birth plan help

[Happy912]

So far I have just vaguely discussed that I want an all natural birth with my midwife, without intervention "unless there is an emergency" situation (the birth will be in a hospital).

My cousin was telling me that she really got burned last time she only had a convo and didn't have a written out birth plan that specifically detailed how she wished situations to be navigated.

Despite the advice in my books, since I've never had a child before, I am really struggling to know what to include- Does anyone have their birth plan typed up? Would anyone be willing to send/share theirs with me so that I could use it to help write mine up??

If so, I'd be so grateful!

[Dichotomy]

Just poking my head in to say that Im looking forward to reading the responses to this as well.

Although I wont have a birth plan appointment with my midwives until 35 weeks (so 6-ish weeks from now), I want to make sure I have ample time to research the topics so I can make a well educated decision/preference.

Some possible topics to touch on: pain management during labor, who you'd like to be present during labor/delivery, your stance on circumcision/vaccination, your expectations after baby is born, etc.

Will you have an appointment with your midwife where you can go over the birth plan? Having that face to face chat could help with what you end up writing as well.

[quantumleap]

This was ours from last time:

We’re really excited to meet our son or daughter, and our primary goal is a safe and healthy mother and babe.
We understand that sometimes birth doesn’t go as planned, and respect the knowledge and advice of hospital staff. The following are our wishes, but we are willing to be flexible and make changes as the situation requires. We do ask that we be fully informed and given the chance to make decisions. Should K be unable to give informed consent, J is authorized to do so on her behalf.
Other people who may be with us:
-R and/or A, friends and support persons. Both are well informed as to our wishes and are no strangers to labour, birth and postpartum

K would like to be as active and mobile as physically possible throughout labour and birth
-We consent to intermittent fetal monitoring, with a fetoscope or pinard whenever possible *(I was trying to be nice about the fact that I did not want constant fetal monitoring)
-We would like to limit internal exams
-We do not consent to AROM
Pain management
-K is commited to a medication-free labour and birth. Please do not offer pain meds or epidural. If Kate asks for pain relief, please tell her that you will be glad to discuss options in 15-20 minutes.
Second Stage
-K would like to push in whatever position works best for her body. She would especially like to avoid coached pushing in the lithotomy position.
-Please avoid routine suctioning of baby’s airways
-Babe to go immediately to K’s abdomen/chest
-Please do not clamp cord until it has completely stopped pulsing
-Please allow J and/or K to discover and announce the sex
-J may not want to cut the cord, but please offer him the opportunity
-We decline active management of the third stage. Please do not administer oxytocin/pitocin/etc. Please do not apply cord traction.
-We would like to keep the placenta
-If episiotomy is required, a lateral incision is requested
Baby
-We decline HIB vaccination, administration of eye prophylaxis and vitamin K injection
-J will stay with baby at all times should additional treatment be required
-Baby will be exclusively breastfed. Please do not introduce anything into baby’s mouth.
-We would like to bathe the baby ourselves, in our room, at a later time.

We would like to discuss early discharge, as long as this birth is of the “normal” variety.

Once again, these are our preferences, but we are aware that plans may need to change.
Thanks so much for your time and attention during this incredible time of our lives.



I'll tweek it a bit for this time, even though we're planning to stay home. Here they add it to your chart beforehand and *apparently* read it when you arrive at L&D. I will say that, when I've been at births in the past, I've seen birth plans laughed at, dismissed and ridiculed, which makes me hesitant to submit one. But, I guess it's worth a try! I think it's probably more valuable to have a support person who will advocate for your wishes. However, it's also a super good idea to discuss this stuff with your care provider beforehand too, just so you know what policies are and are potentially able to negotiate compromises (ie: management of the third third stage is often something very set in stone, but there's always wiggle room!).

[sarahn4639]

I have assisted in writing many a birth plan as a doula. I would talk with your mw (do you have an independent mw or a group? do you know who will be at your birth?) more about having a birth plan and what are the routines for their practice. Such as, if they encourage movement and work to keep women out of the bed it would be silly to say "I want to walk and be upright in labor" because it would be a given. I think that birth plans are best when they are very short, absolutely, without exception, 1 page or less and they focus on what makes you and your desired experience unique. Don't put silly things like, "I want to wear contacts or have my glasses on", they don't care, or course you can wear your glasses (only exception is a crash c/s and then, really, do you care? A lot of the online forms still have things like no enema or shaving, this will get nothing but ridicule and laughter from the L&D ward.

