Anyone do a hospital transfer birth plan, could you share it?

[phatchristy]

I have a birth plan for the homebirth, and have always had one for a hospital transfer. Of course, the hospital transfer one seems way too long. To the point where I doubt that anyone is going to read it.

So, I'd like to revamp it to make it more straightforward.

Do you have one that you would share?

If you don't, what do you think should absolutely be in there?

[thefarmerswife]

Birth Plan of Curtis and Jamie

Support Team

Curtis Jan
Terri Karen
Jackie


BIRTH- Partner cut cord
Wait until cord stops pulsating to cut
Mother have baby skin to skin
Spontaneous delivery of placenta
Intermittent Monitoring
No IV desired
No artificial rupture of the membrane sac


BABY- We’ll DECLINE being administered eye drops/ointment
We’ll DECLINE being administered hepatitis B shot
NO INK ON CORD
Mom and Dad prefer to bathe baby
Newborn screening test- done only after 72 hours
Breast-feed A.S.A.P- NO FORMULA
Will ROOM IN with mother

IN CASE OF A CESAREAN SECTION
I would prefer a regional anesthetic, such as an epidural block, so that I can be alert for the delivery. I would also like the incision to be a transverse incision and that it be double sutured after the surgery. As with a vaginal delivery, I would like to hold and breastfeed our baby immediately after delivery.

PLEASE UNDERSTAND THERE ARE 2 ISSUES THAT ARE PREVALENT TO US,
they are:

(1)- The process of PARENT/BABY BONDING BE INTERRUPTED ONLY AS ABSOLUTELY NECESSARY (and that when that is necessary, consult/notify us). We observe the first hour following birth to be critical bonding time.

(2)- During our stay should any COMPLICATIONS ARISE or any CHANGES need to be made, please notify/ consult with us immediately.

We recognize that we must be flexible and that changes in our plan may be necessary. We acknowledge that we cannot predict. We are grateful for your willingness to include these beliefs and family values as we together develop a plan of care for the birth of our child.
_________________________

It fits on 1 page, and I think the short bullets make it easier to read then paragraph form......hope this helps :-)

[NicswifeSarah]

i found this one here somewhere....

its pretty long, but i thought very thorough.

Hospital Contingency Plan

Mother: Your Name and Phone #
EDD: February 6, 2009
Father: His Name and phone #
Midwife: Name, her practice and number
Pediatrician: Name, their number
Transfer Hospital: Name, their number


Plan A: Homebirth
We are planning a homebirth, attended by a midwife. We have chosen this option after much research, because we believe that a homebirth—with an experienced midwife present and a hospital available nearby—offers the healthiest situation for our baby.

Plan B: Transfer to Hospital
Since our primary plan and preparation for the birth of this child is for a homebirth, this hospital contingency plan is designed with the understanding that something has gone wrong. For whatever reason, it is evident to us that homebirth is no longer the best course of action. We acknowledge that any or all of the following preferences may be affected by the specific circumstances that have forced us to seek emergency obstetrical care. We further understand that in the face of these unknown factors, it is especially necessary that flexibility, compassion, and mutual respect be maintained between us and the medical staff assisting us.

Vaginal Delivery:
As much as possible, I wish to maintain a natural delivery and avoid (unless medically necessary) interventions such as an epidural, episiotomy, continuous fetal monitoring, amniotomy, directed pushing and laboring in the lithotomy position.

C-Section Birth:
If a C-section becomes necessary, if it is possible, I prefer:
--Epidural anesthesia, with my partner present for the delivery
-- A low transverse incision where my previous cesarean was.
--To have the baby held by me or my partner as soon as possible after delivery.



