Critique my birth plan

[ilovejeff]

I've gone back and forth on writing a birth plan and although I'm 100% committed to a homebirth, I've decided to follow the Boy Scout motto and "Be Prepared".

I've pieced together a lot of this from previous MDC posts, so you've contributed, thanks!

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Jen and Jeff’s Birth Plan

Dear Hospital Staff,

Although we were planning a Homebirth, the need has arisen for further medical attention. We are thankful that we have your expertise and knowledge to turn to and we look forward to working with you during the birth of our daughter.


Please discuss all routine procedures with us – we will give or withhold consent after each procedure and it's risks and benefits are explained. This is very important my sense of well-being and comfort in labor and afterward.

We wish to have an unmedicated, natural birth in every way. Please do not offer medication. We will ask if we change our minds.

We do not consent to observation by students or non-crucial staff.

In Labor, as much as medically safe, we will:
•Have a quiet and dimly lit room with as few attendants as possible
•Have no IV
•Have no routine vaginal exams. They can be discussed on a case-by-case basis
•Be mobile and eat and drink as desired
•We will consent to intermittent fetal monitoring, but wish to decline continuous or internal fetal monitoring
•Have no labor augmentation and absolutely no Artificial Rupture of the Membranes

In Delivery, as much as medically safe, we will:
•Wait for the urge to push and push without coaching.
•Push in various positions
•Not have an episiotomy; I would prefer to tear
•Unless meconium is present, please do not suction the baby
•No augmentation of placental delivery (traction, pitocin)
•Allow the cord to quit pulsing before clamping or cutting
•Baby is to be placed on Jennifer’s chest and allowed to nurse immediately following delivery

Newborn care:
•Baby is to have skin-to-skin contact with Jennifer for the first several hours following birth. We request that all newborn checks be performed while Jennifer holds her.
•We decline eye drops, Vitamin K, and all other shots or vaccines at this time.
•If it is absolutely necessary that the baby be taken for medical observation, Jeff is to accompany her at all times with no exceptions.
•No artificial nipples, including pacifiers, or supplements, including formula, glucose or water.
•Baby will room-in with us


Cesarean Section:
In case of an emergency where a C-section would be absolutely necessary:
•Jeff will remain in the room with me 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.
•The baby is to be placed skin to skin with me immediately after delivery. If that is not possible, the baby is to be given to Jeff immediately after delivery.
•Jeff will 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, S, with me during surgery and in postpartum recovery.

[Shiloh]

Okay I'd suggest putting right at the top that any changes, new suggestions, things not covered on this list will be discussed before hand, that you will be given all the information required, if medications are administered the type, dose, lot and times will be written down and given to you.
This is a good start:


Please discuss all routine procedures with us – we will give or withhold consent after each procedure and it's risks and benefits are explained. This is very important my sense of well-being and comfort in labor and afterward.

We do not consent to observation by students or non-crucial staff.

Maybe something about the trash collection dude, housekeeping, giving out information to babyphoto people, insurance etc.

Unless meconium is present, please do not suction the baby

I might suggest making that broader, I had two babies born so quick their lungs were still wet...I was told they had to be suctioned...maybe that was not correct but...

We request that all newborn checks be performed while Jennifer holds her.

can they check the hips that way? I might expand it to include preferable to be held or on the bed next to her.

• We decline eye drops, Vitamin K, and all other shots or vaccines at this time.

I think you have to have wording that if medical anomolies, emergencies, out of the ordinary conditions... a baby born might need a shot of something, you wouldn't want them to be so scared of being sued and following your plan that they avoid giving some type of treatment.

Also I'd make copies, give to attendants and put headings on them LABOUR, DELIVERY, AFTERBIRTH etc..

In case of an emergency where a C-section would be absolutely necessary:
• Jeff will remain in the room with me at all times.

if its a real emergency section where they put you under then I don't think they do allow that? I'd rather be put under if that can deliver the baby quicker if its a true emergency than waste time with an epidural. Just a thought.

• I want my uterus closed with the 2-stitch method.

I might specify then NO STAPLES as well.

[sarahn4639]

I think it's important to remember the reasons you would transfer. If you are committed to a homebirth you would on'y be going to the hospital if something was wrong or if you needed pain medication. With that in mind, I'll mark in the copy with blue.

