My birth plan

[minkajane]

DH and I are TTC #2 and while I am planning a UC, I made a birth plan in case something comes up and we have to go to the hospital. My birth plan for DS (which I didn't even get to bring to the hospital) was two pages long. I've shortened it to one page and tried to make it very to-the-point.

Critiques, please?

Any and all interventions, medications, and procedures are to be discussed prior to administration.

Induction

• I would like to avoid induction unless absolutely medically necessary. I do not wish to be induced due to postdates if my baby and I are healthy.
• If induction is necessary, I would like prostaglandin gel and sweeping of membranes used prior to Pitocin. I want to avoid AROM until I have reached at least 5 cm dilation. Cytotec is not to be administered at any time.

During Labor

• I would like to remain mobile and active at all times during my labor. Intermittent monitoring with a Doppler is preferable to maintain maximum mobility. To avoid an IV, a Heparin lock may be used.
• I would like to be free to vocalize as necessary.
• I would like to avoid examination or treatment by medical students.
• I would like to use natural augmentation methods such as nipple stimulation and walking before medication is considered.
• Please do not offer pain medications at any time. I will request them if necessary.

During Birth

• I prefer upright pushing positions. I want to avoid the lithotomy and semi-lithotomy positions and the use of stirrups as much as possible.
• I would like as much time as possible to push before intervention (such as vacuum or forceps extraction) is considered. I would like to try position changes if the pushing stage is long before considering assisted birth.
• I would prefer natural tearing to episiotomy.

After the Birth

• Please place the baby on my stomach immediately.
• Please delay cutting the cord until it has stopped pulsating and the placenta has been expelled. Robert would like to cut the cord.
• I would like to use breastfeeding and fundal massage to encourage the uterus to expel the placenta before Pitocin and/or manual extraction are considered.
• I would appreciate a local anesthetic for any repairs necessary.
• Please perform all routine examinations with the baby on my stomach.
• I would like to be discharged as soon as possible and recover at home.
• If it is necessary for me to stay overnight, my husband will be staying with me.

Cesarean

• I would like as much time to labor and/or push as possible before a C-section is considered.
• I prefer epidural anesthetic to a spinal.
• I would like the screen lowered or a mirror placed so I can view the birth.
• Please explain what you are doing as you do it.
• I would prefer dissolving stitches to staples.
• I would like to breastfeed the baby in recovery.

For the Baby

• We would like to room-in. One or both parents will accompany the baby at all times if s/he must leave the room.
• If the baby is a boy, we do not want him circumcised. Please do not retract or manipulate his foreskin.
• I plan on breastfeeding. Please do not supplement with formula or sugar water or offer a pacifier.
• I would like to waive all vaccinations, eye ointment, and the vitamin K shot.

[goosysmom]

Did you hack into my computer and steal my plan from 2 years ago???

I think it's great and to the point...

My MW and nurses were wonderful about it and had it in hand weeks prior and my MW had a doula friend of hers come along...

My afterbirth didn't go as planned...out the window bc dd had shoulder dystocia and needed OUT but she was placed on my belly and chest when she got the all clear and we nursed and used fundal to expell the placenta (and made a placenta tree, a copy of which hangs in my MW's office, she in turn made a copy and it's in the OB's office too..heehe)..

Hope you are able to stay home.....and if you aren't, that the staff at the hospital is as understanding of your wishes as mine were....

[minkajane]

I think I'm going to add something about them not announcing the sex of the baby and wanting to see the placenta.

[goosysmom]

LOL..

Good idea if you don't want to know right away..I knew, had to find out...LOL

I sa wmy placenta and if we had a home of our own a the time I would've asked to take it home and plant a tree with it for dd but we are renting (MW ok'd it)....so we just made the placenta tree....looks like art and nobody is the wiser but dh and i seeing it on the wall at home....

I have the directions if you want them......just bring sure to bring white carstock (the big sheet) or paper to the hospital with you..I sent my nurse looking for it...that is if you have to go....LOL

[minkajane]

I already know how to do a placenta tree and I'm planning on it. Too bad I didn't get to see the placenta with DS. I really wanted to, but the drugs they gave me for the C-section really made me wonky.

[cottonwood]

I like how you've sectioned it out! I am going to copy it as a template for my sample birth plan. (I'm not going to give birth again, but need to have one to show people who ask for advice.)

