Twin Birth Plan

[Adaline'sMama]

Please review this for me, and give me any advice on wording, errors, and order as well as anything I might have missed. Note that it breaks into two pages. The first page is for non-emergency situations, and the second page is for emergency situations. 

"Last Name" Twin Birth Plan

We have been doing everything we can to have the healthiest possible pregnancy and minimize the

risks associated with multiple pregnancy. However, we recognize that multiple pregnancy, labor and birth entail more risk than single-infant pregnancy and birth. We understand the need for flexibility during labor, birth and postpartum, and we know that a healthy outcome for the babies and Mom is the main goal. Our doula and LC, name here, will be present with us for labor and recovery.

Normal, spontaneous vaginal birth

• No IV fluids unless Strep B positive. Heplock placed upon arrival please.

• No epidural, see emergency Cesarean plan below

• Please allow for natural progression of labor

• We prefer intermittent, portable FHR monitoring

• Minimal vaginal examinations

• Please allow for freedom of movement in labor

• Please do not ask if Mom requires pain relief- she will let you know

• Mom prefers to push from the squat bar, at her own pace

• No episoitomy

• Dad would like to cut both umbilical cords

Afterbirth, pending no emergency medical assistance is required

• Please place Baby A on Mom's abdomen, unwrapped with blanket over her back until labor continues

• While Baby B is being delivered, our doula will hold Baby A to allow Dad free hands to cut B's cord

• Please allow for natural delivery of placenta, which will be saved for examination

• All testing and shots are to be done while Mom, Dad or doula is holding babies

• Mom and Dad will take care of infant baths

• We decline the infant eye ointment and the Hepatitis B vaccine

• Please use local anesthetic for stitching

• We prefer no bottles or pacifiers without our request

• Ultrasound identifies both babies as girls, but if any baby is male we request

  NO CIRCUMCISION

Non-emergency Cesarean

-Dad is to stay with Mom at all times

-Spinal is preferable form of anesthetic

-If catheter is to be placed, please place after the spinal

-Please lower the drape as each baby is born

-Please free one hand after both babies have been born so that Mom can touch each baby before recovery begins

-Please use a horizontal incision and double-layered suture to prevent problems with future births.

Emergency Cesarean

- General Anesthesia in the dosage that will allow for minimal time unconscious to allow for breastfeeding as soon as possible

-Dad is to remain with babies, not with Mom

-Please allow our doula to return to Mom if Dad has to leave to remain with babies

-If one baby is required to go to the NICU and one baby is not, please allow the baby that is not with Dad in the NICU to be in Kangaroo Care with our doula until Mom is no longer unconscious.

NICU

-No matter what situation arises during any baby’s NICU stay, we expect to be part of any discussion of, and to give permission for, any medical intervention being considered for our children.

-Please understand that we lost our son to SIDS in 2012 and that we need as much information as possible about the state of our babies.

-We intend to begin pumping to induce lactation as soon as possible, so thank you in advance for Kosiar's excellent pumping facilities. 

[Chloe'sMama]

not a mom of multiples, but seems like a very good birth plan.  All bases covered and very clear about wishes.  

Is there any need for specifics about rooming after the birth if NICU is not needed?

[Adaline'sMama]

Thanks!

No, both hospitals have rooming in. They dont really even use the nursery anymore. The rooms are set up for the babies to be in the room with mom. 

[Brambleberry]

Looks great!  I was just thinking about the issue of eating/drinking during labor.  I labored at home with DD until the point where I didn't have any interest in eating by the time I got to the hospital, but I was glad I had specified that I wanted to be able to drink during labor.  If I end up having to birth an hour from home this time I won't be able to labor at home as long and will definitely want to be allowed to eat.  We'll have to see if I can get it okayed since everyone seems so stressed out about twins being higher risk.

[Adaline'sMama]

Hmm...I didnt think about eating/drinking in labor because I just assumed that I'd do it anyway if I want it. I mean, how are they going to stop me from my water? But, then you might be right because I didnt think about the fact that there will likely be more staff in and out of my room watching over us. Maybe I should add that, or maybe Ill just do it anyway. Last time, Dh had water on him the whole time and he gave me sips whenever he had sips, so I hadnt even thought of it. But, if aspiration is the risk, this IS the highest risk Ive ever been at (as in, I may follow the no eating/drinking rule since I am at a higher risk of emergency c section than before). 

[katelove]

I'd suggest being a bit more specific than just saying "minimal VEs". Their idea of the minimum number and yours may be very different. Do you know what the standard policy is at the hospital? For example, at the hospital where I work and have babies the policy is for a VE on arrival to confirm active labour, then one every 4hrs during first stage and every 2hrs in second stage. That would be what the staff considered the minimum number as we would do additional ones in various different circumstances.

[Adaline'sMama]

Good point. Since my last birth was so short, I've forgotten what it's like to be at the hospital early enough for them to be requesting them. Maybe I should change it to "vaginal exams upon request only".

[tropicofwinter]

Looks really good!  Only things I noticed were the misspelling of episiotomy near the top, and maybe put a (s) at the end of placenta.  I'm astonished at how often I hear about ultrasounds not correctly predicting whether there is one or two placentas in multiples. Only other topic that you two might address is wanting to delay cord clamping or donate/save cord blood.  I wish smooth sailing for your birth.