Newborn Care:
Holding and nursing my baby right after birth is my top priority. If medically possible, my other preferences are:
Cord Care—Delay cutting to maximize baby’s blood volume. Please wait until cord stops pulsating.
Vitamin K—Postponed until after initial feeding. To be given only if conditions of the birth warrant. Please wait for our express consent.
PKU testing—Please warm the heel before performing the PKU testing. We prefer to wait approximately three days, until after breastfeeding is established, for this test.
Antibiotic Eye Ointment—We decline antibiotic treatment.
Feeding—Exclusive breastfeeding is of utmost importance to the baby! Please, no formula, supplements (including water or sugar water) or artificial nipples (including pacifiers) at any time. If supplementation of any sort is medically indicated, please wait for our express, written consent.
Immunizations—We will decline all immunizations at this time. We will initiate immunizations for the baby a later time.
Temperature—If possible, we prefer to attempt kangaroo care rather than use of an incubator.
Above all else, please help us to avoid separation from our child. Please allow one or both parents to remain with the baby at all times, from birth until discharge.

Other Complications:
In case of stillbirth or neonatal death, we wish to see and hold the baby, and will make arrangements for a funeral.

If I am unable to make medical decisions for myself or our child, (my partner) is authorized to do so for me as my health care proxy. (See attached Medical Power of Attorney document.)

I am an organ donor. If I or my baby are declared brain dead, please do not take heroic measures to resuscitate or artificially prolong our lives. Please help us make arrangements for any transplantable organs to be used. My family is aware of and in agreement with this choice.

(signed)



attached:
--birth plan
--power of attorney
--insurance information
--contact numbers

[JamieCatheryn]

Mine is very long, I was about this specific with the same hospital with #1 and it was received and followed wonderfully, so I took that as a go-ahead to do something similar with a few changes based on our experience last time. I wrote it as if we intended to birth there, not bringing up how it's a transfer if we're there. I also didn't assume we'd need zero medical help, if we're there it's because we might need something, and I want to avoid a cascade of interventions in connection with whatever it is. Here's the plan, ever so nicely worded.

Birth Preferences Sheet for University Hospital
Mother: Jamie lastname
Father/Support: John-Philip lastname
It is very important to us to be involved in making decisions regarding any medical treatment. In a non-emergency situation we’d like to discuss all our options and have time to decide on medical care. Please don’t assume anything is routine, as our religious and medical preference is that labor go naturally and undisturbed as possible. In an emergency with no time for discussion, please still tell us briefly what is happening and ask consent for the proposed treatment. Thank you for being a part of this special event in our family, for being there to ensure safety, and for respecting our wishes.

In labor:
•Please don’t offer chemical pain relief, we will use natural means to improve my comfort and I will accept what pain comes. If an epidural (or if available, Entonox) becomes necessary we will request it specifically.
•Please don’t speak to me during contractions; I will be distracted and working hard, unable to communicate. Speak to John-Philip, my husband. He is well informed and very involved in this birth and may make choices on my behalf.
•Please minimize the number and frequency of people coming into the room, this is a private event.
•Staying off my back and mobile during labor is important to me; please help to ensure this is possible.
•I consent to a Heparin lock but please, no routine IV.
•After the initial strip on continuous EFM, please monitor FHT at intervals with a Doppler.
•We very much want to avoid using Pitocin to augment labor, please suggest natural solutions first if progress slows.
•We would like the amniotic sac to rupture in its own time, please do not break the waters.

Second stage, birth, and third stage:
•I may want to push on hands and knees or up in a squat, please help to facilitate this if so.
•My least desired position is semi-sitting; I would prefer on my side or flat on my back to this.
•Please have everyone stay quiet during pushing as I prefer not to have cheerleading or instruction.
•I do not want an episiotomy done, please do not perform one.
•I would like my baby placed directly on my chest or abdomen immediately.
•Please cover us both with a towel or blanket(s); I will dry the baby myself.
•Please delay cord clamping and cutting at least 3 minutes after birth. John-Philip or I will cut the cord.
•If the baby needs resuscitation please do it with the umbilical cord attached if possible.
•Unless Pitocin has been used during labor please don’t inject any for the delivery of the placenta or uterine involution.
•Please do not apply traction on the cord; I will birth the placenta when ready.

In the event of a Cesarean birth:
•I prefer epidural or spinal anesthesia over general.
•I want my husband to be in the room to support me and witness the birth.
•Please take care to avoid idle chat or possibly disrespectful comments as this birth is serious and sacred to us.
•Please use a double layer suture to close for strong healing, should we have more children we will attempt VBAC.
•I want to see, touch, and hold our baby as quickly as possible.

