Birth Plans « Back to Group Discussions

[writermama12]

Hi, I was wondering if some of us would be willing to post our birth plans, especially ones dealing with complications or interventions, c/s...in order to help out those of us who have not BTDT and may miss something important to us without realizing it. 

I will post mine after I write it. Hoping to see some of yours first though to get more ideas about wording and details.

Edit to add: a gentle c/s plan I will be drawing from  http://birthwithoutfearblog.com/2012/09/18/a-family-centered-cesarean-birth-plan/

[Chapsie]

Here was my birth plan with my last birth (an in-hospital VBAC).  I was pleasantly surprised to find that everything on my list was respected by hospital staff!

Birth Preferences - (my name)

Due Date: June 5th, 2010
Patient of (my midwife practice name)

After a difficult labor and emergency c-section with our son in August 2008, my goal is to have a successful VBAC with this delivery.  We have been practicing self-hypnosis techniques for this birthing and the best way you can help us is to aid in (My name's) relaxation.  Low lights and quiet voices would be much appreciated.  Please direct questions to (husband) or wait until (my name) is between contractions with her eyes open to ask her questions.  

In the event of an emergency, if the situation becomes life-threatening for mom or baby, we will of course yield to any request for life-saving intervention after the briefest of consultation.  In the strong likelihood that we have the normal birth we are expecting, we ask to refrain from routine intervention that we have not previously agreed upon.  

Thank you for your help!

(my name and husband's name)

Labor

• I would like to be free to walk around, move, and change position at will.
• I would like to have a saline port inserted instead of being hooked up to IV tubing during labor to facilitate free movement.  

Monitoring

• I do not wish to have continuous fetal monitoring unless it is required by the condition of my baby; I prefer intermittent monitoring.

Labor Augmentation/Induction

• I do not wish to have the amniotic membrane ruptured artificially.
• I would not like to be administered pitocin at any point during labor.

Anesthesia/Pain Medication

• My goal is to attempt natural childbirth with nonpharmacologic pain relief methods;  please do not offer narcotics or an epidural.  

Cesarean

• Unless absolutely necessary, I would like to avoid a Cesarean.
• I would like my husband present at all times if my baby requires a C-Section.
• Immediate visualization of the baby and skin to skin contact as soon as possible with my baby would be greatly appreciated!

Episiotomy

• I would prefer not to have an episiotomy unless absolutely required for my baby's safety; I would prefer to tear naturally, if necessary, as medical literature indicates natural tears often heal better than episiotomies.  
• If possible, I would like to use perineal massage and/or warm moist compresses to help avoid the need for tearing/episiotomy.

Delivery

• I would like to be allowed to choose the position in which I give birth, including squatting.
• Even if I am fully dilated, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
• I would like to use mother-directed pushing techniques; please do not tell me when to push unless I request your guidance.  
• I would like to have my baby placed on my chest immediately after delivery.

• I plan to breastfeed my baby and would like to begin very shortly after birth.
• I would like to room in with my baby and practice non-separation.  

________________

As a nurse who works in OB, I would like to say that it is helpful to keep birth plans quick and to the point.  A lot of times, nurses don't have time to do much more than skim the birth plan, so bullet points preferably kept to one page is ideal!!

[MissMuffet]

Have you personally observed (as a nurse in OB) that perineum massages and warm compresses really help in preventing tears? (Desperate to avoid tearing this time! )

[Melany]

Originally Posted by MissMuffet 

Have you personally observed (as a nurse in OB) that perineum massages and warm compresses really help in preventing tears? (Desperate to avoid tearing this time! )

Not an OB nurse here, but my OB did that between contractions as I was pushing during both of my previous births in addition to NOT allowing me to push on my back (he has all his patients on their side) and I had no tears either time.

[Chapsie]

Originally Posted by MissMuffet 

Have you personally observed (as a nurse in OB) that perineum massages and warm compresses really help in preventing tears? (Desperate to avoid tearing this time! )

I do believe it helps!  Don't have medical literature sources at the moment to back up my anecdotes, but I have seen that patient and controlled delivery is so important to avoid tearing.  My VBAC daughter was 9 lb 8 oz with a 14.5" head and 15" chest (that is HUGE-- i've measured a lot of newborns... most have heads between 13" and 13.75" and chests between 11" and 13").  I did perineal massage prenatally at home (i'll see if I can post instructions for it... I really think this helped-- if you're not too weirded out by it, I would definitely try doing it!) and then my midwife used oil and perineal massage and counter pressure during the actual birth (and was just all around patient with me... I think I pushed for 45 minutes) and I only had a TINY first degree tear (from her chest popping out so fast, haha, not her head... usually a baby's chest is smaller than the head, lol, but my girl was pretty beefy!).  

