Birth plans? « Back to Group Discussions

[bjacques]

(I searched for a birth plan thread and didn't find one... forgive me if I'm repeating something that's already been addressed.)

Since this is our 5th delivery, I'm going very simple.  My first was an emergency c-section, second was a VBAC, third a scheduled c-section (they let me go 11 days late, but I never went into labor), fourth was a VBAC, and this one will be a scheduled c-section (blah).  It's worth pointing out that I've had a baby in LA and a baby in Boston... and now we live in this bodunk little town in Central Pennsylvania.  The fact that I'm nursing and not having him circumcised makes us a bunch of crazy hippies.  There will be some nurses who see this and disregard it as new age and silly.  That's why I'm going so basic.  So here's my very basic birth plan... what am I forgetting?  

C-section and Recovery Plan for the Child of Barbara and David.

This is our fifth child.  We understand anything we “plan” is flexible and our ultimate goal is for our child to be healthy at all cost.  We appreciate the time you’ve taken to read this and your understanding in regards to any anxiety we may deal with.

Drug Allergies:  Penicillin, Codeine, Compazine, Sulfa 

Delivery:  C-section performed by Dr. L.  If Dr. L is not available, I would like to talk with the doctor who will be performing the c-section prior to being in the OR.    

Medication:  Pain medication is very welcome.  Anti-anxiety medication may be a good idea, too.  The last time I was in Labor & Deliver we struggled to deliver our son, who had died in utero.  I may be prone to feeling very anxious while in the hospital. 

In OR:  David’s primary concern should be the baby once he’s delivered.  If the baby needs to go to the NICU for any reason, please be sure David goes with him.  

I have no desire to see any part of the delivery process.  No photos until the baby is clean and safely bundled up.  No photos of anything medical that may upset my older children.  Unless it’s absolutely necessary, please don’t tell me what’s happening.  In fact, the less I know about what’s going on with my own health, the better off we all are.  Dr. L is quite versed in my ‘less is more’ preference.  

The oxygen tends to blow in my eyes.  Please help me adjust it so that doesn’t happen.

Please tell me as soon as possible that the baby is healthy.  I don’t need to see him immediately, but please reassure me and let me hear him cry.  

Feeding:  We understand blood sugars may be an issue.  It is our strong preference that this baby be breastfed.  A bottle should be used only if I am unable to nurse and blood sugars are a concern.

Please do not use pacifiers until breastfeeding has been successfully established.  

Circumcision:  Under NO circumstances is our child to be circumcised.  

[NewMumJoy]

Perfect timing!  I'm working on my birth plan this week to show a draft to my doc at next week's appointment...... I've found other threads on MDC but I don't think we have one in our DDC yet, so thanks for getting this started and sharing yours (I think it looks great!)

Here are the main points in my draft so far.  There are a few details that I still need to research a bit more..... Ours is very specific as we're new to this province and know very little about the hospital's procedures and practices - so we're spelling out all our wishes.  I'm sure my doc will alleviate most of my concerns next week when we review it together.  

LABOR

• My husband Josh and my doula Linda T. will be present through the duration of labor/birth.
• We plan to labor at home as long as possible.
• We wish to create a comfortable atmosphere with the use of aromatherapy, low lighting, music, and the door closed for privacy.  Please limit number of staff/students in the room as much as possible.
• We would like labor/birth to be attended by nursing staff who are experienced with natural birth (medication free) birthing techniques.
• Intermittent Fetal Monitoring is preferred - please limit the use of EFM unless medically needed.
• If I need to have an IV, please use a heparin/saline lock so that I can retain mobility.
• We wish to employ natural pain management techniques (such as showers, hot/cold cloths, birth balls, massage, counter pressure, breathing, movement, walking).  Please do not offer any pain medications to me unless I explicitly ask for them.
• Please allow me full range of mobility to try various labor positions and pain relief options.
• I wish to be able to eat and drink as desired (unless there are medical complications that would deem it unsafe).
• Please do not artificially augment labor (no pitocin, or stripping of membranes) unless medically necessary.  Please allow amniotic sac to rupture naturally.
   

