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Subject: misc.kids.pregnancy Birth Planning FAQ (part 2 of 3)

This article was archived around: 17 Mar 1997 23:19:26 -0800

All FAQs in Directory: misc-kids/pregnancy/birth-plan
All FAQs posted in: misc.kids.pregnancy, misc.kids.info
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Archive-name: misc-kids/pregnancy/birth-plan/part2 Posting-Frequency: monthly Expires: Fri, 18 Apr 1997 00:00:00 GMT Last-Modified: 1995/10/06
This is a collection of responses that Laura Weaver received when she solicited examples of other people's birth plans. ----------------------------------------------------- Here is the summary of responses I received. Note that one of the responses was a summary someone else had done earlier this year. Hope this helps; I got a lot out of reading what others had included. Laura laweaver@ralvm29.vnet.ibm.com ******************** Start of Summary *************************************** ========================================================================= BIRTH PLAN FOR _____ AND _______ We have prepared this Birth Plan to help you understand our philosophy and the kind of care we hope to have for the birth of our child. The pregnancy has gon e very well thus far. We have been careful to eat well and stay fit, and have done everything we can to prepare for a healthy and uncomplicated birth. We have chosen our obstetrician, Dr. ____, because she shares our desire for a low-intervention birth and respects our need for good communication. We wish for as natural a birth as possible, avoiding unnecessary procedures and medications. However, if medications or procedures become necessary, we ask that you discuss them with us in advance so that we can participate in the decision making. It is important to us that we remain together at all times during the labor and delivery (vaginal or cesarean). We would like to have our labor coach, ____, stay with us throughout, as well. We hope to avoid routine procedures (e.g., prep, enema), to delay introduction of an IV feed unless needed, and to keep the number of vaginal examinations to a minimum. If procedures or medications are proposed, we ask that you discuss them with us and suggest alternative therapies or comfort measures so that we can make well-informed decisions. We would like to have the option of sucking on ice chips, and may also want to try walking, different labor positions, and perhaps a hot shower for pain relief in labor. As long as things are progressing well, we prefer intermittent monitoring with an external fetal monitor. We very much want to avoid internal fetal monitorin g unless it is specifically medically indicated. Because we want labor to progress at a natural pace, we hope to avoid artificia l induction or augmentation of labor (e.g., amniotomy, stripping of membranes, pitocin). We would also like to avoid an episiotomy and try perineal support o r hot compresses instead. We would like to have a mirror placed so that mother can watch the birth, and, if things are progressing well, mother would like to be allowed to touch the baby's head as it begins to crown. It is very important to us to hold and nurse our baby immediately after birth, and to have the weighing and bathing done in our room so that we can watch. If this is not possible, we would like to have father stay with the baby at all times. Also, we ask that you discuss any routine neonatal procedures with us before they are performed. We plan to exclusively breastfeed our baby, and therefore request that s/he not be given bottles, water, or a pacifier without our prior approval. We also would like to have a private maternity room with 24 hour rooming in, and a cot or comfortable chair for father. We thank you for taking the time to go over this Birth Plan, and appreciate your cooperation in getting our new family off to great start. Patient ________________________ _________ Coach ________________________ _________ Physician ________________________ _________ ========================================================================= Birth Plan [my name (husband's name)] Obstetrician: name Doula: name Hospital: name My husband, _____ _____, and the doula, _____ _____, should be present with me throughout labor and delivery. Corrective Lenses: I need to wear contact lenses or glasses at all times when conscious, as my vision is so bad that being without corrective lenses is unbearably disorienting. This should not be a problem, as my contact lenses take very little time to remove in the event of an emergency, and furthermore are extended wear, so there would be no problem if they were left in my eyes for an extended period of time, up to a week, including periods of sleep. My husband will have my glasses in case I need to remove my lenses. External Fetal Monitoring: We do not wish to have continuous fetal monitoring unless required by the condition of the baby. We expect that there will be a period of being monitored by the external fetal monitoring upon first arriving at the hospital, and afterwards monitoring will be intermittant as long as everything looks ok. Prep: I would prefer to avoid an enema or extensive shaving of pubic hair. Free Movement: I wish to be able to move around and change position at will throughout labor. I would like to be allowed to choose the position in which I give birth, including squatting. IV: I do not want an IV unless I become dehydrated. If necessary, I will accept having a device (heparin lock?) inserted into a vein so that an IV can be started up quickly when needed, but without the IV being connected until it is needed. Artificial Rupture of Amniotic Membrane: I do not wish to have the amniotic membrane ruptured artificially before the birth unless signs of fetal distress require an internal monitor. I do not want the internal monitor unless the baby has already shown some sign of distress. Fluids by mouth throughout first stage of labor. Anesthesia and Pitocin: I do not wish to use any anesthesia unless I request it during labor. I will want local anesthesia for repair of tears or of episiotomy, of course. I do not want routine pitocin to be used; we should be allowed to try position changes and nipple stimulation before pitocin is used. Episiotomy: I do not wish an episiotomy unless required to avoid an extensive tear. I would prefer a medium-sized tear to an episiotomy, although I