Delivery

The delivery of your baby is a very cherished time and brings with it much excitement. It is also one of the most critical events in your child’s development. We hope that by choosing us, you bestow a sense of trust that we will maintain the highest of standards in delivering your baby. Dr. Wheeler has delivered over 5,000 babies over his career and has maintained a highly successful practice in a very competitive area based on delivering the highest services with the highest satisfaction amongst his patients.

It is very important that you understand that there are standards of care that are set down by agencies which oversee the practice of medicine by physicians, nurses and hospitals. Occasionally, a patient may present us with specific requests pertaining to how they would like their child delivered. These requests many times are obtained from websites, alternative birth assistant, books and other media, which in most cases are written and proscribed by people who have very little hands-on experience in delivering babies. Occasionally, these requests may put the license of your doctor, nurse or Hoag Hospital in jeopardy. Many of these alternative plans assume no liability for the outcome of your delivery and the well-being of your baby.

Please see the list below of practices and procedures which we feel are very conducive to a natural, family-centered delivery. We also ask that you enter this critical phase in your child’s life with an open mind, understanding that many challenges may present themselves which may require deviation from these requests in order to provide the best outcome for you and your baby. If you feel strongly that you would like to follow an alternative birth plan which is outside of the birth plan outlined here, please notify us at your earliest convenience so that we may have the ability to discuss your request.

Please remember that we view the birth of your baby as a cherished and unique event and have one goal, which is to provide you with a healthy baby, a healthy mother and a happy family.

Birth Plan

We realize you will be inundated with information regarding birth and birth plans. The following list is a list of common requests. If you plan on any other requests, please discuss with Dr. Wheeler immediately.

During Labor

• I would like to be free to walk around during early labor
• I wish to be able to move around and change position at will throughout labor
• I will be bringing my own music to play during labor
• I would like the environment to be kept as quiet as possible
• I would like the lights in the room to be kept low during my labor
• I would prefer to keep the number of vaginal exams to a minimum
• I would like to wear contact lenses or glasses at all times when conscious

Labor Augmentations/Induction

• If labor is not progressing, I would like to have the amniotic membrane ruptured before other methods are used to augment labor

Anesthesia/Pain Medication

• I realize that many pain medications exist and I’ll ask for them if I need them.
• Before considering an epidural, I would like to try an injection of narcotic.
• I would like to have an epidural when possible

Cesarean

• If a Cesarean delivery is indicated, I would like to be fully informed and participate in the decision-making process
• I would like the labor coach present at all times if the baby requires a Cesarean delivery

Episiotomy

• I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch
• If possible, I would like to use perineal massage to help avoid the need for an episiotomy

Delivery

• I would like my partner and/or nurses to support me and my legs as necessary during the pushing stage.
• I would like a mirror available so I can see the baby’s head when it crowns
• I would like a chance to touch the baby’s head when it crowns
• I would appreciate having the room lights turned low for the actual delivery
• I would appreciate having the room as quiet as possible when the baby is born
• I would like to have the baby placed on my stomach/chest immediately after delivery if possible

Immediately after delivery

• I would like to have ___________________ cut the cord
• I would like to cut the cord myself
• Labor coach does not wish to cut the cord

Pregnancy Plan

12 weeks: OB Work-Up and Prenatal Labs including HIV & Cystic Fibrosis Screen (if not already done). First Trimester Screen, as part of the Sequential Screen for Down Syndrome and Trisomy 18 and Neural Tube Defects. If over 35 years of age, this is done at Magella. CVS if desired or indicated.

16-18 weeks: Routine OB visit with MD or NP – This includes: weight, urine, blood pressure, measure of uterine size and listening to the fetal heart. This does not include an ultrasound. Second part of Sequential Screen or AFP test- best done between 16 and 18 weeks.

• If under 35 years of age at time of delivery. Ultrasound at 18-20 weeks with ultrasonographer
• If 35 years of age or older at time of delivery. Ultrasound, Genetic Counseling, and Amniocentesis, if desired, at Magella/UCI. You will be given a referral for this test.

20 & 24 weeks: Routine OB visit which includes weight, blood pressure, urine specimen, measurement of uterine size and listening to the fetal heart rate.

28 weeks: Routine OB visit. One hour Glucose Test and Complete Blood Count (CBC), done at lab. If Rh Negative-Glucose Test, CBC, Antibody Screen & Rhogam done at Hoag Out- Patient Lab.

32 & 24 weeks: Routine OB visit

36 weeks: Routine OB visit plus a pelvic exam and Group B Strep culture.

37 weeks on: Weekly OB visits with pelvic exams.

Always call (949) 642-1363 after hours and weekends. After hours, our messaging center will prompt you on how to contact the on-call doctor. If a physician does not return your call in a reasonable length of time, please call Hoag Hospital Labor and Delivery at (949) 764-5789 or go directly to the hospital if indicated.

When to Call

• Regular contractions.
  • If before 36 weeks- Regular contractions that do not go away with resting on your side for an hour.
  • First baby after 36 weeks – Every 5-10 minutes for an hour, strong enough that you cannot talk through them.
  • Second baby and thereafter, after 36 weeks – Every 10 to 15 minutes for an hour and seem serious.
• Rupture of the membranes (not mucus plug)
• Bleeding like menstrual flow
• Decreased fetal movement – less than 10 kicks in 2 hours
• Any perceived emergency