"Home Birth at the Hospital" Birth Plan

[spewie]

I really want a home birth, but it looks like it's not gonna happen (still have a while, though, so things *could* change)

I was messing around with a birth plan and was hoping for your thoughts. What I really want to say is "keep your hands off me and my baby" but I don't think that would go over well.

I am anticipating a very hands-off/low intervention birth. Please consult me before any procedures, routine or otherwise.

In early labor –
I would like to be able to move, eat and drink as my body tells me
I would like Doppler monitor after the initial strip
I will be practicing Hypnobirthing and request that pain relief not be offered to me. I will ask for it if I need it.
The tub is my friend and I see myself spending a lot of time in it.
Please enter the room quietly and speak softly when needed

During pushing –
I would like to push when/how my body tells me without any "coaching"
I would like to catch the baby myself and be the first one to touch her

After birth –
I would like the baby to not be suctioned as birth naturally does that
I would like the cord cutting to be delayed to give the cord time to stop pulsing.
I would like to not have pitocin after delivery as I will be nursing right away.
I would like the placenta to be delivered naturally without manual traction

Baby Care -
As I do not have any STD's, we will be declining the Eye Ointment
Baby will receive no vaccinations
I would like to be the one to give Baby her first bath
I will be exclusively breastfeeding and ask that the baby receive no bottles or pacifiers.
Baby will room in with me.

I realize that I am going against the grain and I appreciate the extra effort on your part to help me have a natural birth.

[kltroy]

I would keep your birth plan very short and simple. Stick to those things that you see really as key - find out what the hospital policies and routines are and don't bother asking for what you'll already get - it just detracts focus from the things you NEED to ask for. See my comments below.

I am anticipating a very hands-off/low intervention birth. Please consult me before any procedures, routine or otherwise.

In early labor –
I would like to be able to move, eat and drink as my body tells me
probably not necessary to put this in the plan - just do it.
I would like Doppler monitor after the initial strip
I will be practicing Hypnobirthing and request that pain relief not be offered to me. I will ask for it if I need it.
I would change this to just say "Do not offer me pain relief. I will ask for it if I want it.
The tub is my friend and I see myself spending a lot of time in it.
Not necessary to say - just use it
Please enter the room quietly and speak softly when needed
Easier to post a sign on the door of your room than put this in the birth plan I think

During pushing –
I would like to push when/how my body tells me without any "coaching"
I would probably just say "No directed or coached pushing, please
I would like to catch the baby myself and be the first one to touch her
Isn't this redundant? Just say you want to catch your own baby.

After birth –
I would like the baby to not be suctioned as birth naturally does that
I would like the cord cutting to be delayed to give the cord time to stop pulsing.
I would like to not have pitocin after delivery as I will be nursing right away.
I would like the placenta to be delivered naturally without manual traction
I would probably just reword so they don't have to read the extra verbiage:
- No suction
- Delay cutting the cord until it stops pulsing
- Expectant management of the third stage of labor

Baby Care -
As I do not have any STD's, we will be declining the Eye Ointment
Baby will receive no vaccinations
I would like to be the one to give Baby her first bath
I will be exclusively breastfeeding and ask that the baby receive no bottles or pacifiers.
Baby will room in with me.
Don't all hospitals do this now? No need to have it on the plan if yours does

I realize that I am going against the grain and I appreciate the extra effort on your part to help me have a natural birth.
I would probably put this up front - and no need to mention the "gonig against the grain" part

[spewie]

All very excellent points! Thank you so much!

[prothyraia]

I would absolutely remove the phrase "I would like" from all of those and replace it with something more assertive. I'd also eliminate arguable points.

So, instead of "I would like the baby to not be suctioned as birth naturally does that", try "Do not suction the baby after birth" or "I do not consent to my baby being suctioned after birth"

Instead of "I would like the cord cutting to be delayed to give the cord time to stop pulsing.", try "Do not cut the cord until it has stopped pulsing and I have okayed it" (nurses/doctors definition of "stopped pulsing" are often a little...off.)

[pampered_mom]

I would agree about changing the wording in some of your items. If it's something that would be done to you or babe and you feel strongly about it not happening then the only statement you can use that has clear legal power behind it is "I do not consent". That way, if they do it anyway it's clearly medical assault and battery on you.

