In my experience, having an OB sign your birth plan ahead of time and have it on file at the hospital makes a LOAD of difference -- it becomes a "prescription" for the kind of birth you desire, rather than a wish list you bring in and hope they'll follow. I was a HB transfer, and my birth plan made a huge difference in terms of the way I was treated in my transfer. The hospital staff was VERY good about following it, though they required reminders about some things (bright lights, Pitocin after birth, etc.) No matter how good your birth plan is, you'll still need to stay on top of things a bit to make sure you get everything you want.
I concur with other recommendations above about birth plans, especially 1) keep it to one page, and 2) keep it short and sweet. Bulleted lists are much easier for everybody. You can make your requests sound more polite without making it too long.
I think it's perfectly acceptable to refuse an IV and/or heplock until/unless you need one. At the hospital-based birth center where we're birthing this time, a heplock/IV is NOT standard. My MW is very clear about that. They might give you a hard time about it, but if you're insistent (and can convince your OB to sign off ahead of time) you can usually get your way. If you need an IV, they can place a line then. I would not, personally, consent to a heplock in labor "just in case." The whole point of a natural birth is that you don't do the "just in case" interventions.
I had an IV placed during my last labor, but only after I was 3 days in labor and pretty dehydrated from constant vomiting. I needed it at that point. It made me feel loads better and gave me my energy back. I wouldn't discount the value of one -- but it's definitely not appropriate "just in case." They know how to place an IV line on a dehydrated patient, they would just prefer not to do it. I'm not interested in the hospital's preferences; I'm interested in what makes my labor easiest and least interventive. Plus, I hated that they kept the stupid thing in me for hours after the birth and refused to remove it after several requests.
Two things I would have included on my birth plan, in hindsight: "DH wishes to announce the sex of the baby" (we forgot about this one and were disappointed when the OB stole our thunder) and
"please do not disturb us in our room postpartum except when absolutely necessary for the health of the baby or the mother." I hated having people walk into our room every five minutes for two days after DD was born. I didn't get a wink of sleep, and the interruptions made me anxious and angry. This time, we're delivering in a place that has a policy that babies delivered naturally are released from the hospital after 6 hours. Thank heaven!
CookAMH, your birth plan is excellent. I'm going to review mine for this birth and may be stealing some of your ideas!
OP, a couple of points on your birth plan that I noticed:
Whatever my GBS status, I DO request a hibiclens/chlorhexidine wash (or the equivalent) be administered at the time I go into labor or at rupture of membranes, whichever occurs first (If it has not already been administered) I concur with a PP -- most hosp. staff won't know what this means and will probably ignore it in any case.
I prefer that fetal heart tones be monitored intermittently with an external monitor or Doppler. Where I delivered, CEFM was standard, so you should check to see if you need to include or not. I had to fight over this one. (They tried to place an internal monitor without even telling me -- I just happened to notice it go by my head and screamed bloody murder over it until they took it away.)
I would like no internal vaginal exams (THIS INCLUDES DILATION CHECKS) during my labor until I have an urge to push. Most L&D's will not admit you until after they have done a VE to ensure that you are in active labor. You might have a hard time getting around this one.
As long as the baby and I are healthy, I prefer to have no time limits on pushing. I would use stronger language here. Usually they will cut you off at 2 or 3 hours "for the good of the baby." My OB knew how strongly I felt about this, and defied hospital policy for four solid hours while I pushed. You should discuss your OB's "time limits" ahead of time, and be clear that you are willing to bend on this issue if pushing really isn't making any progress and baby isn't descending.
We would not like babies to be removed from the room. I would be stronger on this one too! Something like "under no circumstances are babies to be removed from the room unless they are accompanied by one or both parents." This was on my birth plan and I STILL had to get out of bed in the middle of the night when nursery staff came into my room and whisked my newborn away while I was sleeping!!
We would like ONLY the orally administered vitamin K to be given to our babies. If it is not available, do NOT administer vitamin K to our babies. Check with your ped on this one -- you probably won't be able to get oral Vit K in the hospital at all. And in some places, they will call CPS on you if you refuse it. You can include something like "unless there is birth trauma, we refuse Vit K," because that acknowledges that you understand what it's for and aren't crazy child-endangering people.
We decline routine PKU testing at the hospital and have made other arrangements for this procedure at a later date this week. You might want to think about where/when you will do a hearing test, too, if you plan to refuse this at the hospital. We realized it would be super difficult to arrange for one afterwards, so we went ahead and did it in the hospital. They're totally harmless and most babes sleep right through them, but they're a very good idea for a newborn (one of my BFF's is an audiologist) :)
And here are a few comments on a PP's plan too:
- We want to take both placentas home with us. Please ensure that they are placed in the provided containers which will be labeled to identify baby A or baby B. You might have to sign some crazy waivers for this, depending on where you deliver. Some hospitals consider this "biohazard medical waste" and won't release it without a serious amount of paperwork. Just a forewarning!
- If baby B is breech we would like to request external version Check with your HCP, but I don't think external version is something they ever attempt when someone is in labor.
- If baby B is not able to be turned vertex we would like to attempt breech delivery Again, you definitely want to check with your HCP on this one. If you have an attending OB or MW who does not have experience with vaginal breech deliveries, they can do more harm than good by intervening at the wrong moment. If you have someone who does not know how to handle a vaginal breech birth (i.e., leave it the heck alone), the baby is probably safer with a C-section.
- Babies will be exclusively breastfed. No formula, water/sugar water, or artificial nipples I think sugar water is highly unusual now; this might be a red flag for staff to think, "oh yeah, this person has no idea how we do things here."
- If the babies are healthy, I would like to hold my baby and nurse immediately in [C-section] recovery. You might want to specify that you want your partner or other support people with you in recovery. Some hospitals keep you alone in recovery as a matter of policy.
Edited by Comtessa - 12/31/10 at 9:23am