imagine that it may be hard to judge how much tearing will occur. I intend to take all possible measures to avoid the need for an episiotomy. Birth: I would like to be allowed to hold the child immediately after birth. We would prefer that the cord not be cut immediately, but given a few minutes to cease functioning first. Caesarian: If a caesarian is necessary, I wish to have an epidural for anesthesia, and to have my husband and, if possible, [the doula's name] present for the birth. The child, if he is not in distress, should be given to my husband. Circumcision: We do not wish to have circumcision performed in the hospital. (Better to go to a specialist who uses local anesthesia, if you want this done.) Breastfeeding: I intend to breastfeed the infant and do not wish to have any bottles given to him, including glucose water. [This was not followed, which caused big troubles!!!] Rooming-in: We would like to have the baby remain with us in our room. We do not want the baby to be taken away from us unless he requires medical treatment, or unless we request to have him taken to the nursery. We would like to have the baby examined in our presence. ========================================================================= Below is a summary someone else compiled recently. Laura Weaver ***************** Original article ********************************** I would like some net.wisdom about birthing plans. I know some people will make a written statement about their wishes and desires during labor and take this to the hospital. I have a friend who is about 30 weeks pregnant at the time and she didn't have a nice experience last time. So now she is trying to get it better by talking about things beforehand. I think she really would be helped by hearing how other people handled their birthing plans. So I have a bunch of questions for you. What topics did you cover in the birthing plan? When in your pregnancy did you discuss it with your ob/gyn/midwife? When you have delivered already: did the birthing plan work out, did things go as you would have wanted them to go? Do you think you missed some topics in your birthing plan you might like to add next time? *************************** Reactions ***************************** Thanks to all who responded. I got a lot of reactions. My friend really liked all the replies she got. It was her first encounter with the internet and misc.kids and it really was a positive one. The replies gave her a lot food for thought. She already started last week by discussing some things with her gyneacologist. I ordered the reactions by first giving the general reactions, at the end the birth plans. A lot of people wanted their names omitted, so I decided to omit all names. *************************************************************** My birthing plan covered such topics as: 1. Number of people allowed with me during birth 2. Upon addmittance, no IV's, and an external fetal monitor only and for only 15 minutes per hour 3. No drugs to be offered even if I scream for them 4. My husband gets to cut the cord 5. If an emergency c-section is necessary, to have it only after approval of both my spouse and I, plus my spouse to be allowed to be with me during that procedure 6. I wanted to have ice chips during labor 7. To be allowed to breast feed immediately after birth 8. To hold my newborn for at least 1/2 an hour before taking her away to finger print, etc. 9. To be release from hospital the next day unless told in detail why I couldn't 10. I wanted a private room after birth plus rooming-in. 11. No episiotomy 12. To be able to move about during labor and birth in any position I found comfortable. All this was written in a way as not to irritate my doctors. A disclaimer was written allowing for complications - If something was terribly wrong I would get an IV or fetal monitoring, etc. as the doctor saw fit - but only after discussing it with us. I presented my birthing plan as soon as possible and showed it to all my doctors (I belong to an HMO). Some did not appreciate it - they knew what was best for me! Another one told me if I went against doctors orders, I would not be covered by my insurance. What actually happened: I did not get an IV nor did I take any drugs. I was allowed ice chips only but that was enough to get me through all those long hours! I had an external fetal monitor on for most of my labor but I didnot really notice it - plus it showed when my baby was being deprived of oxygen so it was ok. I was allowed to have 4 very close friends help me give birth and share my experience. I did not need an episiotomy but I did tear slightly. My husband did not cut the cord nor did I get to hold my baby immediately because the cord was wrapped around her neck thus requiring immediate medical intervention. I couldn't room-in because my baby was in ICU for a week. All in all, the birthing plan gave me and my doctors an idea of what I wanted in the best case scenario. Although everything did not go as planned (do they ever?) I was quite happy with my birthing experience. Good luck! *************************************************************** > It seems to me > that somehow in the rush to avoid "needless interventions" we are setting > ourselves up as peers of the medical establishment, able to make and execute > competent and rational decisions that will always result in a perfect outcome I would tend to agree. Months before labor started looming, I had filled my head with horror stories I'd heard and read about dealing with involuntary administering of "twilight sleep" (some of the stores were pretty OLD), being strapped down like a crucifix with legs spread eagled and forced to push flat on my back, while a class of medical students, just passing through at an opportune time decide to stay for the birth and take notes (all against my wishes). Oh, and the obligatory "here is your IV, Demerol and epidural we're supposed to give you because WE know what's best for you". Not to mention the routine episiotomy. But in birthing class, the nurses explained to us what hospital policies are these days in the two hospitals up here that do births. The one I was going to allowed the mother to walk freely during her labor, no obligatory IVs or drugs, and laboring women were allowed ad librium clear fluids, even during an induction, even during the pushing stage. I had control and was going to be treated