Birthing with an unfriendly OB, what do you think of this birth plan?

[JamesMama]

I'm facing the problem where I have a 50-50 chance of either delivering with an unfriendly OB or an only marginally more friendly GP (my midwife has suddenly taken an extended leave of absance for personal reasons, DH is 1000000% opposed to a UC, I do not know how to go about finding a HB midwife around here, I only have 5 weeks at most and don't have the money to pay one anyway).

So I tweeked my brith plan from the 'please and thank-you' language I would use with my midwife because she KNOWS ME to the 'this is how it's gonna go' language because this OB is intervention happy and has a wee bit of a God complex

To whom it may concern: I realize that with even normal pregnancies things can go awry quickly during labor and am understanding that some things may need to change. I am open to changes, within reason, and only request that I am given notice and that nothing be done to stray from this plan without my permission.


1st stage:
- Since I have a history of my membranes rupturing prior to the onset of labor, I will labor at home until my contractions are less than 5 minutes apart. I would like to allow labor to start on its own and request that I be given a minimum of 12-16 hours for this to happen.
- I would like to discuss other options, such as antibiotics, prior to agreeing to induction if I have prolonged (more than 20 hours) rupture of membranes without beginning contractions.
- I request that cervical checks be kept to a minimum, most likely only one when I feel ready to push ONLY. I would prefer to NOT be checked upon admission.
- I would like access to food and drink as desired.
- I would like access to a labor tub or shower if desired, even if my membranes have ruptured.
- I would like to maintain mobility during labor
- I realize there are several pain medications available, if I feel the need I will request them. Do not offer, please
- I would like intermittent monitoring by Doppler rather than continuous fetal monitoring.
- I would prefer not to have an IV or Hep-lock, barring medical concerns
- I would prefer the labor room be kept quiet and the door shut
- I do not consent to any students or extra personnel, except as required for medical reasons.

2nd stage:
- I would prefer to push when I feel the urge and not be coached.
- I would prefer to push in whatever position feels the most comfortable
- Barring medical necessity I would like to avoid an episiotomy. Tell me if you believe one is necessary if the baby is showing signs of distress. I am okay with tearing.
- I would like the labor room to be kept quiet, I want baby to hear our voices first.
- I would like my husband to catch our baby
- Baby is to be placed on my chest immediately after birth
- I would like to delay CLAMPING and CUTTING of the cord until it has stopped pulsing
- My husband will cut the cord
- I would prefer NOT have routine pitocin to deliver the placenta
- I would prefer the placenta be allowed to come on it’s own without controlled traction on the cord.

Baby-care:
- If necessary, my husband is to stay with our baby at all times if any medical care is required
- I do not consent to the Hepatitis B vaccine, Eye ointment or Vitamin K shot
- I will allow the PKU and the hearing screening do be done in my or my husbands presence ONLY.
- Baby will room in unless requested otherwise by me
- Baby is not to be bathed by hospital personnel. I will do it myself.
- Barring medical concerns baby is NOT to receive a bottle or pacifier. We will exclusively breastfeed.
- I DO NOT CONSENT TO CIRCUMCISION.
- Do NOT RETRACT my sons foreskin for any reason
- I request that all medical exams be done in my or my husbands presence and diaper changes be done ONLY by us.

In the event that I require a cesarean birth
- My husband will come with me into the OR
- I prefer epidural anesthesia
- I prefer low transverse incision to classical
- Please lower the drape so I can see baby being born
- I would prefer my hands not be restrained during the surgery
- I would like baby to be with me in recovery if possible
- If baby has to leave my husband will be with him at all times
- double-layer sutures when stitching uterus
- suture rather than staple for outer layer of skin
- please, no idle chit-chat - even though you are at work, I would like for the atmosphere during the birth to be quiet and focused on the event at hand as this is still a sacred event for my family.

After birth-

- I want NO VISITORS other than my husband and my children
- I would prefer to go home at the 24 hour mark no matter what time of day
- My discharge time may need to center around my husbands work schedule, so I would like my baby and I to be able to go home sooner than 24 hours if required.
- I DO NOT CONSENT TO MY CHILD BEING CIRCUMCISED.


(yes, I do believe putting the circ thing in twice is necessary, I live in Iowa)

[JamesMama]

Oh, my m/w had said she'd allow me to go 18 hrs with broken waters without worrying if contractions haven't started because I also have a history of fast labors so I'd deliver well before the 24 hour mark

[MyLittleWarrior]