BIRTH

• I would like to be able to view Baby’s birth with a mirror if possible, and be allowed to touch my baby’s head as it crowns.

• I would like to try to wait until I feel the urge to push (if no complications); please allow me to push at will, unless medically necessary.

• I would appreciate guidance in when to push and stop to allow the perineum to stretch.  Please employ any methods to keep my perineum intact and avoid an episiotomy, and discuss those methods with me.  [SHOULD I ACTUALLY OPT FOR TEARING?]

• [ARE THERE BENEFITS TO WAIT FOR PLACENTA, NO PULLING??]

POSTPARTUM

• I would like immediate skin to skin contact with the Baby.  Please delay the cord clamping, and allow Josh to cut the cord.   [USE BLANKET OVER BOTH OF US, INSTEAD OF HAT ON BABY?]
• Evaluations and bathing should be done in-room; please inform us of all exams and procedures and delay them as long as possible, to allow bonding.
• OK with Vitamin K, PKU test
• Erythromycin in eyes [NOT SURE YET?]
• Please consult us before administering any additional medicines, vaccinations or injections.
• It’s a boy!  Please NO circumcision.
• Baby is to stay with us at all times; if moved to nursery, we (or at least Josh) will accompany him.
• We wish to breastfeed only.  Please do not give Baby any formula, bottles or pacifiers.
• I would like to meet with a lactation consultant to help me breastfeed effectively.
• If Baby is in distress and must be taken for further medical treatment, please allow Josh to accompany him at all times.

IN THE EVENT OF A C-SECTION

• Please allow Josh to be present during the procedure.
• Please place Baby immediately upon my chest (or make skin to skin contact) and let him remain there as long as possible.
• If skin to skin contact not possible with me, then please place Baby with Josh for skin to skin contact.
• Please allow breastfeeding to take place as early and as often as possible.
• Evaluations and bathing should be done in-room if possible (and please delay to allow time for bonding); Josh is to accompany Baby at all times if he must leave the room.
• [NEED TO RESEARCH PAIN MEDS - I’ve had nausea reactions to painkillers such as percocet and vicodin....]
• [NEED TO RESEARCH SUTURING - what heals the best? scars the least? safest?]

[LilyTiger]

NewMumJoy, yours looks a lot like mine.  A few things you might want to add/consider:

- do you want to wait until the cord stops pulsing before they cut it?  You might want to specify how long of a delay you'd like.

- Your baby doesn't have to have a bath at all.  They can just wipe it down.  I get freaked about the crazy chemicals in whatever soap they use, so we'll just be rubbing the vernix in.  Totally personal choice, but you might want to make it clear if it matters to you.

For your questions....

- My understanding on pulling to get the placenta out is that it can (in rare cases) lead to bleeding and other complications.  We're going to just let it come naturally (assuming I have a vaginal birth).

- And my understanding (again, someone please correct me if I'm wrong) is that tearing is better than an episiotomy in terms of recovery period and so on, so you might want to just decline any cutting at all.  My doc says she doesn't even remember the last time she did an episiot., so they are definitely not medically necessary. 

Looks good though!  Again, our birth plans are pretty similar.  I also haven't done the research yet on the erythromyacin and some of the other more specific stuff.  I'm going to sit down with my doc for a play-by-play of everything that might be done and see what she says about it all.  Everything I've said above is a result of just reading various books, MDC, and my Bradley classes, so there's still a lot to learn.  Hopefully more knowledgeable moms can add or correct anything I threw in there.

AFM, mine really looks a lot like the above....  My major emphasis is being able to move around.  I do not handle pain well if I feel constricted or unable to move (in fact, I get claustrophobic and freak out), so movement is really really important to me.  Most of my birth plan is built around that fact.  I'm excited to see what other moms and moms-to-be have come up with!