One thing I'd do, just to make it even more easy to read: I'd add descriptive titles for each point, and bold them. For instance:

During Birth

• Position: I will most likely birth in a kneeling or hands-and-knees position, to allow gravity to assist and my pelvis to open as wide as possible. Please provide a sheet to put on the floor, and something soft as well, if possible.
• Pushing: I will begin pushing when my body signals to me that it is ready, which may not be as soon as my cervix is fully dilated. Do not coach me on how to push.
• "Stalling": My body may experience a "rest and be thankful stage" between full dilation and pushing. Please do not disturb me during this stage, so that I can take advantage of it and store up energy for the pushing phase.
• Manual extraction: Please do not use vacuum or forceps. I would prefer a cesarean section.
• Episiotomy: I do not give my permission for an episiotomy to be done.
• Catching: I would like to catch the baby myself. If that is not possible, I would like my husband to do it.

[bradleybirth2mom]

looks great, just one thing...

When you said that you would prefer a tear to an episiotomy, you're right on the money, but the doctor will likely give you one anyway if you don't refuse it at the time he think's it's medically necessary. I put that I do not want one under any circumstances and while the baby was crowning the doctor says, "You're gonna hate me later for this," and did the snip in one second, resulting in a fourth degree. I took a year to heal up from that. Be SURE you have someone verbally back you up with this one since you can't talk while you're pushing.
Also, when you're in transition, the part where it hurts the most for a short period of time and you feel really disconnected, nurses have a habit of coming in and asking if you want drugs. When they ask you this, know that you are really needing emotional support and you can make it---this part only lasts a very short time. Plus, if you say yes to the drugs, you may not get to actively push your baby out--he will have to be extracted, which can damage your vagina or baby's head permanently. Again, having someone to turn the nurse away and help you say no to interventions is key, which is great since you will have your DH in the room with you during this.
One more thing---you can wait two hours before having to do the eye drops required by law. Good luck!

[minkajane]

I forgot about adding that I will push when I'm ready. If a hospital birth is necessary, I plan on having a doula. I will make sure she is very familiar with my birth plan and knows exactly what I do and do not want.

[CryPixie83]

Originally Posted by minkajane

Cesarean

• I would like as much time to labor and/or push as possible before a C-section is considered.
• I prefer epidural anesthetic to a spinal.
• I would like the screen lowered or a mirror placed so I can view the birth.
• Please explain what you are doing as you do it.
• I would prefer dissolving stitches to staples.
• I would like to breastfeed the baby in recovery.

I thought an epidural was a spinal?

[minkajane]

An epidural is injected into the epidural space around the spinal cord. A spinal is injected slightly deeper, into the space around the spinal cord itself. I had a spinal for my C-section. From what I've read, an epidural is slightly less risky, leaves you with the ability to move, and wears off faster. A spinal, however, works faster and is less prone to "pockets," or places where it doesn't work. If a woman has had problems with an epi not taking in the past, she would get a spinal so that she wouldn't have any pain during a C/S.

[maxmama]

Spinals are also not repeatable and last around 1-3 hours. An epidural can be redosed, so they're used for labor and for sections after an epiduralized labor.

[CryPixie83]

Ah, thank you for explaining that Now, let's all hope we never need to use that bit of knowledge

[Satori]

I just wanted to point something out, your just stating you'd perfer this how it goes as if you were asking for vanilla rather then chocolate ice cream. I would put it something like this and yes it may seem a bit more adversarial but it shows there is no room for barganing.

Your version:
During Labor

• I would like to remain mobile and active at all times during my labor. Intermittent monitoring with a Doppler is preferable to maintain maximum mobility. To avoid an IV, a Heparin lock may be used.
• I would like to be free to vocalize as necessary.
• I would like to avoid examination or treatment by medical students.
• I would like to use natural augmentation methods such as nipple stimulation and walking before medication is considered.
• Please do not offer pain medications at any time. I will request them if necessary.

My version:

• I am to remain mobile and active at all times during labor. Intermittent monitoring with a Doppler is to be used to maintain maximum mobility. (A hep lock is just as bad as an IV, if you don’t want it don’t get it and put something like “I refuse an IV or heplock at this time”.)