So, more constructively, things to include would be:
* a sentence or 2 about you and your experience ie, "I am deathly afraid of needles and want to avoid an epidural at all costs, this is of the utmost importance to me." or "my mother recently died and this is a very emotional time for me, please me sensitive to that fact."

*divide it into 4 sections "labor", "birth" or "delivery" (I hate that word!), "immediate postpartum", and "unexpected situations"

*for "labor" put only non routine things, there shouldn't be much. examples: "I will refuse an IV and hep lock unless my labor becomes long and I am unable to keep myself hydrated orally" or "I am using Hypnobabies, please respect my need for quiet and do not ask me about pain scales, please mark that I refused"

*for "birth" keep doing only non-routine things such as, "I want the squat bar on the bed and the birth stool in the room so that I will have options in pushing positions." "I will not be laying on my back unless I personally find it comfortable, I prefer an upright position" "Please do not perform perineal massage." "The cord is not to be cut until I have birthed the placenta"

*for "immediate postpartum" again, non routine, "Do NOT cut OR clamp the cord until the placenta is born" (yes, I would repeat this) "Do not suction the baby routinely and talk to me if you feel there is a medical need" "the baby is to remain on my chest for all baby checks unless there is a life threatening complication and I expect to have that communicated to me at that time." "we are refusing the eutheryn (sp and no desire to look it up right now!) eye ointment and the vitamin K injection. If there is a situational need for Vit K we can discuss that after the birth." "no management of the 3rd stage, please. If you feel there is a need to intervene, discuss it with me at that time." "I refuse pitocin post birth, if there is a medical need, it can be discussed at that time." (It is becoming routine to administer pit either in the IV or shot in the thigh at the time of the placental birth to assist the uterus in clamping down. I have seen this given without mention or consent many times.)

*"unexpected situations" "if I require a c/s, and it is not a crash under general, I want 2 support persons with me, my husband and my doula (they will *not* allow 2 family, but many anaesthesiologists will allow the doula as a second support). If the anesthesiologist is not in agreement on this, please call in a back up who is." "I want the baby to be placed with me, skin to skin as soon as it's health is evaluated, assistance with holding the baby is appreciated if it is needed."

So, the basic gist is to be straight forward and only address the things that make you unique. If you have anything out of hospital policy such as no IV or monitoring with the Doppler or something, have your midwife sign it, get a copy to take to the hospital with you and request a copy be in your chart that is sent to the hospital. It will make it a little easier during check in. Sorry this is so rambly!

[Climbergirl]

My first question was going to be if you were birthing at home or in a hospital. I am birthing at home and went over with my midwife some of the things that were important to me and those were her normal mode of operation.

I am trying to decide if I should have a back up transfer birth plan for the hospital.....

[nova22]

I'm a little confused too over where you're birthing; I can't tell from what you wrote if you are going to a hospital only in an emergency, or if you're planning a hospital birth. If you're planning a hospital birth, I would write a short birth plan (should easily fit on one printed page) so if there is a shift change or whatever it can be briefly read. When I made my hospital birth plan I used a large-ish font, kept it on 1pg, and put the really important things in red (like "if an emergency c-section is required I want to have my husband with me at all times" and "if baby needs to be transfered at least one parent will be with him/her at all times" and things like that).

If you're planning a homebirth, you could do one more detailed plan for your midwife as well as the short plan to bring with you in case of transfer. My midwife gives all her clients a birth questionnaire so moms-to-be can answer all her questions instead of writing out a traditional birth plan. She expects it to be long and she likes details. Mine ended up being three printed pages and she was really excited when she saw it. When I had an OB with my first pregnancy I handed them one full page and then a second page with two lines on it and she looked like she was about to pass out, and didn't even read it. OBs are on a tighter schedule apparently. For a homebirth, you can spend more time writing about your personal preferences and less time writing about procedures - e.g. most homebirth midwives won't recommend an episiotomy so I didn't bother mentioning it, but I did mention that I don't like strong fragrances and that I need reassurance and a quiet, dimly lit atmosphere in order to feel relaxed when I'm in labor. If you want the entire thing I'll email it to you but it's way too long to post here!

