Can someone skim my transfer birth plan and tell me what you think, please?

[flapjack]

•This is my fifth baby, and was my fifth planned home birth. If you are reading this then something has gone wrong with these plans. Please consider that we are feeling scared and vulnerable right now and treat us compassionately and courteously.
•I have never had a hospital birth before and I’m not familiar with hospital routines. Please explain all proposed actions clearly, including clinical terms where relevant, so that I can give informed consent to any action proposed, and be prepared to discuss risks and benefits with me.
•I know that movement and an upright position has been important to me in previous births. Please support me in using the same coping mechanism this time, including using an upright position for any periods of continuous fetal monitoring necessary.
•For my dignity and privacy, I would prefer that vaginal examinations are kept to a minimum. Please consider the timing of the last such examination and what new information you are seeking before asking permission to perform another.
• I wish to avoid artificial rupture of membranes- please do not offer this intervention.
•Feel free to offer constructive criticism to keep my labour as natural and gentle as possible- positions, breathing, anything that may help me. If I’m here, I need your help- please give it. I have symphsis pubis dysfunction, so some postures may be difficult for me to adopt. If there is a reason that you believe I would benefit from a particular kind of pain relief, please tell me.
•I want baby to be in my arms as soon as possible after birth and dreamt of catching him myself. Please keep us together, and do not separate us for routine care.
•Successful breastfeeding is vitally important to us, as I have an asthmatic child with milk allergies. We want to initiate breastfeeding as soon as possible after birth, to keep baby close, lots of skin to skin contact and gentle nurturing. Please help us with this. Do not offer artificial baby milk under any circumstances, but discuss the other options with us.
•I want a physiological third stage with cord cutting delayed until initiated by ourselves. Please tell us quickly, clearly and concisely if there is a need for alternative action at this time.
•Please do not ask me or my child to remain in hospital unless there is a clear clinical need. I would prefer to return home straight from the delivery suite, unless a surgical or assisted delivery becomes necessary, and would ask for your help to make this possible.


I know that the homebirth midwives are prepared to be fairly hands off, and are calm about most of this stuff anyhow, so it really is just a case of hospital transfer. What do you think?

[Jezzy]

it gets your point clearly across! I hope you don't need it!

[flapjack]

Me too : Then again, to get me in that place either he or me would have to be nearly dead, so there's really no point in worrying about details, is there?

[sarahn4639]

I think it sounds great. It is very diplomatic and even friendly while being firm in your desires. I like it alot.

[gerlassie]

That sounds great but... you may want to add your preference for pacifiers ( give, don't give or will provide my own ). Also, you mentioned milk/formula sometimes hospitals will give a glucose type solution to nursed babies so, you'll need to be specific about that. And lastly, because of liability many hospitals may require you to stay up to 12 hours after giving birth but, that is not too long of a time and you'll be able to rest a bit.

Hope this helps,
gerlassie

[Mommy2Austin]

You had me worried for a second until I realized you just wanted us to critique it

Sounds pretty good. I'd also make sure to make evident that you do/do not want him circumsized (if it's a boy.) Leave no room for them to mistaken that fact.

Also if it were me I would make sure to state that if for some reason baby has to be taken away you want your DH to be with him and know whats going on!

That's all I can think of.

[the elyse]

it's really great! i might steal it....

[applecore]

It's very well written. It's also respectful and non-confrontational, which should help with the way it's received. One thing you might think about adding is that if baby needs help starting up (god forbid), that you would like it to be done with baby on your chest- if that's important to you. I know in the states they are so quick to whisk them off to a hard table, but they could just as easily do it with the baby still with its mother, and probably with better success. I don't know if it's the same in your neck of the woods.

[Lact-o-Mama]

I'm not sure where you stand on this: what about routine procedures done to newborns? Like Eye Prophylaxsis (sp*), PKU Testing, Nasal Aspiration, etc etc. If you wish to not have those types of procedures done, you may want to add that to your list.

It sounds really good.....but if I had to put my 2cents in somehow, I may suggest being slightly more brief if possible with your reasonings. The only reason I say that is because the chances of you getting a nurse who is hesitant, let alone has the time to read thorough responses such as yours, is unfortunately high. It's not at all that I personally think your responses should be shorter...I'm just thinking from a "busy, mainstream nurses" point of view, YKWIM.
You could section your requests like: Labour, Delivery and Post Partum, making it easier for your caregivers to find your requests during critical times.
For example: Your comment about Successful Breastfeeding being vitally important...
How about:
~Please, only Breastfeeding Support. No artifical Milk or Pacifiers. Babe to be brought to my chest, skin to skin, as soon after delivery as possible.
~Baby to be left on my chest as long as possible, avoid any routine procedures unless medically necessary

[nausicaamom]

I would agree with Lact-o-mama - try to make it a bit more concise and I would also include a provision for surgical birth preferences as well to have all your bases covered.