Originally Posted by ilovejeff

I've gone back and forth on writing a birth plan and although I'm 100% committed to a homebirth, I've decided to follow the Boy Scout motto and "Be Prepared".

I've pieced together a lot of this from previous MDC posts, so you've contributed, thanks!

--------------

Jen and Jeff’s Birth Plan

Dear Hospital Staff,

Although we were planning a Homebirth, the need has arisen for further medical attention. We are thankful that we have your expertise and knowledge to turn to and we look forward to working with you during the birth of our daughter.


Please discuss all delete (routine) procedures with us – we will give or withhold consent after each procedure and it's risks and benefits are explained. This is very important (for) my sense of well-being and comfort in labor and afterward. I would probably just say We request that all procedures and medications be explained fully before we give consent.

We wish to have an unmedicated, natural birth in every way. Please do not offer medication. We will ask if we change our minds. I would take this out because the chances are that if you transfer you will want medication, but also, they have to ask at admin anyway.

We do not consent to observation by students or non-crucial staff. excellent!

In Labor, as much as medically safe, we will:
•Have a quiet and dimly lit room with as few attendants as possible
•Have no IV whether it's a complication or medication for transfer, IV would be required for those situations. If for some reason you transferred in a different situation you could jus refuse
•Have no routine vaginal exams. They can be discussed on a case-by-case basis
•Be mobile and eat and drink as desired It's much better to just DO this, don't make it an issue. It would be pretty unusual for you to get a hospital's blessing to eat in labor.
•We will consent to intermittent fetal monitoring, but wish to decline continuous or internal fetal monitoring. An epidural requires continuous monitoring and if there is an issue with the babe it would be used then as well. I don't know if I'd leave it or add something like. We will discuss it's use if the need arises or something like that...
•Have no labor augmentation and absolutely no Artificial Rupture of the Membranes. I would just leave this out because, again, if you are transfering it is possible that you will want to try these things to avoid a C/S. If it is a situation where you don't just refuse and always keep your eyes open for an amnio-hook. Your doula will be helpful with this.

In Delivery, as much as medically safe, we will:
•Wait for the urge to push and push without coaching.
•Push in various positions You could take this out and just do it. Shorter is better with birth plans.
•Not have an episiotomy; I would prefer to tear
•Unless meconium is present, please do not suction the baby
•No augmentation of placental delivery (traction, pitocin)
•Allow the cord to quit pulsing before clamping or cutting Try to have someone remind the doc at as the head is born, this is often a reaction they don't think about and just do it. If you have a good nurse, this will be her doing that, otherwise it needs to be you or your husband.
•Baby is to be placed on Jennifer’s chest and allowed to nurse immediately following delivery you could take this part out to shorten it up. When she's on your chest you can do what you want.

Newborn care:
•Baby is to have skin-to-skin contact with Jennifer for the first several hours following birth. We request that all newborn checks be performed while Jennifer holds her.
•We decline eye drops, Vitamin K, and all other shots or vaccines at this time. (I think if there is a birth injury they will talk to you about Vit K, if not and forceps, vacuum or any bruising occurs, you may want to request it in those cases but I'm sure they would talk with you about it if that were to occur.)
•If it is absolutely necessary that the baby be taken for medical observation, Jeff is to accompany her at all times with no exceptions. (If it is truely a life/death emergency, he won't be able to go and that is actually likely for everyone's benefit ie, staff able to focus on;y on baby and not worry about DH, traumatic for DH to watch, just my thoughts)
•No artificial nipples, including pacifiers, or supplements, including formula, glucose or water. I would say, baby is breastfeeding and is to have nothing by mouth including pacifiers
•Baby will room-in with us


