Old Pregnant Lady!

So...  Since I'm 35 years old I am officially what is known in the medical world as "Advanced Maternal Age."  I've never worried too much about it since age 35 is an arbitrary cut-off and so far all of the testing I've had done leads us to believe that Sesame is perfect.  At one of my first appointments however, my obstetrician (and friend) made a remark or two about my "advanced maternal age" and proceeded to make a big deal out of showing me that the language used for billing purposes is even worse...  "Elderly Multigravida" is how my visits are coded (which means Old Woman Who's Had More Than One Baby).  ARGH!
Well, I couldn't let that rest without doing something... So at my 32 week visit I dressed up like an old lady and presented him with a birth plan that took into consideration my elderly state.  Here's the birth plan and a few pictures...

Birth Plan for Christy - Elderly Multigravida

January 15, 2011

We are looking forward to sharing our birth experience with you. We have created this birth plan in order to outline some of our preferences for birth. We would appreciate you reviewing this plan, and would be happy to do so with you. We understand that there may be situations in which our choices may not be possible, but we hope that you will help us to move toward our goals as much as possible and to make this labor and birth a great experience. Thank you!

Please Note: 
I am hard of hearing. My vision is impaired. And I have lapses in my memory. I am often incontinent. I require assistance with ambulating and pose a serious fall risk. I hope that this birth plan will help accommodate for my Elderly Multigravida state.

Labor, Delivery and Postpartum Care:

I would like to have an enema upon admission to the hospital and on a daily basis as long as I am hospitalized - as I have chronic problems with bowel movements and frequently require manual disimpaction.

I would like to ambulate freely, however I require assistance and will need a walker at my bedside as I have problems with imbalance and frequent falls.

It may be helpful to write down my plan of care and the names of those caring for me because I have problems with my short term memory.

My husband is also elderly, and at times forgets that I am his wife. Please gently remind him that I am his wife and that we are having a child together.

I would like to wear my dentures at all times unless needing to be put under general anesthesia.

I would also like to wear my hearing aids at all times. Unfortunately my husband is nearly deaf and refuses to wear a hearing aid so you will need to speak loudly when communicating with him.

My uterus is old and tired. Please respect that when considering augmentation with pitocin.

I can be cantankerous.

During stage II of labor, please avoid over-abducting my legs as I have an artificial hip and this positioning could dislocate it.

I also have two artificial knees.

I would like to have the birth recorded with photographs, video tape and/or tape recording as my dementia is likely to prevent me from remembering the occasion.

I would rather tear than have an episiotomy.
And, if you could tack up my hydrocele while you're down there it would be greatly appreciated.

I prefer prune juice and oatmeal for breakfast – this helps me avoid the manual disimpaction that was previously mentioned.

I would like to be provided with an ample supply of hemorrhoidal ointment and suppositories.

I would appreciate a consultation with the discharge planner to determine if discharge to a skilled nursing facility would be appropriate.

Thank you for your dedication to providing me with exceptional care. It is rare to find someone who specializes in the field of Geriatric Obstetrics.