#BellyBirth Plan — Twins Edition!

My CBAC (Caesarean Birth After Caesarean) Birth Preferences, Twins Edition!

I’m sharing this because a number of people on Instagram expressed interest in reading it. It’s specific to CBAC with twins, but you can download a more general/de-personalized version and adapt it to your needs.

This is my last pregnancy, and although lots of my preferences are standard at my hospital, I decided to include them so that everyone—DH, our doula, and others—are on the same page. With that in mind, after the traumatic birth, I also included a section on what my wishes are if the shit hits the fan.

Caesarean Birth Preferences

We are so looking forward to finally meeting our twins and to having the most positive birth experience (our last!) we possibly can. We acknowledge not all preferences can be accommodated, but thank you for taking the time to read our preferences and, where circumstances permit, for doing anything you can to make them a reality.

♥

Pre-Op

• IV placed in left arm/hand.
• Doula to accompany me to the OR, if permitted.
• ECG dots to be placed away from my chest (for skin-to-skin contact in the OR).
• All medications to be compatible with breastfeeding.
• No sedatives or drowsy medications – I want to be alert for our babies’ birth.
• To have one or both arms free from being strapped down.

In the O.R.

• Please take photos (and videos, if permitted) of babies’ births and Apgar checks.
  • This will help me feel like a more active participant in the birth, and will help me remember the birth in case sedatives/drowsy meds become a medical necessity.
• DH and our doula both to be present.
• Please use a clear drape so we may see our babies enter the world.
• Delay cord clamping/cutting, if possible.
• I would like to see the placentas.
• Immediate skin-to-skin If not me, then DH.
• DH to accompany babies to the warming table and be present for their checks.
• DH to trim the umbilical cords, if he wishes.
• Breastfeed as soon as possible after the birth.
• If either baby should need to leave the OR without me, DH will accompany them.
• Delay Vitamin K, Hep B, and erythromycin for an hour, until each baby and I have made eye contact.
• DH and/or I to hold babies while Vitamin K and erythromycin administered.

Post-Op Recovery

• If we are separated, DH to remain with babies and doula to remain with me.
• My mother and DH’s parents are welcome to visit us.

Breastfeeding

• To nurse immediately following the birth.
• To meet with a Lactation Consultant as soon as possible.
• No formula, glucose, plain water, or pacifier to be given without my consent.
• Donor breast milk is okay if it becomes medically necessary.
• All medications to be compatible with breastfeeding.

Postpartum

• Delay bath and shampoo, as standard.
• Have the catheter and IV removed as soon as possible.
• Get up and walk around as soon as possible.
• Eat as soon as possible.
• Take pain medication at regular intervals to stay on top of my pain.
  • Percocet okay, but no Vicodin (triggers headaches)
• Nurse/hold babies as they get the heel prick.

Dealing with the Unexpected

This has been an easy twin pregnancy. Both babies have grown well and I haven’t had any complications.

However, with my history of pregnancy loss, primary and secondary infertility, high risk pregnancy due to placenta previa, and suspected placenta accreta and postpartum haemorrhage, I know that sometimes the unexpected can occur.

I have a few requests in the event that something goes wrong.

Emergency Hysterectomy

In 2014, when I was haemorrhaging, I was very calm, even after DH was asked to leave the OR.

• If possible, I would like to stay awake with no sedation while the hysterectomy is performed—even if DH and our doula are asked to leave the OR.
• Should general anaesthetic be required, I request one that minimizes the risk of post-operative amnesia, if possible.
• I request that as many photos and videos be taken of our twins’ first hours (by family members, our doula, if she is still available, and medical staff, where appropriate) to help me remember.

NICU

• If only one baby goes to NICU, DH would accompany them and doula will stay with me and other baby until I am able to visit.
• I would like to visit NICU as soon as possible and as often as possible.
• If supplementation is necessary, I prefer my twins be given donor breast milk via SNS.

ICU

In 2014, despite losing 3.6 litres of blood, I was exclusively breastfeeding my daughter on the day of discharge—and I nursed her until she was 2!

• If I end up in the ICU, I would like to pump to encourage breastmilk
  • If I am unconscious, I consent to having my breasts hooked up to a pump.
• If supplementation is necessary, I prefer my twins be given donor breast milk via SNS.

Pain Medications

After a 3-hour caesarean, once the euphoria of delivering my daughter wore off, I was slammed with pain and was given morphine. This caused me to forget many details of my daughter’s first 24 hours.

• Please take as many photos and videos as possible.
• Please wipe my back regularly with a wet washcloth. Morphine is itchy!
• If I am complaining about the catheter hurting, please check my thigh (last time the tubing caused a friction blister).
• I prefer our twins be given donor breast milk via SNS.

♥

You’re welcome to download a de-personalized version of my #bellybirth plan here. If you do, I’d love to hear what you changed—and how your birth went!