input needed on my birth plan

[Vaquitita]

this will be my first hospital birth, so i'm working on a birth plan. i'd love to hear some input on what i have so far. I'm trying to figure out how to make it sound more friendly and not confrontational, iykwim?

BIRTH PLAN
(I'm not sure which of these two opening paragraphs I prefer. One thing I'd like to include, but haven't figured out how yet, is to indicate I've already had two healthy homebirths so I do know what I'm doing)
I have no risk factors to indicate any likely problems, and expect to have another natural childbirth. We do not view the average labor and delivery as a medical event, and intend to decline any intervention unless it becomes medically necessary for the health and safety of baby or mother. Please discuss with me or my husband all procedures for myself and my baby so that we may make an informed decision.

OR

I am planning an intervention-free and natural birth. As labor can be unpredictable, we understand that we may need to deviate from this plan at times. Please discuss with me or my husband all procedures for myself and my baby so that we may make an informed decision.


LABOR
•In general, please leave me to labor alone as much as possible
•Please be respectful of my privacy by knocking and not turning on lights or making unnecessary noise
•No routine vaginal exams
•No artificial rupture of membranes
•External intermittent monitoring only, via EFM or Doppler
•No I.V. without cause
•Please don’t offer pain medication, I will ask if I want any
•No students or unnecessary people in the room


BIRTH
•I prefer to push instinctively, please do not tell me how or when.
•I will choose the birthing position that feels most natural for me, please do not interfere.
•I do not consent to an episiotomy.


POST PARTUM
•Immediate skin to skin contact with baby.
•Please delay cord cutting for 5 minutes.
•NO active management of the 3rd stage of labor, unless medically necessary.
•Please delay all non-emergency procedures until we have had time to bond.


BABY
•Please delay all non-emergency procedures until we have had time to bond.
•APGARS to be performed while baby is held by me.
•I do not consent to the administration of eye ointment.
•I do not consent to the administration of vitamin K, unless there is visible birth trauma.
•I do not consent to the administration of the HepB vaccine.
•If my baby is a boy, I do not consent to circumcision.
•Please do not bathe the baby, we prefer to do it ourselves.
•Baby is not to leave my side. In case of medical necessity, baby is to be accompanied by my husband at all times.
•NO bottles or pacifiers.

eta: This does fit on one page, but I'm thinking shorter would be better. Any suggestions on which things to leave out?

[Beccadoula]

OK - I'm a doula and I strongly encourage all my clients to keep their birth plan/preferences short and easy to read - The bullet points are a great way to do this, but I would take out any and all non-essentials. ANYTHING that you are not just set in stone about should be cut out - because it can look to a nurse like you just don't trust her and that is insulting. For instance, when you arive and first meet your nurse you can just tell her that privacy is really important to you and could she keep any unnecessary people out? I've been to a lot of hospital births and never seen a nurse not knock, I'm sure it does happen, but you probably don't need it in your b-plan. You have good things in your plan, but you might want to make it a little more reader friendly. Have a wonderful birth!!!

[Beccadoula]

oh - also, I like your second intro better...

[MegBoz]

Re your first paragraph - I'd clarify "natural childbirth." to "pain-med free natural childbirth." Since some think 'natural' just means vaginal.

But I definitely think it's worth including!! So many people seem to think that those of us planning NCB are naively optimistic at best, stupid & clueless at worse - so the fact that you've BTDT should be noted.

"intend to decline any intervention"

I'd take this out - the fact that you say "decline" implies you expect it to be offered. Instead, I'd just rephrase to, "Intend to birth without any interventions, unless...." which assumes that, of course they won't even offer any interventions unless necessary. So there's no need for "declining."

"•No routine vaginal exams"

If you are going to go this route of listing out specific details like this, then I'd get more detailed here. I personally wrote this, followed by, "I consent to an exam upon admission to confirm I'm in labor, & when I feel the urge to push to confirm I'm complete, but otherwise I'd rather not know how far dilated I am."
(I really DIDN'T want to know anyway! Didn't want to be tempted to do "labor math" & get stressed worrying how far along I am & how much longer I had to go.

"•No I.V. without cause"

Sometimes I see "IV" referred to as just the port itself (i.e. "hep-lock" or "saline lock") whereas other times it seems to refer to actually having an IV infusion. Again, if you're going to bullet list specific details, you might want to clarify here, "No IV fluid infusion or hep-lock IV placement without cause"

As far as fitting on one page, if you put it into 4 blocks, it should fit! Mine was even longer than that! I had sections for labor, birth, postpartum/baby care, plus a block on c-section & my doula made it fit- it was an awesome layout.

