Hospital transfer birth plan

[ltlmrs]

Any ideas of what to put in the transfer plan?  If it's a true emergency requiring an ambulance ride, a birth plan would be furthest from my mind (I want a good birth, but in the end I want a healthy baby!), but I'm thinking of a transfer situation for exhaustion or high BP or something like that where I would still like to try for as low intervention birth as possible, despite a need to transfer.

Also, is there anything special I should include in the "transfer" bag aside from the obvious clothes, toiletries, etc?

TIA!

[XanaduMama]

I don't know...I think if you're transferring, then it's either going to be an emergency (and, like you said, any "plans" are then going to be somewhat irrelevant), or because your existing plan wasn't working (ie, you want/need an epidural for exhaustion, or there's another reason baby's not progressing, or whatever). I'd say that your plan, then, should include the essentials that apply however your birth ends up looking: do you want the eye goop or vitamin k? Circumcision...formula/pacifiers (though IME they won't do either of these without asking)... stuff like that. You should include the possibility that you'll have a c/section--what do you want, specifically, in that case?

I never put together a transfer birth plan, I guess because I felt that if I was transferring, then it meant that all my plans were out the window. Mostly, I'd prep your partner or doula to fight for things like interventions on baby etc, in the (unlikely) event that you can't insist on them yourself. Impress upon your partner the things that you care deeply about, because s/he might not know you need him/her to fight for them. Talk to your MW about what happens if you transfer, and agree upon the things you don't want to compromise on, no matter what. A piece of paper isn't going to make much difference in those circumstances, I feel, but having people speaking up for you really might.

[Comtessa]

I agree with Xanadumama, it's important to have your advocates there if you transfer.  BUT, having a birth plan with a few basics can be VERY helpful.  During my HB transfer, I am convinced that having a birth plan on file -- signed by my OB -- made a sigificant difference in the kind of care I received in the hospital. 

It helped that mine was a non-emergemt transfer for exhaustion/dehydration, so I was still "with it" and able to advocate for myself, too. 

Here's what our transfer birth plan looked like:

Dear hospital staff: We appreciate you being here to support us through the birth of our first child! We have spent a lot of time researching the medical evidence for all of the decisions listed here, and we feel confident in the choices we have made. We thank you for respecting them, especially when they fall outside of “usual” hospital procedure.

We are preparing for a home birth. If we are in the hospital, it is because we require some intervention that was unavailable at home. Therefore, we are very prepared to be flexible on everything listed below if medical necessity arises. Barring a major medical crisis, we ask that you please discuss with us any and all interventions, allowing us the opportunity to give informed consent to any procedure you suggest.

In labor:
• Please offer us the minimal amount of medical intervention necessary for the health and safety of mother and baby. Like most natural birthing couples, we prefer to avoid routine procedures (continuous EFM, IV, epidural or pain relief drugs, Pitocin augmentation, etc.) unless clearly necessary for a safe birth.
Find out if the hospital you're birthing at has a general understanding of natural childbirth - many hospitals will already know the "laundry list" of things that natural-birthers wish to avoid, and will not need you to go down the list. Also, be aware of what is generally obsolete - i.e., if no OB's in your practice ever do episiotomies anymore, it's probably unnecessary to put on your birth plan that you don't want one. Note the language you're using, too - "saline lock" is more accurate language than "hep lock," for example. If you refer to lots of outdated practices in your birth plan, it will seem like you didn't really do your research.

• I am GBS negative and allergic to many antibiotics. Therefore, I do not consent to any antibiotics without evidence of infection. If there is something you feel really strongly about, make sure you put in "I do not consent" - that there looks like legal language, and they're more likely to pay attention to it.

• We request that two or three support people be available in the labor and delivery room with us at all times. This will include up to two doulas and/or our family members. We had to fight for this one, but they gave in because it was on our birth plan and our doc approved it. Don't underestimate the power of a good birth plan!

After the birth:
• The baby should be placed skin-to-skin with its mother immediately. This time is precious to us and we strongly desire that there be no physical separation of mother and baby for at least the first hour after birth. This was way against hospital procedures, but the OB supported us and we managed to get what we wanted.
 

