Delivery and Birth Plans
All of us at Tepeyac Family Center want to support your pregnancy and birth in any way we can. We are happy to have the opportunity to be partners in your health care. We greatly appreciate couples taking the time to educate themselves about their pregnancy through books, classes, etc. Once a week a childbirth educator, Marsha Jacobeen, teaches an excellent childbirth class.
We want you to feel secure that we will honor your birth plan to the best of our ability, as long as we are given the chance to review it before the birth. We would like to feel confident that you will work with us in respecting some of the limits we feel necessary.
Birth Plans: Our practice does not require that you make a written birth plan, but it is an excellent communication tool. The website www.babycenter.com can help you create your own birth plan. It is a great thing a couple can do together and it helps you to think about what is on your "wish list".
Cesareans: We would like to reassure you that we have no desire to do even one unnecessary c-section. Every one of us can remember a delivery where we had almost given up hope of a vaginal delivery. Unless it is a medical emergency, there usually is plenty of time to discuss the necessity of a c-section with the parents.
Cutting the Cord: We deliver babies that are born vaginally and are doing well onto mom's tummy. Babies who have medical difficulties, such as meconium in the amniotic fluid, are handed immediately to the neonatologist or newborn nurse. If your baby does not need immediate care, the cord is usually cut shortly afterwards. It is not difficult to let it pulse for 5 minutes, but if we wait until it completely quits pulsing, this can take 20 minutes or longer. Waiting more than 5 minutes to cut the cord delays the routine procedures the nurses expect to do. They want to weigh, measure and dress the baby, so that they can move on to another job. They do this at the warmer in the room and do not keep the baby long if she is well. While the baby is being attended to, the mother can deliver the placenta and get any stitches she may need. After that she can sit up and hold her baby for breast feeding.
Circumcision: This optional surgical procedure is performed by the doctors on the 1st or 2nd day after the birth, not on the day of delivery.
Doulas: A doula accompanies a woman or couple to their birth as a trained support person. They bring lots of knowledge, tools, and skills with them. They provide physical and emotional support to help you fulfill your childbirth goals. Having a doula at your birth can be amazingly beneficial. If you are considering hiring a doula, you can look on the doula bulletin board in the Tepeyac waiting room.
Electronic Fetal Monitoring: This is done externally, on the abdomen in most cases. Internal monitoring is used only if medically indicated. Monitoring the baby's heartbeat with a stethoscope or hand held doppler is not sufficient, because this does not produce any permanent record. A woman does not have to be in the bed for external monitoring. Sitting in a rocking chair next to the bed, or standing is also fine, as long as the heartbeat is being picked up. Internal monitoring of the contractions is only used in special occasions.
Episiotomies: We are not eager to cut an episiotomy. We make one either because the baby's heart rate is worrying us, the baby's head is starting to bruise, or we suspect that the mother will have a large tear. If you do not want an episiotomy, even to prevent a large tear, please talk to us and add this to the birth plan.
Eye Ointment: Virginia state law requires hospital personnel to administer an antibiotic ointment (erythromycin) to the newborns’ eyes within one hour of birth. The nurses are willing to wait until the baby has been breast fed and can put the ointment in the eyes while the baby is in a parent’s arms. Parents who refuse the ointment for their baby must put this in writing. Please add this to your birth plan.
Food and Drink: The hospital anesthesiologists are uncomfortable with women eating solid foods in labor. They do accept clear liquids, which includes any drinks that are see through without pulp, Jell-O, popsicles, hard candy, and gum. The hospital provides apple juice, cranberry juice, and grape juice. They have cherry, orange and grape popsicles, and cherry and orange Jell-O. Any similar item can be brought to the delivery. Women planning a vaginal birth after cesarean (VBAC) may be restricted to ice chips and gum.
Induction of Labor: Your due date is the start of the 40th week of pregnancy. A baby is "on time" if she comes between 37-42 weeks. We will not try and stop a woman's labor if she is 36 weeks. We may suggest an induction before 42 weeks, but each couple can choose to wait until the baby would be truly late, >42 weeks. In this case a monitor strip of the baby's heart beat and any contractions (called and NST) would be done in the office at 41 weeks. Of course there are individual medical conditions that alter our advice.
IV's: IV's are required only if a woman chooses an epidural, is on pitocin, or had some other medical reason for one. The hep lock is the name of the IV access that is capped off, without fluid running. This is a good solution for a woman who tested positive for the group B Strep bacteria (GBS). She will need antibiotics every 4 hours during labor to protect the baby. A heplock also makes walking in labor easier. If a woman is GBS negative and does not want even a heplock, this should be discussed with one of us ahead of time during a prenatal visit.
Laboring at Home: We are not currently able to offer home births. If you plan to work through a lot of the labor at home, please discuss this plan with us ahead of time. If you are in early labor and still comfortable you do not have to go to the hospital immediately. Until 9 p.m., call the office number (703) 273-9440, to give us a heads-up that labor has started. The answering service will page the person on call. After 9 p.m., just call when you are ready to go to the hospital or have a question you need answered.
Lotion: Remember to bring lotion or massage oil. Most moms appreciate massage during some part of their labor.
Music: It is fine to bring a CD or tape player with you. It is a simple way to create an atmosphere that you feel "at home" in.
Prenatal Care: We provide you with a yellow handout that explains the timing of prenatal visit and what tests are usually ordered during pregnancy. If you wish to come less frequently or to decline one of the tests, please make sure that we have discussed it. Many women prefer special combinations of vitamins in pregnancy. If this is the case, please discuss it with us.
Vacuum vs. Forceps: Many couples include in a birth plan that they prefer a vacuum extraction over forceps. A vacuum is seen as gentler, but it can only be used to pull with. It is not appropriate for adjusting the position of the baby’s head. Your doctor would always explain why she feels one of these assistive devices is needed, if time allows.
Vitamin K Shot: A small vitamin K injection is routinely given to the baby in the thigh muscle shortly after birth. This protects the baby from bleeding due to insufficient blood clotting. If you plan to refuse this injection for your baby, please discuss this with the baby’s future pediatrician before the 35th week of pregnancy. Please note this in the birth plan.
Walking in Labor: Fair Oaks hospital policy requires electronic fetal monitoring once an hour. It usually takes 20 minutes to determine that the baby's heart rate pattern is good, unless the baby is taking a nap. After monitoring, a woman can move around the room freely, or walk around the halls. They prefer patients not to leave the floor without notifying the nurse.
Water Breaking: If your water breaks, we would like you to call and tell us. The only exception is if it is in the middle of the night, you are Group B Strep negative, you are not having contraction, and want to stay home a while longer. Your water must be clear, not GREEN. By 6:30 a.m., at the latest, we want to know that your water has broken. We will not break your water during labor without discussing it with you first.
Whirlpool: Fair Oaks Hospital has 3 rooms with whirlpools: 17, 18 and 25. They leave these rooms open for couples, who want to try natural childbirth. When you call us to tell us you are in labor, please tell us if you want one of these rooms, if available. The whirlpool cannot be used after the membranes have been ruptured. All of the rooms have showers and the same type of adjustable birthing bed.