Contingency Birth Plan?

[To-Fu]

Has anyone here written an contingency birth plan for in the event that they need to be transferred to the hospital? I feel like I should do it this time, and probably pack a bag just in case, but the thought is just so depressing that I don't know where to start.

I'd love to see what other people have come up with, or links to templates or whatever.

Thanks!

[HankyPanky]

I have similar questions. Part of me thinks a birth plan would be useless since as of right now, the only way we'd transfer is for a medical emergency and in that case, a birth plan would probably be useless, right? I also wonder how I would feel about it mentally -- as if making a birth plan would invite fear/anxiety in about not having a normal homebirth.

Would love to hear what others have to say about the subject.

Edit: perhaps if I decide to make a birth plan I would have the bare minimum and most important things: no episiotomy, no pain-relief, skin-to-skin ASAP, baby never leaves our sight (assuming baby is healthy in event of transfer), etc. I'd forget all the other things people usually put on there (lights dim, no IV, minimal monitoring, etc.) Again, this is assuming it's an emergency transfer.

[MeepyCat]

I think that a birth plan is useful, even in an emergency. I mean, yes, it's being an emergency will limit the things you have choices about, but it won't remove all choice. You will still want to say things about who is with you, about not being separated from the baby, about your plans and preferences concerning breastfeeding. And not all emergencies require the same things - you won't know in advance what choices you'll have.

[babycatcher12]

I'm planning on making one even though I know that *if* I have to transfer it's going to be an emergency situation. (and I'm not planning on transferring)

It doesn't mean I give up all my choices and options. The biggest reason I'm planning on doing it is for after the birth. For example...that I don't want the baby to be removed from the OR or my room at any time after the birth if he is stable and healthy and if he does have to go to the nursery DH will be with him at all times no exceptions. I don't want him given formula etc (pretty much the standard stuff).

My "birth plan" for the hospital if I transfer is more to make sure I have the postpartum care I want for myself and my baby. YKWIM?

[flitters]

Originally Posted by babycatcher12

My "birth plan" for the hospital if I transfer is more to make sure I have the postpartum care I want for myself and my baby. YKWIM?

This is me too... no eye goop, no shots, no formula, no circ, baby with us at all times (unless NICU care needed or something). I just want it written down so that if we do transfer (which would be due to an emergency situation) these things don't get done by default.

[emnic77]

I have not, and don't plan to. Mostly because in the unlikely event of a transfer, my midwife will come with us as a doula, and she knows what I want and will advocate for me, as will my husband. Stuff like eye goop, vitamin K, circ, hep B, ....the emergency hospital I would be going to is the hospital I had my DS at and no matter what you write down they're still going to ask you anyway, because of consent forms, so IMO, a birth plan is kind of pointless (for me).

[jennica]

If I transfer, I'm just going to take the hospital ride. I know what the results of fighting are which is why I am having a homebirth this time and I wont put myself in that situation again. My mindset is if I transfer they can just do whatever they want. I know they ask before doign major things to baby (like circ, or hep b) and once baby is is born we wont allow bottles etc., but the last thing I need to think about in labor in an emergency situation is fighting. It will be stressful enough for me to enter a hospital again.

[*MamaJen*]

Here's a recent thread that has a good discussion: http://www.mothering.com/discussions...ht=contingency

[alton]

I've written birth plans for everyone that could potentially be involved because I'm a bit of a control freak like that. I find it helps me relax to know that all my wishes are written down in black and white because the first thing that disappears when I'm under pressure is my ability to communicate! I felt a bit depressed when I started on the hospital transfer plans but it actually felt better to write it.

I figure that transfer could take place for tonnes of different reasons, not all of which are medical emergencies. For instance, I'm not sure if it's the same for everyone but I can only have a homebirth between 37 and 42 weeks so going a day early could land me in hospital. And if anything, my views on what I do and don't want in a hospital setting and even stronger than what I want at home.

Writing transfer plans actually calmed me down because it made me realise that I wasn't necessarily going from my ideal birth environment to my worst case scenario!

As I said, I'm a control freak, so I even wrote out my preferences for the ambulance ride (e.g. don't strap me on my back! Don't give me pethidine!)