[bjacques]

Just something I've picked up along the way - keep your plan short and to the point.  If the nurses have to flip to a second page, generally they won't.  I remember my first birth plan was like a text book when I wrote it 16 years ago.  Luckily the doctor asked to see it at my 36 week check up and we quickly edited it down to one page.  I've also been told that it helps to have two versions - the abridged and the unabridged.  If you end up with a very busy day at L&D, you have your down and dirty plan on hand for your busy nurses.  If it's a calm and quiet day, your longer version can be handed over and discussed as time allows.  

Because my last baby died, I've really evaluated what's important to me... and what's important is that this baby comes home with me.  It's amazing how much our loss has changed me and how different I feel about the birth process.  In the whole scheme of things, it's a short period of time and walking through my front door with a wailing newborn is what's important.  Had you asked me 15 or 12 or 8 years ago, I would have been all about the atmosphere and the music and the details.  I envy anyone who can include those details... I wish I could still focus on that.  

[sallyrae17]

I actually got a little packet with a checklist in it for the birth plan at my doctor's office. It came in a folder of information for expecting parents. It actually covers every single detail that I'd want covered. It makes me love my doctor even more. As for the eye goop, I don't do it and I also tell them to not bathe my baby. My son didn't get a bath after he was born and the nurses had to put on gloves every time they touched him, which annoyed them to no end, but I didn't care in the least. He was MY baby, not theirs. :)

bjacques - I feel you on things being different this time around. I've never lost a baby like you have, but I definitely had to deal with how my birth went last time. In the end, all that matters is a healthy baby and a healthy mama. End of story.

[LilyTiger]

I'm planning on doing two birth plans - a one-pager for the nurses and then a detailed one for DH and my doc.  It's not that I don't trust DH exactly, but he's not really as informed about some of this stuff (nor do I really think he will be by the birth), so while he's supportive, I'd like to give him some ammo he can use (in terms of why we've made certain decisions) if I'm out of it (which I expect to be).

bjacques, I can't even imagine what you went through losing a baby, but it's obviously important to remember that the most important thing of all is healthy baby/healthy mom at the end of the day. 

[NewMumJoy]

Thanks for the input ladies!  Yes, I am leaning towards "letting it tear" and I plan to bring my own soap for the 1st bath (although I have heard that bathing can lower baby's body temp so we may ultimately skip it).  With the delayed cord clamping, I've heard about risks of jaundice as too much time passes, so some additional reading and discussion w/my doctor will be helpful.  The vaccine issues (such as HepB) are taking the longest for me to consider as we'll be moving to a large city (which means lots of time on subways, w/crowds, etc..) and we both travel quite frequently (exposed to and bringing home germs, etc), so I'm still weighing the risks/benefits....

bjacques - I totally understand where you're coming from (and hugs to you!!)  The whole point of having a birth plan is to address our unique and individual needs to our caretakers, because we are all approaching birth with different experience, concerns and priorities, .  After what you've been through, reading your birth plan makes perfect sense to me.  In my case, as a first-time mom, you're correct that I have that luxury of fresh hope, mapping out the perfect scenario, rather than recovering from a traumatic experience.  And as soon as I am holding my healthy son in my arms I'll probably be saying "... what birth plan??"

[rebecca10]

Bjacques, I think your birth plan looks great and helpfully focused on your particular needs of which the nurses are unlikely to be aware.  The one thing I thought of is whether you have any specific preferences for things like Vitamin K or the Hep B vaccine. If you do, you might want to mention it. BTW, oddly enough we have exactly the same alleries ;) 

