IF transfer is necessary... birthplans?

[Mi_LuBelle]

If you transfer, what are you including in your birthplan?

I'm skipping all of the statements involving labor as I only plan on transferring in the case of an emergency... in which case I'm assuming we'll be facing a CS anyway.

Just wondering what you all included or those that transferred in the past would suggest including...

[cileag]

In that case, I would put just the things that mostly pertain to baby. Here's mine:

Our Birth List

People who might show up:

(I have their real names here)
husband
my mother
sister-in-law
Certified Professional Midwife, Licensed Midwife
Certified Professional Midwife, Licensed Midwife


We'd like to see the CNMs if we don't risk out. Otherwise, no residents please.
Dr. Great with kids for a pediatrician.
If possible, I'd like to avoid rooms 353 and 354.

We don't know the sex of the baby--if possible we'd like Dad to announce it.

No thanks, we decline the Hepatitis B vaccine here in the hospital.

No thanks, we decline the erythromycin eye ointment.

Yes please, we would like the Vitamin K shot.

No thanks, we do not plan on circumcision.

No thanks, I'll skip the TDAP.

Yes please, give me the flu shot.


So it's very simple---I'm an L and D nurse at the hospital we would be transferring to so I know exactly what things they would want to do/know---and I'm just answering them so my husband wouldn't have to worry about repeating himself. I also wanted to introduce people who might be with us because I like to know who is who in the birthing room.

Other than that, if we're transferring, it's for a good reason and I trust that the staff will have the same goal as I will--healthy mom and baby asap.

[Juvysen]

yeah, I expect the only way I'm going in is if I'm having a pp hemorrhage or something happens with the baby or if I need an emergency cesarean... so probably in an ambulance. I guess i should probably write something out about no circ, no vax, no eye goop? I dunno. I think if it comes to that, I'll just be happy that we all survive...

[fruitfulmomma]

If possible, I'd like to avoid rooms 353 and 354.

You've piqued my curiosity. Is there something special about those rooms?


Hmm... we did not have a written birth plan. My husband knew my wishes and was able to communicate them to the staff when we transported during birth #2. We also transferred care to the on-call doctor for baby #3 for an AROM induction/possible birth defects with baby and that time I talked with the staff a bit before hand. With my last baby I went in for a check on the baby and penned some things down on a paper before we went, which the nurse read over with me and then put into my file. Basically I said I prefered no pain meds, no vaccinations, no vit. k unless it was a traumatic birth, and no circ. Didn't end up needing it because I got sent home and had the baby there a few days later.

[mysticmomma]

We are planning a homebirth for this pregnancy, and thus far, I have had an uneventful pregnancy. I fully expect to have an uneventful labor and birth. I understand that sometimes a transfer is necessary, but we didn’t plan to be in the hospital. This is a huge change for us. We appreciate your expertise in labor, delivery and care of a newborn. Please help us have the birth most like we wanted, keeping in mind that many of these are not optional due to our religious beliefs. We are not unreasonable and welcome the opportunity to discuss any alternatives.

In Labor… as much as medically safe we will:

1 Have a quiet and dimly lit room with as few attendants as possible.
2 Eat and drink instead of having an IV.
3 No Vaginal exams. They can be discussed on a case by case basis
4 Keep my membranes intact and avoid augmentation.
5 Use intermittent fetal monitoring so that I may remain mobile.

In Delivery … as much as medically safe we will:

1 Wait for the urge to push, and push without coaching in any position that feels right.
2 Not have an episiotomy. I would rather tear.
3 No speaking when baby is born, as we want her to hear our voice first.
4 Eric will announce the sex of the baby. Please do not push for information.
5 Please do not suction baby.
6 We request no augmentation of placental delivery (traction, pitocin)
7 DO NOT CUT CORD!

Cesarean Delivery… as much as medically safe we will:

1 Keep Eric with me at all times, including while spinal anesthesia is administered.
2 Photograph as much as possible. We will not take shots of any personnel’s faces.
3 Please use a double layer of sutures instead of the standard one layer.
4 Avoid general anesthesia and keep my arms free.
5 I will breastfeed in recovery and have someone with me at all times to assist. I understand this may be contrary to hospital policy, but it is not optional for us.

Baby Care… WITHOUT EXCEPTION: Parental consent will be obtained prior to conducting any procedures (routine or not), including blood draws, injections and medication. Eric will accompany our newborn at ALL times.

NO VACCINES
NO CIRCUMCISION
NO ABX EYE TREATMENT
NO VITAMIN K
NO NEWBORN SCREENING Performed at pediatricians.

[Peace+Hope]

mysticmomma, yours looks great, a lot like i'm imagining mine will be.

i've also thought about adding immediate after birth (vaginal) things like, skin to skin contact with mom (to allow for possible breastfeeding and bonding) BEFORE apgar testing/weighing. maybe hospital policy does not allow this?

[cileag]

Originally Posted by fruitfulmomma

You've piqued my curiosity. Is there something special about those rooms?

These rooms happen to the rooms we most often use for our patients who have had fetal demises or still births--they are out of the way and quieter. Too many negative/sad associations, so if it's possible I'll take another room.