If your water breaks at home, just don't go in until labor has established and you feel you're ready. If they ask when your water broke and it's been longer than they want but you still feel comfortable with the time frame I'd just say right before you left for the hospital. They can't do anything to you if you're still at home. Also, I wouldn't ask about food and drink. Pack it in your labor bag and if you get hungry, eat. And they may fight you pretty hard about not being checked for dilation upon admission, but if it's important to you then go ahead and stand your ground. I'll copy in my birth plan too. It's an emergency transfer plan since I'm planning a home birth, but on the off chance that I need to transfer for pain relief or dehydration I went ahead and included a labor and delivery section. It's very similar to yours, very to the point and not overly polite, but I figure in a real emergency no one is going to really read it anyway. It would be a good idea to make sure your husband is completely on board and knows all of your wishes so he can enforce for you. Also, are you using a doula? They can also be very helpful in keeping your environment the way you want it and giving you the space to make decisions when the doctors come sweeping in with interventions you don't want. Here's my transfer plan:

Hospital Transfer Birth Plan: Brad and Amanda M____, Aria M____ (baby)

Dear hospital staff: We appreciate you being here to support us through the birth of our 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 understand that birth is unpredictable, and are open to discussion of the below points if medically necessary.

Labor and delivery:
•Verbal consent must be obtained before any and every procedure or intervention. If I am unable to give consent, Brad holds my Health Care Power of Attorney and may give or withhold consent on my behalf.
•Please offer pain relief upon arrival. If I decline, please do not offer again. I will ask for it if I need it.
•I consent to an internal exam upon arrival, and when I feel ready to push. I do not consent to any other internal exams.
•I do not consent to internal fetal monitoring
•I do not consent to an IV or heplock unless necessary for requested pain relief.
•I do not consent to pitocin or other labor stimulating drugs.
•I do not consent to antibiotics without signs of maternal infection.
•I do not consent to artificial rupture of membranes.
•I do not consent to an episiotomy. I prefer to tear naturally.
•I do not consent to cord clamping until the cord has stopped pulsing
•Baby is to be placed directly on my chest or abdomen, and all newborn exams and procedures can be preformed while I hold her.
•I do not consent to cord traction or manual removal of the placenta. Please allow the placenta to deliver naturally.
•I will take possession of my placenta and provide an appropriate container for bringing it home.

C-Section:
•I do not consent to a cesarean section unless my or my baby’s life is in immediate danger.
•I request a spinal or epidural anesthesia and to be awake for the procedure.
•I want my husband and doula with me at all times. If both are not possible and my husband needs to leave to accompany the baby I request my doula be allowed to take his place as my support person.
•I do not want my arms restrained; I promise I will hold still.
•Holding and nursing my infant immediately is my top priority. I would like my infant with me in recovery, and I will have a support person to assist with nursing.
•I request a low-transverse incision to be closed with the double layer suture method.
•I request sutures rather than staples be used to close the outer incision.
•I do not consent to any drugs or medication after the surgery that would interfere with my ability to hold or nurse my baby.
•I will take possession of my placenta and provide an appropriate container for bringing it home.

Newborn Care:
•The baby is to remain with me at all times. If a medical emergency dictates that I be separated from my baby, Brad will accompany the baby at all times.
•Please postpone all routine newborn procedures until after the first hour and breastfeeding has been established.
•I do not consent to any vaccinations at this time. All vaccinations will be discussed with our pediatrician at our first checkup.
•If baby is a boy, I do not consent to circumcision.
•I do not consent to formula, glucose water, bottles, or pacifiers as this baby is being exclusively breastfed.
•Please do not bathe the baby. My husband and I will give her first bath.


This fits on one page, and the most important parts are bolded for quick reference. Again, this is a transfer plan and I have no intention of using it, but it's nice to feel prepared and going into a transfer with no OB care previously established I'm ready for who ever happens to be there that night.

I think your plan is very well thought out and very clear. Good luck with your birth, I hope it's everything you want it to be.

(If parts of this birth plan look familiar, I drew on this forum as a terrific resource and I hope no one minds that I borrowed parts I liked from several different birth plans I saw posted. Thanks for everyone's help!)

[*MamaJen*]

Do you have a doula? I think that would be the most important factor right there. A good doula will help advocate for you when you're in the thick of labor and unable to advocate for yourself.

[nia82]

I agree about the ROM - do not tell them when! I didn't either! Just say it happened in the car on the way to the hospital...
I agree also about the food stuff - just eat and drink... And pain meds - I took that out of my plan, it takes away valuable space (shorter is better for birth plans) and you can make that clear verbally...
Another great advice I was given: call the hospital ahead of time that you are coming and ask for a natural birth friendly nurse - the nurse can make or break your birthing experience.
I kept it all short and didn't bother with too friendly language - I know some disagree, but I put it like: I do not consent to an episiotomy / I do not consent to cord clamping/cutting until placenta is delivered. I made it clear as crystal. No room for interpretation.
I also second the doula...
And for the baby info I had a second extra sheet, as not always the doc/midwife handle that. E.g. with me, the mw just handed me DS. The nurse looked at him while he was on my chest (Apgars). I posted the baby plan visible and told the nurses about it (like don't offer shots, eye goop, circ, etc).
Good luck

[JamesMama]

The nurse told me to be as detailed as possible...this OB isn't at all 'natural friendly' so I want to make sure I leave no stone unturned. I don't want to overlook something and have them do it because it's routine or something.