[flapjack]

OK, Jenn, shoot with the surgical birth preferences. If it comes to that, what do I need to know? Rooming in afterwards is standard, and there isn't a routine separation for observation for baby after a c-section- mum and baby share the recovery room.

Circ/eye ointment/ aspiration etc. won't be offered over here, due to the lack of clinical indication (we're on evidence-based midwifery, the same as AUS) and there's no routine EFM on admission. PKU is done on day 5 by the community midwives- we would have been opting out of vitamin K, but if it comes to an assisted delivery will reconsider.
As far as breastfeeding goes, it's highly unlikely that anyone will supplement without asking and certainly not with glucose water immediately/soon after birth but that's not as big a deal to me as actually just avoiding milk: I'm literally carrying a t-shirt in my handbag that says "give me formula and mummy sues you for assault". There's a breastmilk bank in Oxford who will supply Swindon mums, and there's a few of my friends who will pump for bean if we need it. What MAY, however, happen, is that it drops way down everyone's list of priorities, that a trip to SCBU (who are apparently very good at getting people to pump and very bad at getting people to breastfeed) is likely to lead to problems in the form of routine supplementation.
Unfortunately, if baby's slow in starting it's going to have to be clamp and cut as soon as possible, as there is just no way that even the community midwives will do oxygen or resusc. with baby on mama's chest- I did try arguing the point on that one and I'm not going to win. I can't face two funerals, so : That won't interfere with my natural third stage, but it will with his...
Gerlassie, I'm not sure but I think the guideline over here is either four or two hours before discharge- but there's always AMA.
I'll go for the concise wording somehow, not sure how. I just realised that I also need to specify a large BP cuff.

[mama_nym]

c-section - some use staples, some stitches to close. 2 rows of stitches is preferable (they often, at least in the US, do one layer of stitches instead of 2) for healing and comfort.

[nausicaamom]

Originally Posted by flapjack

OK, Jenn, shoot with the surgical birth preferences. If it comes to that, what do I need to know? Rooming in afterwards is standard, and there isn't a routine separation for observation for baby after a c-section- mum and baby share the recovery room.

One of the biggest ones for me is that no mind-altering meds be given without my express consent barring an emergency situation - this includes the anti-nausea med Phenergan (not sure what the name is in the UK) since it has drowsiness as a side-effect. I know in the US, they typically give you a mild sedative as they are prepping you and the will give a mild amnesiac while they are closing you up as part of the SOP - there are chunks of Michael's birth that I can't remember but my husband does and he was just as traumatized by parts of the experience as I was so it's not just selective memory on my part. I don't know if it's part of the SOP in the UK, but you may want to make sure your husband can be in the surgical suite with you and hold the baby himself after birth or help you hold the baby while you are being closed up. You may also want to request that one or both of your arms be free during the surgery (in the US it's SOP to have both arms strapped down). Other than those, take a gander at the C-Section sticky in Birth & Beyond just to make sure something doesn't jump out at you.

As for making it concise, just take out some of the reasoning behind your requests - e.g. the asthma/milk allergy thing being a big reason to avoid ABM,
and maybe just state that you wish to leave the hospital immediately after the birth barring an emergency situation rather than requesting that they not ask you to stay. You want things to sound nice, but you also want your care providers to be able to skim the list and tick off in their heads that you don't want X, Y or Z. Maybe a leading sentence and then bullet points underneath.

I hope you don't think I'm jinxing you, but I know a hospital transfer is going to be a traumatic thing for you to begin with and I'd hate to see insult added to injury by not being prepared with something written for a surgical birth. The good thing is once you have things typed up and several copies made (and I do mean SEVERAL - stash them everywhere you can think of), you can safely forget about it and concentrate on pushing that baby out at home and hopefully not ruining another white Egyptian cotton duvet. Maybe you can truly break-in your new kitchen

[nausicaamom]

Originally Posted by mama_nym

c-section - some use staples, some stitches to close. 2 rows of stitches is preferable (they often, at least in the US, do one layer of stitches instead of 2) for healing and comfort.

