Feedback on my birth plan anyone? Also need baby's chart

[Thparkly]

Hi everyone,

I am expecting my first noodle in April and have started making a birth plan.  I am pasting it below and would also appreciate feedback on how to make a baby's chart in case I get separated from baby.

This is basically the birth  'plan' I'd have nurses and unknown docs/midwives read.  But basically, I plan to give birth with a midwife at henry ford in west bloomfield and am using hypnonbabies but want to be prepared for anything. The 2nd page is basically what I'd prefer in case of any complications. I also put little hearts on the actual printout so it stands out.

                           Our Birth Preferences             

                            Mom: deleted for privacy (DOB_)

                            Dad: deleted for privacy     

Thank for being part of this very special time.  We would be greatly honored if you would cooperate with the following preferences and let us know if you have any questions/concerns:

Environment:

• Mom may be involved in deep hypnosis at times.  Therefore we prefer medical discussion be directed in private with Dad (unless Mom’s immediate involvement is required). 
• Please avoid use of words such as ‘pain’, ‘contraction’, ‘hard labor’, ‘caesarian’, ‘induction’, ‘pitocin’, ‘failure to progress’, etc: first, privately talk to Dad if such words are needed.
• Mom would love a fairly private and quiet birthing experience; please prevent resident doctors, students, unapproved visitors, and unnecessary staff from entering the room;

Before Birth:

• Please keep vaginal exams to the required minimum
• Discuss membrane rupturing with dad first and only if it’s really needed.
• No offer of drugs/induction/breaking water/Etc. prior to private discussion with Dad.
• No IV/heplock unless required.
• Doppler fetal monitoring only when necessary
• If you have non-medical methods to help in Mom’s progress, feel free to mention them.

During birth:

• Please maintain a relaxed, positive, and calm atmosphere with dim lights and low voices.
• Mom’s choice of birthing position
• Spontaneous Bearing Down
• I would prefer to tear over episiotomy, but please use compresses, massage and positioning, Etc, and Local Anesthesia for repairs.

Baby:

• Do not suction if baby has started breathing unassisted /only if really necessary.
• Delay the cord cutting as long as possible (offer to Dad first).
• Baby immediately to mom’s chest to breastfeed.
• Perform all possible exams/procedures on mom and otherwise involve Dad
• Baby to stay in room at all times.
• Let mom and dad give baby’s first bath.
• No eye meds/erythromycin, no vitamin K shot, no Vaccinations or injections.
• Do not retract the foreskin if it’s a boy.
• PKU test to be performed in mom’s arms

~Please see next page for medical necessities or emergencies~

          Part 2: Medical Necessities  

                                    Mom: Natasha Verma DOB 12-22-77

      Dad: Vikram Verma     

:

In case baby needs special care:

• Allow dad to attend any medical procedures required if mom cannot also attend
• Please help me Breastfeed ASAP: No formula, pacifiers or glucose water unless provided by mom.
• No procedures performed without fully informed parental consent unless it’s an emergency.

Pain relief we prefer:

Walking epidural and/or Medications that don’t cause sleepiness

Vaginal birth:

Alternate positions (such as all fours)
Prefer vaccum rather than forceps

Prefer alternative to cytotec if induction is needed

Prefer tearing and support of perineum than having episiotomy

In case cord is around neck, simply and calmly pull it away.

Don’t flick babie’s feet, spank or use unnecessary recussitation

C-Section
* Spinal/epidural anesthesia
* Partner present
* Doula present
* Screen lowered to view the birth or mirror
* Free one hand to touch the baby
* Partner to cut the cord
* Breast feeding in recovery room

• Do not sew up uterus in plain view of mom
• Dad should be involved and present in any procedures.