with dignity. I backed down from my previous stance of "I'd rather give birth at home in a toilet than let these guys near me when the time comes". I discussed all my concerns with my doctor who was also of the minimal-interventionist school, and we discussed his protocols for deciding when to do an episiotomy, an induction, a C-section, etc. I mentioned my concern for the "med school class" scenario, and he told me I had the final say on what non-essential personnel are allowed at the actual birth, as well as labor. As it turned out, nothing went according to my little idealized plan. My water broke early, I entered the hospital at that point as per my doctor's instructions (to make sure the cord had not prolapsed), I walked around for 20 or so hours in "woosy" labor (I watched 3 Star Trek epsodes during that time in the scrub room), agreed to an induction after it was determined that in all that time I was still only 3 cm and 80% effaced, lived through the induction for 10 hours and ended up with a monster of an episiotomy after 2+ hours of pushing because the baby just wasn't making it that last cm or so. After a failed suction attempt. With no drugs as per my choice. And yet I was quite pleased with the whole business.I gave it my best shot. After the birth, contrary to my plan of getting the heck out of there as fast as possible, all I could think of was "please, please let me stay here even one more day to recuperate". Oh but I'm rambling. The take home messages: talk to your caregiver beforehand, discuss the birth plan but don't be confrontational, learn his/her protocols and that of the hospital's (you might not need to include all your points), and remember that even the best laid plans can go awry, just do the best you can with whatever hand nature deals out to you and don't feel guilty. You never know how you're going to feel until you're acutally there. *************************************************************** >> 3. No drugs to be offered even if I scream for them >> 9. To be release from hospital the next day unless told in detail why I >> couldn't >> 10. I wanted a private room after birth plus rooming-in. >> 11. No episiotomy In our birth plan, we had similar, though simpler, wishes than she (i.e. "no drugs" rather than "even if I scream for them"). But, we also stressed to our obstetrician that the birth plan was basically our articulation of what we would like in an *ideal* labor and delivery situation. We went into labor and delivery with our eyes wide open, knowing full well that the chances were pretty good that the ideal wouldn't actually happen. But, our birth plan gave us a good starting point, and it let our medical providers know generally that we were well-informed consumers, and had thought about the whole process. We got a lot of positive comments from the nursing staff about our birth plan, BTW. By reading it, they were able to get a pretty good sense of the type of birthing experience we were after. That doesn't mean, of course, that the experience was dictated by the plan, but it was a good guide. *************************************************************** While I agree with ___ that making rules like "no drugs even if I scream for them" seems a bit severe, educating oneself and not writing anything down is a little lax. I followed this approach, was very educated, but ended up not being able to think clearly due to all the drugs and Csectiotn required by my preeclampsia. I wish I had written down things like "rooming in" & "bring the baby immediately" so that someone might have at least brought her to show me though I was too weak to think of asking for her. Also I wanted to see all the products of conception--placenta, cord, etc.--it would have helped make sense for me where this baby came from-- also to see it emerge. This would have been possible--if someone had asked me if I wanted to see I would have said yes, or videotaped--but because I could not think clearly I couldn't make these wishes known as they were forgotten in the heat of the moment. Maybe if I'd written it down folks still might have forgotten but maybe not. (oh well. I swear if there is a next time I want to SEE IT ALL even IF I have a section). *************************************************************** I think the most important thing is to understand your doctor's attitudes and the reasons for them. In my opinion, the best way to do this is with direct questions to the doctor about what s/he will do in particular situations. The ideal is a doctor whose general philosophy is similar to your own. Then, you can pretty much let the doctor be in control of the whole birth experience (which makes it mentally easier for you). It's important to ask the doctor a lot of questions now (I started this at my first visit). The best thing to do is to write a list of questions (at least 5 per visit) and then ask them to the doctor at the end of the appointment. Try to be non-confrontational about things. If you think you don't agree with something, consider the doctor's reasons carefully before challenging it, and then try to get your point across without making it sound like you think the doctor has a dumb idea. Most doctors have a "standard" birthing plan. My doctor had it written down. In your birthing plan, you should discuss things not covered in the doctor's, or things that are a little out of the ordinary. (Like, I specifically asked her not to break my water unless it was medically indicated.) You should discuss everything in your birth plan orally before showing your doctor a written copy. Bring a copy or two to the hospital with you for the nurses and others there, in case they don't have it. *************************************************************** Just make your plan flexible. My OB doesn't like to make a birth plan because he says you never know what will happen. He is very open and we talked about how I wanted it to be and his basic philosphy fit my needs. I did end up with an episiotomy and a forceps delivery after two hours ouf pushing. Make sure you take into considerations all the What ifs. Also, if the doctor you normally see might not do the delivery make sure certain things are stated well. A friend's plan said she wanted no medication. The baby came very fast and she had a lot of tears. The OB on call took her no meds literally and gave her no local while he stiched her