|Care Preferences in Case of Hospital Transfer
A and DH
We have had a very normal pregnancy and plan for a home birth. If for some reason, however, our midwives recommend that a hospital transfer is the best decision for A’s and the baby’s health, we will be transferring into your care. We understand that this may place us at a higher-risk category and necessitate certain interventions that we would otherwise try to avoid, however we do have some preferences for ourselves and for our baby that we would like to convey to you on paper.
We may be transferring in order to obtain pain relief for A if her labor has been prolonged to the point that she is exhausted and unable to continue without assistance. However, we would like to use an epidural as a last resort, and instead use narcotic pain medications or sterile water injections first if that is deemed appropriate to our situation.
If an IV is required, we request that a heparin lock be placed for the administration of mediations and left unattached to a constant fluid drip. As long as A is still able to eat and drink on her own, she would like to be able to do so.
Our transfer may be out of concern for the baby’s well-being; however we would like to avoid constant fetal monitoring if at all possible. As long as intermittent monitoring is appropriate, we would prefer that method of monitoring our child. We would also prefer the use of the fetoscope over the Doppler whenever appropriate, and that ultrasound exposure, whether for a test or to obtain the heart rate, be constrained to a minimum.
We decided, after a careful review of available literature, to decline the test for Group B Streptococcus. We realize that it is the policy of the hospital to treat all untested mothers as if they were positive; however we do not consent to antibiotics for A or the baby without a positive culture and symptoms of illness. We also do not consent to testing for GBS disease in the baby unless s/he shows symptoms of illness; at a minimum this means two consecutive high temperature readings taken four hours apart.
In the case of a vaginal birth, A would like to avoid directed pushing, lithotomy position, and episiotomy. We have not discovered the gender of our child during this pregnancy and would like for DH or A to announce it. We would like skin-to-skin contact immediately after birth. During the third stage, we request that cord clamping be delayed until after the cord has stopped pulsing, and that cord traction not be used at all in assisting with placental delivery. We would like at least an hour be given between the birth of the baby and the birth of the placenta before intervening.
If a c-section is indicated, DH would like to be present for the entire procedure. He has extensive experience in the operating room environment and would like to be present and able to witness the surgery, even if general anesthesia is used. We would like to be able to photograph the birth. We would like for DH to announce the gender of the baby. If possible, we would like the baby placed on A’s chest or abdomen until the cord has stopped pulsing before clamping and cutting it, and for the placenta to be allowed to detach naturally.
If the baby needs to go to a special nursery, we ask that DH accompany the baby at all times. If DH and the baby leave the operating room and A is not under general anesthesia, we ask that one of A’s support people be allowed to join her in the operating room for the remainder of the surgery.
We do not consent to the administration of antibiotic eye ointment, since A does not have gonorrhea or chlamydia. We do not consent to the administration of Vitamin K, either orally or by injection. We do not consent to the administration of the hepatitis B vaccine. We will sign any legal forms that are necessary for the hospital in order for us to decline these procedures.
We ask for suctioning be avoided if at all possible. We want to minimize separation after birth. If a vaginal birth, we would like the exam delayed until after breastfeeding occurs. If birth happens by cesarean, we ask that the examination be as quick as possible, and that baby is wrapped up and handed to DH as soon as is reasonable. If DH or A is unable to hold the baby at any time during the first several hours, we ask that an available staff member hold the baby until one of us is available. We do not want our child left in a bassinette or a warmer, especially during its first hours of life. An exception to this is during hallway travel from room to room, when we understand that safety regulations may require that the baby be in a bassinette. However, as soon as possible, we would like the baby to be picked up and held again.
We are planning on exclusively breastfeeding and would like to avoid any artificial nipples or formula being given to our child.
We thank you for your expertise and assistance in welcoming our first child into the world. For all of these requests, we are willing to discuss our options at any stage as the situation may demand that we compromise. We would ask, however, that any changes be made only after consulting with us and allowing us time in private (when possible) to make a decision. Thank you again.