• Labor is an intense time and I may choose to vocalize what I am experiencing, please do not tell me to “quite down” as my personal beliefs prohibit this.

• At no time do I consent to medical students being involved in my treatment or examinations.

• Should my labor stall unacceptably long please feel free to discuss your concerns with me so that I may begin natural methods such as nipple stimulation and walking to get labor going again.

• Do not offer me pain medications at any time, I will ask for them should I deem them nessasary.

[kellid]

Hijacking

I am making my birthing plan now also, and I'm definately not informed on the things you speak of in your birthplan. Anyone who know the answers can help, please. Or a link that I can read to be more informed. I know that I will agree with everything I just want to have the knowledge to back it up, always. Thanks, sorry for interrupting, it just is right along the lines of what I'm presently doing.

Any and all interventions, medications, and procedures are to be discussed prior to administration.

Induction

• I would like to avoid induction unless absolutely medically necessary. I do not wish to be induced due to postdates if my baby and I are healthy.
• If induction is necessary, I would like prostaglandin gel and sweeping of membranes used prior to Pitocin. I want to avoid AROM until I have reached at least 5 cm dilation. Cytotec is not to be administered at any time.
Woulds you explain whyyou would request this, please.

During Labor

• I would like to remain mobile and active at all times during my labor. Intermittent monitoring with a Doppler is preferable to maintain maximum mobility. To avoid an IV, a Heparin lock may be used.
• I would like to be free to vocalize as necessary.
• I would like to avoid examination or treatment by medical students.
• I would like to use natural augmentation methods such as nipple stimulation and walking before medication is considered.
• Please do not offer pain medications at any time. I will request them if necessary.

During Birth

• I prefer upright pushing positions. I want to avoid the lithotomy and semi-lithotomy positions and the use of stirrups as much as possible.
Why? What are the benefits? What is lithotomy?
• I would like as much time as possible to push before intervention (such as vacuum or forceps extraction) is considered. I would like to try position changes if the pushing stage is long before considering assisted birth.
• I would prefer natural tearing to episiotomy.
Why would you prefer natural tearing as apposed to episiotomy?

After the Birth

• Please place the baby on my stomach immediately.
• Please delay cutting the cord until it has stopped pulsating and the placenta has been expelled. Robert would like to cut the cord.
What is the benefit to this?

• I would like to use breastfeeding and fundal massage to encourage the uterus to expel the placenta before Pitocin and/or manual extraction are considered.
What is the benefit to this?

• I would appreciate a local anesthetic for any repairs necessary.
As apposed to what?
• Please perform all routine examinations with the baby on my stomach.
Is this just so the baby can stay with you?

• I would like to be discharged as soon as possible and recover at home.
• If it is necessary for me to stay overnight, my husband will be staying with me.

Cesarean

• I would like as much time to labor and/or push as possible before a C-section is considered.
• I prefer epidural anesthetic to a spinal.
• I would like the screen lowered or a mirror placed so I can view the birth.
• Please explain what you are doing as you do it.
• I would prefer dissolving stitches to staples.
• I would like to breastfeed the baby in recovery.

For the Baby

• We would like to room-in. One or both parents will accompany the baby at all times if s/he must leave the room.
• If the baby is a boy, we do not want him circumcised. Please do not retract or manipulate his foreskin.
• I plan on breastfeeding. Please do not supplement with formula or sugar water or offer a pacifier.
• I would like to waive all vaccinations, eye ointment, and the vitamin K shot.

[cottonwood]

Kellid, if you do a search here at MDC for these terms, you will find SO much.

Cytotec is not approved for use by the FDA as an induction drug, and can cause the uterus to contract in such a way that makes uterine rupture more likely. There is a very good article at Salon.com about it by Ina May Gaskin. (I'd post the link, but I can't get it to come up at the moment, but you can google it.) AROM (artificial rupture of membranes) can cause all sorts of trouble, from cord prolapse to "failure to progress" (if the body isn't ready to go into labor and you are on a time limit because of concern of infection which is an issue specifically because the AROM has been done) to making labor harder to deal with because the "cushion" has been removed.

Lithotomy position is with the mother on her back and legs up in stirrups. In this position the mother cannot make use of gravity to push the baby out, and the pelvis (which is mobile at this point) is collapsed which makes it far harder to push the baby out. In an upright position the mother has gravity to aid her, and the pelvis opens approximately 30% further. Lithotomy (or semi-reclining) is also a very exposed position, which can make the mother feel inhibited which will interfere with hormone production. It also puts the mother into a prime position for episiotomy.