NewMumJoy--yours looks great too.  One thing that caught my attention--not pushing until you feel the urge to push.  This is probably really good advice for 99% of people who have non-medicated births. But I happened to fall into the 1%-despite having no pain meds or epidurals, I never developed an urge to push.  My pain just got worse and worse, and finally someone check me and realized I was at 10 cm, and told me to start pushing. It was immediate relief, and apparently my daughter was perfectly ready, since for a first time birth she came out extremely fast once I started pushing. Which is not to say that you should take it not being told to push out of the birth plan--like I said it's probably a really good initial plan. But like all this stuff, you might want to be wiling to reevaluate in the moment. Re the not articially augmenting labor, personally, having been through it once, I might consider adding something along the lines of. "Absent a medical emergency in which there is no time, please consult with my and/or my husband before any such action is taken, and if pitocin is given, before every increase of dosage." I really think the only reason I was able to have a unmedicated birth despite the pitocin was that I (a) made them delay for 12 hours from when they first wanted to give it to me, and then only let them increase the dosage more slowly than normal.  And regardless, feeling like I was in control over the decisions was enormously important for my birthing experience.  Anyway, just something to consider. 

AFM, I haven't done one yet, but will use the hospital's form like I did last time, since they apparently pay a lot more attention to it that way, and keep it pretty short.  I think for me the things that will be most important to include are not asking if I want pain medications, what I just said about the pitocin, not giving Hep B right at birth (although we will get it before we leave the hospital at around 24 hours because my husband insists), and as I learned the hard way last time, no nurses wearing perfume, since I am highly allergic.And the typical breastfeeding only; we want to stay with the baby sort of stuff--but that's pretty standard at the hospital I'll be delivering at.  I also have to figure out what I'm going to do if I'm Step B positive, since I really don't want to catch c. diff from the clindamycin again. And I never gave adequate thought to what if I had a c-section, so I really need to do that, especially since I have very bad reactions to most narcotics, so I really want to limit those if possible.

[Lizbiz]

This is great stuff to consider... 

My two cents on some of it: 

I've never bathed my babies right after the birth - not until a few days later.  The vernix just rubs in and the babies wipe down with blankets quite nicely.  They are not smelly/bloody at all.  I've always just thought that with how much the little babe's been through with the birth, I'd just skip pouring water/soap on them so soon after that.  

I've heard that using traction to pull the placenta out can cause both increased bleeding and possibly the increased chance that some part of it gets left behind, which can lead to further bleeding and infection.  A lot of hospitals (from what I've heard) give women a shot of pitocin and then use traction to get the placenta to move out faster.  My own placentas have come out naturally about 20-25 minutes after the birth, from what I remember.  

I think letting it tear can be a good approach - but in certain circumstances - I'd probably go for the episiotomy (like if the baby is really coming out in a tough position and is for sure going to tear you significantly - I might want to control where you are cut/tear).  One thing I've done to avoid tearing altogether: I push slowly and have someone (husband or midwife) massage my perineum with olive oil and hot clothes to naturally give that area more stretch.  I've also never had anyone 'help' pull the baby out - I push the baby out slowly, on my own, and my husband or midwife catches. 

As for Hep B - I live in China - Hep B paradise - and we waited on the Hep B shot until the first round of vaccinations.  If we were in the US - I don't think we'd do it.  Something to look into - I know this (along with all of these things) is a really personal choice and there aren't necessarily 'right' answers.  Just good to have dif't perspectives.  

[KristyDi]

Since I'm changing providers and hospitals I'm not doing a formal birth plan yet.  I figure I'll tailor it based on what I learn about the procedures of both MW/OB and hospital I end up at.  But I have been thinking about it.  I see the value in keeping the plan you hand to the nurses during labor as short and to the point as possible.  They have neither the time nor the inclination to read an essay for each patient.  Bullet points of the really important stuff is how I plan to go. And I plan on discussing stuff in more detail with my Dr/MW in visits before labor day

Mobility is really important to me so I'll have a bullet point about limited and intermittent EFM as well as a hep-lock.  One of the worst things i remember about my last labor was the feeling of being literally tied to the bed.

I'd rather tear than be cut.  I had a 2nd degree tear last time and it honestly barely hurt.  The hemorrhoids were more painful than the tear.  I figure you'll tear just till the pressure is off and baby is out.  The dr. is guessing how long the cut needs to be.

