my baby and no companions allowed for 2 hours before being taken back to the room. They took my baby away for monitoring and the nurses couldn't / wouldn't tell me when i could have her back. It was so distressing. After 6 hours of waiting (couldn't sleep as I was too anxious about my baby) I ended up walking down to the nursery by myself (sore and battered from such an arduous labor and after not having slept for nearly 48 hours and waiting for her to finally be brought in).
She was also vaccinated against Hep B without my permission (something I feel very strongly about and also due to my family's weird immune issues) and I only found out she had been vaccinated when it appeared on the hospital bill.
After that I changed doctors and hospitals determined that the birth of this baby (probably my last pregnancy) would be something that I would be an active and empowered participant in - regardless of how the birth goes... and I know my Obe will not be knife happy. She will only do a CS if it is medically required.
Below is my birth plan - discussed and agreed with her yesterday. She also told me she wants me to eat and drink as I like during the delivery (and that doing so is not a problem even in case of emergency CS), and to manage my own blood sugar. She will monitor intermittently (unless there is a problem) and encourage me to move around as much as I like / can. She is confident I can manage well without epidural. Her confidence is contagious and very reassuring. She also recommended a pediatrician who I will meet tomorrow (as long as Lauren is still staying put) to discuss the delivery with as well... who she says is also on the same page in terms of a minimally intervened birth.
Delivery Plan for Sally Ann Clark, 41 YO
Attending Obstetrician: Dra XXX
I believe childbirth is a natural process, not a medical procedure. I would like to keep the birthing and delivery process as natural and minimally intervened as possible, in close coordination with my Dr. who shall use her best medical judgment for my case and progress.
The following are my wishes for the delivery:-
1. Natural delivery, if at all possible.
2. I would like to be able to move around and take whatever position I find comfortable during labor and delivery. I have pelvic and sacroiliac pain – lying on my back is very uncomfortable. Squatting, kneeling or other position may be appropriate.
3. Do not break my water for me. Let it break by itself.
4. I would like to try birthing pool during labor / delivery and even a water birth.
5. Please do not count / yell / coach / push on my belly during pushing. Please tell me when it is ok to push / not ok to push. Please ask me if you want to hold my legs, etc. I will ask for help if I need it.
6. No routine episiotomy, please help me support the perineum during delivery.
7. Pain relief, only if necessary, in coordination with my Dr. I prefer not to do epidural due to past experience: I have permanent leg numbness / pain from epidural 3 ½ years ago.
8. Please delay Umbilical Cord clamping until it has stopped pulsing. I would like to cut the cord myself.
9. Allow the placenta to deliver by itself without routine oxytocin, unless it is judged necessary by my Dr. I would like to breastfeed immediately to encourage uterine contractions.
10. Bring baby to my chest and allow her try to breast feed immediately and spend time with me before she is weighed and checked, if she is stable. I understand that there is ‘risk’ of her having low blood sugar due to my having diabetes. I would like to manage this by immediate breastfeeding (I have milk/colostrum already).
11. Except in case of “emergency” as judged by Dra., please do not carry out any medical procedure on me or the baby without discussing with me first and getting my express consent.
1. I do not wish her to have Hep B vaccination (I am vaccinated against Hep B) or have Vitamin K injection at birth (I take a vit K supplement and intend to fully breastfeed). I would like to sign a waiver on this / have clear instructions given to the attending pediatrician on this.
2. Breastfeeding only and no formula at any time.
3. She should be with me all the time unless there is medical reason for her to be in NICU.