up. *************************************************************** I suggest Sheila Kitzinger's book _Your Baby, Your Way_ for information on putting together a complete birthing plan. *************************************************************** My doctor had a sample birth plan. I talked about everything from drugs to jacuzzis. If I had a questions or wish, I talked it over with the doctor. My biggest request was for her to let me know what she was doing and why. She explained everything before she began anything. I had an episiotmy ( sp?) and I still tore extremely bad (inside). I did not have a spinal or epideral. My husband was able to cut the cord, the nurses took pictures for me. I had rooming in. For this to be my first child it was relatively easy. The only thing I would change and suggest for your friend is to have ALL your calls held once you go into hard labor. My whole labor/delivery only lasted 11 hours, but the doctor had to sew me up for about 2 hours. During that time the phone kept ringing with well-wishers (sometimes people just don't use common sense). My parents were at the hospital and they could have watched if they had wanted. I didn't have any restrictions on who was allowed in and I had a mirror so I saw everything myself. It really was the MOST amazing experience of my life. I'd love to have a hundred kids. Although I was really scared during pregnancy that I would be able to go through it. Every time I'd read some info, I'd start crying and tell my husband I couldn't do it. Then I stopped and thought, that if it was something SO outrageous that we'd be able to have babies some other way. I'm a Christian and I finely said a little prayer to the extent of "Lord, don't let it be anything I can't handle". Then I just quite worrying about it. I remained calm and never got excited or tense. My daughter was 8lbs and 10oz. The doctor was amazed that I pushed her out so "easily". My hard labor only lasted 3 hours. I was very lucky and I wish everyone could have an experience like mine. *************************************************************** > This kind of stuff is probably what gives me the negative impression I > have when I read most "birthing plans" that end up on the net as models. > FOR MYSELF, I preferred to go into the labor/birth without some > kind of rigid framework of rules like that. The point that you seem to be ignoring is that you ARE going into the labor/birth with just such a rigid framework of rules, regardless of whether you have any sort of birth plan. The protocols of the hospital and the doctor are what you will get. How rigid they are, and what they consist of will probably be completely unknown to you unless you ask. And you certainly won't know what is subject to modification. The apparent rigid and absolutist tone to some birth plans is perhaps explained by the difficulty of dealing with most of the medical pro- fession. Doctors and hospitals are used to, and prefer, the passive and accepting patient. Any questioning of normal procedure must usually be done forcefully or it will be ignored. Of course there are many exceptions, and everyone must do what she feels most comfortable with. My personal preference is to stay at home, thus avoiding all medical protocols for a non-medical situation. If a normal birth hits difficulties and becomes a medical situation, then it's time to bring out the previously-prepared plan. The plan is prepared just as much to ensure that you've considered all the issues and know what you want and care about, as it is to guide the medical professionals. *************************************************************** FOR MYSELF, I've noticed several things which worried me in the various birth stories I've read in this group, and I'm wondering whether some kind of planning in advance (such as having a birth plan and bringing some sort of extra support person of my own who has already been through this and is familiar with dealing with doctors and nurses) could avoid some of the things which worried me. For example: 1. If I need a C-section, I would like, if possible, to be able to have an epidural. Most of all, I want to avoid general anesthetic except in a real emergency, because general anesthetic *terrifies* me, more than childbirth itself, more than a C-section. And I understand that it is rare nowadays, even in the case of C-section, and probably the standard procedure would be to put me under only if it were a real emergency. *But*, I read where one woman had to argue her doctor into letting her stay awake during a planned C-section, because he didn't understand why she would want that. So, I wouldn't just want to read up on things, I would want to check that at the hospital I would use, staying awake during a C-section is standard procedure. And if there was any doubt about it, you can bet I'd want that in a birth plan. 2. Some of the birth stories seemed to describe situations where the women really didn't seem to be watched or coached all that closely. (I remember one case where it took considerable argument to convince staff that an epidural was not on, and another where a woman tore various devices out because she was finding the pain too much and didn't have any medication.) Hearing things like that, I'm not sure I just want to expect the hospital to take care of everything (this is why the idea of an extra support person is starting to sound good). 3. Some people described babies being mysteriously whisked away. I'd like to be able to hold my baby first, or, if there's a medical reason why I can't, I at least want someone in my family to be able to keep track of what is happening with the baby and let me know (and still be alert enough to do this - another reason why I'm leaning toward the idea of more than one support person - but I guess this is a separate issue than birth plans). 