Can you share your hospital transfer birth plan?

[Jilian]

I'm working on getting together a birth plan in case of hospital transfer. I had one from my last HB but cannot seem to find it now : My MW suggests keeping it pretty basic since when you transfer in from a HB the hospital staff pretty much already knows you desire as natural a birth as possible.

I need help with an intro.

So far I have:

My name, DH's name
MW info
Pedi info

Thank you for being a part of our daughter's birth. Our goal is to have a natural vaginal birth free from medication and intervention. We understand that labor is unpredictable and that any plan is subject to change. However, as much as possible we prefer the following:

Labor
- we are using hypnobabies hypnosis for childbirth and prefer a calm and quiet environment for birthing, especially during the pushing phase (how do I nicely say I will lose my sh** if you scream PUSH?)
-We'd like to discuss ALL interventions in advance before consenting
-I do not want an episiotomy, I'd rather tear

Baby Care
-we'd like baby placed immediately on mom's chest and all necessary assessments to be performed here
-we'd like cord cutting and clamping delayed until cord stops pulsing
-we'd like to delay all non emergency procedures for the first hour including eye drops and vitamin K
-Baby will not be vaccinated
-baby will be breastfed so no pacifiers, bottles, or sugar water
- if baby is to be seperated from mom, dad will accompany baby

Cesarean (need help with this part!)
I am very fearful to cesarean birth and will need my husband present for support at all times
-please describe all of my options with me beforehand, I'd like to make informed choices
-minimal seperation of mom and baby
-dad will accompany baby is she needs to go to nursery

What am I missing? I want to keep it short and that is why I put that I want to consent to every intervention. I only listed the extremely important things. DH knows all of our wishes and is not afraid to speak up. I'm a labor doula so he knows a LOT about birth and will protect me and the baby.

[sunshynbaby]

I need help on the C-section part myself. I know I'm going to include that the baby be immediatly placed in husband's arms unless there are medical reasons not to and that the baby be placed with me as soon as possible for nursing...

[MiamiMami]

Sounds really good so far. I would include keeping the baby with you in recovery should you need a cesarean. Otherwise it could be hours before you see the baby. I didn't see dd for over 4 hours

Oh, what about taking ownership of the placenta? They whisk it off to pathology for no reason much of the time. What about food/drink?

This is something I cannot bring myself to do I didn't even pack a bag last time, remember. It makes me sick to even think about a transfer again. I just can't.

[Jilian]

Originally Posted by MiamiMami

I didn't see dd for over 4 hours


This is something I cannot bring myself to do I didn't even pack a bag last time, remember. It makes me sick to even think about a transfer again. I just can't.

I'm sorry mama. You won't need a transfer this time.

[Comtessa]

Here's ours!

Dear hospital staff: We appreciate you being here to support us through the birth of our first child! We have spent a lot of time researching the medical evidence for all of the decisions listed here, and we feel confident in the choices we have made. We thank you for respecting them, especially when they fall outside of “usual” hospital procedure.

We are preparing for a home birth. If we are in the hospital, it is because we require some intervention that was unavailable at home. Therefore, we are very prepared to be flexible on everything listed below if medical necessity arises. Barring a major medical crisis, we ask that you please discuss with us any and all interventions, allowing us the opportunity to give informed consent to any procedure you suggest.

In labor:
• Please offer us the minimal amount of medical intervention necessary for the health and safety of mother and baby. Like most natural birthing couples, we prefer to avoid routine procedures (continuous EFM, IV, epidural or pain relief drugs, Pitocin augmentation, etc.) unless clearly necessary for a safe birth.
• I am GBS negative and allergic to many antibiotics. Therefore, I do not consent to any antibiotics without evidence of infection.
• We request that two or three support people be available in the labor and delivery room with us at all times. This will include up to two doulas and/or our family members. we had to fight for this one, but they gave in.

After the birth:
• The baby should be placed skin-to-skin with its mother immediately. This time is precious to us and we strongly desire that there be no physical separation of mother and baby for at least the first hour after birth. this was way against hospital procedures, but the OB supported us and we managed to get what we wanted.
• We will use direct skin contact to maintain the baby’s body temperature rather than a warmer. again, against policy, but they were super supportive of this.
• Please delay cord clamping until the placenta is delivered, or at least as long as feasible.
• Please allow up to an hour for the placenta to be delivered naturally. Please do not rush this process. We request no routine Pitocin for this purpose unless it is clear that breastfeeding is not working to stimulate uterine contractions.