Believe me, your hospital is quite aware of this, but they will assume you are not. Obviously, I wouldn't put that in front of everything, but I would definitely use it with the items I feel strongest about.

For example, in your baby care section I'd probably word it accordingly:

We do not consent to prophylactic eye medications.

We do not consent to the administration of the Hepatitis B vaccine. All vaccinations will be addressed with our Family Practitioner at a later date.

We do not consent to any artificial nipple or supplement use in our child. If there are medical concerns about glucose or nutritional status, these will be discussed with us before any action is taken. I plan to exclusively breastfeed our child.

And I'd probably add the following statement:

If it is necessary, because of specific and urgent medical concerns to take our child from my presence, my spouse will accompany our child wherever s/he is taken. We do not consent to being both separated from our child at any time, under any circumstances without prior consent.

We do not consent to routine infant care in any place other than the room where I am recovering or residing. We want complete rooming in to be assumed, unless we specify otherwise. Any evaluation of our child can take place in my room, in my presence.

...but that's just based upon my prior experiences with my ds.

[elspethshimon]

I just want to say that while all of this (and the input from previous posters) looks great, if it comes down to it, "keep your hands of me and my baby," is more than appropriate.

[SublimeBirthGirl]

And just so you have realistic expectations, even a really great hospital birth is not going to be like a homebirth. I wish someone had told me that when I was pregnant with my 1st!

[phathui5]

Are you using a fairly "liberal" group of midwives? Will they (or a doula) be present throughout your labor to protect you from hospital policies?

[sunnymw]

I agree and disagree with one of the above posts... On things that you WILL NOT compromise on, period, I would put "I do not consent", but on say, pick a few things that aren't QUITE as crucial and put "I would like", because very few OBs and L&D nurses will take kindly to being "bossed around" in a birth plan

And I would DEFINITELY discuss this IN DETAIL AND AT LENGTH with whomever is going to be your attendant. Otherwise, IME, it just won't happen. And then when you see that person at the beginning of your labor, talk about it again. And at the prenatal visit, give them a copy and have them *sign* yours... that way the L&D nurses will take you a little more seriously.

I know that all sounds horrible, but I gave birth in a very very very interventive hospital and I only had maybe 2 wishes on my entire birth plan honored, even though I did do some of these things

[queenjulie]

Originally Posted by sunnymw

And I would DEFINITELY discuss this IN DETAIL AND AT LENGTH with whomever is going to be your attendant. Otherwise, IME, it just won't happen. And then when you see that person at the beginning of your labor, talk about it again.

That's definitely true. Honestly, we were so distracted when we finally were allowed to be admitted into the hospital (mine doesn't admit until you're 5 cms, which for me was after 22 hours of agonizing contractions with a posterior baby), we never even bothered to get the birth plan out of the suitcase. We just told whoever was closest, "Hey, don't clamp the cord! No, please leave her here, she doesn't need to be bathed right now. Please don't scrape out the placenta," etc.

[queenjulie]

PS: You may not have to worry about the last couple of things on the list; you should ask your hospital about rooming in, etc. I go to a military hospital, and the military has a reputation for being super-conservative, etc., but our hospital has no nursery at all--rooming in is the only thing they do, they don't keep any pacifiers in the hospital anywhere, and they treat breastfeeding as the default and never offer formula unless the mother is very ill or something goes seriously wrong during the birth. You also get a visit from a lactation consultant the day after the birth automatically, for free.

[Canita]

Originally Posted by queenjulie

PS: You may not have to worry about the last couple of things on the list; you should ask your hospital about rooming in, etc. I go to a military hospital, and the military has a reputation for being super-conservative, etc., but our hospital has no nursery at all--rooming in is the only thing they do, they don't keep any pacifiers in the hospital anywhere, and they treat breastfeeding as the default and never offer formula unless the mother is very ill or something goes seriously wrong during the birth. You also get a visit from a lactation consultant the day after the birth automatically, for free.

I'm birthing at a military hospital, too, here in San Antonio and same thing! Not even a nursery in the maternity ward, rooming in is the only way!

[RockStarMom]

Originally Posted by SublimeBirthGirl

And just so you have realistic expectations, even a really great hospital birth is not going to be like a homebirth. I wish someone had told me that when I was pregnant with my 1st!