Episiotomy is a cut through muscle, whereas a tear is usually superficial. If a woman's perineum is left alone, she may tear or she may not (and there are ways to virtually ensure that she does not.) If an episiotomy is done, tissue trauma is assured. What's more is that a deep tear into the rectum is virtually unknown without episiotomy. Episiotomies also take longer to heal than tears and cause more postpartum pain, without improving outcome. There is an excellent article on episiotomy by Henci Goer here: http://www.efn.org/~djz/birth/obmyth/epis.html

Leaving the cord intact until it has stopped pulsing allows the baby to receive as much blood and oxygen as it needs. If a baby is slow to start breathing, that extra oxygen is crucial. It also ensures that the hormonal feedback system is not interrupted, which protects from hemorrhage.

Fundal massage should not be done before the placenta is expelled because if the placenta has not yet fully separated, it can cause fragments to remain. Breastfeeding will release oxytocin which will help the placenta to detach properly. Manual extraction is invasive, painful, and can create complications. Pitocin is a synthetic hormone that can interfere with the ability of the body to create its own hormones. [edited to reflect the fact that I actually *do* know the difference between a uterus and placenta -- thanks Crystal for catching that ]

A local anesthetic is preferable to no anesthetic.

All necessary clinical care of the baby (if any) should be done (if possible) with the baby on the mother to facilitate bonding, normal separation of the placenta, and the breastfeeding instinct.

[CryPixie83]

Originally Posted by fourlittlebirds

Fundal massage should not be done before the uterus is expelled because if the uterus has not yet fully separated, it can cause fragments to remain.

I think you mean before the uterus has expelled the placenta.

I would seriously be worried if someone were to expell their uterus.

[kellid]

Thanks!!!!!!!!

I appreciate the time you took to answere my questions, as I had tried to do a search on a portion of these topics with no luck. (I think I must be doing something wrong on my search inquiry, but I have never had a problem before.) I also new I would get an educated, informed answer from someone, and I did!

*Satori* Fundal massage should not be done before the uterus is expelled because if the uterus has not yet fully separated, it can cause fragments to remain. Breastfeeding will release oxytocin which will help the placenta to detach properly. Manual extraction is invasive, painful, and can create complications. Pitocin is a synthetic hormone that can interfere with the ability of the body to create its own hormones.

*minkajane* I would like to use breastfeeding and fundal massage to encourage the uterus to expel the placenta before Pitocin and/or manual extraction are considered.

These two statements seem to contradict one another. Is it just a difference of oppionion?

Here is the link you spoke of for anyone else.
http://archive.salon.com/health/feat...tec/index.html

Thank you for the info again, I appreciate it.

[minkajane]

I've never heard of fundal massage causing fragments of the placenta to remain. I've read a lot of hospital birth stories in which the nurses began fundal massage immediately to encourage separation. Satori, do you have links to anything on this topic?

[Satori]

Originally Posted by minkajane

I've never heard of fundal massage causing fragments of the placenta to remain. I've read a lot of hospital birth stories in which the nurses began fundal massage immediately to encourage separation. Satori, do you have links to anything on this topic?

I didn't say it, fourlittlebirds did I plan on doing fundal massage if the placenta is delayed and there is a lot of bleeding.

[savithny]

Kellids... one resource

Go find a copy of Henci Goer's "The Thinking Woman's Guide to a Better Birth."

She has a chapter on most of the things you question. Most of them that are things that are done unthinkingly by many practitioners because "they're traditonal" or there's a medical belief that they improve outcomes in some way -- except that they don't, and what they do is make birthing more painful, difficult, and likely to go wrong.

About the artificial rupture of membranes -- Doctors (or midwives) will sometimes break your water to "speed things up" or "get things going." However, if things are going slow, its often because the baby is not optimally positioned, and unbroken water allows baby time and space to move into a better position. Contractions are often harder and more painful after water breaks. And if the water is broken before baby is fully engaged there's the danger of cord prolapse. Ironically, doctors will sometimes try to put the fluid *back* when the water breaks early and the baby is getting distressed. Best to let them break in their own time, when they're ready.