Transfer Birth Plans

[ErinMSB]

Just wondering if anyone is preparing a birth plan in the case they transfer to a hospital? A friend recently suggested I make one in case of transfer with a vaginal birth and another in case of transfer with a c-section. So any suggestions on what to include? Thanks!

[Momtotwo2004]

I wasn't going to make one but then I realized, in the unlikely situation that the scenario is one in which I'm unable to speak for myself, I want them to know what's important to me. So I made one quickly. I'll add it here.
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In the case of transfer to the hospital during my homebirth, these are my requests. I understand that in the case of an extreme emergency, some of the following may be null and void.

-I would like to avoid an IV hep-lock unless necessary.
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-It is important that I move freely and give birth in the position of my choice if I am physically able.
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-I would like intermittent fetal monitoring rather than constant monitoring.
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-I prefer to refrain from medication during labor, including induction medication or pain relief medication unless I have had the opportunity to discuss it with medical staff or ask for it myself.
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-I prefer to push at my own discretion and at my own speed/timing.
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-Please refrain from pulling or turning on the baby’s head unless there is an immediate need for him or her to be removed.
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-Please allow the placenta to be birthed on it’s own time without any pulling or tugging on the cord and allow the cord to stop pulsing before clamping.
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-I will keep my baby with me and on my body immediately after s/he is born and postpone any testing or measuring until I give you notice.
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-If I am unable to be with the baby immediately following birth, the baby is, at all times, to remain with his or her father unless separation is absolutely medically necessary.
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-The baby is not to be given any fake nipples. The baby is not to be given a pacifier. The baby is not to be fed with a bottle. If the baby is unable to nurse from me, s/he is to be fed with a dropper, with a spoon, or finger fed.
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-The baby is not to receive formula unless I am absolutely unable to provide breastmilk, either through breastfeeding or pumping. If it is expected that I will be unable to provide the baby with breastmilk within a few hours, the baby can be fed sugar water through one of the above mentioned methods.
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-If the baby is male, we will not be circumcising.

[foodmachine]

I searched for this recently in this forum and found a few threads on it. GL.

[goldenwillow]

I was sure to make one and wanted the folks who may help me at the hospital (if need be) what choices we had made. I have a long history of sexual assault as a child, so it was important to me to have some plan in place, at least for my own head. Here is my birth plan, didn't have to use thank goodness!!


We thank you for assisting our child’s birth. We are here due to an unsuccessful homebirth. We appreciate you and all the help you bring to ensure a healthy, positive birth experience.

It is of utmost importance that there are minimal staff interventions and we ask that staff members introduce themselves, if able. Family is not allowed in the birth room.

Birth Team:
Chad – Father
Michelle Antonich, Midwife
Marion – Michelle’s assistant

We prefer a natural childbirth, please do not offer medications, we will inform you if desired.

Please delay all newborn procedures until bonding and breastfeeding have occurred.
Please perform all newborn procedures in my or Chad’s presence.

Please no vaccinations or erythromycin eye ointment.

Oral vitamin K is preferred and we have with us.

Please do not cut the umbilical cord until it is done pulsing.

Episiotomy – Only if completely necessary for baby’s health.
Pressure episiotomy is preferred.
Any episiotomy or tears are to be stitched up after the baby’s cord has finished pulsing and has been cut.

If Baby is a boy, please no circumcision.

If induction is necessary- we prefer natural techniques first:
Breast Stimulation
Walking
Acupuncture

If my water breaks before I go into labor:
We would like to have as much time as possible for spontaneous labor.
I would like freedom to walk and use positions I find best.

Please do not offer our baby:
Formula
Pacifiers
Artificial nipples
Sugar water

I want to breastfeed or express milk for my baby if unable to breastfeed. I want as much bodily contact (Chad or I) with baby as possible for bonding.

Hope this helped!!

[womenswisdom]

I did write a transport plan, but it did not look like the ones here. I thought through the reasons I might transport and limited my transport plan to things that would be applicable in those cases. For example, some reasons for transport might be pain relief (which would require constant monitoring, an IV, etc.), maternal exhaustion (same), FHT issues (requiring constant monitoring), or problem after the birth like PPH (so pitocin or other measures would be needed) or breathing issues in the baby (requiring extra monitoring or intervention for baby). I could not forsee a circumstance where I would transport and not need constant monitoring, a saline lock and some of the other "normal" interventions, because if I transported, it would be because there was a true medical need. Those interventions are not appropriate on a routine basis, but they are if there is a need for them. OTOH, I had a very supportive backup OB and so did not feel the need to cover every minute detail (I have seen him in action on more than a few occasions as a doula and knew he would be supportive and discuss anything in advance). If I didn't end up transporting to him, it would be because there was an emergent situation and I would likely need all the interventions they could offer.

