Birth plans

Ahhh, the birth plan. By definition: a written description from the parents to be of what they would like to have and what they would like to avoid during their labor and delivery experience. Sometimes people come in with a short one, for example "I'd like to have the baby placed on my chest as soon as she is born, and I'd like to nurse as soon as possible. Also please do not give my baby the Hepatitis B vaccine." And sometimes they come in with a birth plan that is 4 pages long. These are the people that you might as well get the OR ready for their C-section. Such is the case of "Jill," a 34-year-old primip (first pregnancy).

Jill and her husband "Brian" took the Bradley classes. If you don't know what those are, Google it. Her birth plan was so complex that we could about guarantee she wasn't going to get everything she had requested. It just wasn't possible. Included was that she wanted nothing to induce or augment labor, she wanted everything to go totally naturally. Ok. So when she finally went into labor, 3 WEEKS past her due date, against the strong advice from her midwife that it wasn't good to still have a baby in there that long, we were expecting a rather large child. Nonetheless, Jill's birth plan insisted on no medication, no IV's, no anything to help things along. It was reasonable until after she was in labor for 24 hours. We said "Jill, we understand your birth plan, but now that it has been 24 hours and you aren't making any progress (she was 3 cm dilated) perhaps we ought to think about starting an IV to get you some fluids and maybe a little Pitocin just so that we can get your baby here a bit faster."

You'd have thought we suggested a C-section with no anesthesia. She freaked out on us. So that was the end of that suggestion. Also I should mention in said 4 page birth plan we were also instructed "medical staff is not to address Jill directly as her relaxation is of the utmost importance. All questions will be directed to Brian." which is ridiculous and not legally possible. We have to have the patient answer certain questions for us, we aren't allowed to take what the husband says as an answer for many things. So we continue on with Jill's contractions coming every 3-4 minutes and not much change in her cervix. Another 24 hours later (we're now at 48 hours since she got to the hospital) Jill is now about 4-5 cm dilated. We thought maybe we could address this and suggest the possibility again of starting some Pitocin or perhaps breaking her water. Sometimes that helps. Jill also hasn't slept in over 48 hours, remember. Again we got resistance and were asked to not ask her about anything to speed up her labor again. Hopefully, her baby was doing fine and wasn't in distress, but it was difficult to tell as we weren't allowed to monitor her baby, we could only dopple for fetal heart tones once an hour. Which by the way is totally against our protocol, but patients can refuse anything they don't want.

Now any other patient would have already had a C-section before 48 hours of labor and only being 4 cm dilated. But since there wasn't an emergent need for one she wasn't taking one. We didn't even suggest that to her! Around hour 62, Jill's water broke. Around about hour 64, Jill was finally completely dilated. Amen to that. Jill was coached on pushing. She started pushing. 3 hours later, she still hadn't had a baby. She was pushing effectively, it's just that the baby was so big, he wasn't getting very far. Jill refused a vacuum extraction, forceps, or an episiotomy. So she continued to push.

Thankfully, an hour later, Jill delivered a 10 pound baby boy. Jill also suffered a 4th degree tear, which means she tore all the way from the vagina through her rectum. So she got to go back to the OR to have that repaired. It was so bad we had to have a colon/rectal surgeon come assist. When I assessed her afterward, she looked like raw hamburger meat. Bet she was wishing for that epidural now, huh?