[Happy912]

Thanks for all the great examples and areas to consider!

Sorry for the confusion- I have a midwife, but she only does hospital births so yes, it will be a hospital birth.

I am doing a hospital tour soon- does anyone know if the "tour guide" or someone on the unit would be able to tell me their "hospital policy" on certain situations/interventions/procedures?

For example, I want to labor at home as long as possible- my friend who did this said that the hospital was horrified and immediately insisted she get an IV and antibiotics...can they insist on that?? Or ultimately is it up to the momma?

[sarahn4639]

You can ask on the tour about hospital policy, you may or may not get the whole story. The person doing tours is usually a L&D nurse. It is best to discuss it with your mw for sure.

Yes, all decisions are ultimately up to you, however, women in labor are often very vulnerable and "they" know how to present things to get compliance (i.e. the freaking dead baby card as it's known). BUT, "the hospital" is actually her care provider, so it's really your mw that makes the decisions for the most part.

[ein328]

Originally Posted by selkat

This was ours from last time:

We’re really excited to meet our son or daughter, and our primary goal is a safe and healthy mother and babe.
We understand that sometimes birth doesn’t go as planned, and respect the knowledge and advice of hospital staff. The following are our wishes, but we are willing to be flexible and make changes as the situation requires. We do ask that we be fully informed and given the chance to make decisions. Should K be unable to give informed consent, J is authorized to do so on her behalf.
Other people who may be with us:
-R and/or A, friends and support persons. Both are well informed as to our wishes and are no strangers to labour, birth and postpartum

K would like to be as active and mobile as physically possible throughout labour and birth
-We consent to intermittent fetal monitoring, with a fetoscope or pinard whenever possible *(I was trying to be nice about the fact that I did not want constant fetal monitoring)
-We would like to limit internal exams
-We do not consent to AROM
Pain management
-K is commited to a medication-free labour and birth. Please do not offer pain meds or epidural. If Kate asks for pain relief, please tell her that you will be glad to discuss options in 15-20 minutes.
Second Stage
-K would like to push in whatever position works best for her body. She would especially like to avoid coached pushing in the lithotomy position.
-Please avoid routine suctioning of baby’s airways
-Babe to go immediately to K’s abdomen/chest
-Please do not clamp cord until it has completely stopped pulsing
-Please allow J and/or K to discover and announce the sex
-J may not want to cut the cord, but please offer him the opportunity
-We decline active management of the third stage. Please do not administer oxytocin/pitocin/etc. Please do not apply cord traction.
-We would like to keep the placenta
-If episiotomy is required, a lateral incision is requested
Baby
-We decline HIB vaccination, administration of eye prophylaxis and vitamin K injection
-J will stay with baby at all times should additional treatment be required
-Baby will be exclusively breastfed. Please do not introduce anything into baby’s mouth.
-We would like to bathe the baby ourselves, in our room, at a later time.

We would like to discuss early discharge, as long as this birth is of the “normal” variety.

Once again, these are our preferences, but we are aware that plans may need to change.
Thanks so much for your time and attention during this incredible time of our lives.



I'll tweek it a bit for this time, even though we're planning to stay home. Here they add it to your chart beforehand and *apparently* read it when you arrive at L&D. I will say that, when I've been at births in the past, I've seen birth plans laughed at, dismissed and ridiculed, which makes me hesitant to submit one. But, I guess it's worth a try! I think it's probably more valuable to have a support person who will advocate for your wishes. However, it's also a super good idea to discuss this stuff with your care provider beforehand too, just so you know what policies are and are potentially able to negotiate compromises (ie: management of the third third stage is often something very set in stone, but there's always wiggle room!).

Do you mean "we decline Hep B vaccination?" To my knowledge, Hep B is standard at birth, while HIB doesn't come until later....

[ein328]

Here's mine:

Our goal is to deliver our baby as safely and naturally as possible without unnecessary medications or procedures. While we are committed to this ideal and have taken great care to prepare ourselves physically and emotionally for a natural birth, we understand that birthing is a process that seldom goes precisely as planned. As such, we will work willingly with our care providers to adjust our plan and to make alternative decisions about labor, delivery, and postpartum care should the need arise. We understand that final decisions about our care will be discussed and agreed upon in the birthing room with Emily’s well-being and that of our baby being the most important considerations.