Cesarean Section:
In case of an emergency where a C-section would be absolutely necessary:
•Jeff will remain in the room with me at all times. As a PP said, if it is an actual emergency that won't be possible but most CSs that are called emergencies are only kind of, in that they need done but it's not a run down the halls, give mom general, STAT kind of thing.
•I’d like an epidural and to be able to watch the birth and touch my baby. If you haven't already had the epidural it would be a spinal in the OR. How much you can watch and touch is up to the anesthesiologist so he'd be the one to direct these desires to when you hypothetically meet him
•I want my uterus closed with the 2-stitch method. you may want to word this as double layer suture closure.
•The baby is to be placed skin to skin with me immediately after delivery. If that is not possible, the baby is to be given to Jeff immediately after delivery. After a CS baby goes to warmer, they won't hand her directly to DH but your DH can advocate that she doesn't need a full newborn exam done at that time. Once they look her over and she that she's breathing and all is well he will need to push to get her at that point, otherwise they tend to keep babies for quite a while doing all the routine things)
•Jeff will stay with the baby at all times and through all postpartum procedures.
•I do not consent to Versed post-delivery. great point, again, be sure to direct this to the anesthesiologist, they will likely not see your birth plan.
•I would like my doula, S, with me during surgery and in postpartum recovery. This again, depends on the anastesiologist/hospital. Locally, there is one hospital that has a very strict 1 person only rule and another that is pretty good at allowing 1 person plus doula but it can be hit or miss.

Discuss this with your doula as well. She will know how to best address/word it to fit your local hospital scene and which hospital you'd transfer to. I'm sure you won't need any of this but I completely understand needing to do it. I had a transfer plan for my home birth as well. Best of luck on a great birth!

[isign]

• Baby is to have skin-to-skin contact with Jennifer for the first several hours following birth. We request that all newborn checks be performed while Jennifer holds her.

Some hospitals require that the baby be taken to the nursery after an hour or so. Mine was one of those wonderful places. It was in our birth plan for it not to happen, but it was a long, over night labor, and DH was asleep when they took DD. I was not emotionally or physically in a position to argue this. Thankfully the L&D nurse was someone we knew and got her back after 1.5 - 2 hours instead of the 4 they require. They also took her back so the ped could see her, because they did not do 'in room visits'. I was there 2 mornings, so I let her go while I got a shower and then went and got her. If I had waited for her to be brought back to me, it would have been several hours. Anyways, I said all that to say that I'd look into these policies to see what you and DH might possibly be up against.

[SandraS]

One of the most important things for me, too, was going home right away. You may want to add that to the bottom - I made sure my doctor was fully aware of, and made the hospital staff aware of, my wish to leave immediately. I was home within 4/5 hours or so. As long as you are both healthy, get outta there and recover at home!

[MegBoz]

Originally Posted by SandraS

One of the most important things for me, too, was going home right away.

Yes, I wanted to get out ASAP too! But in my hospital, my MWs were more than happy to let me go in a matter of a few hours, but DS had to be officially discharged by a pedi. I think that is probably common that it'll be more difficult for you to get a pedi to discharge the baby than to get your HCP to discharge YOU.

So, I don't know that I'd bother to include this on your birth plan. Since it's best to keep it short & sweet, & discharge isn't really an L&D issue.

[cileag]

I also second Sarahn's suggestions. The reasons you transfer would probably negate or change the majority of your birth plan---the C/S stuff is obviously relevant, but I second the unlikelihood of them allowing your husband to be in the room if you are put to sleep--it can be quite traumatizing for the partner and the staff is unlikely to want an extra person around for a truly emergent c/s.

I'm always an advocate of only putting the stuff on that you can't control---so the food, dim lights etc can all be controlled by your husband and doula. The shorter the better.

[LilacMama]

I think it's good you've written this out so that you've had time to think about it all. But honestly, I would get rid of most of it. Just leave the bare essentials.

Think about reasons you would transfer from a home-birth. The main ones are:

1) you're exhausted, and you need pain medication or
2) baby is showing some signs of distress

In both cases, you will want and need an IV and continuous monitoring.

Best wishes to you with a happy, healthy home birth!

[SandraS]

I had no difficulties with the on-call pediatrician (one of them was even very old - I figured he would give me the biggest problem) signing babes out right away. No fighting, no debating, no battles. Ever. It's not like they can hold us against our will anyways.

[MegBoz]

Originally Posted by SandraS

It's not like they can hold us against our will anyways.

