birth plans --

[Momma Aimee]

ok this is my game plan for getting my birth plan finished and ready ....

Tomoorow night -- Doula meeting me here to go over teh plan
Fri the 7th -- drop off the Birth Plan for OB to read
Oct 18 -- next OB appt -- discuss BP with OB and come to woring agreement
Sept 25 -- meet with Doula-- finalize bp
oct 2 -- meet with OB -- get BP singed off on and into file
Oct 5 -- Fri -- have hosiptal paperwork finished and mailed in with agreed upon birth plan

sooooooooooooooooo here is the birth plan as it stand NOW... mostly pulled from the plan i had with Theodore's birth -- mod to reflect what i don't think is necessary to put in this time based on what i expereinced with T at the same hosptial I will be birthing again....

Anyone else have any thing that is NOT on here ... that i need to add or consider...

Thought? too pushy? too nice? wording? things i can leave out as no duhhhhhhh?

Looking forward to hearing what you think..................
(I would looove to see your plans too ).............

Packard Birth Plan Nov 2007 -- 2nd birth

General
My support people are Scott (Husband) and Amelia (Doula) they will be with me at all times.
Our son Theodore might visit the labor room with his Grandmother as we, the parents, see fit.
We are seeking a calm and peaceful birth, with low stress and no rushing or conflict.
I would like time to discuss any interventions (monitions, labor augmentation, medications, etc) with my husband and Doula privately.
We will control the lights and music in our room, as well as the tempitture.

Labor
I would like to be totally mobile during labor, free to walk or change positions at will.
I would like to shower or soak in a tub to aid in relaxation.
I would like to be able to have food and drink by mouth throughout labor.
I would prefer to keep the number of vaginal exams to a minimum.

Monitoring
We will not have continuous fetal monitoring unless it is required by the baby’s condition -- we would really like to avoid this.
We will not have any internal monitors (baby or contractions) unless the baby has shown some definite, repeated, or unchanging signs of distress.

Labor Augmentation/Induction
We do not wish to augment labor and delivery or alter the natural process in anyway.
We prefer only natural methods of encouraging labor.
We do not wish to have the amniotic membrane ruptured artificially.
We prefer to strip (sweep) the membrane and try other non-drug interventions in place of medication.
We refuse Cytotec which has not been approved by the FDA for use on pregnant woman, nor for labor induction, and has been proven dangerous.
We would like to give labor a good opportunity to re-start if stalled before Pit is administered.

Anesthesia/Pain Medication
We realize that many pain medications exist — We’ll ask for them if I need them.
We strongly prefer not to have any pharmaceutical l pain management suggested.
We prefer to utilize a short acting pharmaceutical such as Fentanyl first to try to regain natural management.
We prefer to try a slightly longer acting narcotic pain relief (Nubain, Sublimaze, Stadol or similar) next.
We prefer to save Demerol as a final option.
We intend to avoid an epidural unless medically necessary.

Cesarean
Unless absolutely necessary we would like to avoid a Cesarean
We would like to attempt forceps, again, or vacuum before a surgical birth.
If a Cesarean delivery is indicated, I will be fully informed and to participate in the decision-making process.
I would like Scott and Amelia present at all times if a Cesarean delivery is necessary.
I wish to have an epidural for anesthesia.
I will not have my hands restrained in any way.
So I can view the birth, please lower the screen just before delivery.
Baby should be given to Scott (or Amelia) immediately and not removed from the mother’s sight.
I will nurse Our Baby as soon as possible; within 30 minutes of birth, even after a C-section.

Episiotomy
I prefer not to have an episiotomy; I prefer to tear naturally.
I prefer local anitisa for any tearsing.

Delivery
I would like to be allowed total freedom to choose the position in which to give birth, and the freedom to change positions frequently.
Scott and Amelia will offer physical support.
I prefer to push only spontialus and as hard or for as long as I feel the need (avoiding purple pushing).

Immediately After Delivery
Scott will cut the cord.
The cord should be allowed to pulse until it naturally stops before being clamped and cut.
I will hold the baby while I deliver the placenta and any tissue repairs are made, if that is not possibel Scott or Ameilia will hold the baby.
We would like to view the placenta.
ALL evaluations of the baby are to be done on my abdomen (or beside me on the bed), not the warming table.
Scott will take the baby to be weighed and return the baby to the mother.

