Ideas for my Hospital Birth Plan

[onetwoten]

I am so woefully early, but I've been doing nesty things all day and am trying to sit for a bit before my babysitting charge gets here for the evening and wears me out. 

Tips for things to put into my {I deperately wanted a homebirth or UC, but am stuck in the hospital} birth plan? Here are the general points I have so far, which of course will be reworked into a nicer sounding letter of sorts, but it's all just thoughts for now. 

• Baby is to be placed on my chest immediately after birth
• Newborn exams will be delayed for at least one hour after birth and performed on my chest
• I do not wish to be touched while baby is being delivered, including perineum support, unless I ask for you to do so
• I do not consent to oxygen, IV medication, or a saline lock ‘just in case’
• I do not consent to a pitocin shot after birth
• My baby will not receive the vitamin K shot or erythromyacin, and will not have blood drawn without prior consent
• I do not consent for the cord to be cut until it has stopped pulsating unless lifesaving measures are needed
• I do not consent to traction, gentle or otherwise, on the cord. I will deliver the placenta once it has detached on it’s own
• I will eat and drink as I wish during labor
• I wish to breathe my baby out without assistance. Please do not count.
• As long as baby and I are doing fine I do not wish to have time limits placed on second stage.
• I will not lie in bed labouring on my back unless medically necessary
• Please do not offer pain relief. If I wish to have some myself or my husband will ask for it.
• I do not consent to continuous monitoring unless intermittent monitoring shows something that needs closer attention.
• I wish to be free to push in whichever position feels comfortable.
• I do not wish for my water to be artificially broken unless I request it
• I will not have an episiotomy cut under any circumstances, please let me know if you think I am going to tear, and I would prefer to try position changes, counterpressure, and then to tear naturally if needed
• The baby will room in with us and should not be taken out of our sight without consent
• The baby will receive no vaccinations while in the hospital

What am I missing?

[Magali]

Hi mama.  Have you taken a tour of your hospital yet?  When I took my tour I found out that they always do skin to skin after birth, encourage partners to room in with u and baby, never take baby from you etc...  You might find that a few of your points can be left  off and I think it is a good idea to keep plans short.  I like all of your points.  I made a blanket clause that nothing is to be done to myself or the baby w/o informed consent, and that I wish to labor as peacefully and privately as possible, and that I realize that labor is unpredictable and that at certain times emercency intervention may be necessary.  I ended up having an amazing, empowering experience even with AROM and an epidural (neither of which were forced upon me). The worst part was that the epi didn't work lol.  Don't let the hospital get you down.. you can have a good experience there!!!

[onetwoten]

I've been a doula for several births there and I've found it greatly depends on who your caregivers are (and the nurses moreso than your own Dr), but that they place baby on your chest, let you enjoy him for a few minutes, and then drag him away for "important newborn procedures". They do also typically room-in, unless the baby goes to the NICU, however I've also seen labors where they took baby away "for observation" while you were moving rooms... and just never told the mom until she started asking why she'd been in her room for 20 minutes and the baby hadn't made it yet!

I'm feeling a lot more confident about the hospital, but part of that is being sure that I'm doing everything I can ahead of time to get my wishes listened to and respected. It helps, in an OCD kind of way. *shrugs* lol

[Magali]

I hear ya, because I was exactly the same way!  My first birth I was clueless and it was still great, but I learned a lot since then and was really on guard for my second and spent my entire pregnancy working on my birth plan and my wishes.  Now if I ever get pg again I think I will be somewhere in the middle and not stress so much about my wishes etc...because I did such a good job of that last time.  They did take my dd away for a few minutes after birth because she was having a bit of minor trouble, but my dh knew to stay by her side and reassured me that nothing horrible happened to her while I was being stitched up.  Oh and someone from the lab tried to take her away the next day for a heel prick and  I said "no, I'll bring her" and it wasn't a big deal,  mind you the lady was shocked I wanted to go.

[AliceMay]

I had a wonderful natural birth in hospital. Started out a bit rocky since my water broke early and a resident wanted me to induce but we held firm and things started on their own and after that all the other staff were great about our wishes. Helps we were in a great hospital with many progressive policies. A few things:

I agree with keeping it simple and short - find out hospital policy (like skin to skin) and then cut out extra stuff. Maybe organize it into stages of labour or something? (you probably have...)

about the cord: our doctor was totally happy to do whatever we wanted but did mention that some of the latest research shows increased jaundice when they wait till the cord stops pulsating, though there are also benefits to not clamping right away....she said one option was to wait for a bit, not clamp it right away but not wait till it stops pulsing, so we did that. You might want to look at the latest research - we didn't have time because labour started the same day after the appointment where we discussed this!

Lastly, I tried to give my plan a positive and polite tone, not a "list of demands" (again, I realize you were just being brief to get your thoughts across!) it is important to defend your wishes, and certainly if you suspect people will be resistant to you ideas it is even more so. But I thought I was most likely to get support if I treated the nurses as if they WANTED to respect my wishes and that they just needed to know what they were. (because mostly that is the case!) Where possible I tried to talk about what I DID want instead of what I didn't, if you know what I mean.

Have you thought about what happens if you have complications? Like can you do skin to skin after a c-section? (you can ask that the Dad does skin to skin if you can't for some reason. My husband did, after I'd had our daughter on my chest for almost two hours and I was going to have a quick bath. ) Hopefully you will not have to but it would be good to check out the options. I would imagine taking steps to allow that to happen would be extremely important, especially if other aspects of birth can't go as planned. But I'm sure you will be fine.