[jojoboy]

For birth #1, I had everything but the kitchen sink in our birthplan (suture types, etc). For birth #2, after I had thought about it, I realized that if I was going to the hospital, it was because me or baby was in trouble, and I put in the stuff that was most important for us to still feel connected to the birth process. We did Birthing From Within, and thought about the question, "How can you have a birth that you still feel good about, even if you have to go to the hospital?" For us, it mostly involved us staying together as a family as much as we could during an emergency.

The other portion involved interventions to our baby after the birth. Here's ours:

HOSPITAL TRANSFER
Throughout labor, delivery and postpartum, it is very important to us to be kept fully informed and involved in hospital procedure. We would also appreciate having time to discuss and consider the options available to us when the need arises. Please do not perform any procedures or administer any medications (routine or otherwise) without allowing us to do so.

LABOR AND BIRTH
We plan to have the following people present at the birth: (husband), (mother-in-law) and (our son). In the case of emergency, I would like my husband to be with me at all times.

C-section:
I would like (hubby) to be present.
We would like to hold our baby immediately after delivery. If the baby needs warming, we would like for hubby to hold the baby skin to skin instead of having the baby go to the warmer.

FOLLOWING BIRTH
Please do not perform any procedures or tests or administer any medications or vaccines to our baby without our full knowledge and consent.
We would love to have:
Immediate skin to skin contact with our baby
Our baby with us at all times from the moment of birth.
Hubby will accompany him at all times if our baby needs intervention
Hubby cut the cord after it has stopped pulsating.

Our feeling about typical interventions for our newborn baby:
Bottles, pacifiers, formula – no thanks. We plan to breastfeed exclusively.
Bathing – we’d like to bathe the baby for the first time.
Eye ointment – we’d like to administer this ourselves
Hep B vaccine – no thanks.
Vitamin K – we will make this decision after the birth and after discussion with our midwife
Circumcision – no thanks.

[HollyRhea]

Hi, Mi_Lubelle,

I wouldn't assume that you'd only transfer for surgery. Frequently women transfer from home to hospital for the judicious use of those drugs and tools we're trying to avoid at home. Say you have an OP baby and just an exhausting three day labor. You choose to get some pain medication because that rest is going to enable you to finish this labor. Or what if you're pushing for a really long time because your baby has a little hand up by his/her head - so you transfer for some pitocin when your uterus tires out. These are all rare things, of course, but sometimes using the hospital tools at just the right time make all the difference between vaginal and cesarean birth. (these are also examples I've seen working as a doula). Lots of times women transfer to hospitals from home and still go on to have great vaginal deliveries. Hopefully this helps in case you do face a transfer.

So! for myself, I'm including an entire birth plan just as if I'd been planning a hospital birth. I also have some suspicions about this birth for myself, so I'm probably projecting a little of that over-preparation. Take what you will. And happy birthing!

Holly

[Juvysen]

Originally Posted by HollyRhea

Hi, Mi_Lubelle,

I wouldn't assume that you'd only transfer for surgery. Frequently women transfer from home to hospital for the judicious use of those drugs and tools we're trying to avoid at home. Say you have an OP baby and just an exhausting three day labor. You choose to get some pain medication because that rest is going to enable you to finish this labor. Or what if you're pushing for a really long time because your baby has a little hand up by his/her head - so you transfer for some pitocin when your uterus tires out. These are all rare things, of course, but sometimes using the hospital tools at just the right time make all the difference between vaginal and cesarean birth. (these are also examples I've seen working as a doula). Lots of times women transfer to hospitals from home and still go on to have great vaginal deliveries. Hopefully this helps in case you do face a transfer.

So! for myself, I'm including an entire birth plan just as if I'd been planning a hospital birth. I also have some suspicions about this birth for myself, so I'm probably projecting a little of that over-preparation. Take what you will. And happy birthing!

Holly

I was under the impression that these kinds of things are *much* more common for first time moms than for later births. My midwife has a 1% transfer rate for her second time moms (closer to 10% for first time moms).

[HollyRhea]

Originally Posted by Juvysen

I was under the impression that these kinds of things are *much* more common for first time moms than for later births. My midwife has a 1% transfer rate for her second time moms (closer to 10% for first time moms).

I think transfer rates are higher for first-time mothers, but those sorts of issues can happen with any labor. A poorly positioned baby can cause a long labor no matter how many babies you've had. It seems to happen a lot with third babies, I've seen - thought that's completely anecdotal. I call the third babies the "trick ponies" and another doula friend of mine calls them "wild cards".

[Juvysen]

Ugh... don't tell me that!

On the other end of the trick pony thing - I know a woman whose third labor consisted literally of TWO contractions... the other labors were *much* longer... She had an accidental UC but had planned a hospital birth! So crazy.

[JennTheMomma]

I have 1 that is printed out for an emergency. It basically says if I were to need a c-section that I want DH with me and that I would like to be stiched this way. If its not a c-section but need to be in the hospital its basically keep room peaceful, DH, mom and MIL are allowed to be in the room. Aswell as my Midwife if she wishes to continue to be with me. Cut cord when placenta is out, place on tummy, BF as soon as possible, no Pitocin, Vit K, nothing else.

[Comtessa]

There are good threads that pop up on this topic every month or so. Here are October, September, and August threads, respectively:

http://www.mothering.com/discussions...704&highlight=

http://www.mothering.com/discussions...250&highlight=

http://www.mothering.com/discussions...858&highlight=

Moderators, could we please have a sticky on this topic? Please?