[momto9kidlets]

Please don't take this the wrong way but your plan is way too long.  I can't tell you how many times I have seen people come in with long birth plans and no one reads they - they simply don't have time and even if they do have time they just won't do it.  There is simply too much information for them to remember.  You need to cut this down to one page or less for it to be super effective.  Also make sure you are picking a medical provider that does the things you want.  If you choose the right provider you can very often remove tons of stuff from your plan because they will already be doing those things you want them to do.  For example - when I chose my provider - I knew she always put the baby right on mom's chest so I didn't have to put that in my plan (I also knew her back up did the same).  I also didn't have to put on my plan that I wanted to birth in xyz position because I knew she would let me do what I wanted.  

You have the same thing in your plan several times where you say something about dad being present - you can probably cut out some of those because you are saying the same thing over and over.

The two things below say the same thing, so you can get rid of the first one.

• Discuss membrane rupturing with dad first and only if it’s really needed.
• No offer of drugs/induction/breaking water/Etc. prior to private discussion with Dad

[phathui5]

I would change "Please keep vaginal exams to the required minimum." to something like "Vaginal checks are to be performed at the parents' request."

One suggestion is to have a copy signed by your caregiver and made part of your chart there and at the hospital.

With these:

• Discuss membrane rupturing with dad first and only if it’s really needed.

•  No offer of drugs/induction/breaking water/Etc. prior to private discussion with Dad.

• I'd also recommend tetting rid of the first one and possibly the second half of the second one.

I would discuss this with your provider in lieu of putting it on paper- "In case cord is around neck, simply and calmly pull it away ."

[Banana731]

I agree with pp's suggestions. It really is way too long, they just won't read it when it's like that. Also a lot of the stuff on there should be changed from "when necessary" terminology to things like "upon consent" or "at request." Necessity is in the eye of the provider, I haven't met many who didn't find it "necessary" to keep mom on EFM for one reason or another, for instance...so it might be better to say "I prefer intermittent fetal monitoring" or something of that nature.

Also, are you sure you want to ask a cp at hospital to be doing something to your perineum. You can have your partner use compresses, you can provide your own counter support if you feel you need it. I mean, maybe your cp is some kind of super gentle midwife, but if it's just the on call OB the chances are good that he/she isn't actually going to do anything helpful for you if his/her hands are messing about down there.

[LizD]

I have to second the comment/s that it's far too long. I am an OB nurse and our childbirth center really does try to do a lot of these things as the standard of care...but the nurses still laugh at and hoot over birth plans at the nurses' station (as well as joke to get the OR ready- and our hospital is committed to maintaining a low c-section rate). If you want this much control over your care you need to plan an out-of-hospital birth. I'm sorry to be so discouraging but I was a doula for many years before I became a nurse, and I had a good relationship with the hospitals' staff and I saw and heard it all. I had my own children at a freestanding birth center and at home. 

As it is, I'd say keep the birth plan to the bare minimum, most important things- request that pain medication not be offered, that you decline all routine med stuff for baby (your state may mandate eye ointment and vitamin k, however). Discuss having both partner and doula at a csection beforehand- many hospitals do not allow two people in the OR, though when I was a doula I attended all cesareans. I cannot imagine any caregiver willing to sign a birth plan- they have to be able to practice in the moment. We add the birth plan to the chart but that doesn't make it any kind of binding agreement. 

Again, I'm sorry to be so blunt but if these are the things you want you have to stay out of the hospital to begin with. 

[sarahn4639]

way too long, it should fit on an index card to be most effective and to get read. i would do something like this:

I am using hypnosis, for this reason, please discuss any interventions with my husband in the hall so as not to disturb my relaxation. I want to push as directed by my body and in positions I find helpful. I do not consent to an episiotomy, discuss it with me if you feel it is necessary. I want the baby to be placed immediately on my chest and remain there for all newborn exams. The cord is not to be clamped or cut until the placenta is delivered. We refuse all routine newborn medications and are breastfeeding so no pacifiers or bottles. If a cesarean is necessary, I want to be as involved as possible.

Also, your name is still on page 2.

Make sure your husband and doula are well educated on your wishes, this plan is good for them to have the details, but your providers only need the very most important things and you can discuss everything else in the moment. Also, you can ask for a natural birth loving/hypnosis experienced nurse when you arrive and you may luck out with a nurse that is right in line with your desires and can be a great advocate for you.

