Your Birth Plan...

[redpajama]

Hi,
I swear I tried to search for this--I *know* I've seen discussions of it in the past, but I couldn't find anything pertinent.
I'm a beginning doula, and I'm looking for a few good examples of birth plans to show to clients as we prepare to compose their plans. I'm interested in using a few different examples that may be formatted different ways to give them examples of how to set one up, but also ones that may have addressed things they wouldn't have thought of. If you have a copy of your birth plan that you don't mind sharing, please post.
Thanks!!

[monkeybum]

My Birth Plan

Hi Susan,
My BP for DS#1 was 3 pages, bullet point form and was not very effective. No-one read it, or if they did, they certainly didn't remember it as it was not followed at my birth at all. For baby #2 (now 12 days old!) I reduced it to one page so it was more to the point and easier to remember. I also printed it out and had it at home at the time of my birth, (rather than expecting my MW and Doula to remember what was "in my file" at the office).

My Doula had a 2-3 page "checklist" that she went through with me at my second visit. She then created a birth plan that was in a chart form, but I wasn't crazy about it. I just wanted something simple, to the point that everyone could remember when it came to "crunch time".

One thing I really did like about my Doula's birth plan though was that she included how I wanted things handled if either I or the baby had to be transferred to the ICU, or to a specialty children's hospital out of town, and that varied on whether I was fit to accompany the baby or not. It also included who I would want where should the need for a C-section arise.

So here's mine for #2:

Birth Preferences – [Insert Name]
March 2007

For myself:
•Keep vaginal exams to minimum
•No artificial rupture of membranes
•No membrane sweeping
•No pitocin
•Please do not offer medication (epidural, etc.)
•Prefer to keep lighting dim
•Please minimize chatter/discussion next to me when possible
•Prefer hot compress, slow pushing etc. to avoid tearing if possible
•No directed pushing – prefer to push/bear down when urge comes
•May decide to stay in tub for pushing – ok with waterbirth if it happens
•Discuss pitocin for delivery of placenta following birth (prefer spontaneous delivery of placenta if delivered relatively quickly)
•If cesarean or emergency transfer required, please explain reasons to me
•I would like husband and/or doula present if cesarean required
•In case of hospital transfer, request private room

Pain management:
-tub
-shower
-walking/change positions
-hypnosis tapes/relaxation
-birthing ball

For Baby:
•Baby placed on mom’s tummy/chest immediately
•Wait to clamp chord until it stops pulsing
•Midwife to cut the chord (once stopped pulsing)
•Baby to breastfeed as soon as possible after birth
•No eye drops/ointment
•No vaccinations
•No formula, sugar water, or pacifiers
•No retraction of foreskin, no circumcision
•(Vit K injection ok)

* consent required for all procedures performed on mother and child

[redpajama]

JUST when I had given up on getting a response...

Thanks, Monkeybum, for responding. I'm glad to have your birth plan, because most that I've seen are longer--like what you were describing with your first--and given my rather thorough and sometimes verbose nature, I probably would have been inclined to propose such a birth plan.
Thanks again--this is very helpful.

And now that the ball's rolling...others? Maybe an example of the longer variety birth plan? Different ways of organizing them, et cetera? Please?

[moonlightinvt]

I like the sample birth plan on this site: http://www.unhinderedliving.com/childbirth.html

Toward the bottom of the menu on left of page there are the headings: sample plan and birth plan check sheet. For some reason when I click on "sample plan" a totally different site comes up--not the plan I have read before. At least the "check sheet" is there and maybe the other will work again soon.

If it doesn't come up I could email you mine (as an attachment--it is at least three pages, as I recall). Let me know.

[BetsyS]

Mine was very simple.

Please don't count while I'm pushing
If I need a c-section, do a double layer closure.
No erythromycin.

I left off some stuff, because I birthed at a pretty great hospital, and I asked about their protocols before hand. I didn't mention induction, cause I knew that that would be something discussed in the office. I mean, if I didn't want an induction, I didn't have to agree to have one scheduled. That sort of thing. They didn't offer pain meds; I had to ask. Could eat/drink in labor. I nursed in recovery (had one of the 7% of c-sections). Roomed-in, even though technically my dh should have been there the first night (he went home, so the nurse took the baby to the nursery, weighed him, then brought him back "to eat", and he stayed in my arms all night). Dh or I was with the baby continuously. They have you sign consent at the hospital for Hep B and circumcision, so it was a matter of not signing it. It wasn't automatic. My hospital did do 3 blood sugar checks on the baby, but they asked first, and I felt it was appropriate (he weighed 11 lb, 14 ounces)

Some things I knew that I could consent to at the time. My midwife asked if she could check me every time. Asked if I would consent to Pitocin. Asked if I would consider an epidural. I wanted folks to chit-chat throughout labor and my c-section, because I know that, generally, when the chit-chat stops is when the provider is worried that something isn't going right. The chit-chat was reassuring. And, I knew that I could tell them to shut up any time. I ate after my c-section when I felt up to it. I went home at 36 hours postpartum.