I've stopped worrying about transfer and started to worry about my husband's reaction when he is presented with his written instructions!!!

[thefreckledmama]

Originally Posted by jennica

I know they ask before doign major things to baby (like circ, or hep b)

Unfortunately, this isn't always true. With my first two births I wasn't as informed as I am now, and my daughters were given Vitamin K and Hep B shots without my prior knowledge or consent-they were also given the eye drops and heel stick test before anything was said to me about it. Most hospitals have their sequence of events that take place after a baby is born, and if not specifically told otherwise, will just do the things they're used to doing-circumcision probably being the only exception because it's a surgical procedure that requires consent. Besides that, usually when you enter the hospital, in the paperwork there is a blanket consent form that usually covers everything like eye goop, shots, sugar water, etc.

[Zoeanne]

Here is mine.

It is very important to us to remain with our baby at all times, except in the case of extreme medical emergency. Please obtain consent before performing any medical procedures or administering any medication to Zoe or the baby.

CESAREAN BIRTH

If a Cesarean birth must be planned ahead of time, it should be scheduled to occur after labor has begun on its own.

We would like for Robert and Nancy or Stacy to accompany Zoe into the operating room.

If possible, please play Zoe’s CD during the procedure. Those present should refrain from extraneous conversation. It would be appreciated if a doctor “narrates”, explaining events as they occur.

Please do not administer any pre, peri, or postoperative medication without prior verbal consent from myself, or my spouse if I am incapacitated. I wish to discuss the complete anesthesia protocol with the anesthesiologist prior to any medication administration. I prefer to avoid general anesthesia except in the case of extreme medical emergency.

Please do not place the urinary catheter until after regional anesthesia is in place,.

Please do not strap my arms down unless I am physically unable to control them.

The incisions should be a “bikini cut” and a low transverse incision; I do not wish to receive a vertical uterine incision.

If possible, please lower the screen/curtain to allow Zoë and Robert to view the birth unobstructed. If not possible, perhaps a mirror or curtain with a window could be used to allow the parents to view the birth.

Please do not clamp/cut the umbilical cord until it has stopped pulsing.

I wish to take the placenta home.

We wish for the baby should be placed immediately on Zoe’s chest after birth, with a warm blanket covering her, unless medically impossible. We would like to make physical and verbal contact with the baby as soon as possible. The baby should remain on Zoe’s chest during checks for baby’s health and repair of the incision, if possible.
Please use the double-suturing method to close the uterus.

If the baby needs to go to the nursery or intensive care for emergency medical reasons, Robert would like to stay with the baby at all times, and Nancy or Stacy will stay with Zoe.

The considerations/requests for care listed below should also be honored during a Cesarean birth as much as possible.

VAGINAL EXAMS

Please do not perform any vaginal exams without my request/agreement.

Please do not strip my membranes during a vaginal exam.

GROUP B STREP

I decline testing for Group B strep. I do not wish to receive to antibiotics during labor except possibly in the following cases: Labor or rupture of membrane before 37 weeks, rupture of membrane 24 hours or more before delivery, fever during labor.

PRIVACY

I would like for people entering the room to speak softly.

Please keep my door always closed during labor.

SECOND STAGE OF LABOR

Please do not perform an episiotomy.

Please do not use forceps or vacuum-assisted birth.

NEWBORN/RECOVERY:

Please do not separate my baby and myself at any time unless there is a medical emergency. In the case of medical emergency, Robert would like to stay with the baby at all times.

I would like my baby to be placed immediately on my abdomen following the birth, skin-to-skin with a warm blanket over her.

Please do not suction the baby’s airways unless it becomes absolutely necessary.

Please do not clamp/cut the umbilical cord before it has stopped pulsating.

Please delay all essential routine procedures on my baby until after the bonding and breastfeeding period.

I would like all newborn routine procedures to be performed in my presence/sight, and preferably in my arms.

Please do not give the baby a bath.

I do not consent to eye drops for my baby.

I do not consent to the Vitamin K shot. If some trauma has been suffered that may cause blood loss, we will consider oral Vitamin K.

I do not consent to any immunizations for my baby.