• We will use direct skin contact to maintain the baby’s body temperature rather than a warmer.
 

• Please delay cord clamping until the placenta is delivered, or at least as long as feasible.
 

• Please allow up to an hour for the placenta to be delivered naturally. Please do not rush this process. We request no routine Pitocin for this purpose unless it is clear that breastfeeding is not working to stimulate uterine contractions. I actually asked the nurse to take the Pitocin bag out of the room altogether when I was pushing - which was smart, since when I asked her she insisted, "but you'll definitely need it after the baby is born!" This made it clear to me that she had not read that part of my birth plan - so I was grateful that my DH pointed out to me that it was in there.

For the baby:
 

• The baby is not to leave our room at any time for any non-emergency reason while we are in the hospital. If an emergency arises, one or both parents will follow the baby at all times. Be prepared to fight for this one - the nursery nurses are really good at sailing into your room while you're half-unconscious and saying blithely, "we're just going to take the baby for a minute!"
 

• No Vitamin K shot (unless bruising or birth trauma occurs) I've seen birth plans that just say "ask us about Vitamin K, please."
 

• No Erythromycin eye ointment, please.
 

• No vaccinations are to be given at this time. "at this time" is a good way to not set yourself up for a vaccine lecture (or, depending on the ridiculousness of your state laws, a call to CPS).
 

• No formula or pacifiers at any time, please.
 

• No antibiotics without evidence of infection.
 

• No screening tests of any kind are to be given without our explicit and specific permission.
 

• Please do not bathe the baby. We would like to give our baby its first bath. We recognize that this means you may need to wear gloves while handling the baby; thank you for doing this.

In case of a Cesarean section:
 

• we are not squeamish and would like to be able to watch as the baby is born.
 

• Please place the baby skin-to-skin on mom's chest as quickly as possible after it is born, health permitting. If she is unable to hold the baby, please place baby skin-to-skin with dad.
 

• If the baby must leave the room for emergency reasons, dad will accompany him/her.
 

• We request that the mother have at least one support person in the O.R. and recovery at all times; if the father must leave, please allow another support person to step inside to accompany the mother.
 

For my most recent (planned hospital) birth, I added the following items to the C-section list: requested no sedatives (these can have an amnesiac effect), requesting dual-layer suturing of the incision, requesting sutures rather than staples to close the incision, and requesting that the doctor "narrate" what is happening during the procedure so we were included. 

Thank you for taking good care of us and our baby!
We appreciate your support and care.

Signed:
____________________________ mom
____________________________ dad

Approved by:
____________________________ obstetrician We found it particularly helpful that our OB signed on to this ahead of time - it was already in the hospital computer system with his signature on it when we got to the hospital. This meant that it was taken more seriously - his signature on the document made it a "prescription" for a better birth. Don't hesitate to bully your OB into signing this, giving you the original, and putting a SIGNED copy into your file at the hospital.


Incidentally, there are 2 other things I would have put in my birth plan (in hindsight): 1) I would have specified that I wanted someone to take photographs during the birth, so I didn't have to do battle with the nurses to get a camera into the L&D room while I was pushing, and 2) I would have indicated that DH wanted to announce the gender of the baby.

As for packing your transfer bag, here's my recommendations:

nice, smelly lotions and soaps that make you feel a little pampered -- I was feeling really bummed about being in the hospital after my transfer, and having a bunch of essential oils, nice-smelling lotions, and yummy shampoo at hand was a really nice pick-me-up.  Especially because everything in the hospital smells like disinfectant!  It was nice to be the exception to that rule. 

You may also want to bring more frivolous things like a nail file, hair bands/clips and brush, makeup, razor, hairspray, jewelry, and perfume.  It helps you feel less like a 'patient.'  So do comfy clothes (rather than jammies) and shoes (rather than slippers).  You'll want to bring maternity clothes 'cause you'll still have a six-month (or so) belly after your birth -- so don't pack pre-pregnancy clothes, they won't fit yet! 