I'll be declining the bath.  I remember being really seriously annoyed at the nurse bathing DD last time.  She's over there trying to get every last bit of vernix out of DD's hair while DD is crying and I'm laying there thinking "Give me my freaking baby!  I don't care if shes waxy!"  It wasn't that the nurse was rough or anything, I just really wanted to be holding DD.  On top of that, we later realized that the Johnson's and Johnson's baby soap caused her skin to get irritated.

I'll also ask that the cord clamping be delayed this time.

I may also discuss with my provider about having a person, rather than the machine take my BP.  I remember last time the cuff really hurting after a while and my arm was sore for a few days after the birth where the cuff was.  I told the nurses several times that the cuff really hurt, but was kind of ignored.

[1stTimeMama4-4-10]

For our first, we drafted a ridiculous five page birth plan.  Then, when realized that we really needed it because we did not trust our care providers, we switched.  We chose to switch to a birth center (we transferred to the hospital during labor due to a prolonged labor without progression and a desperate need for pain medication so I could sleep). We decided to skip the birth plan altogether because our midwives were 100% aligned with what we wanted (we talked about our plans at length pretty much every visit) and we knew that if we ended up at the hospital, most of it was out of our hands for a reason, so we would trust in our midwives to advocate as much as possible for our wishes at that point.  It worked out perfectly and we will probably do the same this time. The hospital did not do ONE single thing against our wishes and no one did anything at all unless we specifically instructed them to or it was absolutely medically necessary. All of our wishes were followed - no episiotomy, DH caught our daughter, immediate skin to skin with NO bath, no vaccines/eye goop, it was fantastic. 

That is NOT to say that you shouldn't have a birth plan, I only bring it up because I switched at 28 weeks last time and the difference was night and day.  I am a type A control freak, and I found that I trusted my midwives so much that I didn't even need a birth plan.  That's amazing for me.  So if you find that you need a birth plan because you don't trust your care provider to look out for you or advocate for your wishes, you may want to consider switching practices. If you are birthing in a hospital, there will be nursing staff you don't meet ahead of time and I think a birth plan is necessary in that case no matter who your care provider is. 

[ithappened]

In the whole scheme of things, it's a short period of time and walking through my front door with a wailing newborn is what's important.  Had you asked me 15 or 12 or 8 years ago, I would have been all about the atmosphere and the music and the details.

This is pretty much me in a nutshell this time around- - After experiencing a birth here before, their 'normal' expectations here line up with mine- they have a tub at the hospital, balls, I can walk during labor, skin to skin contact and breastfeeding is the norm not exception..  I think if I was in a radically conservative area some demands would be made however :)

[LilyTiger]

Originally Posted by 1stTimeMama4-4-10 
 If you are birthing in a hospital, there will be nursing staff you don't meet ahead of time and I think a birth plan is necessary in that case no matter who your care provider is. 

This is right on, for me at least.  We have a fantastic doctor who is 100% on board with everything we're doing, but there are no birth centers in our area and our doc told us that the hospital nurses are really hit or miss in terms of natural births and so on, so she highly recommends a birth plan for that reason.  It really depends so much on your particular situation, your doctor, and what facilities are available in your area.  My friend who birthed at the same hospital I will 6 months ago had an amazing nurse who really pushed her through a terrible back labor.  The doctor on call from her practice basically said that if that nurse hadn't been there, my friend would have had a C-section.  So there is an element of luck involved too.

[Ninetales]

I haven't written mine up yet, but my doula gave me a nice little checklist which appears to cover just about everything.  My doctor mentioned in the past about writing up a birth plan so we'll see what she says tomorrow. 