Make sure to push based on what feels good to you at the time.  Listen to your body's urges.  Unless your baby is in some kind of danger and needs to come out ASAP (which doesn't happen nearly as often as you'd think), you can take your time to push and "breathe your baby down."  Its when your legs are pushed back to your ears and you are being told to PUUUSH to the count of ten against a closed glottis that risk of tearing is increased.

Episiotomies are still routinely performed by a lot of OBs in my area (UGH) and it is often just because they are impatient.  Finding a care provider who will be patient during pushing is the BEST thing to do for yourself!  

[Chapsie]

Originally Posted by Melany 

Not an OB nurse here, but my OB did that between contractions as I was pushing during both of my previous births in addition to NOT allowing me to push on my back (he has all his patients on their side) and I had no tears either time.

YES!  Pushing on your side proven in the literature to be least likely to cause tearing.. but it can increase pushing time slightly.  I know I have read this in the literature... I can try to find the source later today.  

[Melany]

Originally Posted by Chapsie 

YES!  Pushing on your side proven in the literature to be least likely to cause tearing.. but it can increase pushing time slightly.  I know I have read this in the literature... I can try to find the source later today.  

My OB also mentioned that he has been tracking the incidence of incontinence later on and has noticed a significant drop in the number of women who suffer from that later on (he asked me at every yearly check-up even my last one years after my last birth) who have given birth on their side as opposed to on their back. 

[Chapsie]

Writermama, sorry for hijacking the thread!   

here are instructions for prenatal perineal massage:  

[Melany]

I cannot find my birth plan from last time (of course, it's been 7 years), but the hospital was also very receptive to my request to not remove baby from my chest until after breast feeding was established. Baby was wiped down, not bathed. All the "normal" post birth baby stuff happened after she had nursed and when she was sound asleep. Even the weighing. She slept through and didn't even notice the heel pricks or the shots they gave her (that I might skip this time).

[SlimP]

Chapsie, that's a lovely concise birth plan, I hope you don't mind my copying it almost in entirety.

[Chapsie]

Originally Posted by SlimP 

Chapsie, that's a lovely concise birth plan, I hope you don't mind my copying it almost in entirety.

Haha, that's fine! (it served me well.  I think I stole most of my ideas from various websites anyway, haha).   Keeping it concise and simple goes a long way.  Emphasize what is MOST important to you and the hospital staff will be more likely to implement and remember those points (whereas, if your birth plan is 3-4 pages long, some things will get forgotten).

It may be a good idea to have a Labor and Delivery birth plan and a separate Newborn Nursery birth plan with baby stuff on it.  Make sure there are multiple copies of it/them-- a copy to give your midwife or doctor a few weeks before the birth (have them sign it that they agree to it) and make a copy for your labor and delivery chart and a copy for your baby's chart.  

Also, when you get to the hospital in labor, be sure to ask for a nurse that supports natural birth.  Some nurses really enjoy working with natural labor mamas and will be a lot more supportive of your birth plan than others.  

[firespiritmelody]

Originally Posted by Chapsie 
Also, when you get to the hospital in labor, be sure to ask for a nurse that supports natural birth.  Some nurses really enjoy working with natural labor mamas and will be a lot more supportive of your birth plan than others.  

And if you're not hitting it off with your nurse, don't be afraid to ask for a different one!

[SlimP]

Thanks Chapsie :) It's one thing to have it all in your head but quite another to vocalise it during the labour. Helpful to literally keep DH on the same page too.

[MissMuffet]

Thanks for all the great info, Chapsie and Melany.

[withlittlelungs]

Here's my birth plan. Chapsie, I am interested in hearing your advice!! It is a little lengthy (2 pages), but I wanted to make sure we had all of our bases covered!

Twin Birth Plan

Patient of DR. XXXX

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.

During labor and birth I request to have my partner, XXXX, my doula, XXXX, and birth photographer, XXXX, present at all times.