There is only 1 nurse on duty generally, unless they have a lot of women in at once, which is rare. This hospital had less than 200 births last year, it's not really 'hopping'

The only doula option (free) I have is a girlfriend. I'm going to talk to her, but it will be very much dependent on time of day. Her DH works long hours and she'd have no one to keep her kids, plus she has a young nursling that I don't feel comfortable asking her to leave.

I'm not going to tell them unless I deem it necessary about ROM...I'm just nervous about a LONG time period passing and there being an issue.

[Plaid Leopard]

Honestly, if you must go to the hospital, then wait until the very, very, very last minute. Like, when you are pushing.


Can your midwife not recommend anyone else? Is there no other hospital where you could deliver? Have you posted in the triabl areas board to se if anyone in your area can recommend someone else?

I would take the next few weeks to find a doula, another midwife, another option. Also, learn about emergency childbirth "just in case". Ask your husband to learn about it as well. Even if you are planning a hospital birth there is always the chance that the baby comes really fast, and you don't want your FH to panic. Also, you don't want him to pressure you to go to the hospital as soon as labor starts, just because he is uncomfortable or scared.
Does your DH understand the imlications of laboring in the hospital with an aggressive, intervention-happy OB?

Good luck with everything!

[Peace+Hope]

jamesmamma, i hope you can wait a long time to go in!

any chance you will be able to discuss this plan w/ one or both OBs before the birth? i'd think that even these drs could sympathize enough w/ you losing your MW that they'd understand you want to continue the model you've been working with and preparing for your entire pregnancy. maybe if you explain/introduce it that way, they would be less threatened than they (might) be otherwise???

since the L&D is so small, maybe it is worth trying to talk to them ahead of time as well. get to know a nurse or two, or at least the head nurse?

even if they don't really get your choices, it just seems like they could understand that you aren't springing this on them, but you have had something sprung on you and need as much support as possible from them to maintain what you were planning.

big s!!!

[JamesMama]

I'm going to make as many phone calls as possible between now and then...try to find another option. I have a couple leads and I will see where they pan out.

DH says he's open to a homebirth so long as I have a midwife here to assist. Hopefully I can find one.

I'm not taking this lying down, I'm going to do whatever it takes in the next 4/5 weeks to avoid dealing with that OB.

Either way I have an appt on the 2nd with the GP to go over my birthplan and I will make an appt with the OB the following week to go over it with her. I'm making H come to BOTH appts to get a read of how hostile/accepting the drs are going to be about the plan. Since I have a 50-50 shot of either one showing up I want to make sure they both know how I want it to go. That way I can, hopefully, get some of the fight out on some of the issues (hep-lock, monitoring, etc). If either one give me too much grief I will flat out tell them that unless there is an ACTUAL medical emergency I will not consent to a hep-lock, I will not consent to continuous monitoring...if they don't like it tough nuts. I have good veins, any nurse/dr worth the space they take up should be able to place an IV in an emergency. No one has EVER had to try more than once to place an IV in me. I have excellent veins

As for the husband...he don't really care actually. He figures so long as you have a healthy baby who the hell cares how you get there (oh, and the ONLY WAY ON EARTH to get a healthy baby is to have medical personnel standing by). He doesn't see it as an issue that I am violate during labor because the problem is with ME not accepting the 'mainstream' or how things are done...it's not the doctors fault my head is full of ideas of how things should go.

[Plaid Leopard]

Unfortnately I think there are a lot of husbands and partners who just don't get the importance of being safe and secure and not messed with in labor. I'm not sure my DH ever fully got it, bit he went along with what I wanted.

Ifyour dh thinks that all that matters is a healthy baby, perhaps you need to concentrate on getting him information showing the effects interventions/stress on the baby.

I hope your leads pan out.

[JamesMama]

I've tried that...he says that there is a reason those interventions were needed and THATS why there were issues w the baby...has nothing to do with the hospital.

[Plaid Leopard]

Maybe some of these articles/links will help your husband see your pov.

evidence based maternity care
lots of good info here including discussion of overused maternity interventions such as continous fetal monitoring and AROM, as well as underused interventions including "Practices to Foster Women's Satisfaction with Their Childbirth Experience"

http://www.birthinternational.com/ar.../wagner01.html

http://www.midwiferytoday.com/articl...nal_impact.asp

The belief that more medical intervention is better, regardless of cost, isn‘t supported by research.


... in the US, the norm in maternity care that is provided is technology-intensive and not consistent with the best available research. Healthy women often are given tests, drugs, surgical procedures and other interventions that could have been avoided. ... some procedures or interventions are done freely and routinely, whether or not the mother or baby has shown a clear need. [they] are disruptive, uncomfortable, can cause serious side effects and often lead to the use of other interventions. Further, these procedures are often done without informed consent...

http://www.hencigoer.com/

http://www.naturalbirthandbabycare.c...rventions.html