4. I found ___'s story worrisome. I hate the idea that my obstetrician and I could make one plan, and then I could discover that what I am getting is something completely different, not because medical circumstances have changed, but simply because I wound up getting a different doctor for delivery. Maybe a birth plan would make this less likely? I mean, if my doctor's approval for something medically reasonable were in writing, it would have more weight than just me saying that my doctor had approved it. Or is there something else that can be done to avoid this kind of situation? I don't know whether a birth plan is the answer to my concerns, but I know I'm not altogether satisfied with the idea of doing a lot of reading as my only preparation (maybe I'm just too much of a control freak). (By the way, though I currently hope to try without drugs first, I have *absolutely no intention* of writing a plan which involves "no drugs even if I scream for them." Not with my hips.) *************************************************************** > 4. I found ___'s story worrisome. I hate the idea that my > obstetrician and I could make one plan, and then I could discover > that what I am getting is something completely different, not > because medical circumstances have changed, but simply because > I wound up getting a different doctor for delivery. Maybe a Anybody you have arranged things with might be unavailable when needed. The best way I know of to get what you want is: 1. Know as best you can what it IS you want. This means doing a lot of reading so you know what the choices are, Know thyself. 2. Ask a lot of questions so you know what your helpers (spouse, midwife, doula, doctor, hospital) intend to happen by default in all circumstances. 3. Write down what you want, in all circumstances you can think of (a birth plan), concentrating on those areas where you are in disagreement with others or want some- thing unusual. 4. Seek out helpers who agree with your decisions or at least will respect them. 5. Make sure that your helpers have backups (or that you have backups for your helpers), that are reasonable, that you have met, and that you have discussed your plans with. This reduces the possibility of ending up with an incompatible helper. All this takes work. If what you want is to not work, and let the experts take care of things, then you should do that. The most important thing is that you feel comfortable with what you are doing. ******************* Sample birthplans ************************* How it worked out? Great! We were lucky and everything was as uneventful as you may possibly wish for. To increase the odds of everything going well we hired a private midwife, who came to our house during the labor and did not let us go to the hospital (7 minutes away) until I was ready to push. My daughter was born 2 1/2 hours after our arrival at the hospital. I did not take any medication, I did not have an episiotomy and my perineum did not tear, I think for two reasons: I did a lot of perineal massage, for at least 5-6 weaks, and my daughter was quite small, 6lb 4oz, and had a relatively small head for a newborn. She was in a great shape, a few tiny bruises on her head, her face was pink, eyes wide open, she was too interested in her surroundings to nurse. They cleaned her in our room, she roomed in with us the whole time. We had a most wonderful experience you can imagine. To sum it all up, a normal course of labor and delivery is essential to have a good experience in childbirth. However, it is up to you to make sure that if your body is doing all the right things nothing gets in the way of the natural wonder unfolding. I think that the $600 spent on my labor-support midwife was the best investment I've ever made (her hands on my lower back during transition performed miracles). The attitude is also important---you want to be taken very seriously by your OB team. It might help to bring up these issues early on, it makes you a more active participant in your regular visits. You also need a doctor who is willing to listen and is not a control freak. I am sure some of the doctors in my OB's practice thought I was a pain, but the attending OB sure did everything exactly the way the plan said. I could go on for ever, I better stop with the advice I give to my pregnant friends: to maximize the odds of everything going well, minimize the exposure. I hope the plan helps. Dear Dr. _______ and Birth Center Staff, We are very pleased to be sharing our birth experience with you. We have worked very hard to make this pregnancy healthy and low risk and to prepare for the birth of our first baby: we attended a comprehensive birth class; read a number of books about pregnancy, labor, delivery, and child rearing; ___ religiously did her 200 Kegel exercises every day, along with tailor sitting, pelvic rocks, squatting, and other exercises recommended during pregnancy; she faithfully ate 80-100 g. of protein daily, as well as deep green and orange vegetables, a quart of milk, lots of high-fiber and vitamin C foods, wheat germ, and even some things she had never heard of before; together we practiced relaxation techniques for each stage of labor, as well as laboring and pushing positions. As you can see, we did all that is in our power to give our baby a good start in life. Now, as the pregnancy is approaching its final weeks, we are eager to share with you, our birth team, our hopes for a natural and trouble-free birth of our baby. We hope for a normal, natural birth, and we feel well prepared and look forward to it. Any help you give us will be most appreciated. Of course, we realize that unusual circumstances may arise. It is for that reason that we chose excellent professionals like you. However, if the course nature takes appears to be within the limits of the ordinary, we do have preferences regarding routine hospital procedures for the mother and the baby. These preferences are expressed in the following Birth Plan, which we wrote along the guidelines given in the brochure RYour Guide to a Healthy Birth,S which we obtained from your office. Birth Plan for [names of parents] Birth Team We would like to be part of the decision-making team and to be consulted about and asked for our consent before any medical procedure is performed. We highly value our privacy, so we would like to keep the birth team to a minimum necessary number, which excludes residents, trainees, and other nonessential personnel. Labor and Birth We respectfully request that there be as little intervention as possible unless an emergency arises. This includes: routine IV, electronic fetal monitoring, use of medications for pain or labor augmentation, amniotomy, frequent vaginal exams. We would like to have the freedom of motion and a free choice of laboring positions, particularly in the second stage (this includes the possibility of a full or partial squatting positions). We ask kindly that a fetoscope be used for