Postpartum
I will shower ASAP with our doula and change clothing, while Scott holds the baby.
We would like all medical equipment put away or removed ASAP and the bed remade so our son can join us and see his new brother or sister as soon after the birth as medically possible.
Unless required for the health of the baby, the baby is not to be removed from the mother for any reason.
The baby will stay in my room -- all tests and exams will be done there. If the baby must be removed from the mother for the hearing and PKU test the father will be in physical contact with the infant at all times (we prefer these tests be done in the mother’s room),
If the baby must be removed from the mother for any medical reason, the father or another adult designated by us will be with and in physical contact with the baby at all times.

Baby Care
We refuse the eye ointment.
We refuse a routine Vit K shot.
The baby is to receive NO vaccination at the hospital.
The baby is to receive NO medication or tests without prior written consent of the parents.
The baby does not need to be bathed immediately, mother will bath the baby with a nurse attendant after a time of rest and calm.
We prefer to hold the baby – mother or father – skin to skin rather than have the baby artificially warmed.
We do not want our baby admitted to a special nursery merely for observation,

Breastfeeding
I will exclusively breastfeed Our Baby and will begin nursing immediately after birth.
Our baby is not to receive a bottle for any reason.
If our baby is unable to nurse she/he should receive only mother’s milk (or medication) via a nasogastric tube.
We do not want Our Baby to be given a pacifier, other any other artificial soother.
We do not want any formula or anti-breastfeeding materials brought into our room, no gift packs, no promotional material, nothing.

Circumcision
We do not want our son circumcised.

After the Birth

•We may choose to leave at the 24 hours mark, rather than the 48 depending on recovery of the mother and time of day, so to avoid unnecessary time away from our older child.
•Our 24 month old son, Theodore will visit as soon as reasonable to see his new sibling…the length of his stay will be determined by the parents.
•Theodore may stay with us as we feel best for the family as a whole.

[maisiedotes]

If it is OK I would like to "borrow" your birth plan as a guideline for my own... did you use any kind of template? I am so afraid I am going to forget something! You are very thorough.

[Living Slowly]

Wow Aimee, the birth plan is fantastic! I think you covered just about everything. Good job!

[Momma Aimee]

If it is OK I would like to "borrow" your birth plan as a guideline for my own... did you use any kind of template? I am so afraid I am going to forget something! You are very thorough.

go fopr it -- it is harly orginal I started with a number of them -- back in 05 -- i found on line, and cut and paested together what i liked. I added stuff from my sisters, and other firends. the rest i have pulled out of books like Sears and Ina May's Guide.

Help yourself -- that is what we are all here for

[Valerieg]

Great birth plan. It looks a lot like my own in many ways!!!

The only thing I would suggest is to limit your wording. Say that you refuse Cytotec and leave it at that. The last thing you need with your OB, a nurse, etc. is a debate over the other things you wrote.

I'd do the same with the pain medications. Simply state that if you are interested in having pain medications you will ask for them. Have the following bulletpoints spelled out for your doula and DH (print them out, so you don't forget) but they don't need to be on there. If the hospital knows you're open to something, they're likely to mention it.

The shorter the birthplan the better really. But you should be able to shorten it a little after talking to the OB. Just state what you want "No internal fetal monitoring" on the birth plan and leave it at that. You've already stated that you want to be involved in decisions, so your reasons for allowing it don't need to be stated, they have to ask you before doing it.

[crunchywannabe]

I would shorten it. how many pages does it print on?

If you get too long, the nurses and other staff really do tend to not read it all.

[Momma Aimee]

it is two pages printed right now

[crunchywannabe]

the "rule of thumb" (or so they always say) is to try and condense it down to 1 page so that it will actually get read.

you can take that FWIW--but that is just what I hear constantly (from working in the offices, having L&D friends and being a doula)

HTH

[monocyte]

I would suggest shortening it as well - but, that said, I'm having trouble with mine for the same reason.

I've been somewhat anal with mine and have articles attached (pubmed, midwfy today, etc) just so I have a reason for not doing things. More so to share information with DH and he can pull back out if needed. Topic this week - no suctioning at birth.

[AimeeandBrian]

I was reading a midwife's blog and she went through a birth plan she had come across and picked it apart from the point of view of nurses and OBs. It's a blog written to other health care professionals, so it seemed kind of mean, but I thought it would be a good resource...I can't remember what blog it was though!

[AimeeandBrian]

http://observant midwife.blogspot.com/2007/08/lets-critique-birth-plan.html

Here's the blog...I put a space in between observant and midwife because I can never quite understand the UA lol

[kathteach]

Sounds great Aimee.