After birth:
•I would appreciate that the newborn exam be done very close to me and that the baby not leave our sight
•Please don’t give the baby Vitamin K or vaccination, do not circumcise, and please delay eye ointment.
•We will have the baby room-in with us and one of us, the mother or father, will accompany baby to any tests.
•I will exclusively breastfeed our baby, please don’t offer bottles, pacifiers, or formula gift bags

[Mainstream Hippie]

I am still working on it, but have begun modifying this one, from my last home birth. I thought I had previously included a blurb along the lines of "Please understand and respect that this was not our original intent, and as such, my's feelings may be conflicted. Please continue to treat me as an intelligent participant in my birth," but I don't see that on here.

In the Event of Transfer to Hospital During Labor

Mother: ...
Father: ...
Estimated Due Date: ...
Primary Maternity Caregiver: ...
Obstetrical Back-up: ...
Doulas: ...
Pediatrician: ...

If Mother and Baby are in good health:
•I wish to continue an as unmedicated, low-intervention birth as feasible.
•I would like the lights to be dimmed and allowed to continue to drink to thirst.
•I would like to try non-conventional labor positions, such as squatting, if at all possible, before lithomy.
•We would like the option to film my labor and birth.
•As long as my son is handling contractions well, I wish to push to my own comfort, not on command.
•I would like my son to be delivered onto my stomach, and allowed an opportunity to bond with him.
•We are requesting delayed cord clamping and unassisted delivery of the placenta.
•Please do not perform any procedure on my son before discussing it with me.
•In the event of a tear or episiotomy, I wish for local to be used during repairs.

If Augmentation is Indicated:
•As long as baby and I are in good health, I would like to be allowed to labor without time limits or augmentation.
•If augmentation is necessary, I would like to try the following methods, in the following order of preference:
oThumb-sucking and acupressure
oNipple stimulation with breast pump and warm compress (will bring)
oStripping membranes
oPitocin
oAROM

If a Caesarean-Section is Indicated:
•Time-permitting, I would like a second opinion.
•Time-permitting, I prefer an epidural and the ability to be awake during the surgery.
•I would like to be given the option of viewing the birth by either lowering the screen, or placement of mirrors.
•We would like the opportunity to film the birth.
•I would like to have a hand free to touch my son after he is born.
•I would like to delay newborn procedures, including bath, until after I have been reunited with my baby.
•Please do not perform any procedure on my son before discussing it with me.
•My husband is to stay with our son until I am able to be with him.
•I am breastfeeding and wish to be reunited with my son as soon as possible. He is not to be giving any supplementation nor artificial nipple of any kind without my express permission.

PLEASE: No Bottles, Formula, Pacifiers, or Sugar Water

We DO NOT consent to our son being circumcised.

I also have an obnoxiously lengthy list of birth preferences for my doulas. But I found that even with a single page, at my hospital birth, no one read it. The nurses asked for the gist, and were respectful. The on-call OB ignored my birth preferences, written and verbal.

[minkajane]

Since we are planning a UC, a trip to the hospital means something's wrong or I want pain medication. I have written a very short birth plan accordingly. I put the most important things so that it will be one page with size 12 font.

***

Our primary birth plan was a home birth. We have chosen to transfer to the hospital for the remainder of our labor and birth. The following are our wishes regarding this contingency situation.

Pain Relief:
- Mother would like pain relief offered immediately.
- Epidural anesthesia is preferable to IV medications.
- After the initial offer, please do not offer again unless requested.

Interventions:
- If Baby is in distress, please discuss the need for interventions such as Pitocin, vacuum/forceps delivery or Cesarean delivery.
- No Cytotec is to be administered at any time.
- Please do not perform an episiotomy. Mother would prefer to tear naturally.

Second Stage:
- If physically able, Mother will assume upright positions for pushing.
- If medicated, Mother would appreciate assistance for squat, side-lying, or all-fours positions.
- Please do not count or direct pushing unless Baby is in distress or Mother is unable to feel to push.