[Banana731]

That's nice Sara, super short. I added the red, because it is super disturbing to see vag exams done with only, "I'm going to check you" and then right in there. It feels like such a violation to me.

Originally Posted by sarahn4639 

I am using hypnosis, for this reason, please discuss any interventions with my husband in the hall so as not to disturb my relaxation. I want to push as directed by my body and in positions I find helpful. I do not consent to vaginal exams or an episiotomy, discuss it with me if you feel it is necessary. I want the baby to be placed immediately on my chest and remain there for all newborn exams. The cord is not to be clamped or cut until the placenta is delivered. We refuse all routine newborn medications and are breastfeeding so no pacifiers or bottles. If a cesarean is necessary, I want to be as involved as possible.

 

[Beccadoula]

OK - here is the advice I give my clients...this is directly from my doula website, hope it helps.

Making a good birth plan

Q. What is a birth plan and how do I make one?

A.   A good birth plan states clearly what you want or don't want for your birth experience. It can include all kinds of things, but is taken most seriously when it is quick to read, reasonable and polite.

• It is a good idea to have the doctor sign it, showing his staff that he supports your plan.
• It is a good idea to only include the essentials in your birth plan.
• Be polite.  No one wants to be treated like an idiot or mistrusted.  Your medical staff will be more compliant if they feel you are being reasonable with your requests and not making wild demands of them.
• Be realistic and flexible.  You may have a text-book labor, but you may not...if you get into labor and find that you really aren't doing well and want to change your birth plan, don't feel bad about letting people know that the plan has changed.  You may think you don't want a certain proceedure, but find that it is medically necessary for some reason, don't be crushed by this.
• If you feel you're not being taken seriously before the birth, find another doctor or hospital to deliver with...there are options, but be realistic in your goals.
• DO NOT ASSUME you will have trouble with your hospital, doctor, nurses or midwife.  Take the time to ask all your questions and to communicate with them.

A good birth plan might look something like this....

Dear___________staff,

We want you to know that we have confidence in you and we are looking forward to having our baby with your help. 

 Our goals for this birth are:

• a healthy baby and mother
• informed consent be given before any medical intervention is done
• epidural - if requested by mother (please do not offer pain medications)
• no episiotomy
• total mobility through-out the labor
• intermittent external monitoring
• breastfeeding immediately following birth

Thank you so much for helping us bring our beloved son into the world safely and gently.

Signed_______________________  Date_________

Doctor______________________ Date__________

Things to consider/research/talk with doctor about, when thinking about a birth plan:

• epidural ?
• episiotomy?
• narcotics ?
• food/drink during labor?
• how many people in the room with you?
• water therapy during labor - bath or shower use for pain management?
• labor positions?
• position used during pushing? (flat on your back, stirrups, squatting, standing, sitting up, kneeling, hands and knees, etc.).
• fetal heart monitors (internal or external or telemetry)?
• what to do if a c-section must be done (i.e. - who holds the baby after the birth while the closing is being done? does mom breastfeed while they are closing? Who goes into surgery with mom?)
• birth pool?
• parents to cut cord?
• dad to "catch" baby?
• natural pain reducing techniques?
• informed consent? (meaning that all your questions are fully answered before you agree to any intervention - and that you can refuse treatments)
• directed pushing?  -  do you want to be told "push" or allowed to wait for the urge to push?
• breastfeeding?
• nursery? or rooming in?
• bathing the baby - who does it and when?
• circumcision? -do or not do? - when? where?
• vaccinations?

Keep in mind that your hospital or doctor may have limitations on things you want.  And in some cases your doctor or nurse may be unhappy with you for making a birth plan at all.  When choosing your doctor and hospital you need to know as much as possible about their goals for your birth.  (see birth team page)  

Having helped several couples over the years to make good birth plans I can say that most nurses and doctors like the final birth plans they are handed when these rules are kept. 