I would put:
That I expect to discuss all procedures before they are done.
I plan to labor unmedicated but will request medication if needed.
I prefer to tear.
Let the cord stop pulsating before cutting unless resusitation is needed (actually, in my case, I would want them to leave the placenta attached for 12 hours).
Immediate skin-to-skin contact and delay newborn procedures for 1 hour as long of health of baby permits.
No routine Pitocin after birth unless Pitocin was needed during labor.
Any newborn procedures I plan to decline (hep b, vit k, eye oint, circ).
I will breastfeed, do not offer anything else by mouth, including pacifiers.
Special requests for a c-section, like seeing the baby born.

I would also put some statement about how I am flexible if medical needs warrant it and that I appreciate their help and their sensitivity to this change of plans in birth location.

[cileag]

Here's what I had:

Our Birth List

People who might show up:

Husband
My mother
Sister-in-law
Certified Professional Midwife, Licensed Midwife
Apprentice Midwife

We'd like to see the CNMs if we don't risk out. Otherwise, no residents please.
Dr. Funny for a pediatrician.
If possible, I'd like to avoid rooms 353 and 354. (We use these rooms frequently for our fetal deaths and as an L and D nurse I wanted to avoid them if able).

I'm A+, Hep -, Non-reactive/non-reactive, rubella immune.

GBS negative.

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

Yes please, we would like the Vitamin K shot.

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

No thanks, we decline the erythromycin eye ointment.

No thanks, we do not plan on circumcision.

No thanks, I'll skip the TDAP.

Yes please, give me the flu shot.

I figured everything else would be open for negotiation if I was transferring it would be for an emergency, exhaustion, or pain management.

[*MamaJen*]

Here's a recent thread that had some good ones:
http://www.mothering.com/discussions...ht=contingency

[spanishcrunchymama]

here is our plan:

Hospital Transfer Birth Plan

We are thrilled to be welcoming our first biological child into the world and planned a home birth. Should we be transferred to the hospital, it means that something has gone wrong with our planned home birth. Please understand that we may be very upset and discouraged. Please respect that this scenario is in no way “Plan A”.

We chose to have a home birth for many reasons. One important reason is that we do not wish to have medical interventions and/or procedures as part of our birthing experience. To that end, we would like you to consider the following:

Environment
We would like a private birthing room.
Peace and quite while laboring, our own music if possible.
Be able to wear my own clothes rather than a hospital gown.
Be able to take pictures during our L&D.
Induction/Augmentation:
I would like to avoid induction unless it is medically necessary to preserve my life or the baby's.
Induction of any kind including AROM should not be done without my consent (or my husband's).
Procedures and Labor:
I would like to choose my positions (body stance) for pushing and giving birth.
I request my husband (******), doula (*****) and midwife (*****) with me at all times.
If for whatever reason I am unable to voice my desire/requests my husband will be my advocate.
My hydration will be maintained by drinking water and juice until no longer tolerated, then ice chips before the intravenous hydration method will be considered.
Monitoring are to be external and intermittent ONLY when medically necessary.
Please do not offer me pain medications we will ask if they are needed.
Episiotomy
I would prefer to avoid the episiotomy even in the event that I might tear.
If possible, I would like to use perineal massages during pushing to help with stretching.
Local anesthesia is preferred if repair of the perineum were to be necessary.
Assisted Birth:
Should extraction become absolutely medically necessary I would prefer a hand delivery and manipulation first, followed by vacuum extraction and/or forceps as a last resort.
Complications & Cesareans:
If my primary caregiver recommends a cesarean birth I would like a second opinion if time warrants.
In the event of a Cesarean Delivery
Please allow my husband to be present.
Prefer a spinal block with no pre operative sedation.
Leave my hands free to touch the baby.
When suturing the cesarean incision please use multiple layer stitches, as in the future we would like to attempt a VBAC.
My husband will cut the cord once it has stop pulsating.
I would like to hold our baby while I deliver the placenta vaginally without the assistance of pitocin unless absolutely medically necessary.
Baby Care
I plan to keep our baby on my chest following birth and would appreciate if the evaluation of the baby can be done with the baby on me, with both of us covered by a warm blanket, unless there is an unusual situation.
If the baby were to be in need of further care, please allow my husband to accompany our baby for all checkups and evaluations immediately following delivery.
No baths are to be given to the baby during our stay.
Please consult us first should any procedures or vaccinations be necessary for the baby.
I would like to breast feed immediately, no pacifiers, formula or sugar water.
I would like the baby to room in with his mother (me) for the duration of the hospital stay; not in nursery unless a NICU stay were to be absolutely medically necessary.