I had a nice delivery, but I credit alot of that to choosing a good provider and a good hospital.

[cidercat]

My very simple NCB plan

Here's my birth plan. Very simple. Definitely less than a page.


It is our desire to have as much of a natural, medication- and intervention-free childbirth as possible. We have educated ourselves and are prepared for the work involved. We understand that complications do arise and in such instances ask that you discuss with us any procedures or medications before administering them, whenever possible. We greatly appreciate your cooperation in realizing our plan. We would love to be assigned a nurse who enjoys assisting in low-intervention/ epidural-free deliveries.

First Stage:
•Would prefer to keep vaginal exams to a minimum.
•Maintain mobility (Walking, rocking, up to bathroom, etc.)
•Intermittent fetal monitoring
•Eat and drink to comfort.
•Prefer no IV (Would prefer not to have heparin/ saline lock either, if possible)
•Please do not offer me pain medications, I will ask for them if I want them.

Augmentation:
•I would prefer not to use Pitocin nor stripping/ breaking of membranes to speed labor

Second Stage:
•Choice of position
•Prolonged length, if progress is being made
•Spontaneous Bearing Down
•Birth/Squat Bar
•I would prefer to tear than have an episiotomy, but please use compresses and positioning.
•We would like to have Erik involved in catching the baby as much as possible.

Third Stage:
•Delay the cord cutting
•Prefer for the placenta to be delivered spontaneously, without Pitocin.

Baby Care:
•Delay the eye medication/ other non-emergency medical procedures for several hours
•Postpone immunizations until later time.
•Breast feeding only

[MsElle07]

This was for a birth center birth, so a lot of the normal hospital routines are not included. This was one page typed.

Intro/General information
I am hoping for a peaceful birth. I would like for the birth process to unfold with as few interventions as possible. I would like to utilize hypnosis to help me stay relaxed and cope with the pain. (I will have an MP3 player to listen to.) We’ll be bringing our camera, and if everyone could help us take pictures (time permitting, of course), that would be appreciated.

Things I would like to do/have:
·Pictures taken – I can always delete any photos I don’t want, so too many pictures is better than too few
·Reminders to eat, drink, and use the bathroom
·Suggestions for position changes or comfort measures
·Use of jacuzzi for pain control
·Massage/counterpressure
·Verbal encouragement without distracting me too much from my relaxation
·Someone to reassure my husband that everything is OK and that I’m doing fine. Also someone to remind him to eat, drink, and use the bathroom.
·I would like to choose my own birth position, but please remind me that I want a position that is off my back, if possible.
·I’d like to see the birth in a mirror, if possible.
·I would like to wait until the placenta is out to cut the cord, allowing the placenta to detach and be expelled naturally.
·I would like to see the placental exam, but my husband does not. He tends to be a bit squeamish, so perhaps I could see it while he is otherwise occupied.
·Someone to reassure my husband that my after birth blood loss is normal. (He was worried about me at my last birth.)
·I’d like to be reminded to take ibuprofen and acetaminophen shortly after birth to avoid as much cramping pain as possible.

Things I would like to avoid:
·I am GBS+, and will be declining antibiotics unless there are other warning signs that would indicate their use. (Fever, prolonged rupture of membranes, etc.)
·Because of my status, I would also like to avoid cervical checks and membrane sweeping unless necessary. I would like to be asked if it’s OK rather than informed that they must be done.
·Please don’t offer to break my water – I will request it if I want to consider it.
·We’ll be declining Vitamin K unless there is indication of a traumatic birth/possible newborn hemorrhage.
·We’ll take the erythromycin ointment with us to use at home if necessary.
·I would like to avoid a managed 3rd stage, particularly aggressive uterine massage, pitocin injections, and cord traction. (If they are medically indicated, I would prefer to be consulted before having these things done. )

Thank you so much for being with us at our birth and for helping to make this a positive experience!

[herwitsend]

Here's ours... we highlighted the part about Brandon announcing to me the baby's gender because we were afraid they would miss it or forget and shout it out!

We have written this birth plan to communicate to our hospital staff our desires in an ideal birth situation. We realize that we cannot script something as unique as birth. We acknowledge and accept that there could arise situations where our birth plan cannot be followed for the safety of Amy and/or our baby. We hope, though, that we will be kept well informed and fully aware of all of our options. We have planned and prepared for an intervention free labor and birth and we look forward to a wonderful experience.