In addition, Emily wishes:

- Please do not offer medications or suggestions for use of medications unless requested by Emily
- Intermittent (not continuous) monitoring, preferably via Doppler
- Emily would like freedom to move/walk around and use tub/shower during labor
- Emily would like to stay hydrated through fluid consumption, not an iv
- To avoid augmentation measures such as the artificial rupturing or stripping of membranes and/or pitocin unless a specific medical need arises.
- If our midwife determines that a Cesarean birth is indicated or if other complications arise, we request that all courses of action be explained thoroughly and performed only with our active consent.

- A range of choices of positions for pushing
- To avoid episiotomy, to protect actively against tearing through the use of perineal massage/hot compresses/position changes- please don’t rush pushing
- Please place baby immediately on mother’s abdomen after delivery- we will rub in vernix
- Allow Brett (dad) to announce the baby's sex
- Allow Brett to cut the cord, only after it has stopped pulsing
- Baby to breastfeed as soon as it is ready
- No pitocin/pulling of cord to deliver placenta- to save the placenta
- Baby to room-in with mother at all times, or to be accompanied by Brett if need arises
for baby to visit nursery
- Please allow Emily to give baby’s first bath
- Please delay all routine procedures for the baby for at least one hour after delivery
- No Hepatitis B vaccine, antibiotic eye ointment, Vitamin K to be given to baby
- Baby to be breastfed exclusively. Please, no bottles, pacifiers, formula, or water

Thank you again for your support and for your kind attention to our choices.

[raspberry.swirl]

I drafted mine from Candace Leach's site: http://www.birthgoddess.com/8601.html

She was a mentor to my doula with DD and was going to serve as my HB mw, due to Julian's cleft lip and palate, she'll now serves as my doula. I will birth in a hospital attended by the same CNM group that attended DD birth. They respected the plan.

#1 Tip: KEEP IT TO ONE PAGE

[quantumleap]

Originally Posted by ein328

Do you mean "we decline Hep B vaccination?" To my knowledge, Hep B is standard at birth, while HIB doesn't come until later....

Where we lived when dd was born, HIB was standard at birth. Pneumoccocal (sp?) vaccines are also very routine wherre we were at birth, but we were not in the "target" population (First Nations and/or people who had to fly in to have their babies) Hep B came at the 2 month well check, I think. But, yes, Hep B would be the relevant thing for most people!

[Happy912]

Originally Posted by ein328

Here's mine:

Our goal is to deliver our baby as safely and naturally as possible without unnecessary medications or procedures. While we are committed to this ideal and have taken great care to prepare ourselves physically and emotionally for a natural birth, we understand that birthing is a process that seldom goes precisely as planned. As such, we will work willingly with our care providers to adjust our plan and to make alternative decisions about labor, delivery, and postpartum care should the need arise. We understand that final decisions about our care will be discussed and agreed upon in the birthing room with Emily’s well-being and that of our baby being the most important considerations.

In addition, Emily wishes:

- Please do not offer medications or suggestions for use of medications unless requested by Emily
- Intermittent (not continuous) monitoring, preferably via Doppler
- Emily would like freedom to move/walk around and use tub/shower during labor
- Emily would like to stay hydrated through fluid consumption, not an iv
- To avoid augmentation measures such as the artificial rupturing or stripping of membranes and/or pitocin unless a specific medical need arises.
- If our midwife determines that a Cesarean birth is indicated or if other complications arise, we request that all courses of action be explained thoroughly and performed only with our active consent.

- A range of choices of positions for pushing
- To avoid episiotomy, to protect actively against tearing through the use of perineal massage/hot compresses/position changes- please don’t rush pushing
- Please place baby immediately on mother’s abdomen after delivery- we will rub in vernix
- Allow Brett (dad) to announce the baby's sex
- Allow Brett to cut the cord, only after it has stopped pulsing
- Baby to breastfeed as soon as it is ready
- No pitocin/pulling of cord to deliver placenta- to save the placenta
- Baby to room-in with mother at all times, or to be accompanied by Brett if need arises
for baby to visit nursery
- Please allow Emily to give baby’s first bath
- Please delay all routine procedures for the baby for at least one hour after delivery
- No Hepatitis B vaccine, antibiotic eye ointment, Vitamin K to be given to baby
- Baby to be breastfed exclusively. Please, no bottles, pacifiers, formula, or water

Thank you again for your support and for your kind attention to our choices.