I do not consent to circumcision for my child.

I do not consent to the heel prick for PKU testing; we would like to wait, and delay the PKU testing until our first pediatrician visit.

Please do not give my baby any of the following: formula, sugar/glucose water, artificial nipples (pacifiers/bottles/etc)

If the baby must be cared for in the NICU, we would like to use kangaroo care, and would like to be with the baby as much as possible.

THIRD STAGE OF LABOR

I would prefer for the placenta to be born spontaneously; please do not use pitocin, and/or controlled traction on the umbilical cord.

I would like the option of taking home the placenta.

VISITORS

I would like my other child (Logan) to be allowed to visit with me for as long as he wishes or as long as hospital policy permits.

I would like my husband and child to have the option of rooming in with my baby and me.

[jennica]

Originally Posted by thefreckledmama

Unfortunately, this isn't always true. With my first two births I wasn't as informed as I am now, and my daughters were given Vitamin K and Hep B shots without my prior knowledge or consent-they were also given the eye drops and heel stick test before anything was said to me about it. Most hospitals have their sequence of events that take place after a baby is born, and if not specifically told otherwise, will just do the things they're used to doing-circumcision probably being the only exception because it's a surgical procedure that requires consent. Besides that, usually when you enter the hospital, in the paperwork there is a blanket consent form that usually covers everything like eye goop, shots, sugar water, etc.

Good point, I might write up an index card of bullet points just for the baby. I'll just put Dh in charge of delivering the information so I don't need to worry about it.

[MyFillingQuiver]

Thank you so much for these suggestions! Zoeanne, your birth plan is so great, I'm hoping to borrow much from it. It is very helpful.

I plan on discussing this with my MW tomorrow at my prenatal. Here are my questions on this subject...with my last baby, a VBA2C, I had to travel about an hour, to another state, to have a hospital birth with a great OB. So, in the event of a transfer, it's likely I'm going to our local hospital, which is where I had my totally unnecessary repeat c-section due to a VBAC ban....

My MW will come with me in the event of a transfer. Will she remain my advocate while there? Has that proved a helpful thing for any of you in the past? My only concern with a c-section birth at that point would be the health of the baby, as obviously I'll have no chance on an intervention free/minimal vag birth!

So, my focus would be on the baby not leaving, no vax'ing/eye goop/sugar water or formula of any kind, etc. Of course the other important things such as rooming in and all-which the local hospital is pretty good about in my experience.

Sorry it's a ramble...just made me realize how much I have to ask her tomorrow! I can see an issue prior to labor can get me to the VBAC friendly hospital/OB, and possibly in early labor..but since I will only be open to transfer for major issues, it seems a c-section anyway! Right? Ugh! So much to think through since I do not want to be stuck in a bad position ever again due to my own ignorance!

[etsdtm99]

i am planning a homebirth and i am not planning to write a birth plan - i have birthed at the hospital i would transfer to twice before with no birth plan and things went 'fine' ..fine as in, nothing wuold have been different with a birth plan.. i expressed my wishes, or my DH did and they complied or they didn't ..

[springfever]

I've got a bit of a birth plan in case of transfer.
It's not very long or detailed but the important things are there.


Vaginal delivery
- Wait for cord to stop pulsating before it is cut.
- Give baby to me to have skin to skin contact and breastfeed before he's cleaned off and weighed.
- I will be keeping the placenta, refrigerate or put on ice immediately please.
- I do not consent to my baby being given bottles, pacifiers, sugar water, or formula
- I do not consent to my baby being given a vitamin K shot
- I do not consent to eye ointment


C-Section

- Lower curtain so I can see the baby come out.
- Let me hold him before he's cleaned off
- I would not like my arms to be strapped down.
- I will be keeping the placenta, refrigerate or put on ice immediately please.
- I want to breastfeed as soon as possible within first hour.
- I do not consent to my baby being given bottles, pacifiers, sugar water, or formula
- I do not consent to my baby being given a vitamin K shot
- I do not consent to eye ointment

[Friday13th]

I'm planning a Baby Care plan rather than a birth plan. Possibly with some mention of discussing what is being done with us before it is done (barring an emergency) but my primary concern is that someone is with the baby at all times, no vax, no circ and nursing ASAP. I feel like if we're transferring it'll be because we need something the hospital offers and I don't want to watch another long nit-picky birth plan get totally flushed down the toliet due to circumstances I didn't see coming.