Thank you in advance for helping us have the birth experience we desire.

[AustinMom]

I would make sure, more than just having one written that you and hubby have fully discussed it. Especially if you have a CS and they only allow one support person in room. If we transfer, I'm taking my MW and Doula with us, and they will help with all the advocacy duing labor/birth outside of the OR, but in the OR, I have made it very clear to hubby that baby is to be taken from tummy to my chest, not taken aside for all the newborn screening, and routines, those can all either be delayed or are better done while baby is with me.

I fine this much more important, as most hospitals look down on birth plans, and most will be noncooperative with a CS birth plan, so we are just going to do it, and not ask really. It's our baby, we get to choose how she is treated from the moment of birth and before

[Sustainer]

Here's mine

www.devrock.5u.com/whats_new.html

[MsBlack]

Originally Posted by womenswisdom

I did write a transport plan, but it did not look like the ones here. I thought through the reasons I might transport and limited my transport plan to things that would be applicable in those cases. For example, some reasons for transport might be pain relief (which would require constant monitoring, an IV, etc.), maternal exhaustion (same), FHT issues (requiring constant monitoring), or problem after the birth like PPH (so pitocin or other measures would be needed) or breathing issues in the baby (requiring extra monitoring or intervention for baby). I could not forsee a circumstance where I would transport and not need constant monitoring, a saline lock and some of the other "normal" interventions, because if I transported, it would be because there was a true medical need. Those interventions are not appropriate on a routine basis, but they are if there is a need for them. OTOH, I had a very supportive backup OB and so did not feel the need to cover every minute detail (I have seen him in action on more than a few occasions as a doula and knew he would be supportive and discuss anything in advance). If I didn't end up transporting to him, it would be because there was an emergent situation and I would likely need all the interventions they could offer.
[list]

I would also put some statement about how I am flexible if medical needs warrant it and that I appreciate their help and their sensitivity to this change of plans in birth location.

I agree with the basic point made here. If you are transferring care, this will either be for something non-emergent like pain relief--in which case you will not get all of your preferences--or for a more emergent/concerning situation where you also will not necessarily get all of your preferences either (nor will you necessarily want all of your 'usual' prefs). So your Alternative Birth Plan, as I call it, is not really like creating a regular birth plan as if you'd intended a hospital birth all along.

Here is something I wrote for my clients who transfer care. It is offered as a suggestion--no one is required to use it (and I wrote it following a couple of closely spaced transports last year, with none occurring since then--so none of my clients have used it as yet).

First though, there are 2 primary things to consider about transfer to hospital care: 1. of course, you want to make your preferences known, if possible--and you want informed consent--but you also want medical care so you are best prepared to deal with med care as gracefully as possible for your own/baby's sake--rather than planning to 'go in fighting'. And 2. there is some benefit in allowing certain 'small things' to be done by the staff that you were not planning--such as the Vit K shot. Hate to have to say it, but there is some benefit to you and your baby in looking 'sane and responsible' by THEIR definition! Helps you to be treated, on the whole, with greater ease and respect from med staff.

So anyway, this doc is to be attached to the General Admissions Informed Consent, then shown to various key players in the hospital.

If you like it, feel free to use/alter it as you please.

Informed Consent Addendum

I/we, ________________________________________, choose to seek birth, neonatal and/or postpartum services at this hospital, _____________________, with the intention of making all testing and treatment decisions independently, in light of our legal right to informed consent. Informed Consent under the law mandates patients’ right to make all decisions concerning medical treatment for self or dependents; it mandates the patient’s right to receive, and medical providers’ obligation to provide, prior to execution where patient condition allows, explanations of tests/treatments in language patients plainly understand, explanations of the risks and benefits of tests/treatments, and explanation of other forms of care including their risks and benefits, and also including the option of doing nothing for the time being.

I/we have chosen to seek services here because we believe that it may be safest for mother/baby to receive some forms of medical evaluation and treatment. I/we intend to work together with hospital staff toward the healthiest possible outcomes for mother/baby; I/we expect to be treated respectfully within our legal and ethical rights by all doctors and support staff. Specifically:
1.I/we will communicate with respect and courtesy toward all personnel.
2.I/we will make all decisions independently, and intend to include my/our support person/s in all discussions to facilitate understanding and due consideration of proposed care.
3.I/we will take as much time as needed to make decisions, in privacy.
4.I/we will insist upon communicating only with doctors/staff with whom clear, calm, evidence-based and mutually respectful exchange is possible.
5.I/we will communicate with the same or different personnel about tests/treatments already refused, only if new signs in mother/baby condition merit my/our renewed consideration.
6.I/we will consent to some forms of clearly warranted and evidence-based evaluation/treatment.
7.I/we will be utilizing some forms of safe, evidence-based prevention and healing modes that may not have recognized merit within medical care.
8.I/we know that some conditions of labor/birth/postpartum are life-threatening emergencies that allow little or no time to consider treatment options, and I/we will give consent accordingly.
9.I/we will utilize my/our legal right to insist that any attempt at coercing consent via legal threats is handled strictly between our respective legal representatives.
10.I/we assume sole legal and moral responsibility for all decisions I/we freely make concerning mother/baby care, where medical evaluations and treatments are conducted with due evidence-basis, and performed competently within accepted medical standards.
Informed Consent Addendum
Signature Page