Thanks so much for sharing!! I appreciate it!

[macandcheese]

DDCC from January—Sarah, this is SO helpful. I'm planning a home birth and I wasn't totally sure what to include on my birth plan (the MW likes everyone to make one). This gives me a great starting point. Thank you!

Originally Posted by sarahn4639

I have assisted in writing many a birth plan as a doula. I would talk with your mw (do you have an independent mw or a group? do you know who will be at your birth?) more about having a birth plan and what are the routines for their practice. Such as, if they encourage movement and work to keep women out of the bed it would be silly to say "I want to walk and be upright in labor" because it would be a given. I think that birth plans are best when they are very short, absolutely, without exception, 1 page or less and they focus on what makes you and your desired experience unique. Don't put silly things like, "I want to wear contacts or have my glasses on", they don't care, or course you can wear your glasses (only exception is a crash c/s and then, really, do you care? A lot of the online forms still have things like no enema or shaving, this will get nothing but ridicule and laughter from the L&D ward.

So, more constructively, things to include would be:
* a sentence or 2 about you and your experience ie, "I am deathly afraid of needles and want to avoid an epidural at all costs, this is of the utmost importance to me." or "my mother recently died and this is a very emotional time for me, please me sensitive to that fact."

*divide it into 4 sections "labor", "birth" or "delivery" (I hate that word!), "immediate postpartum", and "unexpected situations"

*for "labor" put only non routine things, there shouldn't be much. examples: "I will refuse an IV and hep lock unless my labor becomes long and I am unable to keep myself hydrated orally" or "I am using Hypnobabies, please respect my need for quiet and do not ask me about pain scales, please mark that I refused"

*for "birth" keep doing only non-routine things such as, "I want the squat bar on the bed and the birth stool in the room so that I will have options in pushing positions." "I will not be laying on my back unless I personally find it comfortable, I prefer an upright position" "Please do not perform perineal massage." "The cord is not to be cut until I have birthed the placenta"

*for "immediate postpartum" again, non routine, "Do NOT cut OR clamp the cord until the placenta is born" (yes, I would repeat this) "Do not suction the baby routinely and talk to me if you feel there is a medical need" "the baby is to remain on my chest for all baby checks unless there is a life threatening complication and I expect to have that communicated to me at that time." "we are refusing the eutheryn (sp and no desire to look it up right now!) eye ointment and the vitamin K injection. If there is a situational need for Vit K we can discuss that after the birth." "no management of the 3rd stage, please. If you feel there is a need to intervene, discuss it with me at that time." "I refuse pitocin post birth, if there is a medical need, it can be discussed at that time." (It is becoming routine to administer pit either in the IV or shot in the thigh at the time of the placental birth to assist the uterus in clamping down. I have seen this given without mention or consent many times.)

*"unexpected situations" "if I require a c/s, and it is not a crash under general, I want 2 support persons with me, my husband and my doula (they will *not* allow 2 family, but many anaesthesiologists will allow the doula as a second support). If the anesthesiologist is not in agreement on this, please call in a back up who is." "I want the baby to be placed with me, skin to skin as soon as it's health is evaluated, assistance with holding the baby is appreciated if it is needed."

So, the basic gist is to be straight forward and only address the things that make you unique. If you have anything out of hospital policy such as no IV or monitoring with the Doppler or something, have your midwife sign it, get a copy to take to the hospital with you and request a copy be in your chart that is sent to the hospital. It will make it a little easier during check in. Sorry this is so rambly!

[Happy912]

Pros/Cons of certain procedures

Everyone's examples definitely made me realize we have a lot of choices and I am not really sure the pros/cons of several of them. Please chime in if you have done research and know the benefits or drawbacks to getting some of these things done:

- Cutting or clamping the cord right away vs. after placenta birthed vs 1 hour later
- Holding baby immediately, before bathed or anything else vs waiting until after they have done all the things they want to do
- Having hospital staff suction/bath baby vs not having them do this
- Allowing them to administer the eye ointment/treatment and Vitamin K injection
- Management of birthing placenta

Thanks for the wisdom!