birth plan

[ghuaghua]

I read the older thread about whether or not to pack a hospital bag in case of transfer...and I decided that while I probably won't do that, I will want to have a birth plan of sorts. What exactly would I need to include on a birth plan designed for an emergency transfer? I guess in my head I'm thinking that a transfer would be a worst case scenario and that it would automatically mean c-section?

[Gray's Mommy]

I am a doula & have had a few of my homebirth clients transfer...the number one reason is for maternal exhaustion. If you have a vocal partner/husband that can stand up for what you want in your birth then I wouldn't do a preference listing.
Their births turned out to be hospital births with no meds & no interventions...it must have been the "threat" of a c-sec that made them get down to business.

[phoebemommy]

I had an emergency transfer plan for my midwives. They recommended I pick 2-3 things that were of crucial importance to me so that they could advocate. The idea of 2-3 was that in an emergency, they couldn't necessarily make sure every little thing made me happy, yk? I think mine were NO EPISIOTOMY!, my holding the baby immediately after birth, and delayed cord clamping.

I also made a very long list for dh detailing what I might need him to advocate for me, and our plan for if the baby had to be separated from me -- that he would go with and make sure no Hep B shot, info for him about the Vit K shot, etc.

I think there was also a very basic, bullet pointed list to have on hand for people at the hospital with all the basics we did and didn't want, in case it was opportune to give it to them. This included no eyedrops, no Hep B, no bottles or pacis, etc. I didn't transfer, though, thankfully!

For the list to give to the hospital, I left certain things off like no EFM, because I figured they would be things I could say yay or nay to depending on the situation.

[ghuaghua]

Thank you for your replies! I'm happy to hear that things can still go relatively well even if I have to transfer.

[jessitron]

Yeah, they can. They did for me.

I don't write a birth plan since if we transfer it's because we want some sort of intervention. DH is a good advocate, and we both know what we want and will stand up for it.

[MsBlack]

I have a document for my homebirth families that discusses making an alternative birth plan in case of transport. While this doc. covers much of what one might encounter in the hospital so that parents might write a plan that is detailed if they so desire, the most important element is really Informed Consent. That is, you will want informed consent for ALL/ANY med treatments/procedures for mom and baby. Some parents, rather than making a detailed list, simply write a short statement and make a few copies to provide to the staff they will deal with. This statement says that they expect to receive informed consent, as is their right under law, prior to any treatment being done to mother or baby once they are admitted.

When you enter the hospital, you are expected to sign their general waiver/informed consent in which you basically agree to let them do whatever they deem necessary for your care. Before signing this, I suggest that parents write a statement in the margin (and initial it), that modifies this 'blanket' consent: 'ONLY with specific informed consent for any and all treatments'. With this and a few copies of your own signed statement to hand to your primary care providers, you will flag yourselves as parents who are informed and who must be involved in all care decisions. Not that you will then have no struggles--just that it will be understood at the outset that you won't be just going along with 'whatever', and they will have to talk to you and include you in all care decisions (except for life/death emergencies, which really aren't usual anyway--NO, not all transports end in csec, for some it's merely an epidural/other, pitocin, fluids and otherwise a 'normal' birth).

[MsBlack]

I should add that even if you don't make a detailed birth plan, it is wisest to be aware of standard procedures of your nearest hospital, so that you are ready to decline/approve various things as appropriate. For instance, after csec, staff will take even a healthy baby away from even a lucid, stable mom, to deal w/baby in nursery while mom is being stitched up. You can insist on keeping baby w/mom and dad in OR instead--no reason mom can't hold and even nurse baby on the table, if both are ok. If mom is gbs positive, or status unknown, they'll want to stick baby to test for infection, even in absence of any signs of infection--and you can decline this too and insist that they undertake 'expectant management' (waiting to observe signs of infection prior to testing/treatment). Of course, most hospitals will want to do bath, exam, vit K, eye ointment, etc, so know what to expect and be prepared to make your stand where necessary. It doesn't have to be in your birth plan...but probably should be in your head.

[SublimeBirthGirl]

In my head, I knew the #1 reason for transfer is maternal exhaustion. In my heart, I knew I wasn't setting foot in a hospital unless there was something very wrong. My c-section birth plan is pretty simple: spinal if there's time (standard), horizontal incision if possible (standard), double sutures, and give me my baby or else dad stays with her. I figured my husband and I would remember w/out writing it down. I was pretty sure, somehow, I wouldn't transfer (I didn't).

[sing4jy]

I did have an emergency birth plan available, but I've never packed a bag. I figure if I actually had to transfer, after the baby was out dh could go home and get me what I needed.