Parents:
Full Name:_____________________________________________ ______________________
Signature/date: __________________________________________________ _____________
Full Name: __________________________________________________ _________________
Signature/date:_____________________________________________ ____________________
Admissions Agent: I hereby acknowledge receiving the document “Informed Consent Addendum” as presented by the parents named above, and attaching said document to the family’s file/s.
Full Name:_____________________________________________ _________________________
Signature/date:_____________________________________________ ______________________
Attending Physician, OB/Maternity: I hereby acknowledge receiving and reading a copy of the document “Informed Consent Addendum” presented by the parents named above.
Full Name:_____________________________________________ ________________________
Signature/date:_____________________________________________ _____________________
Attending Physician, Pediatrics/Neonatology: I hereby acknowledge receiving and reading a copy of the document “Informed Consent Addendum” presented by the parents named above.
Full Name:_____________________________________________ ________________________
Signature/date:_____________________________________________ _____________________
NICU Shift Supervisor: I hereby acknowledge receiving and reading the document “Informed Consent Addendum” as presented by the parents named above.
Full Name:_____________________________________________ ________________________
Signature/date:_____________________________________________ _____________________
Assigned L&D Nurse: I hereby acknowledge receiving and reading a copy of the document “Informed Consent Addendum” as presented by the parents named above.
Full Name:_____________________________________________ _________________________
Signature/date:_____________________________________________ ______________________
All other staff: please initial this document somewhere, to show that you read and understood it.

[MsBlack]

I need to add:

1. my clients also read an essay I wrote about these alternative birth plans in case of transport, which does include a list of tests/treatments they are likely to encounter and that they may want to refuse or negotiate (vit K, where to do newborn exam, formula/paci's, antibiotics, etc). So I do encourage families to be aware and ready.

2. I tell them that the most important thing is *what they want from me* upon transfer of care. The choices about most, if not all, particulars of care can be handled 'in the moment' with clear, assertive communication to staff--I don't believe that a written birth plan is needed (nor even the Informed Consent doc I wrote). But something that can help the most in a transfer is having a clear idea of what kind of help you want from your mw during med care. Some families only want me to smile encouragingly, hold their hand, be a quiet doula while they handle all comm and choices themselves--and some want the benefits of all of my knowledge and comm skills in helping them get what they want, in understanding all that is proposed by staff, what are reasonable compromises under the particular circumstances of your transport situation, etc--and some want something in between.

Transfer of care involves a certain amount of stress--whether a lot or just a little, it is uncomfortable to transfer care most of the time. Having an idea about what you are going to want from your mw upon transfer is pretty important then, in reducing that stress and helping you keep your poise and control, and having the most positive possible birth experience.

So all of this needs to be considered by the family, and discussed with your mw prior to birth--whether or not you create a written plan. She needs to know what you hope for, from her, by way of 'the right kind of support' in YOUR view.

[goldenwillow]

My MW said it was important to have it as short, sweet and kind as possible. Staff at any hospital have "their way of doing things", naturally (like any work place). It is important to let them know you are grateful so that you don't have that hovering stigma of a "failed homebirth" (URGH!! Don't like that term!).

Our initial plan had statements like:

NO Vaccinations, NO Vit K, NO.... etc. We thought we were protecting ourselves but it ultimately sounded negative without even trying. We used "softer" words in the end but still writing what was important to us. Your MW should be there with you if you transfer, she will be a guide as well!

[St. Margaret]

I'm planning on printing up a variation of our birth plan from last time (which the fab OB already knew by heart, dear thing, and the nurses were really happy about! Crazy good OB and he picks the best nurses to work with). Just to make it perfectly clear-- no eye goop, no vax, avoid cutting, no circ, etc. It's a baby-friendly hospital so at least we wouldn't have to worry about fake nipples/formula. The plan last time was phrased very clearly and in positive language, and was a page, so this time I would imagine it will be even shorter-- short and sweet == clear!