As far as making it "friendlier" you could put some cheesy wording at the top about how you've been working to optimize your health through good nutrition & exercise & are looking forward to the birth experience with the trusted staff at XYZ hosptial. My doula added that wording too - not that it was the least bit sincere on my part & I don't know if anyone would have seen right through it, or actually viewed it as sincere. But I guess it can't hurt. Others recommend bringing snacks of some kind for the nurses.

"• In general, please leave me to labor alone as much as possible"

I suppose you could rephrase this to make it friendlier by saying, "My husband has served as wonderful labor support throughout our previous 2 births, so we would appreciate as much privacy as possible for this intimate experience."
That confirms that you won't be alone in the room and that it's nothing personal against the nurses, but just a function of the fact that you want to bond with your DH during this time.

BUT - I honestly wonder how much of a difference all these wording changes make. I suspect they make very little difference. I suspect any nurses who "GET IT" & understand us NCB folks glance at a birth plan like this & see an educated woman & respect her along with her choices**. Whereas others who are anti-NCB see us as a non compliant patient & a pain in the neck. & tweaking the individual phrasing probably doesn't have much impact.

**I had a nurse EXACTLY like this - she came on duty the day after my DS was born, walked into my room & says, "I just want to compliment you. You seem really well read." Wow! I replied, "THANKS! But, uh, how did you know?" We had just met, so I hadn't yet had the opportunity to dazzle her with my vast knowledge, so I was confused. But she said, "based on your birth plan." Not only did she compliment me on it, but she took the time to read it AFTER DS was already born. Awesome!

[Vaquitita]

Ok, how about this one; I've sort of combined my opening paragraph options and added a bit of cheesy wording for the nurses and threw in that this is my 3rd birth. I've cut down the number of bullets, and took some extra wording off a couple too.

BIRTH PLAN
My husband and I are looking forward to our third intervention-free and natural birth. Throughout pregnancy I have worked to optimize my health through good nutrition and exercise. We do not view the average labor and delivery as a medical event, but we do realize that labor can be unpredictable. We understand that we may need to deviate from this plan at times. Please discuss with me or my husband all procedures for myself and my baby so that we may make an informed decision. We are looking forward to a positive birth experience with the trusted staff at XYZ Hospital.


LABOR
•My husband has served as wonderful labor support throughout our previous 2 births, so we would appreciate as much privacy as possible for this intimate experience.
•No routine vaginal exams.
(I would love to have NO exams at all, but probably will have to get the admission one. After I talk with my dr next week about this, I may add that.)
•No artificial rupture of membranes.
•External intermittent monitoring only, via EFM or Doppler.
•No I.V. fluid infusion or hep-lock I.V. placement without cause.
•Please don’t offer pain medication, I will ask if I want any.


BIRTH
•I prefer to push instinctively.
•I will choose the birthing position that feels most natural for me.
•I do not consent to an episiotomy.


POST PARTUM
•Immediate skin to skin contact with baby.
•Please delay cord cutting for 5 minutes.
•No active management of the 3rd stage of labor, unless medically necessary.


BABY
•Please delay all non-emergency procedures until we have had time to bond.
•I do not consent to the administration of eye ointment.
•I do not consent to the administration of vitamin K, unless there is visible birth trauma.
•I do not consent to the administration of the HepB vaccine.
•If my baby is a boy, I do not consent to circumcision.
•Please do not bathe the baby; we prefer to do it ourselves.
•Baby is not to leave my side. In case of medical necessity, baby is to be accompanied by my husband at all times.
•No bottles or pacifiers.


I'm considering leaving off the no AROM. They would ask before doing that right? And would that even be something the nurses would do? Is that only something a doctor would do? I don't plan to go to the hospital till well along in labor anyway, so they shouldn't feel any need to speed me up. Also, I'm thinking of leaving off the part about baby not leaving my side, etc. Rooming in is standard at this hospital. Is it safe to assume that IF they needed to take the baby to the NICU, the father would automatically be allowed to go?

[rparker]

In my experience there's a huge difference between intermittent monitoring with doppler and with EFM. I had both with my first birth and the EFM was way more uncomfortable and seemed to take longer.