I also plan to keep it fairly basic.  The most important things to me are freedom of movement, immediate skin-to-skin contact/delayed procedures, no separation of baby from at least one parent, and minimal baby care procedures.  If I'm expecting a very big baby I know if I want a vaginal birth I need to be able to move around and push in something other than lithotomy postion.  This also pretty much addresses monitoring and the hep lock (which is such a dumb compromise, you can't tell me these nurses don't know how to do an emergency IV).  I am ok with making some compromises in the labor part so long as I can have my way as far as postpartum.

Delayed cord cutting, preferably until it stops pulsing but we'll see how that goes, and skin to skin is very important to me.  I got no skin to skin with Elsa - I didn't even get to hold her until the next day.  And that's the other thing - if they find a reason to take this baby for "observation" that they can't do in recovery with me, I'm going to insist J go with the baby.  I refuse Hep B and the eye crap but honestly, I wonder often if they did it anyway, because how would I know?  Plus I'm terrified they'll circumcise him even though I will not consent to it and make it clear that it is not to be done.  If he has to be separated from me I want that peace of mind.

[NewMumJoy]

It's great to hear all your comments and opinions on these details to be pondered!  Unfortunately I don't have the "warm and fuzzy" good feeling about my doctor or the hospital, but we had very little choice in the matter.  It was either move back to Chicago or stick it out and hope for the best here (we chose the latter and I AM glad to not packing/moving right now!)  That's why we hired a doula and I feel that she'll be our best advocate - she'll be paying close attention to our birth plan and speaking up for us when needed (in case I'm too tired/nervous/pre-occupied to do so myself).

[intime0]

The eye "goop" is actually an archaic practice and totally unnecessary (erythromycin) in my opinion.  It protects the eyes from VD. How many of you have that? How many of you are worried about having it?  That first hour the baby will be the most alert it will be again for a few weeks and you can establish eye contact during that time. But with the eye gel, it blurs their vision and makes it harder for them.  Do research it, of course, don't take my word. LOL.  But for me, it's a no brainer.  I love looking into baby's eyes! 

Here is a small article from Mothering...look at teh bottom and it continues on page 2.  http://mothering.com/pregnancy-birth/newborn-decisions

[1stTimeMama4-4-10]

Originally Posted by intime0 

The eye "goop" is actually an archaic practice and totally unnecessary (erythromycin) in my opinion.  It protects the eyes from VD. How many of you have that? How many of you are worried about having it?  That first hour the baby will be the most alert it will be again for a few weeks and you can establish eye contact during that time. But with the eye gel, it blurs their vision and makes it harder for them.  Do research it, of course, don't take my word. LOL.  But for me, it's a no brainer.  I love looking into baby's eyes! 

Here is a small article from Mothering...look at teh bottom and it continues on page 2.  http://mothering.com/pregnancy-birth/newborn-decisions

I agree 100%.  I know I don't have any sexually transmitted diseases partly because I've been tested twice during pregnancy!!!  So I'm not worried at all about eye infections.  I want my newborn to have full use of all of her senses immediately after birth so that she has an opportunity to look at me - her range of vision is only 6" - 12" guess what just happens to be 6"-12" away from her face?  My face!! I think we mess with mother nature far too often, and this is one that has no benefit in my opinion, at least not for women who have absolutely NO risk of transmitting a venereal disease to their newborn through the vaginal canal. 

[LilyTiger]

We'll probably do the eye goop because both DH and I were sexually active with other partners before we met and because some STDs are very tricky to test for.  I'll do more research though and ask our Bradley instructor what research she has on the issue. 

It's good to get all these perspectives!

[eleuthia]

Is the eye goop only for gonorrhea and chlamydia? Or are there other risky bacterial infections it would treat? I know I will want to at least delay it for an hour or til we've breastfed at least once.

[intime0]

It only protects against VD. If you are at a risk for something like that, then by all means, you should get the drops.  But if you read that article, they say you can easily treat the condition if it develops.  It's like a vaccine basically.  Do you take the risk that they can get it and then treat IF they do.  Or do you just vaccinate against it now so you don't have to worry about it.