[Comtessa]

I had to transfer for exhaustion after 48 hours of labor at home. It was necessary, though certainly not an emergency transfer. And I cannot stress enough how important our transfer birth plan was for our birth experience.

Like all of you, I had no intention of going to the hospital for any reason save an emergency, and I certainly had no intention of getting an epidural. But in the interest of making my husband feel better about our HB, I made sure I had a foolproof backup plan, and I am so incredibly grateful that I did.

Here are the pieces that made a big, BIG difference for us in negotiating our hospital transfer:
- having a hospital bag packed and tucked away in a hall closet
- filling out the hospital registration papers ahead of time, with some lines crossed out and a few things added (I think I added a caveat like, "no treatment may be given to me or the baby without the explicit verbal consent of myself or my husband to that specific treatment")
- having my OB look over and sign our birth plan, put it on file with the hospital, and then give us back the original so that I had it to give to the hospital staff when we walked in the door. His signature made our birth plan into "doctor's orders" which spared us a whole lot of fighting.
- being really candid with my OB ahead of time about our HB plans. He gave me his cell phone number and said to call if I was transferring. He ended up coming in at dawn on his day off to attend my birth, because I was terrified of what might happen if the resident on-call physician was there. (After meeting the on-call physician, I was especially terrified!!!)
- Education, Education, Education. I learned as much as I could about the hospital's policies and procedures, so that I would recognize them when I saw them and be able to consent or not. The on-call doc actually started to put an internal monitor on the baby when we arrived! And because I'd made sure I did my research, I knew what the thing was in his hand, and was able to yell, "stop!!! don't you dare screw that thing into my baby's head! The baby is fine!!!" And sure enough, the baby WAS fine, and the monitor unnecessary. He took one look at my face and didn't argue.

Our transfer birth plan specified a lot of things that were against hospital policy, but we ended up managing to get all of them without too much trouble. There were a few small fights, but we won them. I am SO GRATEFUL that I prepared myself for the possibility that I might end up there, because that preparation meant that I ended up feeling like I was still in control of my birth experience and that I managed to do the best for myself and my little one.

Our birth plan is in the thread that a PP posted: http://www.mothering.com/discussions...60&postcount=5

ETA: Quiver, I noticed that you mentioned your MW coming as your advocate. My MW followed us to the hospital (dad drove me and DH, she followed in her own car), but when I arrived they whisked me up to L&D really fast, and they didn't let her into my room right away. So, it was good to have a birth plan because she wasn't right there with me to help when I first arrived. Then, when she did get there and things settled down, I sent her home to rest because I needed sleep and so did she. Plus I trusted my OB to respect my wishes for the birth, so I knew I'd be ok once he arrived. So... I guess I'd say, expect that your MW will come, but make sure you have a backup plan in case they don't let her in.

[sanguine_speed]

Honestly, if I'm going to the hospital, there is not going to be time for every doctor, nurse and resident to read and recall my entire birth plan in an emergency. I have a doula and supportive partner, and I think those are my best bets at communicating my wishes if I am incapacitated. I have had 3 hospital births in various scenarios, including a transfer after a planned home birth, and yah, a birth plan would not have been on anyone's radar.

[Comtessa]

I noticed a few things on Zoeanne's birth plan that could be problematic - just wanted to mention them.

Originally Posted by Zoeanne

Please obtain consent before performing any medical procedures or administering any medication to Zoe or the baby.

If you've signed their paperwork, you've already given consent. They are very likely to ignore this. You might want to be more specific, like, "please obtain verbal consent to each specific treatment." You could also hand the nurse a written statement after you arrive that says "I hereby revoke the written consent given upon admittance and I require that all hospital staff receive verbal consent from me and/or my partner for any and all non-emergency treatment given to me or my child." That would cover you a bit better.

If a Cesarean birth must be planned ahead of time, it should be scheduled to occur after labor has begun on its own.