I would have liked having clothes that I could wear to birth in AT the hospital, since I absolutely refused to put on the hospital gown.  (My MW says, "put on the costume, play the part!") I ended up half-naked rather than wearing the gown.  A good birthing skirt would have been a nice thing to have, for modesty's sake (not that most of us are overly concerned about modesty when we're in the throes of labor). 

Don't forget to pack things for your partner!  I was totally prepared for myself, but neither of us ever thought to pack things for him.  So he was calling his sister at 6 in the morning to beg her to go to our house and pick up his toothbrush, phone charger, and a change of clothes.

Snacks are a good idea.  Bring oranges or some other nice juicy fruit; stuff with lots of fiber is very smart.  Something salty/crunchy.  And your favorite juices or sodas; I got sick to death of sugary apple juice and Pepsi at the hospital.  Yeughh. 

Change for vending machines. 

Clothes for the baby, some special soft blankets, and a bunting or something to bundle your LO up to get her/him home in cold weather. I also packed a special hat that I'd made. 

Not in the transfer bag, but along the same lines: install your baby's car seat in your car right away and make sure it's installed correctly.  Just a good thing to have taken care of 'just in case.'  Homebirthers don't always think of this 'cause we aren't planning to drive the baby anywhere right away... but you don't want to be trying to install your car seat for the first time in the hospital parking lot.  Trust me, we've done it.  :) 

If your transfer hospital has registration paperwork available to pick up from L&D, or online, it's a good idea to have this filled out ahead of time.  It only takes a couple of minutes, and it keeps you from having to do it when you get there.  (I also made sure I read it carefully and 'edited' the consent form slightly.) I was a non-emergent transfer, and I would have had to sit around filling out paperwork if I hadn't had it all with me already.  On my early-labor list of things to do, I included "put driver's license and insurance card in transfer bag" as well, and I'm really glad I had it all together when I got there.

Another good piece of paper to bring is a sign to put on the baby's bassinet listing things you absolutely do not want for your baby.  It's a bit in-your-face, but it's harder to ignore than a birth plan, when it comes down to it.  I think ours said something like, "Thank you for taking good care of me!  Please do NOT: circumcise me, give me a bath, give me any formula or pacifiers, or stick me with any needles without one of my parents present."  (I should have added, "do NOT take me out of my mother's room when she is sleeping."  Talk about an instant heart attack situation!) 

And don't forget to bring a few extra copies of a transfer birth plan!  I made sure I kept the original, signed version with my OB's signature at the bottom, just in case the one on file had gotten "lost." 

Sending you lots of good wishes for a peaceful home birth without  a transfer!!! :) 

[ltlmrs]

Wow, these are both so incredibly helpful!  Thank you!!!!

[ltlmrs]

This post is a gold mine, but the stuff about the c-section is especially helpful.  I hadn't even thought through what a c-section would be like and the fact that there may even be options that would allow us to at least keep some control and mitigate some of the negative effects.

We will definitely be getting the OB to sign off on this.  Our hospitals are getting better as far as natural birth, but we definitely don't live in a friendly NB area.  With our first birth, having the OB and pediatrician signature on the plan really made things so much easier, we were taken so much more seriously than some friends who delivered at the same time in the same hospital but who did not have signatures on their plans and ended up having to fight over every single little thing with the nursing staff.
 

Originally Posted by Comtessa 
In case of a Cesarean section:

 

• we are not squeamish and would like to be able to watch as the baby is born.
 

• Please place the baby skin-to-skin on mom's chest as quickly as possible after it is born, health permitting. If she is unable to hold the baby, please place baby skin-to-skin with dad.
 

• If the baby must leave the room for emergency reasons, dad will accompany him/her.
 

• We request that the mother have at least one support person in the O.R. and recovery at all times; if the father must leave, please allow another support person to step inside to accompany the mother.
 

For my most recent (planned hospital) birth, I added the following items to the C-section list: requested no sedatives (these can have an amnesiac effect), requesting dual-layer suturing of the incision, requesting sutures rather than staples to close the incision, and requesting that the doctor "narrate" what is happening during the procedure so we were included. 

[cat13]

Comtessa, thank you for sharing this! I am going to my last OB shadow-care appointment in 2 weeks and I didn't even think about having this prepared beforehand to have him sign & put in my folder.