[Ackray]

I'm not commenting on your plan, However...

I think you should change the *refuse*s to decline. Refuse comes off kind of _____, I can't think of the word at the moment with my PG brain. It's kind of a red flag word though, especially when it's in writing. KWIM?

[Momma Aimee]

good point

A

[Valerieg]

You can always have two birth plans...one for DH, the doula, and yourself so that you know which decisions you've already made and for what reason. But the one you put in your chart and on file at the hospital should be succinct and to the point. You want it read and followed. Too much information will get scoffed at.

What you have isn't too much, it's just too wordy IMO. Drop explanations and state clearly what you want and don't want. Under medications, all you really need is, "Please, no mention of pain medication, if necessary I will ask for it." Then make sure your DH and doula know which ones you'd be willing to use and in which order.

Gosh I hope this helps!

[Momma Aimee]

You can always have two birth plans...one for DH, the doula, and yourself so that you know which decisions you've already made and for what reason.

I DO already have two : : DH's copy is more like 4 or 5 pages -- with the REASONS for all the stuff so he knows WHY we do or don't want something :

I will try to cut mine back, more, it started a LOT longer than it is.

[Momma Aimee]

I keep working on it and all i have cut is 1/2 page.

maybe i will just leave it at 2 pages, front and back, we are at th same hosptial -- that is how long it was last time, and all the nurses read it.

we had an CNM last time, and OB this time, maybe the nurses will act diffently??

Packard Birth Plan Nov 2007 -- 2nd birth

General
My support people are Scott Packard (Husband) and Amelia (Doula) they will be with me at all times.
We are seeking a calm and peaceful birth, with low stress and no rushing or conflict.
I would like time to discuss any interventions (monitions, labor augmentation, medications, etc) with my husband and Doula privately.

Labor
I would like to be totally mobile during labor, free to walk or change positions at will.
I would like to shower or soak in a tub to aid in relaxation.
I would like to be able to have food and drink by mouth throughout labor.
I would prefer to keep the number of vaginal exams to a minimum.

Monitoring
We want to avoid continuous fetal monitoring unless it is required by the baby’s condition.
We want to avoid any internal monitors (baby or contractions) unless the baby has shown some definite, repeated, or unchanging signs of distress.

Labor Augmentation/Induction
We do not wish to augment labor and delivery or alter the natural birth process in anyway.
We prefer only natural methods of encouraging labor.
We do not wish to have the amniotic membrane ruptured artificially.
We prefer to strip (sweep) the membrane and try other non-drug interventions in place of medication.
We decline any use of Cytotec.
We would like to give labor a good opportunity to re-start if stalled before Pit is administered.

Anesthesia/Pain Medication
We realize that many pain medications exist — We’ll ask for them if I need them.
We strongly prefer not to have any pharmaceutical l pain management suggested.
We prefer to utilize a short acting pharmaceutical first to try to regain natural management.
We intend to avoid an epidural unless medically necessary.

Cesarean
Unless absolutely necessary we would like to avoid a Cesarean
We would like to attempt forceps, again, or vacuum before a surgical birth.
I would like Scott and Amelia present at all times if a Cesarean delivery is necessary.
I wish to have an epidural for anesthesia.
So I can view the birth, please lower the screen just before delivery.
Baby should be given to Scott (or Amelia) immediately, not a warming table, not removed from the mother’s sight.
I will nurse Our Baby as soon as possible; within 30 minutes of birth, even after a C-section.

Episiotomy
I prefer not to have an episiotomy; I prefer to tear naturally.

Delivery
I would like to be allowed total freedom to choose the position in which to give birth, and the freedom to change positions frequently.
Scott and Amelia will offer physical support.
I prefer to push only spontialus and as hard or for as long as I feel the need (avoiding purple pushing).

Immediately After Delivery
Scott will cut the cord.
The cord should be allowed to pulse until it naturally stops before being clamped and cut.
I will hold the baby while I deliver the placenta and any tissue repairs are made, if not possible Scott or Amelia will hold the baby.
We would like to view the placenta.
ALL evaluations of the baby are to be done on my abdomen (or beside me on the bed), not the warming table.
Scott will take the baby to be weighed and return the baby to the mother.