This is an excellent idea, but doesn't belong on a written birth plan that you will bring to the hospital. If you're in the hospital for a planned C-section, this point will already be moot. L&D nurses have notoriously low attention spans for birth plans - you shouldn't have any more words on your plan than are absolutely necessary for the moment in which you arrive.

There are a couple of things that you've listed that I believe are fairly unusual practice anymore; one criticism I've heard of birth plans is that they often list "do nots" that appear silly to the staff because they never do them anymore. Or, conversely, instructions to do something that they already always do as a matter of course. The birthing woman ends up being perceived as ignorant about the "normal" procedures of birth - and this makes her easier to dismiss/ignore.

I recommend a conversation with the L&D at your chosen transfer hospital about some of these points in your birth plan:

Please do not place the urinary catheter until after regional anesthesia is in place,.

The incisions should be a “bikini cut” and a low transverse incision; I do not wish to receive a vertical uterine incision.

Please use the double-suturing method to close the uterus.

Okay, a few other things:

Please do not perform an episiotomy.

Someone recommended to me that I make this language stronger on mine: "I do not consent to an episiotomy; I would prefer to tear."

Please do not use forceps or vacuum-assisted birth.

These are occasionally actually necessary. If you have strong language in here requiring verbal consent before any procedures, you can at least have a conversation w/ the doc at the point at which they recommend this. But to put it in the birth plan makes it look like you're inflexible about needed treatment.

I do not consent to the Vitamin K shot. If some trauma has been suffered that may cause blood loss, we will consider oral Vitamin K.

Most hospitals/docs don't have access to oral Vitamin K b/c they never use it. Ours didn't have any. If the babe needs Vit K you might have to go with a shot because there's no option at your hospital. You might want to just say something like "please ask me before giving Vitamin K"

I do not consent to the heel prick for PKU testing; we would like to wait, and delay the PKU testing until our first pediatrician visit.

I'm not sure about your state, but in our state there's a significant cost associated with doing PKU testing in a pediatrician's office, though it's free in the hospital. You might want to check out how it works in your state. Most peds in our area don't even have the materials to do a PKU test. Your HB MW probably has them, though, so you could do it with her if you don't want to do it in the hospital.

Sorry for the long message!!! I just know that my birth plan had to go through a lot of drafts before it was something that everyone would take seriously... so I wanted to make sure that you were alerted to some of the same "red flags" that I had.

[lunarlady]

I had a homebirth w/DD, but I did prep a plan in case I had an emergancy transfer. I figured if I transferred for fatigue/pain reasons, then I would pretty aware and able to consent to things that I wanted and let them know what I didn't want. My plan was in case it was an emergancy c-section where I would be put under general anesthetic and therefore NOT concious or able to make medical decisions. My plan was to help my husband/family as they made decisions that would affect us. You'll note that these are all POST birth issues. I figure if it is a medical emergancy, they can do what they need to do to get baby and me safely through it. I was more worried about care of baby and myself during post-op time.

Here are the key points:
-- DH was to stay with baby at all times after the birth. If child needed transfer to NICU, DH would go with child and leave me alone.
-- I did not want child to receive eye drops/vit K/HepB as a matter of course. DH was to consent to these only if there was a pressing need for treatment.
-- As I would be exclusively breastfeeding, I would prefer my child to receive an IV rather than a bottle if I was unable to immediatly feed due to post surgical recovery times. (This was based on the fact that babies sent to NICU are usually given an IV port, and that a baby that didn't need to go to NICU could wait a couple hours until I able to feed.)
-- If bottle feeding becomes necessary due to maternal inablity to feed due to drugs/surgical complications, DH should be the one to administer food to baby. (We had a breastfeeding friendly bottle in the transfer bag.)
-- If baby is premature, has a latching issue, or a medical issue that prevents natural feeding, I would like a breastpump provided so that I can pump colostrum and milk for the feeding of my child. Once pumping starts, I would prefer to be woken and asked to pump rather than have my child receive formula.

I felt calmer knowing that I had prepared for my worst case senerio. I didn't do much to prepare for the things in between...although my Bradley class did go over so much information that I was well informed about hospital procedures/policies so I wasn't going in blind.