Labor

·      No IV fluids. Heplock placed upon arrival—I am Strep B NEGATIVE

·      No epidural or pain medication unless requested

·      Intermittent fetal monitoring

·      I prefer that vaginal exams be kept at an absolute minimum

Normal, spontaneous vaginal birth

If medically safe for me and my babies, I request:

·      To deliver on a bed from L&D

·      XXXX will photograph my birth

·      Push in the position of my choice, at my own pace

·      Delayed cord cutting of babies

·      Baby A to be placed on Mom immediately after birth for skin to skin contact and breastfeeding while labor continues

·      Dad or doula will hold Baby A while mom delivers Baby B

After birth

Pending no emergency medical assistance is required, I request:

·      Spontaneous delivery of placenta(s)

·      We request that the placentas be released to us after delivery

o   Permission has been granted from XXXX for placenta(s) to be released without examination from pathology

o   I designate that my placenta be released to XXXX ASAP after birth

·      We decline infant eye ointment and the Hepatitis B vaccine

-The Hep B vaccine will be given by our pediatrician after discharge

·      All testing/vaccines to be done while Mom, Dad, or doula holds babies

·      No bottles or pacifiers without our request

·      Baby A is male. We request NO CIRCUMCISION.

Non-emergency cesarean

·      Dad is to remain with mom at all times

·      I request that our doulas be present if possible

·      Please lower the drape after each baby is born

·      Please free one hand after babies have been born so Mom can touch babies before recovery

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

·      Please allow our doula, XXXX, to return to mom if dad has to leave with babies.

NICU

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

·      Dad will accompany any baby to the NICU while mom or doula perform Kangaroo Care with the other baby

[storygirlcindy]

I've been working on my birth plan all week and this morning I presented it to my OB... whew! I was admittedly pretty nervous since I haven't talked in detail with him about my labor plans up to this point. I struggled and struggled to get mine all onto one page, but just couldn't do it... even my OB said that that was probably an unrealistic expectation, since I have a major medical condition that complicates things and needs to be addressed in it (like, they want to monitor my oxygen saturation during labor, etc.). I figure if he was OK with it, I'll just leave it. I've heard wonderful things about the hospital I'm delivering at and their willingness to work with natural birth, plus I know my way around a hospital after a lifetime of medical problems, so I'm not too worried about how things will go.

I also don't have a ton about baby care on there, because our hospital strongly encourages rooming in and breastfeeding anyway, and routinely delays the newborn exam and treatments to give skin-to-skin time. (I had all that stuff on there until I did some more research and realized that was already the hospital's policy!)

Note: I (Cindy) have a genetic disease called cystic fibrosis, which leads to many lung problems. Because of my CF, I cannot lie on my back without coughing and struggling to breathe. It is important that I be able to labor and push in positions that are most helpful to me and the easiest for me to breathe in.

Also, I will be using Hypnobabies birth hypnosis for coping and pain relief during labor. I’ve included lots of tips on how to help me have the best Hypnobabies birth possible! I understand that birth doesn’t always go as planned and I am completely open to the fact that changes to my birth plan may be needed.

During hospital admittance, early labor, and transition (transformation) phase:

* We would love to explore any non-medical options for pain relief that might be available to us.

* Please consult with my husband and I before administering any medication, treatment, or exam. If it is not a matter of immediate urgency (mom and baby are both okay), please let us have a few minutes to discuss it privately before proceeding.

* Throughout my labor and delivery, I will be hypnosis, and therefore highly suggestible. Please do not tell me what I will feel. I will communicate what I am feeling to you in my own words. 

* Please also do not ask me about my pain level or imply that what I am experiencing is or will be painful. I am aware of my options for pain relief and will ask for them if necessary. 

* Please be aware that during contractions I will be deeply in hypnosis and not able to talk. If I am having a contraction, pelase either wait until I am finished to speak with me, or talk to my husband or doula instead.

* I would like to have freedom to move about the room and hospital, and to labor in the positions of my choice.

* If labor is stalling/not progressing quickly, I would like to explore available natural options before trying medications to augment my labor. I am aware of the fact that sometimes there are pauses during normal labors; if mom and baby are both doing okay, I would like to be able to take advantage of these natural rest periods to allow my body to get some respite. If a significant amount of time has gone by, or if either I or the baby are in distress, I will be open to other options.

* I prefer not to have an amniotomy if my fluid levels are normal. If you feel it would help labor to progress, please consult with me. If my fluid levels have remained high leading up to delivery and you feel that doing a “slow leak” amniotomy would help avoid a c-section, I am open to that possibility.

* I prefer not to have continuous IV fluids unless I am showing signs of dehydration. Prior to coming in to the hospital I will access my port-a-cath and it will be available for use if necessary.

• I prefer to have intermittent monitoring, including intermittent oximetry monitoring. 

* We would ask that our birthing environment remain quiet and relaxed. I prefer to have only (husband) and (doula) with me much of the time—no visitors.