After the Birth:
- Please place Baby on Mother's chest immediately unless Baby needs immediate medical attention.
- Please do not routinely administer Pitocin or pull on the umbilical cord in order to extract the placenta.
- Please do not clamp or cut the cord until it has stopped pulsating and placenta has been delivered.
- Mother and Baby would like to be released as soon as possible and recover at home.

Cesarean Section:
- Epidural anesthesia is preferable to general anesthesia.
- Please administer anti-emetic medication.
- Please describe the surgery as it is happening and lower the screen for the birth.
- Mother would like to hold Baby while being stitched and breastfeed as soon as possible, preferably in recovery.
- Please use low transverse incision along previous scar line and double-suture uterus.
- Dissolving stitches are highly preferred to staples.

Care of Baby:
- We waive all eye ointments and vaccinations.
- If Baby is a boy, we do not want him circumcised or his foreskin retracted.
- Mother is planning to breastfeed. Please do not administer any liquids other than breastmilk (including formula and glucose) or introduce artificial nipples (including pacifiers and bottles).
- Mother would like to room-in unless medical problems necessitate nursery care.
- Mother and/or Father will accompany Baby whenever it is medically necessary for Baby to leave Mother's room.

Thank you for respecting our wishes and making our special experience a safe and happy one.

[JosieAK]

These are wonderful. I really think they should be in a sticky. It took me a while to find them again. I am taking several of these to combine into my own hybred. I think there is a lot of peace of mind in having my wishes writen down for a time when I may not be able to articulate them.

[Beauchamp]

:

[naturallyspeaking]

Wow, I hadn't thought about this, preparing birth plan for in case of hospital transfer! Thank you for sharing.

[JorgieGirl]

This birth plan is intended to express the preference and desires we have for the birth of our baby in the event of a hospital transfer. It is not intended to be 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 extenuating circumstances, you will be able to keep us informed and aware of our options. Thank you.

First Stage (Labor):
* I request that my midwives and support person(s) accompany my husband and I in the labour and delivery rooms
* I would prefer my own clothes to hospital gown.
* Vaginal exams only if requested
* Maintain mobility (Walking, rocking, up to bathroom, etc.)
* Eat and drink to comfort.
* Please do not offer me pain medications, I will ask for them if I want them.
* Positioning as desired.
* I prefer intermittent manual fetal monitoring using a doppler or fetoscope
* I do not consent to routine augmentation of labour using any form of synthetic hormones or otherwise
* I do not consent to artificial rupture of membranes at any time
* I do not consent to a routine IV or Hep-lock, unless deemed medically necessary for a healthy outcome

Second Stage (Birth):
* Choice of position
* Self-directed pushing; please no coaching at any time
* Prolonged length, if progress is being made
* I do not consent to an episiotomy, and would prefer to tear. Please use compresses, massage and positioning.
* Do not announce the sex of our baby. It is very important to myself and my husband that we are the ones to announce this.

Mother Care and Baby Care:
* Our baby is to immediately be placed on my skin. Please do not swaddle or wipe down our baby.
* I do not consent to the routine use of Pitocin, cord traction or abdominal massage
* Cord cut after pulsating has stopped, with my husband prefferably cutting
* We do not consent to prophylactic eye ointment, we will sign a waiver indicating we have declined this procedure
* Breast feeding only
* No pacifiers or glucose water
* No separation of Mother & Baby. Apgars can be done while my baby is with me.
* Other newborn procedures can be delayed until breastfeeding has been established
* I do not consent to having my baby bathed by anyone other than my husband and/or myself
* If our baby needs to be sent to the NICU, Greg will accompany him/her at all times, or someone else we assign.
* Do not circumcise our son and do not retract the foreskin of our son

In the event of a Cesarean Birth:
* Spinal anesthesia
* My husband present at all times
* Hands free, and not strapped down
* Please use double layer suturing for the incision closure (NOT staples)
* Breast feeding in recovery room as soon as possible
* Do not announce the sex of our baby. It is very important to myself and my husband that we are the ones to announce this
* We do not consent to prophylactic eye ointment, we will sign a waiver indicating we have declined this procedure
* If our baby needs to be sent to the NICU, Greg will accompany him/her at all times, or someone else we assign.

