I haven't made one this time, though I still have my plan from the birth of DS2 and nothing has changed in it so I'll just use it again.
Statement of Purpose
My partner and I have planned and prepared for a peaceful and natural childbirth. We would like to allow our labor and delivery to unfold naturally, with as few interventions as possible. We would like to be informed about all procedures and tests before they are performed. We want to be aware and informed of all of our options in the event of an unexpected emergency.
-- I would like to remain active and use whatever position I find comfortable. Please encourage me to stay off my back!
-- I am happy to have one internal examination to check presentation, but would like to avoid them otherwise, unless there is a particular reason why you think one is necessary.
-- Please do not offer to break my waters, and please be very careful to avoid doing so during any internal examinations
-- If the baby appears to be poorly positioned or labour is not progressing well for some reason, I would appreciate it if you could suggest changes of position or movements which might help.
-- I would like to be able to eat and drink freely and will have what I need on hand. I have also made a list of food/drink and where they are located.
-- I would like my environment to remain as quiet and calm as possible.
I may prefer to labor completely alone. If I have gone in the bathroom or our bedroom and shut the door, this is probably the case – in this situation, please come in one at a time for the sake of my privacy and concentration.
I prefer not to have anyone (other than those listed below) present during labour/birth. Surprise visitors should be turned away. [I do NOT plan to notify anyone that I'm in labour other than those listed below and will have a sign outside of my door indicating that visitors should CALL first before knocking.]
-- Midwife and her assistant(s)
(Back up person for helping with children, if necessary, will be Kayla)
I plan to manage using no drugs for pain relief, and would appreciate your encouragement to use other methods. For example, I might use movement, massage, relaxation, the shower/tub
I agree to an internal exam when feeling the urge to push to insure that I am fully dilated and not pushing through a cervical lip
Please keep the room as quiet as possible during the second stage. I would like to minimise distractions at this time
I would like to give birth wherever feels right to me at the time.
I would prefer not to have an episiotomy unless absolutely required for the baby's safety; I am hoping to protect the perineum.
Even if I am fully dilated, and assuming baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase. I would rather not be told how to push, or guided in the second stage, unless there is a particular reason to suppose that I need assistance, or unless I ask for assistance.
I would appreciate having the room lights turned low for the actual delivery.
Third Stage/immediately after birth:
I would like to have baby placed on my stomach/chest immediately after delivery and wish to commence breastfeeding immediately after birth.
I plan to have a fully natural (physiological) third stage, and to cut the cord only after the placenta is delivered. I want to allow the placenta to turn up in its own time. It is important that the cord is not clamped or cut until the placenta is delivered and the cord has stopped pulsating. Please do not administer any drugs unless you feel there is a real need. I would appreciate your advice to help me deliver the placenta naturally. Please do not pull on the cord or use fundal pressure unless there is a specific indication to do so, as I have read that this is contra-indicated in drug-free third stages. I wish to keep the placenta and will provide an appropriate receptacle for it to be retained in.
I would like to have baby evaluated in my presence; I plan to keep baby near me following birth and would appreciate if the evaluation of baby can be done with baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
Please do not suction mucus from the baby's nose and mouth 'just in case' - only suction if necessary.
Please do not bathe baby.
Repair of the Perineum, if necessary
I would prefer to avoid having stitches if possible, so if you think any tear will heal of its own accord, without stitiches, please let me know.
Care of the baby:
I would like to breastfeed my baby as soon as possible after the birth
I would like to keep the baby unclothed and close to my skin immediately after birth, to maximise skin-to-skin contact (as this may help bonding, be reassuring to the baby, and help your 'breastfeeding hormones' flow)
Please do not administer prophylactic Vitamin K after the birth. If the birth is traumatic for the baby or there is some other risk factor for HDN, I will be happy to discuss this with the midwife and allow vitamin K if we both decide it is appropriate.
Do NOT circumcise baby
In case of transfer to hospital:
I am aware that due to conditions beyond anyone's control, it may become necessary to transfer to hospital; should that be the case, the following are my wishes in the event of a hospital delivery.
Possible reasons for transfer:
I don not wish to be urged into a hospital transfer simply for “failure to progress” unless there is clear evidence that baby is in distress and a transfer is urgently required.
Should meconium be found in the waters, I wish to discuss fully the options dependant on the appearance of the meconium and fetal heart rate.
If transfer by ambulance becomes necessary, please do not strap me in on my back - I would prefer to be on my side, to make contractions easier to deal with.
Do not offer pain relief unless I specifically request it; likewise I wish to avoid any “routine” use of IV, etc and therefore do not consent to having a Venflon inserted.
Labour/delivery in hospital
As above, I intend to have an active birth and prefer to be allowed to move freely and give birth in the position that best suits me. I do not wish to be given an episiotomy; nor do I wish for the lithotomy position to be used.
I do not consent to having student doctors present, during birth or afterwards.
Immediately after delivery
As above, I wish to have a physiological third stage, and to cut the cord only after the placenta is delivered. I want to allow the placenta to turn up in its own time. It is important that the cord is not clamped or cut until the placenta is delivered and the cord has stopped pulsating. Please do not administer any drugs unless you feel there is a real need. I wish to retain the placenta and will wish to take it home; I would appreciate it if it could either be kept refridgerated until I go home, or else given to my husband is aware of my wishes in this regard.
If baby must be taken from me to receive medical treatment, my husband or some other person I designate will accompany baby at all times.
I would prefer to hold baby rather than have her placed under heat lamps.
As above, I do not consent to the administration of Vitamin K after the birth, unless the birth is traumatic. In the case of a traumatic birth, I would like to discuss this and give my consent PRIOR to it being administered
Unless required for health reasons, I do not consent to separation from baby.
I would like to have baby 'room in' and be with me at all times.
As stated above, I intend to breastfeed and wish to do so as immediately after birth as possible. I do not require "hands-on" assistance with regards to breastfeeding.
Please do not give my baby supplements of glucose water or formula milk without my permission. I would expressly like to avoid having any formula supplements unless it is unavoidable, and certainly not in the first two days in any event.
Under no circumstances is my baby to be given a pacifier or be bottle-fed as this could lead to nipple confusion and hinder breastfeeding. If supplements are necessary, please give them by spoon or other method, not by bottle.
I am very keen to avoid a caesarean section if it is at all possible, as I do not want to enter future labours with a scarred uterus. I particularly would like to avoid a caesarean just for slow progress. If labour is simply taking a long time but my baby is not in immediate danger, please would you encourage me to keep going and perhaps to try changes of position or movements which might help. Please do not offer a caesarean unless my baby is in danger.
If my primary care provider determines that a Caesarean delivery is indicated, I would like to obtain a second opinion from another physician if time allows.
If a Caesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.
I would like my husband present at all times if baby requires a Caesarean delivery.
If baby is not in distress, s/he should be given to my husband immediately after birth.
If I suffer a severe post-partum haemorrhage, please do not perform a hysterectomy unless it is the only available course of action.
Please do not admit my baby to Special Care simply for observation, but only if there is a specific reason for concern.
I would like to go home as soon after the birth as I am able to move, unless I or the baby have health problems which require hospital treatment.
Edited by itsajenism - 12/13/12 at 12:46pm
I understand that circumstances may change due to events during labour and birth and that matters may not necessarily proceed as I would wish dependant on any medical intervention I and/or baby may need and accept that I should be prepared to be flexible with regards to this birth plan as a result. I am fully aware that a birth plan can only be a guide to my wishes; however I prefer that all medical treatment and any changes to this plan be discussed fully with myself and my husband and expect to be consulted fully prior to any treatments being carried out on either myself or baby.