For the baby:
• The baby is not to leave our room at any time for any non-emergency reason while we are in the hospital. If an emergency arises, one or both parents will follow the baby at all times.
• No Vitamin K shot (unless bruising or birth trauma occurs)
• No Erythromycin eye ointment, please.
• No vaccinations are to be given at this time. "at this time" is a good way to not set yourself up for a vaccine lecture.
• No formula or pacifiers at any time, please.
• No antibiotics without evidence of infection.
• No screening tests of any kind are to be given without our explicit and specific permission.
• Please do not bathe the baby. We would like to give our baby its first bath. We recognize that this means you may need to wear gloves while handling the baby; thank you for doing this.

In case of a Cesarean section:
• we are not squeamish and would like to be able to watch as the baby is born.
• Please place the baby skin-to-skin on mom's chest as quickly as possible after it is born, health permitting. If she is unable to hold the baby, please place baby skin-to-skin with dad.
• If the baby must leave the room for emergency reasons, dad will accompany him/her.
• We request that the mother have at least one support person in the O.R. and recovery at all times; if the father must leave, please allow another support person to step inside to accompany the mother.

Thank you for taking good care of us and our baby!
We appreciate your support and care.

Signed:
____________________________ mom
____________________________ dad

Approved by:
____________________________ obstetrician

[xelakann]

I feel like I should do one these too... but mainly I am going to focus on c-section and after the birth. I figure if I am transferring (during labor) then there is a medical emergency situation occurring.

Since we don't want any eye goop or vitamin k shots or any other vax I will focus on that. And if baby is healthy I don't want them giving her a paci or formula. I have been reading about moms pumping colostrum prior to birth and saving that for babies (for emergency situations like a hospital transfer that required a c-section).

If I have to transfer prior to birth starting I will have more comprehensive birth plan.

[cristeen]

I think there's something to keep in mind here... there are generally 2 types of transfers.
Emergency - we need to get the baby out now, and you can forget having anyone even look at your birth plan. So you'll need someone who can speak up for things like no eye drops/vit K/vax/bottle, because chances are you won't be able to (under general anesthesia).
Non-emergency - usually maternal exhaustion, in which case you need to take into consideration what type of shape you're liable to be in when you get there.

And it's also going to depend on the facility you're transferring to. I know that for myself I have 2 different facilities for my HB transfer plan. If I'm transferring because I made the call (maternal exhaustion) I go to one that has midwives on staff but is 20 minutes away with no traffic. If I'm going because the MW made the call (emergency), I'm going to the one that's a mile away but will treat me like a piece of meat (from personal experience), and I know that my DH, BFF and MW all have to know EXACTLY what my wishes are for the baby and are ready to push the issue. Those are the only two facilities available to me because of insurance, and at both I'll be stuck with whoever is on-call - so getting "pre-approval" from my OB wouldn't do me a bit of good.

My point I suppose is that two birth plans wouldn't be out of line. In an emergency, a short and sweet list - "no eye drops, no Vit K, no bottles/pacifiers, no bath, daddy to stay with baby at all times." Something that you can have with you ready to hand to the nurse as you're being wheeled to the OR. And the more involved birth plan for the non-emergency transfer when they may actually take the time to read it (but don't count on it - you still need to be ready to stand up for it).

As for what you have written, the one change I would make is that instead of saying "we'd like cord cutting and clamping delayed until cord stops pulsing" - I would state that cord clamping, milking or any other handling is not to be done until after the placenta has emerged. A - don't even refer to cutting, as many docs will clamp immediately so that's what needs to be addressed (they won't cut unless it's clamped). B - I've heard stories of docs clamping after 30 seconds claiming that it's stopped pulsing when in reality they had interfered with it. Any handling of the cord can damage the vessels and negate what you're trying to accomplish by delaying clamping.

HTH

[Jilian]

Thanks ladies! That info is really helpful. I understand that if we transfer for an emergency then a birth plan is unnecessary - in that case DH will be my birth plan. I know he'll protect me. But in a non-emergency situation I'd like everyone to know our wishes to avoid battles.

[Pyrodjm]

We decided that we would only enter a hospital if it were a true emergency (life or death).

