Here is mine. Note that I have a medical condition that required certain points/sections that others probably won't need.
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Birth plan for: Maria LastName
Partner: DH LastName
Support Person: MidwifeA or MidwifeB
Physicians: Dr. Perinatologist, Dr. Endocrinologist
This birth plan was reviewed with Dr. Perinatologist and Dr. Endocrinologist on June 6, 2006. All sections of the birth plan pertaining to post-birth baby care were reviewed with Dr. Neonatologist via phone on March 29, 2006 and May 31, 2006.
Signatures:
________________________________________
Dr. Perinatologist
________________________________________
Dr. Endocrinologist
Dear Staff at XYZ Hospital,
My husband and I are very pleased to be planning the birth of our child at XYZ Hospital and are looking forward to working with you. The following is an outline of our preferences for the birth of our child.
I realize that many of our preferences are standard procedures at XYZ Hospital, for which we feel very fortunate.
I also understand that emergency situations may arise and that in that case, these preferences may not be possible. If that should happen and if there is time, I would appreciate having a brief discussion about my available options.
The support people present at this birth will be my husband, DH LastName, and either MidwifeA or her backup, MidwifeB . MidwifeA and MidwifeB are midwives with Name of Midwifery Practice. They have clinical privileges at ABC and DEF hospitals, but not at XYZ, so they will be attending my birth in a support role. Dr. Perinatologist has worked with MidwifeA in the past and agreed to participate in this somewhat unusual arrangement for concurrent care.
Sincerely,
Maria LastName
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Summary (a.k.a. my most important issues)
IV: I do not want an IV or heplock. I have had numerous IVs in my lifetime and have always found the site to be very painful for 2-8 weeks afterwards. I would prefer not to have to deal with that while also recovering from childbirth. If an emergency IV is necessary, of course I am willing to have one inserted.
My blood sugar: I have been type 1 diabetic for 23 years, am on an insulin pump and have excellent control. My HbA1c readings have been 5.6% or lower throughout the pregnancy. I am a former competitive athlete and am accustomed to managing my blood sugar during long, intense, athletic activities. While at the hospital, my husband and I would like to continue to manage my blood sugar by testing with my meter, using my insulin pump and having me eat and drink as necessary. If my blood sugars become unstable, I would be willing to have an IV insulin and dextrose drip. I understand that my nurses will need to monitor my blood sugar for my chart, and I am perfectly happy to provide blood samples as requested.
Labour: I would like to labour at my own pace, move around, change positions, have the option to use the shower, a birthing stool, birthing bar or birthing ball, and to push without coaching. I would especially appreciate no one counting during pushes.
Birth: Unless the baby is in distress and needs to exit urgently, I would rather tear than have an episiotomy. I would like to hold the baby skin to skin immediately, breastfeed as soon as possible, and deliver the placenta without artificial oxytocin (pitocin). I am willing to have pitocin administered intra-muscularly to treat PPH if hemorrhaging occurs. I am aware that refusing prophylactic pitocin increases my risk of PPH.
Unplanned interventions: If an unplanned intervention such a C-section is required, it is extremely important to me that the procedure be explained to me in as much detail as possible before and during the procedure. Knowing exactly what is happening at each step is very helpful to me in remaining calm and managing my own anxiety.
Baby’s blood sugar: If the baby shows signs of neonatal hypoglycemia, I would like to try breastfeeding first to treat it. If s/he still needs more glucose, I would like to use colostrum that I will provide from a supply expressed ahead of time. If that does not work, I would like to use glucose solution or TRIGR formula administered via cup, dropper, syringe or SNS.
Important Note
We are participating in TRIGR.
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Detailed Version
Environment
I would like to make the environment as comfortable and relaxing as possible for me during labour and birth.
I would like to wear my own clothes, which have pockets for my insulin pump.
If possible, I would like to have the option of:
- dimming the lights
- playing music
- keeping machine sounds off
Staff
I understand that XYZ is a teaching hospital and I am happy to have student nurses, medical students, and residents involved in my care. I would like students and residents to be identified as such to me and to my husband.
I would like the staff to know that I respond very well to supportive encouragement.
Induction and augmentation
Provided I am doing well, the baby appears to be doing well as assessed via regular biophysical profiles and the placenta appears to be doing well as assessed by rate of decrease of insulin requirements, I would like to avoid an induction prior to 40 weeks gestation. I am aware of the increased risks of stillbirth, macrosomia and shoulder dystocia in babies of type 1 diabetic mothers.
I am willing to discuss an induction if it is medically indicated by my symptoms or the baby’s symptoms and/or if I or my health care providers feel uneasy about the health of the baby.
I would prefer to avoid any chemical augmentation during labour. I would like to try other methods such as changing positions, walking, etc.
Please do not, under any circumstances, perform an amniotomy for the purposes of augmentation.
Labour
I would like to labour at my own pace as much as possible. This could include:
- eating and drinking when I wish to
- walking, moving around and showering
- bringing and using a birthing stool
- using a birthing ball or birthing bar
- having a rest period if I am fully dilated but feel no urge to push
- pushing instinctively rather than being coached (a reminder to slow down to avoid tearing is fine)
I would like to avoid:
- continuous EFM (intermittent is fine)
- IV or heparin lock (emergency IV is fine)
- repeated vaginal checks
Pain management
I plan to use hypnobirthing techniques to remain focused and relaxed during labour. Please don't offer me pain medication. I am aware of its availability and will request it if I need it.