Best of luck - hope you have a wonderful birth!

[JamieCatheryn]

Phrase it in a way that's centered on them and how they can help you. Your laboring positions won't matter much to them but keeping you free to move affects their job (you addressed monitoring and IVs). I found the cord pulsating thing is unfamiliar to some of them and somehow they take it as subjective, I'd suggest saying 3 minutes or something measurable like that. Also I read once ("Thinking Woman's Guide to a Better Birth" I believe) tears don't impend they just happen suddenly. Many episiotomies are done for assisted birth (forceps, ventouse), if it came to that you'd be stuck letting the doctor do it the way they're best at it most likely, some can do it without cutting though.

Cesarean plans should be included if you have preferences there, in a transfer situation this is a more likely reason you're there.

Bullet points are good, they're clear and quick to read. Do add in please do this please don't do that, be positive and emphasize the alternatives you want more than the things you decline so they aren't left flustered and saying " well what should we do, then?". Arrange it by stage of labor, definitely. They might absolutely insist on a heplock so be prepared for that. Are you having a UP or do you have a hospital based care provider? If you have one, discuss your (hospital) plans with them to find out what's procedure and what alternatives are easy to get.

[onetwoten]

Thank you for your thoughts everyone :)

Sorry for the confusion... I need to update my signature. I wanted a hands off homebirth with a midwife, but due to a midwife shortage here, and DH not feeling comfortable with a UC, I'll be hospital birthing with an OB instead. I'm hoping to get there very late in labor (and am ok with having an oops UC, but DH is not), but it is still a planned hospital birth. 

The heplock is something I won't budge on. I'm terrified of needles, as in I hyperventilate and going into pretty bad panic attacks. It's just not something I'm willing to compromise. DH is standing behind me on this, and in an 'emergency' if they need an IV and somehow 'can't get one in' (the usual scare tactic for why they require a heplock), then I'm confident in DH's ability to put one in. But I do hear you on the episiotomy. It's probably something that will get cut once I actually write out the proper birth plan, since you're right, and they don't often do them anymore. 

I definitely need to input c-section preferences. I haven't really even started on that. 

Good point on the cord pulsating. I might change it to simply say that it is not to be cut without prior consent from DH or myself. 

It's going to be an awkward situation since the OB I am starting care with for the first few months will be retiring before the birth, and handing my care over to another OB in the practice. Plus, it's such a big practice, that I really don't know who is going to show up at the birth. So I'm trying to make sure I think of everything that's important to me... and then I'll have to condense it into some form of easy to ready letter for whoever happens to show up for the birth!

[kltroy]

There was a thread a couple years ago on this topic (actually, they come up pretty frequently). It's here:

http://www.mothering.com/community/forum/thread/1112963/birth-plan-conundrum

I commented on this thread, as I will reiterate here, that a key thing you should think about is having someone be a "birth plan reminder" for you.  Docs and hospital staff won't *remember* most of the details on your birth plan, even if they are perfectly happy to follow it, unless someone reminds them WHEN THE TIME COMES.  For example, I wanted to catch my own baby.  Clearly, when I was busy pushing, this was not top of my mind, but as the head was emerging, my mom helpfully said, "Karen, do you still want to catch your baby?".  This was exactly the sort of thing that helped me have a really nice hospital birth -- 3 years ago today!!

[onetwoten]

Yes, exactly! Thank you kltroy. That's pretty much my main focus of the plan... I know the doctors and nurses will glance over it... but I want DH and my doula to be able to know it backwards and forwards, and how important it is to me, and be able to jump in if they see something happening they know I would disagree with. 

I'll check out the thread too. Thank you!

[MegBoz]

Looks good to me - but you might want to also organize chronologically. My doula put mine into a great format of 4 blocks, medication & monitoring, labor, Birth & newborn procedures, & CS. Or something like that. Intro at the top, bullet points in the 4 boxes, all fit on one page - it was an awesome plan!

I like that you put "I do not consent"- I think there IS a time to be direct, blunt, and DECISIVE! No need to always try to be all delicate & tip-toe around with phrasings like "If possible," "I prefer," "I wish" in every case. It's your body & you have a right to blatantly state, "I do not consent."

& I'm super-crazy paranoid about episiotomy, so even though they are becoming increasingly less common, I left that bullet point in and even underlined it! The nationwide rate in the US is still 25%, so they are NOT "rare".

[kltroy]

Ahh - found another birth plan thread, which actually has the plan I used, along with my own thought process and comments about how well it was received.  Lots of good ideas here:

http://www.mothering.com/community/forum/thread/1293177/anyone-want-to-share-their-hospital-vbac-vba2c-birth-plan

Cheers! 

[onetwoten]

- Would like to catch my own baby if possible

-Vaginal exams by request only (some wording about checking myself first... ?)

Want to alter this exert from my doula contract:

• I believe birth is not an illness or a condition, but an amazing, wonderful, exciting event that is normal, natural and healthy.
• I believe pregnancy, labour and birth have a profound effect on women and their families. It is an experience that is never forgotten.
• I believe women intuitively and instinctively know how to give birth. Those caring and supporting them need to trust and respect that inner wisdom.
• I believe women’s confidence and ability to birth is either enhanced or diminished by those who care for her and where she births.
• I believe women have a right to give birth free from routine medical interventions. If interventions become necessary, all information needed to support and understand the intervention, should be provided.
• I believe education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their intuition, instinct and inner wisdom.

Anytime anyone has anything done to them by a physician, there is risk. Even a blood draw.

- Dr. Tim Johnson, U of Michigan