monitoring the babyUs heart rate. We would like to avoid a routine episiotomy; if one is deemed absolutely necessary, we would like to try for a pressure episiotomy when the babyUs head is crowning. We would prefer not to use any medication for labor augmentation or anesthesia. Baby ___ would like to breastfeed our baby as soon as she/he is born. We kindly request that the cord not be clamped or cut before it has stopped pulsating. We prefer that there be no or as little separation from the baby as possible, particularly in the early hours after birth. In the case such circumstances should arise that the baby must be separated from the mother for a period of time, we would like ___ to be with the baby at all times. We plan that the baby be breast-fed exclusively, so we kindly request that no formula or any other kind of supplement be given to our baby in the hospital. If the baby is a boy, we do not want him circumcised. Special Cases In the case that a cesarean section needs to be performed, we would prefer a regional anesthesia that would allow the mother to be awake and alert for the birth and the father to be present. If the baby should need special care, we want to be involved in that care as much as possible and want the baby breast-fed or given expressed motherUs milk from a bottle. *************************************************************** "What topics did you cover in the birthing plan?" Everything I could think of -- I started with the list in Pregnancy, Childbirth, and the Newborn (I'm sorry, I don't remember the authors, but it's still in print so it should be in Books in Print by title) and added a few others. See attached birth plan for what we included last time. (By the way, it's not necessary for a birth plan to be as detailed as this one.) "When in your pregnancy did you discuss it with your ob/gyn/midwife?" It's been different for each child, but usually about 3 months before the due date. If you're not sure how your doctor/midwife is going to react, earlier is better, so you can find another caregiver if necessary. "Did the birthing plan work out, did things go as you would have wanted them to go?" Yes, definitely. A lot of the credit goes to my doctor, a family practitioner, who didn't agree with everything I wanted, but who was willing to let me make the decisions after he outlined the risks involved. In the US, having your doctor on your side makes all the difference when you're doing something that isn't standard hospital policy (such as skipping electronic fetal monitoring). "Do you think you missed some topics in your birthing plan you might like to add next time?" I didn't miss the topic, but my doctor *and* my husband forgot last time that I didn't want to deliver half-sitting with my feet in stirrups. (I was too busy to say anything at the time.) I intend to stress the point more in advance this time. That brings up the point that it's important that the coach be willing and able to remind the doctor and nurses about what's in the birth plan, esp when the mother is busy giving birth. ----------------------------------------------------------------------------- BIRTH PLAN [names of parents and children] LABOR: Enema: None Prep: None Presence of family: Coach (Dad) present at all times. Children and their adult friends present at parents' discretion. Position for labor: Whatever works at the time. Onset of labor: Spontaneous. If late or other complications, will discuss other options at the time. Hydration/fluids: Drinking water and juice until no longer tolerated, then ice chips. Food: Anything reasonable until no longer tolerated. Monitoring fetal heart: Stethoscope or Doptone. Pain relief: Relaxation, breathing, comfort measures. Speed up labor: If necessary, walking, nipple stimulation, pelvic rocking. If complications, will discuss other options at the time. To empty bladder: Walk to the bathroom. BIRTH: Position: Squatting, or if that doesn't work, hands and knees. If neither of those two work, try whatever. Expulsion techniques: Bearing down with contractions. Speed up birth: Gravity-enhanced positions. If complications, will discuss other options at the time. Bed for birth: Mother's choice of floor, bed, or whatever else is available. Cleanliness of perineum: Undraped, mother touches baby during birth. Care of perineum: Try for intact perineum with massage, support, and hot compresses. Presence of family: Coach (Dad) present at all times. Children and their adult friends present at parents' discretion. Handling of baby: Mother gets to hold baby immediately, with father helping so baby doesn't accidently get dropped. Suctioning or whatever done while baby is in mother's arms. (Of course, if complications, will discuss other options at the time.) AFTER BIRTH: Delivery of placenta: Spontaneous or encouraged with breast stimulation and nursing the baby. Cord cutting: Clamp and cut after it stops pulsating. Father cuts cord. Presence of family: Father and other children present at all times. Discharge of mother and baby: As soon as possible. If medically feasible, within 24 hours of admission to enhance insurance coverage. BABY CARE: Airway: Baby coughs and expels own mucus. Suctioned only if necessary. Warmth: Baby skin-to-skin with mother, with blanket covering both. Immediate care: Baby held by parents and nursed by mother. Observed in parents' arms. If parents need a break, baby is kept nearby in bassinet. Eye care: Nonirritating agent, such as erythromycin or tetracycline, as late as possible, so baby has a chance to look at her family. First feedings: Breastfeeding on demand. Contact with baby: 24-hour rooming in. BIRTH PLAN (PROBLEMS) C-SECTION: Rationale: Unless emergency prohibits, confirm fetal heartbeat indicators with fetal scalp blood oxygen readings. Partner's presence: Father present. Anesthesia: As little as possible depending on circumstances. No general unless absolutely necessary. Participation: Screen lowered at time of delivery. Events explained as they occur. Contact with baby: Held by father immediately after birth, where mother can touch and see. Breastfeeding as soon as possible. Discharge of mother and baby: As soon as possible. SICK INFANT: Contact with baby: Parents visit and care for baby as much as possible. If baby must be transferred to another hospital, mother goes, too; if that's not possible, father goes with baby. Feeding: Mother nurses baby. If