In that case DH, my mom, MIL and midwife knew: no circ, no shots, no bath, no bottles and someone must be with baby at all times (demanding rooming in, if possible) even if it meant leaving me alone, and get us out as soon as possible if we were healthy enough to leave.
That was our "plan". There was a brief discussion about it with my midwife and that was it. I also did not pack a bag.

[MegBoz]

Originally Posted by Comtessa

We have spent a lot of time researching the medical evidence for all of the decisions listed here,

I LOVE this wording! Particularly fabulous in light of how so many modern American obstetrical practices are NOT at all "evidence-based." Just using the words "researching medical evidence" really shows you know your stuff, IMO.

My doula added this to the CS section of my hospital birth plan:

Cesarean Section:
In case of an emergency where a C-section would be absolutely necessary:
•I would like DH in the room at all times.
•I’d like an epidural and to be able to watch the birth and touch my baby.
•I want my uterus closed with the 2-stitch method.
•If the baby is not in distress I would like to have contact with the baby as soon as possible after the birth. If that is not possible, we would like the baby given to DH immediately after delivery.
•DH would like to stay with the baby at all times and through all postpartum procedures.
•I do not consent to Versed post-delivery.
•I would like my doula with me during surgery and in postpartum recovery.


I read in Dr. Marsden Wagners "Born in the USA" that some OBs were "experimenting" with a single-stitch method of uterine suture.

Doula also told me of an OB giving a client of hers "Versed" post CS without even telling her, let alone obtaining consent. I'm told it can make you forget the whole labor!

My doula formatted my birth plan for me - it was just one page & had 2 columns, each with 3 boxes -

• medication & monitoring
• labor
• delivery
• 3rd stage
• newborn procedures
• CS

so newborn stuff was in a different box.

[MiamiMami]

MegBoz- single layer suturing is done more often than not now. I believe that is the way new OB's are being taught. Good idea to include double layered suturing in a cesarean plan

[~Kristina~]

I really don't have a plan and didn't with my last either. There are 3 hospitals in the area (within 15 minutes) and which hospital I'd be going to is going to be determined by the emergency. I figure that since we'd be transfering, most everything else is already beyond my control.

[*MamaJen*]

Hospital Contingency Plan

Mother: Me, my phone number
EDD: date
Father: him, his number
Midwife: her, her practice and number
Pediatrician: her, her practice and number
Transfer Hospital: hospital name and number
Transfer physician: him, his 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 obstetric backup 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
--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 request erythromycin 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, [DP] 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.

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

[xelakann]

Originally Posted by *MamaJen*

Hospital Contingency Plan

Mother: Me, my phone number
EDD: date
Father: him, his number
Midwife: her, her practice and number
Pediatrician: her, her practice and number
Transfer Hospital: hospital name and number
Transfer physician: him, his 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 obstetric backup 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
--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 request erythromycin 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, [DP] 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.

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

This is great. I am going to use a personalized version of this... thank you for sharing.

[flapjack]

I used a photograph of our family after Skye was born, with

"All three of my children were born at home. If you are reading this, we have transferred to hospital during our homebirth. We are likely feeling scared and unsure. I have no familiarity with hospital procedures, so this is all very new to me.
Please explain the benefits and risks of all proposed treatments to us. Use medical terminology, but offer clarification if we ask you to. Please be prepared to answer questions.
My first daughter was stillborn due to a cord prolapse after pProm. Please do not suggest AROM to me.
Both my sons have milk allergies, so breastfeeding and avoiding formula is very important to me. Please support me to initiate breastfeeding immediately."

I'm in the UK. We don't have blanket consent forms here and they do practice evidence-based medicine.

[Turquesa]

Check out or purchase the book Creating Your Birth Plan. Very helpful!!

Originally Posted by Jilian

Thank you for being a part of our daughter's birth. Our goal is to have a natural vaginal birth free from medication and intervention. We understand that labor is unpredictable and that any plan is subject to change. However, as much as possible we prefer the following:

I find that terms like "prefer" and "as much as possible" leave too many loopholes for staff to do what they want. We wrote:

Birth is an unpredictable process, and we will inform you if we change our mind on any of these requests. If complications arise, we are willing to discuss alternative options with our care team and/or outside providers.

My MW and doula didn't find it too adversarial.