I figured I'd mention this since you said your first two births were home births so I'm guessing no EFM. Before I had EFM I had no idea I'd dislike it so much. If it were my birth plan I'd put just doppler since the EFM was more uncomfortable than the VEs.

[yara1]

Originally Posted by Vaquitita

Please delay cord cutting for 5 minutes

I would say them to cut it in 20 minutes. (According to what is known about delayed cord clamping...). Might as well

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PKU test ..?

[Vaquitita]

Originally Posted by rparker

In my experience there's a huge difference between intermittent monitoring with doppler and with EFM. I had both with my first birth and the EFM was way more uncomfortable and seemed to take longer.

I figured I'd mention this since you said your first two births were home births so I'm guessing no EFM. Before I had EFM I had no idea I'd dislike it so much. If it were my birth plan I'd put just doppler since the EFM was more uncomfortable than the VEs.

good to know. i'll do that.

Originally Posted by yara1

I would say them to cut it in 20 minutes. (According to what is known about delayed cord clamping...). Might as well

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

PKU test ..?

I haven't decided what I want to do about the PKU test. When do they usually do it in hospitals? with my homebirths the mw did it a few days later, or maybe a week later. i can't remember for sure. i'm fine with having it done, and while i might rather wait to have it done, if it was done before we left the hospital that would be easier than me having to go into the pediatricians office.

[MegBoz]

Originally Posted by Vaquitita

I'm considering leaving off the no AROM. They would ask before doing that right? And would that even be something the nurses would do? Is that only something a doctor would do? I don't plan to go to the hospital till well along in labor anyway, so they shouldn't feel any need to speed me up. Also, I'm thinking of leaving off the part about baby not leaving my side, etc. Rooming in is standard at this hospital. Is it safe to assume that IF they needed to take the baby to the NICU, the father would automatically be allowed to go?

Good Q. Yeah, I think only MWs or Docs do AROM - not nurses, although I'm not 100% sure. Yeah, that should be something they would warn you about, but it absolutely has happened that they don't. Maybe it's something to discuss with the OBs - if AROM is something they do rarely and they are well, not UAVs who truly, sincerely believe in informed consent, then I'd leave it off. But if you have doubts, I'd keep it in.

My hospital was NCB-friendly & rooming-in was standard, but at midnight, about 5 hours after DS was born, one nurse came for a weight check & wheeled the bassinet out of the room to do it. That was the one & only time DS left my room, but they did do it. I had been sleeping & since it was just a weight check, I didn't argue, but it did happen. So I'd keep that in.

[yara1]

Originally Posted by Vaquitita

I haven't decided what I want to do about the PKU test.When do they usually do it in hospitals?

rather second day.
I homebirthed, but prior to that was discussing possible hospital birth option with midwife.
In New York we can not refuse PKU. I told midwife that its extremely important for me that a newborn will not be touched with needles, e.t.c.
She told that I technically can skip PKU by doing very early discharge...Like after first day, or so...

[Vaquitita]

i had my appt with my new dr, and have a couple new Q's.

if your hcp does not routinely do episiotomies, would you bother to put it on the birth plan?

she told me they routinely do a shot of pitocin after the baby's born to help with the placenta. though when i asked her if that was the office policy or the hospital policy, she didn't know. she was fine with doing it only if i needed it. what i'm wondering is, is saying "no active management of the 3rd stage of labor" specific enough? or should i say something more along the lines of no routine pitocin administration, only if medically necessary?

i forgot to ask about the vaginal exams. but i figure i will have to have one when i arrive, in order to be admitted. should i add that i consent to that one? any suggestions on the wording for that?

[Honey693]

You might want to rethink the knocking thing. I know if someone had made any extra noise, like knocking I would have flipped out on them. I zoned out and needed absolute quiet.

[EMAID]

I've never done a hospital birth, so I don't know how helpful this is.

What about wording the 3rd stage issue in a positive manner? Like, "We will encourage the birth of the placenta by allowing the baby to begin breastfeeding immediately after birth. Please allow x amount of time before suggesting further intervention." ???

I had the pitocin shot for it in my first birth (birth center) because I was bleeding a lot and they were afraid to let the baby nurse until later.