You would want to request a double suture for your uterine incision as at least in the US it is prefered for a VBAC although studies don't agree on it so it may be a different deal in the UK. As for your outer incision, they will either use sutures and steri-strips or staples. As for the comfort of one over the other, I don't really know (I had staples and had no problem). There is an increased risk of infection with sutures, but cosmetically they look much better when healed than staples which is why many women prefer them.

[flapjack]

Everyone I've spoken to who's had a c-section has had sutures, and a VBAC is pretty much a given over here and highly supported although it would mean I'd have to see an OB next time round... and I'm trying so hard not to think about meds at all. Seriously, I know that an unaesthetised c-section is probably a really silly idea but right now it seems a lot less scary than the idea of letting that place put ANY drug in me.

[gerlassie]

So Flapjack, just a question...if I were planning a unassisted home birth in your town, and had a Midwife for some or all prenatal care and had to go to a hospital mid-delivery would the Midwife come with me? I have read some posts which state that a Midwife will drop them off at a hospital then literally run. I just assumed that those are the ones that are unlicened. My Midwife who is no longer able to do home births is affiliated with a hospital where she has control over the birthing suite and her patients have total control over their births. I labored at home for 1 1/2 days and was in almost hourly contact with her before going to the hospital and once there, wasn't hooked up to anything. Baring anything unforseen of course they still override the staff and have first say in emergency treatment. She will also not leave her patients side and makes a point of clearly discussing all "what if's" as delivery approaches. Do the hospitals in your town have on staff Midwives that you would be able to assist you even if it's for emotional support or is everything pretty clinical once you arrive. Here malpractice insurance rates have priced most OBs out of practice, the general population is now turning to Midwives for pre-natal care...and most of these women would never have considered this before and then quickly return to their OBs after delivery. Even our Midwives are being forced to affiliate with hospitals or birthing centers. Alright here's my question. In the event you need to leave your home, would the hospital staff pose a threat to your wishes because you have managed or wish to manage and maintain some control over your birth? I just find it interesting that a womans rights can vary so much from state to state and country to country...here, some women even cross state lines to go to "The Farm" where they can deliver with dignity.

gerlassie

[flapjack]

We're signed up with a midwife anyhow (god bless the NHS.) If we decide that we need help, the first port of call is to ring the maternity bleep holder at the hospital who will get a midwife out to us- alternatively, we can ring the labour ward and tell them that we'd planned a homebirth and changed our mind, can we come in, please? IF the midwife comes out to me at home, even if she takes one look and says "go now" then she'll stay with me for the duration, or until shift change, whichever comes sooner. If someone transfers in and is in hospital over the shift change then the L&D staff normally take over at that point. I'd have a named midwife for the duration of the labour who would take the responsibility and catch the baby unless she thinks it's necessary to get a doctor involved (and if it wasn't, we wouldn't be there...) but it wouldn't be 1-1 care until I'm close to birthing unless the labour was augmented or I chose an epidural. That said, our midwives are a lot less touchy-feely than yours are- they are medical professionals first and foremost, just woman-centred ones.
Saying that, my m/w has only been on community work for a few months, and was working on the delivery suite before that, and the midwife I started off with is working on delivery now. Apparently they tend to rotate a lot to keep skills fresh.
Oh, and obviously there's always the option of calling an ambulance, who will move me to hospital if it's safe to do so...

[Dea]

I think it's well written, concise and clear.
The line where you mention that you need compassion and courtesy might be unnecessary, unless you believe that you will be treated badly for having tried a home birth.
I honestly believe that nurses and doctors are caring and kind people and they work in a chosen field where compassion is common. But perhaps I am naive and choose to see the good in people.

I had a long conversation with DH's cousin who is a nurse in L&D and post partum about what would be good in a birth plan and she explained to me that anything that is really insistent and full of DO NOTS get mocked by the staff. She also explained that these plans always fail, she said the most successful ones are ones like yours where there is lots of wiggle room.

Anyhow I think yours is beautifully written.

[flapjack]

What I'm gunning for is "be extra-specially gentle with us, we're terrified." Whilst HB isn't that unusual in this country and is getting more common (Wales is aiming for a 50% homebirth rate by the end of the decade) it is still unusual to find someone who has only ever homebirthed, especially with my history. Most people are going to look at my notes, see the 24 week stillbirth or the 43-weeker and assume that one or both of these births took place in hospital, just because it's so unusual for someone to ask to go back home and HB after they know baby's dead: the more usual reaction, apparently, is to want everything over as soon as possible.

[gerlassie]

That is so cool that your "homeland" encourages home births. It's still pretty underground here.

gerlassie