[My*Scorpio]

Well, mine is short. I put my MW would be my doula. I also stated that I am planning to breastfeed and that I do not want my baby's genitals to be cut.

I figured that I'd keep it short and sweet. I wouldn't be going to the hospital for my ideal natural birth.

[devon]

Here is ours from our DS #2 birth. His was a planned hospital birth (but ended up being an unplanned HB). We're going to use it again in case of a transfer this time as it mostly went over well. If we transfer, we'll hopefully be able to have our backup dr for our dr, in which case she knows we were a HB transfer. I'm not specifically noting that we are planning a HB in the case that it ends up predjudicing our care from the hospital. My MW and doula will be there (as doulas) if we transfer so I know they will help us try to have these things enforced.

I did find that being specific (for instance, waiting for us to tell we are fine with them cutting the cord vs. just saying "delayed cord clamping") is useful. For instance, the dr we had with DS #2 interpreted "delayed cord clamping" to be about 2 minutes. For us, that is not long enough and would prefer it to be completely done pulsating and after the placenta is delivered.

one thing we have learned with 2 planned hospital births - it needs to be short and sweet, otherwise the chance of them reading it drastically goes down and they can't remember everything.

Birth Plan for Devon and Jeff

We are excited to have your help and encouragement in our goal of an
un-medicated childbirth experience without interventions! We know there may be complications during labor. Should this happen, we appreciate being well informed so that we can discuss our options with you and make an informed decision.


First Stage Labor – We prefer…

Un-medicated (please do not offer medication unless we request it)
Freedom to move around and change positions
If monitoring necessary, use of handheld Doptone
Minimal number of vaginal exams
Patience in allowing labor to progress without artificial measures or augmentation (i.e. Pitocin, breaking bag of water, etc.)


Second Stage Labor – We prefer…

Help in preventing and minimizing tearing
oPerineal support during delivery of baby’s head
oPerineal massage and warm compresses during pushing and crowning
oGuidance during pushing to prevent/minimize tearing: slow down, stop, etc
Please no episiotomy, unless we agree it is the best option
Self-directed pushing during contractions, except when direction needed to prevent tearing during crowning
Un-medicated
Freedom to change positions during pushing: squatting, hands and knees, etc
Prefer Jeff or Devon to announce gender of baby at birth

After Birth – We prefer…

Skin to skin contact with baby immediately after birth
Immediate breastfeeding
Prefer to use breastfeeding to stimulate delivery of placenta
Prefer no shot of Pitocin
Allowing the umbilical cord to stop pulsating before cutting - please ask us before cutting the cord
Allowing for plenty of bonding time before bathing baby
Keep baby in room with us at all times. We request that one of us go with baby if necessary to remove from room.
No bottles or pacifiers for baby. We prefer only breastfeeding.
If it is a boy, no circumcision

[durafemina]

for my homebirth my hospital transfer plans were this:

* I had a bag packed (that was kept under the bed so I wouldn't look at it and think of going to the hospital, lol)

* I had midwives I absolutely trusted to do everything in their power as per my wishes, and who, furthermore had a good working relationship with the hospital AND I knew friends who had transferred with them and confirmed my belief that they would be pushy about the family's wishes (ie baby with mother as soon as/at all times, no vax, etc)

* I told Dp to make of just ONE thing - I kept it down to just one important thing so he would remember it - *request that the attending/experienced Dr. attend me*. Not that I have anything against health professionals in training (heck, I am one), but I knew if I was going to the hospital it would be for a serious, emergent complication and I have seen residents/students botch up (see below) things and perform them too slowly - not acceptable to me in a true emergency situation involving me/baby.

* have a carseat and willing friend there if we were driving to transfer

(off the top of my head:
resident suturing a woman's labia to her thigh, resident not knowing how to turn on the resus machine with a flat baby that needed O2)