During the first stage of labor, Amy would prefer:
· To maintain mobility / freedom of movement.
· No IV / unrestricted fluids.
· Minimal vaginal exams.
· Intermittent external fetal monitoring.
· To have pain relief offered in non-drug forms (position changes, massage, hydrotherapy, etc.).

During the second stage of labor, Amy would prefer:
· Her choice of position for pushing.
· To be allowed to push spontaneously.
· To avoid an episiotomy.
· To catch the baby if possible.
· For Brandon to announce to her the baby's gender.

For the care of our newborn, Brandon and Amy would prefer:
· Immediate skin-to-skin contact between Amy and the baby.
· To delay cord cutting until pulsing has stopped.
· For Brandon to cut the cord.
· To delay routine newborn care for at least one hour.
· That our baby not be offered a pacifier or any other artificial nipple.

[Robinna]

Here you go! mine was focussed on the fact that dd was breech, and it's addressed to my referral OB (much good that it did me since he wasn't on call when dd decided to present her bum to the world...). It contains a section on c/s as well since we knew we had a higher-than-normal risk of ending up with surgery. The whole thing is pretty comprehensive since we didn't really even know which hospital we'd end up at (there were other OB's at other hospitals who would've caught her... they weren't on call either).

BIRTHING PLAN

Dear Anne-Marie, Dr. P and Hospital Staff: Thank you in advance for your support and sensitivity for our individual needs and wishes. We have educated ourselves in the birthing process (including breech delivery and caesarean birth) and if there are no direct medical contraindications, would like the following preferences to be honoured throughout all stages of our baby’s birth and during our hospital stay.

IN THE EVENT OF AN EMERGENCY: In the event that the situation becomes life-threatening for either Robin or our baby, we will, of course, yield to any request for life saving intervention, upon the briefest of consultation. In the strong likelihood that we have the natural vaginal birth that we are expecting, we ask that you refrain from any routine interventions or measures that we have not previously agreed upon. We do not believe that vaginal breech birth is an emergency, but rather a variation of normal, and deeply appreciate your support in this.

OUR ENVIRONMENTAL PREFERENCES:
·As we did for our first birth, we will be using self-hypnosis for the management of labour discomfort, and for this reason we will bring soft music, use dimmed lighting, and ask for the staff to please use a low voice. Please avoid references to “pain”, “hurting” or “hard work.” These words are disruptive to our hypnosis process, and we thank you for respecting our unique needs. Please do not offer us drugs.
·Support: our Midwife, and name or name, will attend the birth, and are authorized to be present during any examinations or procedures.

DURING LABOUR:
Labour Management
·Labour, delivery, and preferably recovery, should happen in the same room if at all possible.
·Robin will walk around and assume any position that is comfortable for her both for labour and delivery including standing, squatting, sitting, or kneeling.
·Robin will eat and drink lightly during labour as she needs to.
·Vaginal exams should be limited, and performed by our midwife.
Please avoid:
·Augmentation of labour or any use of synthetic hormones.
·Artificial rupture of the membranes.
·Shaving, enemas, or “disinfecting” of the pubic region.
·IV. If necessary, we will accept a hep lock to facilitate a later IV if it becomes needed.
·Please do not allow students or other unexpected strangers into the birthing room. If additional staff is required, please speak with Stephen in advance.

Fetal Monitoring
·We strongly prefer intermittent manual fetal monitoring with doppler.
·Please avoid electronic fetal monitoring, particularly internal fetal monitoring.

Pain Relief
·We are using self-hypnosis techniques for management of labour discomfort. Please keep voices low and calm.
·Please avoid any suggestion of artificial pain relief including oxygen, IV or oral drugs, or epidural.



BIRTH OF OUR BABY
Pushing and Delivery
·If possible, we would like our midwife to deliver our baby with the support and guidance of Dr. P or the OB on call.
·Robin will deliver in a position that feels natural to her and will allow her pelvis to open completely, understanding the need for a breech baby to “hang” with chin tucked during delivery.
·Please facilitate mother-directed pushing. Coached pushing interferes with self-hypnosis techniques. If the baby remains breech, Robin will be happy to accept guidance when it is time to push out the head, and would appreciate perineal support to help minimize tearing.
·Please do not perform a routine episiotomy. As proven by our previous birth, Robin’s tissues stretch easily. Please attempt any necessary manipulations first, without cutting an episiotomy. Should an episiotomy be necessary, please speak to us before making the cut, and explain what it is you need to do that cannot be done without it. Should episiotomy be unavoidable, we prefer a diagonal cut to vertical.
·We are willing to have one or two (only) additional staff in the room for breech-delivery training purposes. These people should be introduced in advance of transition, by name. Please speak to us before we reach the pushing stage to ensure this is still OK. We reserve the right to ask any of these non-essential staff to leave the room at any time.

