Parent's wishes for the birth of Abigail Grace Wilsford
Abigail is a miracle and gift from God. Her birth is an occasion for rejoicing. Please treat it as such, even if she is still born or dies soon afterward. Please refer to her as Abigail or Abby and share our joy and sorrow with us. Our wish is that if she dies, Steve or Mindy is holding her. As a result, we ask that all possible procedures be done in our presence or delayed until her condition is assessed to see if she is stable. Our intent is to provide primarily comfort care for Abigail with minimal intervention. We truly appreciate your help and support, and ask that you understand if we seem indecisive at times. We also appreciate and find great comfort in your expressions of grief, be it through tears or humor, so please do not hesitate to cry or be sad in front of us, if that is how you feel.
We desire to have a third person (in addition to Steve and Mindy) in the OR to take photograph and/or video.
We desire no mechanical ventilation at any time, no CPR (no chest compressions) at any time. Rather, immediately after birth, perform standard suctioning, rubbing, and vigorous drying to aid in her respiratory and cardiac efforts. We desire that the following comfort care guidelines be observed:
1) Assess Abby's respiratory effort after drying, warming, and suctioning.
a) If no respiratory effort, do not try to resuscitate. Give her to Mother or Father.
b) If she breaths well, weigh & measure; then, give her to Mother or Father. Other procedures (footprints, eye ointment, vitamin K, etc.) are to be delayed until both parents have held her; and, if possible, these procedures should be done while the parents are holding her.
c) If she shows some respiratory effort, but has trouble breathing, institute PPV, checking periodically to see whether she can breathe on her own. An umbilical catheter may be inserted at this point for epinephrine administration, comfort care meds, and/or blood testing.
i) If Abby does not begin to make respiratory efforts after 5 minutes, do not continue PPV or try to resuscitate. Give her to Mother or Father immediately.
ii) If Abby begins breathing effectively, oxygen may be administered (prefer nasal cannula) as well as morphine to ease breathing. At this time, if her heart rate is slow, one dose of epinephrine may be administered. Weigh & measure her, then give her to Mother or Father. Other procedures (footprints, eye ointment, vitamin K, etc.) are to be delayed until both parents have held her; and, if possible, these procedures should be done while the parents are holding her.
iii) If Abby is making respiratory efforts, but they are not effective, PPV may be continued for up to 15 minutes. At the end of fifteen minutes, if she is struggling to breath or in distress, morphine should be given through umbilical line to ease her breathing, and she should be immediately given to Mother and Father. Please give her morphine as often as needed to relieve respiratory distress.
2) Comfort Care (DNR) orders are instituted at this point (after the above has been attempted).
3) We desire that Mother or Father be holding her at all possible times.
4) We desire no warming tables, etc. Rather, use warm blankets with skin-to-skin contact against parent's chest.
5) We desire that no procedures be done without parents' presence. Steve is to be with Abigail at all times. As soon as is practical, please have Abigail join Mindy in the recovery room.
6) We desire full rooming in (no NICU, transition nursery) for at least first several hours; later arrangements to be made with parents' permission only.
7) We desire that Steve and Mindy bathe Abigail themselves if possible. If not possible, please bathe her in the same room with the parents.
8) We desire that our children and other relatives be allowed in to see Abby ASAP for as long as we wish.
9) We desire that Mindy try to nurse Abigail. Request that the lactation consultant visit as soon as possible for assistance (Mindy has nursed two previous children).
10) If Abby stabilizes, we desire to take her home ASAP on comfort care.
In case of death:
If Abigail dies during our stay, please notify staff members as soon as appropriate. Mindy will be recovering from a C-section and will probably be best cared for on the maternity floor, but the staff should be sensitive to the situation when possible. Is there a wing for post-surgical patients, gynecological patients, or antepartum patients?
If she dies before being bathed, we desire to bathe and dress her ourselves.
After she dies, we desire that Abigail be with us as long as we desire. Also, we desire that our children and relatives be allowed to be with us during that time.
Abby's name, Abigail Grace Wilsford, must be on the death certificate.