[mrsberman]

I wasn't aware they were going to AROM on me. The doctor came into examine me (at the time I didn't realize this was unneccesary). Then the nurse handed him the hook and I asked what he was doing. He said he was going to break my water, gave me a second to respond and then did it. I guess I was too much in shock to realize what I consented to. In hindsight it was a dumb move.

If you're not going to have VEs during labor then you probably won't have to worry about AROM. If you do have a VE before your water breaks you can bring it up then.

[MegBoz]

Originally Posted by Vaquitita

if your hcp does not routinely do episiotomies, would you bother to put it on the birth plan?

I did, but only because it was something I was crazy paranoid about. I've just read way too many horror stories about epis done without even telling the mama, let alone obtaining consent, & that makes me
However, few OBs truly do epis "routinely" anymore ("routine" meaning with every.single.solitary vag birth.) However, they still may think it's best to do one if you are "about to tear" or "about to tear upward" - you want to be certain they do them ONLY in the case of fetal distress. If you are certain about that, then I'd say it's safe to omit. (My birth plan said, "I do not consent to epis. I'd rather tear. If it is necessary due to fetal distress, I prefer a pressure epis.")

Originally Posted by Vaquitita

what i'm wondering is, is saying "no active management of the 3rd stage of labor" specific enough? or should i say something more along the lines of no routine pitocin administration, only if medically necessary?

Well, I had:
-no cord traction
-wait to clamp the cord until it's stopped pulsing
& i cant' remember if I had "no pit unless medically indicated."

Again, if you're comfortable with the fact that they don't yank on the cord, or worse yet reach up to manually extract the placenta - then you could be less specific.

Originally Posted by Vaquitita

i forgot to ask about the vaginal exams. but i figure i will have to have one when i arrive, in order to be admitted. should i add that i consent to that one? any suggestions on the wording for that?

Mine said something like, "No regular vaginal exams. I consent to one upon admission to ensure I'm in labor & one when I feel the urge to push to ensure I'm complete, but otherwise I'd rather not know how far dilated I am."

I think it's often the nurses who do the VEs & since I figured I wouldn't have had the chance to meet any of them before being in labor, the birth plan would be advantageous in communicating with them. So I'd get specific like that. (It was pretty important to me to not know! I was afraid I'd do "labor math" in my head and think, "OH NO! I'm only 7 - & it took me 12 hours to get here! I may have like 4-5 more hours to go! Noo!" (Silly, it doesn't work that way, but I just didn't want to risk those doubts creeping into my mind.)

[Vaquitita]

thanks for all the help!

[phathui5]

I'm considering leaving off the no AROM. They would ask before doing that right?

It depends on the mood of the person doing it. I've seen where they've asked and I've seen where they've gone "We're breaking your water now."

[Vaquitita]

After showing my dh what I'd come up with, he had a few suggestions. A couple more items were struck off the list (like circumcision, we can deal with that when it comes up). He also felt the first paragraph was too 'preachy'. While I do think simpler is better, the first paragraph doesn't seem to flow well. This is what he suggests:

BIRTH PLAN
This is my third pregnancy. My first two births were midwife attended homebirths. As labor can be unpredictable, we understand that we may need to deviate from this plan at times. Please discuss with my husband or me all procedures for myself and my baby so that we may make an informed decision. We are looking forward to a positive birth experience with the trusted staff at XYZ.


LABOR
•My husband has served as wonderful labor support throughout our previous two births, so we would appreciate as much privacy as possible for this intimate experience.
•No routine vaginal exams. I consent to one upon admission if needed to ensure I am in labor.
•External intermittent monitoring only, via Doppler.
•No I.V. fluid infusion or hep-lock I.V. placement without cause.
•Please don’t offer pain medication, I will ask if I want any.


BIRTH/POSTPARTUM
•I will choose the birthing position that feels most natural for me.
•I prefer to push instinctively.
•I do not consent to an episiotomy.
•Immediate skin to skin contact with baby.
•Please delay cord cutting for 15 minutes.
•No active management of the 3rd stage of labor (pitocin/cord traction).


BABY
•Please delay all non-emergency procedures until we have had time to bond.
•I do not consent to the administration of eye ointment.
•I do not consent to the administration of vitamin K, unless there is visible birth trauma.
•I do not consent to the administration of the HepB vaccine.
•Please do not bathe the baby; we prefer to do it ourselves.
•Baby is not to leave my side. In case of medical necessity, baby is to be accompanied by my husband at all times.

[MegBoz]

looks great!