[Thparkly]

Hi Liz,

I really appreciate your feedback, but I am not birthing in a standard LDR.  My care will be overseen in by midwives who are in the hospital and don't work under OBs, and they are from home birthing or birth center backgrounds and were recommended by several doulas I know. This hospital is new and pretty progressive compared to most.  Your post would have scared the heck out of me otherwise:-)

[Thparkly]

Hi Mom29, I will post the updated version.  It has one main page and one page only in case of urgent care; this isn't clear from what I pasted.  I don't want these two things on the same page because it would be confusing.  And I suppose I can go over several things with the midwives and shorten it more.

Thanks:-)

[Thparkly]

phathui7, thanks for the tips. Ill post my updated birth plan in a sec

[Thparkly]

banana,

Good points.  I am delivering with a midwife and want them to know I am open to non-medical forms of help because they are very good at that where I'm delivering and I want the nurses to know it to; I have heard the nurses are also trained in these things.

Ill post my updated plan in a sec

[Thparkly]

Sarah, great tips, and this helps me with wording. I'll post something updated in a minute anfter I incorporate some of your suggestions.

[Thparkly]

Thanks everyone, Here is my updated plan.  Please let me know what you think:

                                              Birth Preferences                 

Environment:

• Mom may be involved in deep hypnosis; for this reason, please talk to Dad (Vik) privately regarding any special concerns out in the hall so as to not disturb mom’s relaxation.
• Please only required staff to enter the room; no students/residents/trainees/spectators.

Before Birth:

• Please do not offer me drugs unless I request them.
• No induction/No breaking water/No interventions without my full consent.
• Vaginal checks performed only at my request.
• No IV. Heplock only upon consent.
• Fetal monitoring only intermittently using Doppler.

During birth:

• Dimmed lights and low voices.
• I prefer to direct my pushing until baby is crowning and will request help if needed.
• I do not consent to episiotomy. Please give perineum support to avoid/minimize tearing.

After birth:

• Offer Dad the cord cutting after it stops pulsing.
• Do not suction if baby has started breathing unassisted.
• Baby immediately to my chest to breastfeed; perform all exams/procedures on Mom.
• Don’t pull on the cord to deliver the placenta.
• Baby to stay in room at all times or be attended by dad if necessary.
• No eye meds/erythromycin, no vitamin K shot, no Vaccinations, injections, or medications without parental consent.
• Do not retract the foreskin if it’s a boy (and of course no circumcision).
• PKU test to be performed in mom’s arms

In Case of Medical Necessities:         

• Keep us fully informed and as involved as possible for all procedures and medications.
• Please help mom Breastfeed ASAP if baby is distressed or undernourished.
• Walking epidural if option is available
• Codeine-based medication preferred; avoid Demerol.
• Slow/low dose of Pitocin if needed
• Prefer to avoid Cytotec.
• Prefer vacuum rather than forceps
• Please help me to Breastfeed ASAP; preferably immediately Parents to provide own formula if required; no glucose water or pacifiers please.
• If caesarian or intervention becomes necessary I want me and Dad to be informed and involved as much as possible.OB: Please do not sew up uterus in plain view of me but do allow me to see delivery.

[Thparkly]

well i updated it again already

Before Birth:

• I may be involved in deep hypnosis; for this reason, please talk to Dad (Vik) privately regarding any special concerns out in the hall so as to not disturb my relaxation.
• Please only required staff to enter the room; no students/residents/trainees/snoopers.
• Please do not offer me drugs unless I request them.
• No induction/No breaking water/No interventions without my full consent.
• Vaginal checks performed only at my request.
• No IV. Heplock only upon consent.
• Fetal monitoring only intermittently using Doppler

During Birth:

• Dimmed lights and low voices.
• I prefer to direct my pushing until baby is crowning and will request direction if needed.
• I do not consent to episiotomy. Please give perineum support to avoid/minimize tearing.