Ditto. A CNM and doula are more likely to ensure that you are nearer the experience you are looking for. My birth plan gave me a false sense of security and optimism.

[mamabadger]

I would suggest one other thing. Find someone reliable who is familiar with your hospital, such as a doula who has attended births there. Show her your birth plan, and ask her to tell you how difficult each item might be to get, and exactly what kind of opposition or arguments you might encounter. Forewarned is forearmed.

[spewie]

Thank you everyone, I really appreciate all the replies.

I have given birth at this hospital twice with the same OB practice. The first time my goal was to have a vbac and I got that. Along with an epi at 5cm, AROM, etc. But at the time I was happy with that.

Last time I gave birth there I really wanted a natural birth but had to deal with the monitors for 20 minutes every hour, the IV and other crap. I am hoping that a MW would be able to work with me on those things. My birth plan last time had the "I would like" phrase and the Nurse/Dr acted like they had no problem with my requests. I asked to delay cord clamping/cutting and I just watched the video... they waited 40 SECONDS!! Of course my mind was on the baby and time had pretty much stood still so I didn't realize how much time had (not) passed. Plus they were so rough with him! Manually rotating his head, rubbing him with those rough blankets and shoving that stupid suction down his throat. : I don't have a video of #2's birth, but I'm sure it was the same way.

Um, I think I got on a tangent there.

My DH has suggested that I give him a copy of my birth plan and he will be my guard dog. I never thought of giving him that responsibility before, but I think it would help him to have something he can actually "do".

I took out the rooming in b/c that is the norm at the hospital and I condensed it a lot like kltroy suggested. I like the advice to not ask about eating/tub/etc, I learned as a teenager that sometimes it is easier to beg forgiveness than ask permission. Plus, we now live 5 minutes tops from the hospital and I plan to labor at home much much longer than I have in the past.

SublimeBirthGirl
And just so you have realistic expectations, even a really great hospital birth is not going to be like a home birth. I wish someone had told me that when I was pregnant with my 1st!

Don't remind me. I know it can't be anywhere near as good as a home birth, but I'm hoping to make the best out of it.

pampered_mom - the "we do not consent" is good advice. I'll add "we do not consent to circumcision" our boys are intact, but I really feel this one is a girl. I'll add it for now though. (Not that you mentioned circ, it just made me think of it)

Once again, I appreciate all the input!

One more thing: I haven't met the MWs yet. My first appt is on Thursday when I'll be 13 weeks. Any specific questions I should ask?

[Kidzaplenty]

I just thought I should add. Be careful about your birth plan and how you present it, and when you present it. I gave my birth plan to my OB when I was 24 weeks along, a week later I got a letter telling me to find a new doctor because my birth plan was "not in accordance to the standard of care in the United States". I was floored, he refused to even respond to my request on exactly what he was talking about. I was not some first time mom that was ignorant. That pgcy happened to be my SIXTH, and I was not even very forceful. This is a basic copy of my birth plan:

I do not want my husband to be separated from me at any time other than to accompany Baby
I do not want an enema and/or shaving of pubic hair.
I want no restrictions regarding food or drinks by mouth throughout labor.
I would like the environment to be kept as quiet as possible and the lights kept low
I would prefer to keep the number of vaginal exams to a bare minimum, and if the amniotic membrane has been ruptured to have none at all.
I do not want a routine IV or heplock prior to it actually being necessary.
I would like only external fetal monitoring on a non-continuous basis, using a fetoscope or Doppler.
I do not want to have my labor Induced or augmented in any way.
I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
I would prefer to have NO drugs or medication.
If the Baby is not in distress, Baby should be given to my husband immediately after birth.
I would prefer to tear than to have an episiotomy.
I do not want to be moved from a labor room to a delivery room. I wish to remain in one room for the entire “Labor and Delivery” process.
I want to be allowed to choose the position in which I give birth.
I do not like to be told when to push.
I do not want a time limit to be put on labor and delivery.
I would like to have Baby placed on my stomach/chest immediately after delivery.
I would like my husband to hold Baby when I am delivering the Placenta.
I do not want the umbilical cord clamped or cut until placenta has been delivered and the cord is completely drained and white.
I would like to have Baby evaluated in my presence.
I do not want Baby bathed until I bath with him/her.
I do not want Baby taken to the common nursery for “routine evaluation”, an evaluation can be done in the room, in my presence.
I would prefer to hold Baby rather than have her placed under heat lamps.
I do not want a routine injection of pitocin after the delivery to aid in expelling the placenta.
I do not want eye medication for Baby after birth
I do not need nor do I want a shot of Rhogam following the birth of Baby.
I plan to breastfeed Baby and would like to begin nursing immediately after birth.
I do not want the baby offered ANYTHING by mouth other than breastmilk.
I do not want routine vaccinations given to Baby. We have a Religious Exemption to Vaccinations, and a written copy of this will be provided.