Postpartum
I will clean up as soon as I feel able to stand, with our doula and change clothing, while Scott holds the baby.
We would like all medical equipment put away or removed ASAP and the bed remade so our son can join us and see his new brother or sister as soon after the birth as medically possible, and reasonable based on time of day.
Unless required for the health of the baby, the baby is not to be removed from the mother for any reason.
The baby will stay in my room -- all tests and exams will be done there. If the baby must be removed from the mother for the hearing and PKU test the father will be in physical contact with the infant at all times .
If the baby must be removed from the mother for any medical reason, the father or another adult designated by us will be with the baby at all times.

Baby Care
We refuse the eye ointment.
We refuse a routine Vit K shot.
The baby is to receive NO vaccination at the hospital.
The baby is to receive NO medication or tests without prior written consent of the parents.
The baby does not need to be bathed immediately, mother will bath the baby after a time of rest and calm.
We prefer to hold the baby – mother or father – skin to skin rather than have the baby artificially warmed.
We do not want our baby admitted to a special nursery merely for observation,

Breastfeeding
I will exclusively breastfeed Our Baby and will begin nursing immediately after birth.
Our baby is not to receive a bottle for any reason.
If our baby is unable to nurse she/he should receive only mother’s milk (or medication) via a nasogastric tube.
We do not want Our Baby to be given a pacifier, other any other artificial soother.
We do not want any formula or anti-breastfeeding materials brought into our room, no gift packs, no promotional material.

Circumcision
We do not want our son circumcised.

After the Birth

•We may choose to leave at the 24 hours mark, rather than the 48 depending on recovery of the mother and time of day, so to avoid unnecessary time away from our older child.
•Our 24 month old son, Theodore will visit with his Grandmother as soon as reasonable to see his new sibling…the length of his stay will be determined by the parents.

[Da WIC Lady]

You can also reduce the size of the font and change the font to fit the page if you're still having trouble getting it down to a page. I'd reccomend no smaller than 10pt and avoid Times New Roman. That's the space filler font for my old college papers.

Anna

[Momma Aimee]

here is an update ----

I met with our OB regarding our birth prference sheet yesterday -- and he was supportive. we went though it item by item

here it is as he and I agreed on --


Quote:
Packard Birth Preference and Goals

Packard 2nd child EED 11/6/07

These preferences assume a normal pregnancy and labor. They assume a healthy mom and baby. We fully understand, and trust Dr M, that should any emergencies arise these preferences will have to be altered.

General
 We are seeking a calm, natural, gentle birth with no stress, no medications and no interventions. We are willing to take the time necessary.
 My support people are Scott (Husband) and Amelia (Doula) they will be with me at all times.
 I would like time to consider and discuss any interventions (monitions, labor augmentation, medications, etc) with my husband and Doula privately.

Labor
 I would prefer a hep-lock upon admission, not a full IV unless it becomes medically necessary.
 I would like to be totally mobile during labor, free to walk or change positions at will.
 I would like to shower or soak in a tub to aid in relaxation.
 I would like to be able to have food and drink by mouth throughout labor.
 I would like to be reminded to stay hydrated by mouth.
 I would prefer to keep the number of vaginal exams to a minimum.

Monitoring
 We expect intermediate monitoring of the baby’s heart, however we really wish to avoid continuous monitoring.
 We will not have any internal monitors (baby or contractions) unless the baby has shown some definite, repeated, or unchanging signs of distress.

Labor Augmentation/Induction
 We do not wish to augment labor and delivery or alter the natural process in anyway unless there is a true emergency. We would rather be patient and allow my body to do its job.
 We prefer to employ natural methods of encouraging labor first.
 We do not wish to have the amniotic membrane ruptured artificially.
 We prefer to strip (sweep) the membrane and try other non-drug interventions in place of medication.
 We refuse Cytotec which has not been approved by the FDA for use on pregnant woman, nor for labor induction, and has been proven dangerous.
 We would like to give labor a good opportunity to re-start naturally, if stalled, before Pit is administered.

Anesthesia/Pain Medication
 We realize that many pain medications exist — We’ll ask for them if I need them.
 We prefer to utilize a short acting pharmaceutical such as Fentanyl first to try to regain natural management.
 We prefer to try a slightly longer acting narcotic pain relief (Nubain, Sublimaze, Stadol or similar) next.
 We prefer to save Demerol as a final option.
 We intend to avoid an epidural unless medically necessary.