After Birth:

• Offer Dad the cord cutting after it stops pulsing.
• Do not suction if baby has started breathing unassisted.
• Baby immediately to my chest; perform all exams/procedures for baby from my chest.
• Don’t pull on the cord to deliver the placenta.
• Baby to stay in room at all times or be attended by dad if necessary.
• No eye meds/erythromycin, no vitamin K shot, no Vaccinations, injections, or medications without parental consent.
• Do not retract the foreskin if it’s a boy (and of course no circumcision).
• PKU test to be performed in mom’s arms

In Case of Medical Necessity:   

• Keep us fully informed and as involved as possible for all procedures and medications.
• Please help mom Breastfeed ASAP, esp. if baby is distressed or undernourished.
• Walking epidural if option is available (regular for caesarian); lower dose for pushing stage.
• Codeine-based medication preferred; avoid Demerol derivatives.
• Slow/low dose of Pitocin if needed and only with consent.
• Prefer to avoid Cytotec unless dire emergency.
• Prefer vacuum rather than forceps.
• Please help me to Breastfeed ASAP; If needed I will provide a formula; no glucose water or pacifiers please.
• If caesarian or intervention becomes necessary I want me and Dad to be informed and involved as much as possible.OB: Please do not sew up uterus in plain view of me but do allow me to see delivery.

~Thank you~Thank you~Thank you~

[LizD]

I am sorry to sound so dour. But I do not work in a big busy high-risk center, I work in a birth center much like you describe. We have the lowest C-section rate in the area, LDRP rooms and our own OR/PACU, we offer waterbirth, we strongly encourage rooming-in and breastfeeding, we have more midwives (who also deliver at home) than OBs, etc. Some of the nurses are or were doulas as well. However, even when nurses believe in the things you want, they still laugh at birth plans and joke to get the OR ready. I don't like seeing patients/clients exposed to that invasion of their privacy even if they themselves are unaware of it. And I do strongly believe that if you want this much control over your birth, if you want to minimize intervention, you need to prevent the first and most drastic intervention, which is leaving your house in the first place. 

I would drop everything you have under "Medical Necessity." No OB is going to consult your birth plan to see if you have a problem with Cytotec or forceps, they're going to say that because of such-and-such they want to try to use this-and-that. That's your time, or your doula's time to remind you, to say, hey, I really don't like that idea, can you suggest something else? No one uses forceps anymore, they always use a vacuum, so you really don't have to worry about that. Cytotec is really only used now for PP bleeding, not induction, and for things like this you can simply refuse in that moment.

And as far as all the after-birth requests you have listed, just don't be surprised when the nurses want to take the baby to be bathed and have all that stuff done at once. It's a lot easier for them, and they are very busy. All you have to do then is refuse when the nurses or techs come to take the baby. I suggest this because I feel that if you keep the "birth plan" you give them to the absolute bare minimum of as-needed info, you are more likely to have someone read it and remember it. You can make an index card with sharpie for the baby's crib that says NO PACIFIERS NO BOTTLES NO CIRC etc. 

[JessicaE]

Originally Posted by LizD 
Cytotec is really only used now for PP bleeding, not induction, and for things like this you can simply refuse in that moment.

I like many of your reflections, it's great to hear from someone "in the trenches." Just wanted to say that Cytotec is used in both hospitals in my city ALL. THE. TIME. for induction. And routinely to prevent PP hemorrhage, especially by the midwives (docs seem to prefer IV Pit). Neither hospital even compounds Cervidil anymore, so when induction is necessary (subjective, I know), it's Cytotec or straight to Pit.  :(  I have seen numerous Cytotec inductions, but never one with Cervidil.

[LizD]

Originally Posted by JessicaE 

Originally Posted by LizD 
Cytotec is really only used now for PP bleeding, not induction, and for things like this you can simply refuse in that moment.

I like many of your reflections, it's great to hear from someone "in the trenches." Just wanted to say that Cytotec is used in both hospitals in my city ALL. THE. TIME. for induction. And routinely to prevent PP hemorrhage, especially by the midwives (docs seem to prefer IV Pit). Neither hospital even compounds Cervidil anymore, so when induction is necessary (subjective, I know), it's Cytotec or straight to Pit.  :(  I have seen numerous Cytotec inductions, but never one with Cervidil.