I just thought I should put that out there. Not all doctors like birthplans, and some are down right hostile to them.

[MamaLuvsHerBabies]

I just thought I should put that out there. Not all doctors like birthplans, and some are down right hostile to them.[/QUOTE]


I do not mean to be derogatory in any way, but I am wondering why you chose to deliver in-hospital? Was it due to insurance reasons, or was it that you felt it was the safer place to be?

I am a labor and delivery nurse, and I am always perplexed by women who have lengthy birth plans, and who are quite aware that many of these plans will not be met by their OB once they're admitted. Hospitals are notoriously birth-plan unfriendly. Why choose a hospital rather than a birth center or homebirth? I know insurance reasons are compelling, but I had a homebirth with my 4 baby and I scraped together the $3500 out of pocket to do so, because I felt so strongly about having a birth the way I wanted to. I would have done anything to avoid birthing in-hospital because I know the way things go there is anything but normal, and healthy, and supportive of a woman's natural birthing process. Of course, if there were any type of problem with my baby or my health, then absolutely, I would have revoked my wishes to defer to my baby's healthy outcome.

I wish so much, that when it comes time for my daughters to give birth, that there will be better options for them. I wish that there would be widespread, insurance-covered Midwifery care, that offers homebirth as an option.

Your birth plan (in your post) was exactly what I wanted for my homebirth, and was exactly what I got (thank God) in my homebirth. I know that very little of that would have been attained in-hospital.

Blessings to you and your little ones,
-T. (wife of 18 years, mommy to 4 beautiful children, proud L&D RN)

[Kidzaplenty]

Originally Posted by MamaLuvsHerBabies

II do not mean to be derogatory in any way, but I am wondering why you chose to deliver in-hospital? Was it due to insurance reasons, or was it that you felt it was the safer place to be?

Actually, I did not choose to deliver in the hospital. I home birth all the way. But I always have duel care and see an OB until my 38th week. I also "plan" a hospital birth, for "just in case", and I never tell the OB that I am home birthing. (I got burned on that with my second, and quickly learned my lesson.)

I figure that if "just in case" something goes wrong, I am better off to have a birth plan and a doctor all up to date on me my needs rather than an ER visit and a hostile hospital experience due to a HB transfer. So I create my birth plan for what I would ideally want if I did birth in a hospital.

[spewie]

Kidzaplenty - Sadly, I'm not surprised your Dr did that. However, I would much rather find out now that my MWs won't be accomodating to my birth plan that when I'm 37 weeks when they typically go over birth plans.

MamaLuvsHerBabies - I'm not sure if you were refering to me or Kidzaplenty... I'm very sad to be planning a hospital birth, but my dh and I just don't see eye to eye on home birth and I would rather have him there and supportive than there and angry. I'm still hoping for a miracle though. Birth center isn't an option because they don't allow vbacs.

[dlm194]

I had a birth plan for my hospital VBAC and pretty much everything was followed respectfully. I also had a very supportive midwife so I'm sure that helped (and prevented anyone in the hospital from giving me a hard time!). I broke the birth plan down into Pre-Admission/Admission, Labor and Birth, Cesarean Delivery, Following Birth, In the Event of a Stillbirth or Neonatal Death.

I simply listed my preferences with bullet points for easy reading (no nurse is going to stand there and read through something lengthy or wordy). I had a 2 page sheet for my midwives and a 1 page sheet for the hospital. I did bold a couple lines that started with WE DO NOT CONSENT TO.... Hep B vax, erthromycin, and cirumcision. The nurse simply brought us a waiver to sign.

I would have prefered a homebirth but it's illegal for a provider to attend an HBAC in NJ.