[Adaline'sMama]

We do have two placentas! Good call :)

[withlittlelungs]

Thank you so much for posting this! It is going to be so helpful when I get mine together

[Quinalla]

Looks good, thanks for posting it, I will probably use this as a guide when discussing birth options with my OB as this matches up nicely with what I would like. I did have an IV last time (for about 30 minutes at most) and wanted to forgo it this time, but I figure since it honestly didn't bother me it might be something I am willing to give in on to make them feel better. I need to remember to talk about VE too, I only had two at the hospital last time as I waited until well into active labor (I'm pretty sure I was in transition in the car) to go, one at check in and one at my request as I thought I was complete (I was, in your face doubting nurses the panic was very funny in retrospect as I had just gotten to the delivery room) but I may need to get there earlier for various reasons, so I should think about these things a bit differently this time.

[Adaline'sMama]

Right, it's hard to know what to expect when you birthed immediately after you got to the hosptial last time. Things were totally different with DD/DS just because of the amount of time I spent in the room. I guess its probably safe to assume it wont take as long as my first birth, but maybe longer than three hours!

[mamacolleen]

It looks great. Thanks for posting, as it's a good reminder to me of the few things I haven't yet discussed with my midwife or OB.

One thing I didn't notice (and I'm not sure if you're doing this or not) is anything about taking the placenta(s) home with you. If that's something you're planning to do, you may want to mention it ahead of time. I know at our hospital with DD, we had to sign some consent form so they would release it to us. Just a thought...

[Adaline'sMama]

I havent decided whether or not to take my placentas home this time. My doula (who will be present) encapsulated my placenta last time, and I never really got around to using it after Charlie was born, and then when he passed I was trying to get milk to go away so I didnt take them, and then I got pregnant immediately, so they're still in my fridge :) I was planning on taking them after the twins were born (I have 90-ish capsules). So, I dont know if Ill need two more!

Maybe I should ask the l&d admins about it taking them home. 

This birth plan is really for the big city hospital, which if all goes well, I wont deliver at. My OB suggested I write it, but she and I have discussed this birth in length, and we're on the same page (plus, Im the only crazy-ass girl who comes into the rural hospital denying all forms of medical treatment and wanting to do gross stuff like eat my placenta, so they are pretty familiar with me there- plus these will be my 3&4th deliveries there in under 3 years. They are cool with me taking my placenta home). 

What do you guys think about the fact that Im not going to the mfm clinic anymore unless something is wrong and the last time I spoke with the doctor there, I was told that an epidural was required? So, if I have to go to this hospital, I think they are going to assume Im getting it when I walk in to the door. Should I just mail them this plan, or do I have to make another mfm appointment just to go over this with them, even though I know they are pretty much going to disagree with all of it?

[Adaline'sMama]

I just wanted to bump this up to see if I could get any last minute opinions or additions. Im going to try and print it out this weekend and take it in on Monday. 

Anyone who knows about hospital policies, does this make sense to you, and if so is there something I need to do other than just putting it in my birth plan to make sure this happens. Im scared of me having a c-section due to problems and 1 baby going to nicu with dad and then one baby being totally fine but being with the nurses and not getting kangaroo care (and potentially getting eye ointment, etc. Is there some formal way to designate my doula as the person in charge of the baby who isnt in the NICU until I am awake? This may be something I could ask in the csection forum too:

"If one baby is required to go to the NICU and one baby is not, please allow the baby that is not with Dad in the NICU to be in Kangaroo Care with our doula until Mom is no longer unconscious."

[Emelee]

I just wanted to say that unless you want to hand Baby A over, maybe you could hold her and push Baby B out if you want. They told me that I'd have to pass Baby A off while delivering Baby B but I just kinda... held on to her . Also, it sounds like you'll be at a smaller hospital than I was so perhaps they'll know you better but be sure to have your DH on board with watching what's going on because every time I wasn't actively watching the doctors and nurses after the birth (you know, actually admiring my new babies), someone would shove a hand in there and pull out placentas and clots without telling or asking me. Ugh.

I wish you the best of luck with your birth and I hope everything goes as you hope! My labor was actually a lot more relaxed than I thought it would be so hopefully yours will be as well.

[Quinalla]

Originally Posted by Adaline'sMama 

I just wanted to bump this up to see if I could get any last minute opinions or additions. Im going to try and print it out this weekend and take it in on Monday. 

Anyone who knows about hospital policies, does this make sense to you, and if so is there something I need to do other than just putting it in my birth plan to make sure this happens. Im scared of me having a c-section due to problems and 1 baby going to nicu with dad and then one baby being totally fine but being with the nurses and not getting kangaroo care (and potentially getting eye ointment, etc. Is there some formal way to designate my doula as the person in charge of the baby who isnt in the NICU until I am awake? This may be something I could ask in the csection forum too:
"If one baby is required to go to the NICU and one baby is not, please allow the baby that is not with Dad in the NICU to be in Kangaroo Care with our doula until Mom is no longer unconscious."

This makes sense to me, you might ask your OB if there is a more official hospital way to word it, but I think it is probably fine. Thanks again for this, definitely going to use this as my base for my birth plan!

[LeighPF]

I would include a sentence on why you want an spinal rather than an epidural. Makes it much easier for new people to honor you plan if they can understand what is behind it.

I would put a not about Charlie at the top as well, to help people understand your background.

You should be able to designate your doula as a medical proxy with a legal form. Check around.