Cesarean
 Unless absolutely necessary we would like to avoid a Cesarean
 We would like to attempt forceps, again, or vacuum before a surgical birth.
 I would like the cape placed low on my stomach and lowered so I can see the actual birth.
 I would like the incision closed in such a way to promote a VBAC.
 I would like to hold the baby on my chest immediately after the delivery while I am closed; if not possible the baby should be given to Scott – not placed on a warming table or the nursery or given to a nurse.
 Please see separate Cesarean Preference Sheet

Episiotomy
 I prefer not to have an episiotomy; I prefer to tear naturally.

Delivery
 I would like to be allowed total freedom to choose the position in which to give birth, and the freedom to change positions frequently.
 Scott and Amelia will offer physical support.
 I prefer to push only spontialus and as hard or for as long as I feel the need (avoiding purple pushing).

Immediately After Delivery
 The cord should be allowed to pulse until it naturally stops before being clamped and cut.
 I will hold the baby while I deliver the placenta and any tissue repairs are made, if not possible Scott or Amelia will hold the baby.
 We would like to view the placenta.
 ALL evaluations of the baby are to be done on my abdomen (or beside me on the bed), not the warming table.
 Scott will take the baby to be weighed and return the baby to the mother.

Postpartum – dependant on time of day
 I will shower ASAP with our doula and change clothing, while Scott holds the baby.
 We would like all medical equipment put away or removed ASAP and the bed remade so our son can join us and see his new brother or sister as soon after the birth as medically possible.
 Unless required for the health of the baby, the baby is not to be removed from the mother for any reason.
 The baby will stay in my room -- all tests and exams will be done there. If the baby must be removed from the mother for the hearing and PKU test the father will be in physical contact with the infant at all times (we prefer these tests be done in the mother’s room),
 If the baby must be removed from the mother for any medical reason, the father or another adult designated by us will be with the baby at all times.

Baby Care
 We refuse the eye ointment.
 We refuse a routine Vit K shot.
 The baby is to receive NO vaccination at the hospital.
 The baby is to receive NO medication or tests without prior written consent of the parents.
 The baby does not need to be bathed immediately, mother will bath the baby with a nurse attendant after a time of rest and calm.
 We prefer to hold the baby – mother or father – skin to skin rather than have the baby artificially warmed.
 We do not want our baby admitted to a special nursery merely for observation,

Breastfeeding
 I will exclusively breastfeed Our Baby and will begin nursing immediately after birth.
 Our baby is not to receive a bottle or soother for any reason.
 If our baby is unable to nurse she/he should receive only mother’s milk (or medication) via a nasogastric tube.
 We do not want Our Baby to be given a pacifier, other any other artificial soother.

Circumcision
 We do not want our son circumcised.

After the Birth
• We may choose to leave at the 24 hours mark, rather than the 48 depending on recovery of the mother and time of day, so to avoid unnecessary time away from our older child.
• Our 24 month old son, Theodore will visit as soon as reasonable to see his new sibling…the length of his stay will be determined by the parents.
• Theodore will stay with us as we feel best for the family as a whole, including possible spending the night with his mother, father and new sibling.

he did note that it is SOP as part of the vitals taking for the nurses to ask about pain levels and management -- which i know my mom has to as an RN too -- but pointing out i will have one nurse for the whole shift, he said she will likely either not ask, as she will be there so much anyway, and / or won't make teh offer of medications after she realizes i am educated as to my options and that i will ask if i want them. he did point out, at teh start, she will likely want to run though the options with me, just so she knows i know what is avaiable to me .... that is fine, i rspect tehy have a job to do, i just don't want them "pushing" medication and last time i birthed int his hosptial they did not.

the hosptial SOP is "light food" and "clear stuff". she said a couple of teh anistialgists (misspelled) are rather grumpy about people eating anything, or drinking anything, but he went on to point out that THAT is silly cuz you can't treat each laboring mom as pre-sugery, and labor and delivery are physcally demanind and the mom needs SOMETHING.

but he notes there is a fridge in teh room and Scott or anyone else can bring in THEIR food too -- Last time, byt the time i got there, all i WANTED was popcicykles and grape jucie and stuff -- i didn't want a bagle or a muffin or anyting like a cheese burger -- so we'll play along. he told me what he was supposed to tell me, and we'll all smile about it.

we discussed situations where he would like to suggest more active management of the birth ... generally just the expected 'emergencies' of broken water for a long time and a fever starts... type thing ... but he notes that there are very few "EMERGINCES" where there is not room for discussion and compermise in most cases....

just thought i'd share

aimee