Originally Posted by Jilian

- we are using hypnobabies hypnosis for childbirth and prefer a calm and quiet environment for birthing, especially during the pushing phase (how do I nicely say I will lose my sh** if you scream PUSH?)

I love it! Here's what we put:

Please refrain from staff-directed pushing and requests for “purple” pushing.

[QUOTE=Jilian;13902317] -We'd like to discuss ALL interventions in advance before consenting [QUOTE]

Ours:

For all tests, procedures, and medications for both mother and baby—even those administered routinely—parents request explanations on risks, benefits, and alternatives. Patient consent to be either written or oral and in the presence of witness not employed by hospital.

This was worded with the help of the birth plan book and another MDC'er.

Originally Posted by Jilian

-I do not want an episiotomy, I'd rather tear

I put:

The mother does not consent to episiotomy and is willing to tear naturally.

I feel so strongly about this that I don't mind the strongly worded "do not consent" part.

Originally Posted by Jilian

-Baby will not be vaccinated

I like (and may steal) PP's idea about adding "at this time" to avoid the infamous "vax lecture."

Originally Posted by Jilian

Cesarean (need help with this part!)

Here's mine:

Mother will consent following second or third opinions from the provider/s of our choosing. All of aforementioned birth participants and anesthesiologist present for delivery. Localized anesthesia with mother remaining awake. Dissolving stitches preferable. Screen lowered to see baby. No restraints, please.

The first sentence comes from the Creating Your Birth Plan book. I should add something about double suturing, although most likely this will be our last child.

Originally Posted by Jilian

What am I missing?

I specified the birth attendants that I wanted present: DH, DD, doula, MW, MW apprentice, doctor, L&D nurse. I then requested "no additional attendees" (inc. students) because *personally* I consider birth to be extremely an extremely intimate affair. I also requested a respectful atmosphere with minimal noise and chatter.

I also added:

Other Considerations: Mother declines hospitalist consultations, vaccines for herself, and corporate “gifts” and coupons.

"Hospitalists" are very en vogue at hospitals these days. They are on-staff doctors who consult one-on-one with you. A lot of patients don't even know that they are being billed for the visit--or that these doctors are even hospitalists, (as opposed to doctors who would be routinely part of your hospital care anyway). Insurance only sometimes covers them, and I figure that it's nothing that couldn't be taken care of at a later appointment with my doctor or midwife.

I think that THE most important part of your plan is the informed consent part. It covers almost all of your requests.

Chances are, if you transfer during an emergency, the hospital staff won't even get a chance to read your birth plan, so make sure that your MW and DH know it well and can bring up the issues as they become relevant, (great advice that I received from another MDC'er).

[thursday2]

What does everyone think about a very cut and dry checklist? In case of a true emergency, I can't imagine any nurse or ER doctor is going to take the time to read my carefully-worded introductory information... So I was thinking of simply one sheet of paper with two columns, one column headed: I DO NOT CONSENT TO THE FOLLOWING and the other headed PLEASE ENSURE THE FOLLOWING with a series of checkboxes. Then at the bottom, I would have the standard courtesies, "if any of the above requests become medically necessary to change, I hereby give power of attorney to my DH if I am unable to provide consent...", etc.

I don't want to be rude, but on the other hand, most hospitals tend to only care about birth plans as legal documents. They're way more worried about someone having proof to sue than they are about making sure the patient has her desired experience. Too rude, or perfectly pragmatic?

[Jilian]

In the case of a true emergency (like cord prolapse, etc) I don't think anyone is going to take the time to read a birth plan. Your birth partner will need to be your voice if you cannot speak on behalf of yourself. Make sure he/she knows your wishes. My H knows that he will stay with the baby at all times if I cannot and he knows what procedures we want and don't want.

[Youngfrankenstein]

The only thing I would add for the c-section part is that I would want a double stitch wound closure rather than a single.

Until I read about it in Ina May's Guide to Childbirth, I didn't know any different.

[elle7715]

This is my first planned homebirth, but if I DO end up transferring it will probably be because one of us is in distress. In that case I don't think anyone is going to be reading a birth plan. What I am going to do is make sure DH goes where baby goes. He'll have a typed list with him...YES to _____, I DO NOT CONSENT to _____ (hep B, vit K, etc), I CONSENT TO ____ only if _____. I know DH will be flustered but hopefully with the list we'll avoid the major things like a Hep B shot, formula, etc. I'll have a spare copy to hand to the nurses.