Wow. I am quite surprised. That is, as you no doubt know, quite outdated even by mainstream standards. We use cytotec per rectum for PP haemorrhage, and the old standard of cervidil the night before a pit induction. The Cervidil you can at least get out again if indicated. :\

[MeepyCat]

The one thing that's jumping out at me is your thing about IVs and hep locks.  It seems a little backwards.

I'm not a birth professional, but I had one pretty complicated pregnancy, during which the hep lock and I got to know each other dismayingly well.  That's the experience I speak from.

The hep lock itself doesn't do anything.  It's a port that they can jam an IV into in a hurry if they need to get you intravenous fluids or medication.  They can't get anything into your veins without the IV.  Saying "no IV, hep lock only if necessary" is like saying "you can stick a needle in me, but you can't put anything through it."  Would it make more sense to refuse the *hep lock* and allow *IV*s only if necessary?

(That said, this is something you may want to discuss in more depth with your care providers.  In what situations would intravenous medication be administered, are there identifiable advance indicators that these situations might arise, and how hard would it be to put an IV in after the need was definitely established?  How difficult is it to get a needle into your veins in ordinary circumstances?  It was my experience that hep locks could be placed just about painlessly on admission, by anesthesiologists using topical anesthesia.  I have terrible veins, and I knew I was going to need intravenous stuff, so I always took that option - I have heard that IV insertion done by whoever is in the room with hands free when the emergency arises hurts more, and I believe it.)

I also want to throw in a word in defense of residents:  It is absolutely your right to ask that residents not be involved in your care.  In a hospital where residents are treated badly, they will follow orders and keep their heads down, but high-quality teaching hospitals give their residents some running room.  Residents can be awesome.  Their training is fresh, and their habits of practice aren't densely settled, so they are sometimes very open to new ideas.  Additionally, I have found that they're easily charmed by inquisitive patients and they they often have more time to spend with patients than the full-fledged physicians. 

[Tumble Bumbles]

I find this statement really offensive (no matter how true it may be).

 but the nurses still laugh at and hoot over birth plans at the nurses' station (as well as joke to get the OR ready- and our hospital is committed to maintaining a low c-section rate). If you want this much control over your care you need to plan an out-of-hospital birth. 

FWIW, I am planning an out-of-hospital birth, as with my first.

However, people can "laugh and hoot" and joke to "prep the OR" all they darn well want (how very unprofessional I may add) but let's never, ever forget that it is the WOMAN'S body, the WOMAN'S baby, the WOMAN'S money (or insurance) paying the nurses' and doctors' paychecks for their labor/delivery as consumers and no matter who hoots, laughs, jokes, or rolls their eyes, a woman does indeed have complete and total LEGAL control over her labor and birthing process. My 'In Case of Emergency Transfer' document (because if I transfer, it will likely be due to a situation likely requiring a c-section because I wouldn't go in otherwise) has no 'please' or 'I'd prefer' or 'unless deemed necessary' in it. I kept it short and reasonable, but it's assertive. All of those statements are absolutely up for individual interpretation and do not contain a definitive consent/refusal of consent. My plan contains legal and binding statements of consent/refusal of consent to treatment that are only amendable by my husband or my signature on individual items. My husband will not be signing any admitting paperwork that voids my statements of consent/do not consent. He will only sign a consent to treat that does not conflict with our transfer plan. I'm constantly amazed at the misinformation thrown about that doctors and nurses have the right to "allow" or "not allow" a woman to exercise her legal rights in labor and delivery. It may be an uphill battle (which is why we are choosing an out-of-hospital birth), but the rights are there nonetheless.

So, hoot and laugh and joke all ya' want (if that's what one feels is professional behavior as a caregiver who chose a career of service) but if litigation is what the facility is trying to avoid, they would be wise in not performing a procedure the parents have specifically refused consent to in writing. The nurses are free to laugh all they like, as they will be doing nothing else without my consent  I'll be nice, respectful and reasonable but I'm not there to make friends, I'm there to ensure the health of myself and my baby while protecting and exercising my rights. The two are not mutually exclusive.