True, but you'd have to sign out "Against Medical Advice" if they won't discharge early. So, I guess I'd consider that a "battle" of sorts and I WOULD have had to battle on that personally. I was GBS+ but had no time for any antibiotics, so standard is to monitor baby for 48 hours. So it WOULD have been a "fight" (aka "sign out AMA" for me). I don't know the consequences of signing out AMA except my pedi might have kicked me out of her practice.

In any case, as others have said, I agree that it's best to leave the birth plan to the bare essentials & I don't think early discharge would be part of that for any birth plan - HB transfer or otherwise.

[~pi]

I was in a situation slightly related to yours. (Wanted a homebirth; risk factors meant a hospital birth.)

I wrote a very detailed, polite birth plan, and it helped in some ways. However, if I could go back and do it over again, the number one thing I would change would be the way I wrote my birth plan. It was the same as yours -- sorted by category with a list of, "I want this, " and "I don't want that."

In retrospect, it would have been a million times more useful to have a list of ordered priorities. E.g.:

1. Healthy mom
2. Healthy baby
3. Keep me and baby together after birth
4. Have my support people with me at all times
5. Communicate with me about all procedures, including routine ones
6. Vaginal birth
7. Unmedicated birth
8. Ability to move around and change positions
9. etc.

By framing it this way, you (1) make your priorities crystal clear, (2) cover the situations you might not have considered by articulating your broad priorities, (3) avoid coming across as a control freak telling professionals how to do their jobs (it's unfair and unfortunate that moms with birth plans are seen this way, but it is a genuine issue at some hospitals), and (4) keep it short. If you like, you could put the details on subsequent pages, though personally, I would not bother.

FWIW, I have shown this template to a number of compassionate health professionals I know. They all loved it because they thought it would allow them to do their utmost to respect a mama's wishes to the fullest extent possible within the constraints that they have.

Most birth plans don't really distinguish between the points that are really, really important and those that are minor. And when you ask women, those feelings do very much vary. Some women really, really care about things that other women see as minor.

Hope this helps. I am wishing you a wonderful homebirth.

[kkar]

I would do two things:

First, run it past someone at your hospital. As other posters have noted, some of your items might be out of your (or their) control b/c of hospital regulations. Why get your heart set on something that might not be possible?

Second, keep some perspective. With labor, things can all of a sudden go very fast, and especially in an emergency situation, the hospital staff may not have time to read your plan - or bits and pieces here and there might get missed. I think as long as your advocates know what you want, and you realize that some things may go off plan and you don't get your hopes too high, you'll be fine.

Good luck with your homebirth!!!!

[SandraS]

Originally Posted by MegBoz

True, but you'd have to sign out "Against Medical Advice" if they won't discharge early. So, I guess I'd consider that a "battle" of sorts and I WOULD have had to battle on that personally. I was GBS+ but had no time for any antibiotics, so standard is to monitor baby for 48 hours. So it WOULD have been a "fight" (aka "sign out AMA" for me). I don't know the consequences of signing out AMA except my pedi might have kicked me out of her practice.

Deep breath. Obviously that's a different situation. I stated if mom and baby are fine, you can leave. If there's illness or a problem one would not want to check out early, would they?

Early discharge was a VERY important part of my plan that I wanted to ensure everyone was fully aware of. On the lighter end, I wasn't offered menus and fresh clothing and told visiting hours, because I was outta there. And no one questioned my wishes.

[MegBoz]

Originally Posted by SandraS

Deep breath. Obviously that's a different situation. I stated if mom and baby are fine, you can leave. If there's illness or a problem one would not want to check out early, would they?

Actually I don't think being GBS+ is a "problem" or an "illness." But that was their policy. Ironically, early-onset GBS infections show symptoms within 24 hours like 95% of the time! (Whereas late-onset GBS infection can not show up for 3-weeks!) So the 48 hours doesn't make much sense anyway. But I decided not to fight it.

I know some pedis at my hospital want 24 hours monitoring for every baby & there was one who wants 48 hours for all. So, yeah, there may be a "battle" over leaving in less than 24 hours even in the absence of any sort of 'problem.'

[ilovejeff]

Thanks for the feedback! I've touched it up a little and am going to send a copy to my doula and see what she thinks. I'll be taking a copy to my next MW appt as well, to her her feedback.