* If a c-section is required, please take measures to increase my chances of a future VBAC.

During the pushing phase, I would appreciate:

• The ability to push in the way that feels best and most effective to me. In particular, it will be important for me to breathe in the way that my body needs so as to get the most oxygen and avoid become exhausted. I cannot hold my breath for long.
• Being able to push in my position of choice (squatting, all fours, side-lying, etc.)—not lying down or lithotomy position, as these will make it much harder for me to breathe.
• Warm compresses, perineal massage, and lubrication of perineum to help reduce tearing
• I would prefer to tear naturally rather than receiving an episiotomy. Please administer an episiotomy only if it is absolutely necessary, and only after consultation with me. If an episiotomy is necessary I would like local anesthetic. I would also like a local anesthetic if stitches are necessary.
• I would like to use a mirror to see the baby crowning if one is available.
• If my bleeding is not too strong, I would prefer to allow the placenta to detach naturally. I would like to breastfeed immediately to help my uterus contract. Please consult me if you feel Pitocin is necessary.

After the birth:

• Please do not cut the cord until it has stopped pulsing. Allow my husband the chance to cut the cord after it is done pulsing.
• We would prefer that my husband be able to gently pat our baby dry. We do not wish her to be bathed immediately, and would prefer to leave vernix intact. 
• If a c-section is required, I would like to be able to have skin-to-skin time with baby and the chance to establish breastfeeding as soon as possible.
• Please obtain our consent before any routine procedures. We wish to decline a Hepatitis B vaccination for our baby at this time. We will get it done later with her pediatrician.

Thanks so much for being willing to help us have a wonderful birth experience!

We look forward to working with you and sharing this special time.

[mariee]

Miss Muffett- I birthed our son on my side and asked OB to massage the entire time.  I initiated both of those moves, but she was very agreeable to it and I had a very minor laceration that never caused me any discomfort afterwards.  

[writermama12]

Thanks for sharing your birth plans mamas! I am getting a lot of great info and ideas from your plans and that is making writing mine much easier. 

[Tear78]

Here's ours from last time, though I'm not sure it was the final draft. I need to reread it and tweak it. We basically put it away after being admitted for preeclampsia, but we got the important things: healthy baby, healthy mama. I hope to get the chance this time to labor as naturally as possible, but again what's most important is healthy baby and mama.


Thank you for helping us with the labor and birth of our little baby girl!
Labor
*Please match us with a nurse that has the patience, passion, and understanding to support natural childbirth.
*Please do not offer pain medications unless there is a concern for mommy and/or baby's health. We hope to use positioning, massage, meditation and water to help me manage my discomforts. We are aware of the medication options available should we need to change our plan.
Delivery
*To avoid episiotomy or tearing, please perform massage with oil and apply warm compresses. To help my perinium stretch, please help guide my pushing efforts by letting me know when to push and when to stop.
*I would like the option to use a variety of birthing positions (squat, hands and knees, side laying, etc.)
*Upon delivery, we would prefer to keep the baby's cord intact until it stops pulsing. Hubby would like to be the one to cut the cord if possible.
*However, it is very important to us that our baby can go right to mommy's chest after delivery if there is no concern for the baby's safety.
*We would like to attempt breastfeeding as soon as possible. Please perform as many tests as possible with the baby on mommy's chest, and please delay any other tests for as long as possible. Please do not offer our baby formula or a bottle without our knowledge and consent.
*We would like our baby to stay in the room with us. Hubby would like to be present, if possible, for any tests that need to be performed outside the room.
*Please save my placenta and that of our baby's twin if possible.
*Thank you so much for your help and support as we bring our little girl into the world! Obviously her health and safety is our highest priority, as is that of her mommy. While this plan contains our hopes, we appreciate your expertise and knowledge in helping achieve this most important goal.

[Chapsie]

With Little Lungs--

 your birth plan looks great!  Is it policy at your hospital for moms of multiples to deliver in the OR?  Or will they let you delivery in a regular birth room?  

My close friend had natural twins in the hospital two years ago and I asked her for a copy of her birth plan to share with you.  I'll post it when I get it.  :)

This is the only thing that might be tough: " All testing/vaccines to be done while Mom, Dad, or doula holds babies"  Measurements and assessments are really hard to do if the baby is being held (rather than laying in your lap in bed or in a crib nearby).  Maybe just make them know that all testing is to be done in your presence, instead of only in your arms?  Other than that, it looks great-- clear, concise!  Very well thought out!  

I'm excited for you!!!