Blood sugar management
I would like me and my husband (who is trained in the use of my insulin pump and test meter) to manage my blood sugar so long as it remains sufficiently stable. This could include:
- eating and drinking as needed
- continuing to wear my insulin pump
- testing my blood sugar frequently (we will bring our own meter)
We are happy to also provide blood samples for the hospital's meter for my chart at whatever interval is deemed necessary.
During early labour, I would like to avoid an IV insulin drip unless my blood sugar readings are unstable, as judged by my husband and me, relative to my normal patterns.
During active labour, if I have two consecutive readings above 7.0 mmol/L, I would like to discuss the option of an IV insulin drip.
At any stage, if I am hypoglycemic and unable to keep fluids or glucose tablets down due to vomiting, I would like to have an IV dextrose drip.
Vaginal delivery
I would like:
- to risk a tear rather than have an episiotomy (If the baby is in distress and needs a quick exit then an episiotomy is fine. Otherwise, I absolutely do not want an episiotomy.)
- me or my husband to deliver the baby if possible
- the person who is delivering the baby to announce the sex of the baby
- the baby to be placed on my abdomen/chest immediately
- my husband to cut the cord
C-section
Unless absolutely necessary, I would like to avoid a Cesarean delivery. If my primary care provider determines that a Cesarean delivery is indicated and Dr. Perinatologist can be reached in time, I would like Dr. Perinatologist to be consulted for a second opinion.
If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process. I would greatly appreciate having each step explained to me in as much detail as possible before and during the procedure. Knowing exactly what is happening at each step is very helpful to me in remaining calm and managing my own anxiety.
If a C-section is deemed necessary, I would prefer if possible:
- my husband present at all times during the operation
- my support person (MidwifeA or MidwifeB) present at all times during the operation
- to see as much as possible of the procedure, especially the baby coming out
- as much as possible, to be informed of what is happening at each step of the procedure
- to continue to wear my insulin pump
- spinal anesthesia rather than general or epidural
I would like to hold the baby skin to skin and initiate breastfeeding as soon as possible after the surgery.
After the birth
I would prefer to have the baby in physical contact with me as much as possible. If s/he needs medical attention, I would like my husband to be with him/her at all times.
I would like to:
- hold the baby skin to skin immediately after birth to help regulate his/her temperature
- breastfeed the baby as soon as possible
- unless the baby requires immediate medical attention, spend at least an hour skin to skin with him/her before any procedures
- have all heel prick tests performed while the baby is with me and preferably while the baby is breastfeeding
- deliver the placenta without pitocin (Intra-muscular pitocin to treat PPH is fine if hemorrhaging occurs. I am aware that refusing prophylactic pitocin increases my risk of PPH.)
- take the placenta home with me
I understand that normal procedure for babies of diabetic mothers is to test the baby’s blood sugars regularly for at least the first 24 hours after his or her birth. As soon as possible after the birth, once I am feeling well and the baby’s blood sugars appear to have stabilized, I would like to discuss the option of going home. My husband and I would be willing to check the baby’s blood sugar ourselves at home at whatever interval is deemed advisable and return to the hospital immediately if the baby has a blood sugar reading below a cutoff defined by the discharging pediatrician.
In the case of neonatal hypoglycemia
If my baby becomes hypoglycemic, my preferences for treating it are, in order:
1.colostrum via breastfeeding
2.pumped colostrum (provided by me ahead of time) via dropper, syringe, cup, or supplemental nursing system
3.glucose solution via dropper, syringe, cup or supplemental nursing system
4.TRIGR formula via dropper, syringe, cup or supplemental nursing system
Maternal post partum blood sugar management
If my pump has been suspended, I would like to restart it as soon as possible after the birth.
I would like to continue to manage my own blood sugar via my insulin pump. I have pre-programmed my pump so that I may simply switch back to pre-pregnancy basal rates, insulin to carb ratios and correction factors. I will set my target blood sugar to 6.5 mmol/L rather than my usual target of 5.0 mmol/L in order to avoid hypoglycemia as my body adjusts to breastfeeding.
Post partum, I am happy to provide blood samples for my chart and to receive advice from the endocrinology team, but in general, I would like to avoid interference in my blood sugar management. I understand that a common post partum protocol at XYZ Hospital is to treat readings over 10.0 mmol/L and to start with a test dose of 2 units of insulin. At my pre-pregnancy insulin needs, that test dose would make me hypoglycemic. In order to avoid a blood sugar rollercoaster ride, I would like to continue to make my own decisions about treating low and high blood sugar according to my own knowledge of my body, its insulin needs and its responses to stress, exercise and food.
In case of stillbirth or neonatal death
My husband and I would like to:
- be involved in all decision-making
- obtain mementos of the baby (photographs, locks of hair, foot- and handprint) and name him or her
- see and hold the baby after death
- request an autopsy if cause of death is unclear
- take the baby for a spiritual ceremony and burial
: That was not an issue for us, nor were things like eye ointment, Vit K, Hep B vax, etc. And the hospital does not circ, so we didn't have to put "if it's a boy, don't circ" in the birth plan, either.