that's not possible, parents feed mother's expressed milk to baby. If neither is possible, will discuss other options at the time. Contact with support group: Yes. *************************************************************** >When in your pregnancy did you discuss it with your >ob/gyn/midwife? At 30 weeks, once I had gotten out of the hospital for preterm labor. >When you have delivered already: did the birthing plan work out, >did things go as you would have wanted them to go? Do you think >you missed some topics in your birthing plan you might like to >add next time? Things worked out somewhat differently, but that was because I was induced and didn't get to start labor on my own, so I was in the hospital the entire time. But other than that, it went just about how I had planned. My membranes were stripped and my water was broken, but otherwise it was basically what I had planned for. >Are there things I forgot that you would like to tell about your >birthing plan? My birth plan was for a very high risk delivery, so it included every intervention I could think of. You may not need such a complete plan. Mine was also for a twin delivery, so it is in the plural. ___'s Birth Plan Preparation Wear own clothing rather than hospital fare. No enema No shaving or removal of pubic hair IV inserted by someone who specializes in this and will listen to me about my experiences. Local anesthetic, please. Labor Light food and fluids upon request. External Fetal Monitoring hourly but not when I need to be up. Freedom to choose positions and activity in labor, such as walking, sitting, lying on side, etc. Able to walk to toilet when needed Vaginal exams for specific medical indication only or when labor changes Full information about risks and benefits of each suggested medical procedure Artificial rupture of membranes after discussion if needed Pitocin ONLY if needed to boost contractions Analgesia for pain upon request Anesthetics for pain upon discussion after request Labor coach present for any medical procedure Birth Labor coach present for actual birth Position in pushing phase to be determined by me at the time (using gravity enhanced positioning if possible Pushing to begin at my urging, after dilation is complete Pillows, wedge, elevated table back for support at delivery Try for intact perineum with massage, support and hot compresses No episiotomy unless deemed absolutely medically necessary after discussion of options Perineum ice packs immediately after birth Dimmed lights for births Skin-to-skin contact with me upon delivery Erythromycin rather than silver nitrate to be given as late as possible (delayed for maximum number of hours) Babies weighed, measured, footprinted, etc after initial bonding time if possible After Birth Spontaneous delivery of placenta Clamp and cut cord immediately Babies suctioned Recovery Recovery with babies in private Post Recovery Babies remain with me at all times except upon my request (24-hour rooming in) Breastfeeding on demand Person of choice in my room at any time of day Help with breastfeeding from nursing staff NO sugar water between feedings Freedom of movement for me after birth Baby circumcised in hospital (hopefully with local anesthesia by moyhel) C-Section Scheduled after labor begins Labor coach present Regional anesthesia with little or no premedication Obstetrician explains events as they occur Breastfeeding as soon as possible Premature Birth Visit NICU as much as possible Nursing babies and expressed milk given to babies Postpartum Visiting Nurse to help for a period of time ========================================================================= Birth plan I am very happy with the prenatal care I am receiving at ______ _______, and was very pleased with the labor and delivery I had at ____ _______ about two years ago. I felt the staff highly respected my birth plan, and I think that this respect contributed to the degree of satisfaction I have about my previous childbirth experience. I want to direct, but know I can not control, my childbirth experience. I see this written birth plan as a way to ensure that I have as much ability to set the course of my labor and delivery as possible. When this birth plan is respected, then, if we need to deviate from its general guidelines, I will feel better about the change. Let me know right away if you think we need to change plans, and why the change is necessary. I realize that emergencies can happen, and that in the case of an emergency, the health care team will take the best steps for me and our new baby. Labor and Delivery Use of medication for pain relief: I would like to have as unmedicated a birth as possible. I will use breathing, visualization, self-hypnosis, and other mind-body techniques to cope with labor pain and discomfort. In my last labor I found a great deal of relief from the hot tub, and we can use it again if needed. I do not want to be offered medication for labor, and if I request it, I want to discuss it with the midwife at the time. Use of Novocain to repair a tear or for episiotomy is okay (see section on episiotomy). Use of medication for labor induction: my last labor was very long. I expect that this one will most likely be shorter. I do not want to use pitocin for labor induction, and generally shouldn't be considered except at my initiation. We can try other means of induction, including nipple stimulation, and movement. Positions for labor: I am very open to suggestions the staff may have for labor positions. I expect I won't need an I.V. and prefer not to have one unless necessary, and so will be free to move around during labor. I went through transition last time in a rocking chair, and have positive feelings about using the rocking chair during labor. Upright and semi-upright squatting positions make a lot of sense to me, especially toward the end. Electronic fetal monitoring: occasional electronic fetal monitoring is fine. I don't expect you will be doing continual monitoring unless it is necessary. Food and drink: I will do my best to eat lightly but well before I get to the hospital. I would like to have water and other drinks (I remember very clearly a glass of grape juice with lots of ice last time that was offered that was marvelous) available during labor. If I haven't eaten in a long time, I may be very hungry for food after delivery, even if it is not the regular hospital meal