Handling the baby
·Please place the baby on Robin’s abdomen or chest and facilitate immediate skin-to-skin contact, covering us both with blankets. We will dry and wrap the baby ourselves.
·Please defer any newborn procedures (such as weight and length measurements, eye drops, Vitamin K shot) until we have had an opportunity to get to know each other. Apgars may be performed while Robin holds the baby.
·It is important to us that the umbilical cord be left intact until it has stopped pulsing.
·Robin, Stephen, or Robin’s mother will cut the cord.
This will be included in my next “if unavoidable c/s plan”
·If the baby is ready, Robin will nurse the baby during the 3rd stage of labour.

BIRTH OF PLACENTA:
Please avoid active management of the third stage of labour, and facilitate a natural 3rd stage. This includes the use of medication or synthetic hormones, cord traction, or heavy pressure on the abdomen. If bleeding is considered excessive, please allow us to try nursing the baby or to use nipple stimulation first to stimulate natural production of oxytocin. (This will be included in my next “if unavoidable c/s plan”)
·Please do not dispose of the placenta, as we want to take it home with us.
·Robin will hold or nurse the baby during the 3rd stage of labour.

AFTER THE BIRTH:
·We would like time alone as a family as soon as possible after the birth.
·We will be breastfeeding, and therefore ask that the baby not be given water, supplemental feeds, or any kind of pacifier.
·Please do not bathe the baby. We will do this at home.
·The baby should be accompanied at all times by Robin or Stephen. Please do not take the baby anywhere or perform testing or procedures of any kind without one of us present.
·We would like to be discharged as soon as possible. If it is necessary to stay overnight, we would like our baby to “room in” with Robin at all times.




SHOULD AN EMERGENCY CAESAREAN BIRTH BE UNAVOIDABLE:

·Stephen and our midwife should be in the operating room with Robin.
·We prefer epidural or spinal anaesthetic to a general anaesthetic.
·Please insert the urinary catheter after the epidural or spinal is in place and functioning.
·During and after the procedure, please do not administer any “extra” medications including sedatives or analgesics without express permission from Robin and/or Stephen.
·Please “narrate” the procedure so that Robin knows exactly what is going on at all times.
·Please drop the curtain for delivery so that Robin can see the birth. (this didn’t happen)
·Please give the baby to Robin immediately after delivery (barring a requirement for emergency care for the baby) and facilitate skin-to-skin contact, covering us both with blankets. It is very important to us to hold our baby in true “new-born” state, so please do not “clean off” or dry the baby before passing her to Robin. We will do this ourselves. Apgars may be performed with Robin holding the baby.
(this didn’t happen. I’m short waisted and there was NO room for the baby on my chest because the drape was right below my chin. So DH did all of the immediate skin to skin and wiping/wrapping, then brought the baby to rest right beside my face until I could get off the table.)
·Please do not take the baby to the nursery, she should stay with Robin at all times unless emergency treatment is required.
·We would like to take still photos of the birth itself and during the time immediately following the birth.
·Please defer baby weight and length measurements and other newborn procedures (eye ointment, Vitamin K shot, etc) until we are out of recovery.
·Please do not dispose of the placenta, as we want to take it home with us.
·Robin would like to hold or nurse the baby while the incisions are being closed, and to nurse while in recovery.
·Should the baby require emergency care, Stephen will accompany the baby and Anne-Marie will stay with Robin.

AFTER THE BIRTH:
·We would like time alone as a family as soon as possible after the birth.
·We will be exclusively breastfeeding, and therefore ask that the baby not be given water, supplemental feeds, or any kind of pacifier at any time during our hospital stay.
·Please do not bathe the baby. We will do this at home.
·The baby should be accompanied at all times by Robin or Stephen. Please do not take the baby anywhere or perform testing or procedures of any kind without one of us present.
·We would like a private room as soon as one is available.
·We would like our baby to “room in” with Robin at all times. Robin will ask for help if this is interfering with her recovery.
·As much as is possible (depending on Robin’s recovery), please assist Robin and Stephen to be our baby’s primary caregivers while in hospital.
·We would like to be discharged as soon as possible.

[Marvelleaux]

This is such a great thread!

:

[anubis]

Subbing, this might come in handy in the future (well, I'll have to get pregnant first )