times. I hope I can still get food anyway. Visual and aural aids: We plan to bring some tapes from home. A friend has developed a kit for laboring women and is working on a revision. We will try to bring it with us and test it out. To maintain a pleasant atmosphere, we'd like the lights not too intensely bright, particularly after the baby is born. I won't be embarrassed, so I hope you won't be: (1) if I yell, sing, or chant during labor. If the noise is disturbing others, let me know. (2) if I poop or pee during labor or delivery. (I don't want an enema.) I figure you've dealt with it before, and can clean up for me. (3) If I am naked during any part of this. I am not particularly modest, and worrying about such things during labor and delivery seems silly to me anyway. Remind me to cover up for photos after the baby is born so I can show the snaps to a mixed audience (see section on photography.) Episiotomy: I prefer not to have an episiotomy. However, if I had a choice between a big tear and a smaller neat incision, I'd prefer the incision. Still, I'd like to remain as intact as possible. We will be working on perineum massage for a couple of months before the due date, as we did last time. Last time the midwife continued massage through the delivery, and I only had a very small tear. C-section: If a c-section is necessary, I would like my husband to accompany me. I do not want general anesthesia unless it is an emergency and is necessary. Who will be there: I expect that my husband will be with me through all phases of labor and delivery. Depending on the time of day or night, it is possible that my two-year old daughter and my parents will be milling around the waiting room. Of my family, I prefer that only my husband be present until after the baby is born. Then, anyone can come in who wants to. Photography: we will do our best to remember the camera. I expect we will only be taking pictures after the baby is born. Remind me to cover up a little for pictures if I have a breast or suchlike exposed. If Group Health staff is otherwise unoccupied, it would be nice if someone could take a picture of all of us. The new baby Immediately after delivery: after the baby is born, I would like her (at least what the ultrasound tech thinks it's a girl) placed on my belly through the recovery period. I'd like to try to breast feed a little after delivery. Although I had a very successful breastfeeding experience with Rose, I feel a little "rusty", and will welcome suggestions and advice from the staff. I'd like as long a delay as possible before we do the routines of weighing in, and so forth. Eyedrops: We would prefer the use of erythromycin, and if possible, we would like to hold off on the eyedrops for about an hour after birth so that the baby can see clearly (as she can) when she enters the world. Sugar water/bottles/pacifiers: when the baby is in the nursery for observation, we prefer that she not be given sugar water or artificial nipples unless medically indicated. If she wakes up and needs to be fed, please bring her to me for breastfeeding. Rooming-in: At this time we would prefer the baby to room in with me, unless my condition or the condition of the baby warrants otherwise. =============================================================================== Birth Plan for ____ and ____ _____ This birth plan is intended to express the preferances and desires we have for the birth of our baby. It is not intended as a script. We fully realize that situations may arise such that our plan cannot and should not be followed. However, we hope that barring any extuating circumstances, you will be able to guide us toward the birth experience we desire. If procedures or medications are proposed, we ask that you discuss them with us and suggest alternative therapies and comfort measures so that we can make well-informed decisions. We are striving for flexibility on our part, as well as on the that of the birth team. We plan to have a doula, ______, present during labor and delivery as a primary support person. We plan for her to give comfort, encouragement, and generally support us. Early and Active Labor - Want to be able to move about, changing positions often, walk, etc. as desired. - External fetal monitoring only as required by the condition of the baby; we prefer use of the fetoscope. - Would like to have light food and liquids as requested. - Prefer no IV unless I become dehydrated; will accept heparin lock if it is needed. - Prefer no artificial rupture of membranes. - Prefer no enema unless the labor team feels it will speed up a slowly- progressing labor. - No shaving of pubic hair. - Want to avoid medications; prefer to use relaxation techniques, breathing, massage and emotional support to deal with pain. Want to discuss side side effects and alternative comfort measures with my husband and doula before accepting any pain medication. - Would like to be able to shower and or sit in the jacuzzi as desired (unless membranes have broken in the case of the jacuzzi). - Would like to play music as desired. Birth - Would like a mirror for mother to see what's going on. - Prefer no episiotomy except to avoid extensive tear; have been preparing by doing Kegel exercises and plan to use warm compresses to help avoid tearing. - Father would like the opportunity to cut the cord. - Would like to nurse immediately after delivery if possible. - Prefer to wait for spotaneous placenta separation and delivery rather than inducing. - Avoid pain relief except for local anesthesia for stitching up. Contingency Plans C-Section We want to discuss any problems and the associated risks unless there is a medical emergency. If we require a C-section, we want the father and doula to be present unless there is an emergency. We would like to use an epidural anesthesia rather than general unless there is an emergency. We prefer that the anesthesia take effect before the catheter is inserted and that there are no "hot spots" (areas which are not yet numb) before the surgery begins. We would like to hold the baby after delivery if she doesn't need immediate medical attention. Ill Baby If complications arise with the baby, we would like to remain as involved in her care as possible. If possible, we still want to hold and nurse the baby as soon after delivery as is reasonable. *************************** End of Summary **********************************