birth plan--advice?

[Desert Rose]

I wrote a birth plan for the gov't hospital I want to have my unmedicated birth at. Could you all pls help me refine it? Or help me consider points that I have left out?

According to my doc, I am the first woman registered for a delivery at this hospital who will be showing up with a birth plan (besides the emergency cases that are transferred from the ritzy private American Hospital), so I tried to make the tone a bit gentle.

•If labour begins naturally, I want to labour at home until I experience 3 contractions every 10 minutes. At that point, I will admit myself into the ER at Al Wasl Hospital.
•I want to receive a pubic shave, but I do not want an enema to be performed.
•I am willing to have labour induced if my baby appears to be in distress/ has trouble breathing.
•In the labour room, I would like my trusted friend Leslie N with me all the time, even when the nurse/ midwife examines me. I want to have either Leslie or my husband Ziad A with me when I deliver.
•I would like to be mobile during labour, and would prefer intermittent foetal heart monitoring rather than continuous. Also to keep me mobile, I do not want an IV drip. If an IV is necessary, I would like one with a heparin lock so I remain mobile.
•My tolerance to pain is generally high, but if I need pain relief, I would like to use entenox (gas and air) as it won't cross the placenta and affect my baby. I would like to use other means of relaxing my body to cope with pain during active labour such as using a birth ball and use of warm water in the bathroom.
•I want to drink water/herbal tea and eat light food like dates to maintain energy levels during active delivery.
•In the delivery room, I want the lights in my room to be set to “low”. I want to be free to adopt any position, particularly the “down on all fours” position, when delivering my baby. I will prefer a quiet delivery with undirected pushing instructions from the midwife.
•I want to avoid an episiotomy: I would like the midwife attending me to keep that in mind when I am delivering my baby’s head, and quietly guide me to push in such a way that I do not tear excessively. She may also provide perineal support.
•Once the midwife sees that my baby is breathing well, I want my baby delivered straight to my chest, before he is cleaned and while the umbilical cord is being clamped and I am delivering the placenta.
•Unless I am categorized as high-risk, I want to deliver the placenta physiologically (without oxytocin).
•I would like the vitamin K shot, blood screening tests, hearing test, head measurement and record of baby’s temperature and weight to be delayed for 1 hr so that my husband and I can have some quiet time alone with our baby.
•I want to breast-feed right away, and I would like to receive the full support of the post-natal team and hospital lactation counselors in teaching me breast-feeding skills. I would prefer to have my baby sleep with me in my room from the beginning.
•If my baby develops abnormal jaundice within the first 24 hrs after birth, I would prefer that the doctor treat my baby using portable phototherapy lights if available. I want to continue breastfeeding my baby on demand through his jaundice.
•I want my baby to be circumcised within the first week of his life, following the sunnah (lifestyle example) of the Prophet Muhammad, sallallahu `alayhi wa sallam.

Anything I haven't considered? Thanks!

[JustVanessa]

Do you have a preference to weather or not medical/nursing students are present?
Do you want your cord cutting delayed at all?

[Desert Rose]

Hi Vanessa,

When I showed up for my first appt at the govt maternity hospital, I had to sign a waiver saying I was okay with medical students being present at any time during my treatment (since it is the only teaching hospital for future gyne's). So I guess that option is out the window!

Will deff discuss the delayed cord cutting at my next appt this Tuesday.

Thanks!

[elfinbaby]

Okay, I have never given birth in a hospital - just fyi - but I did teach Bradley natural childbirth classes for awhile. That's the extent of my experience w/birth plans.

First, have lots of copies - in your file, at the drs ., faxed to the hospital, and a couple on hand in your bag. Have them signed by the dr.

Second, I think your birth plan is too wordy. Keep your desires short and direct. This document is not going to be studied - it's mostly likely going to get a cursory scan from the staff and then put away.

Third, anything you can discuss afterwards (like maybe the circumcision?) leave out. I'm not saying to cut out a bunch of stuff but, like I said, your bp will be easier for staff to read/remember if there's no "extra" in it. I'm just thinking that something like the circ. or jaundice might be something you'll be able to address afterwards. I don't know - you might have very good reasons for getting it on paper.

I would be less concerned about a gentle tone than being direct. Being direct doesn't = hostile or demanding just clear I worry that w/a lengthy plan, eyes will glaze over quickly and your wishes won't be respected.

Ex.
•If labour begins naturally, I want to labour at home until I experience 3 contractions every 10 minutes. At that point, I will admit myself into the ER at Al Wasl Hospital. Do you need to include this? Can't you go to the hospital when you want? And sometimes births don't unfold like they say in the books anyway, lol. My first two went from 0 to 60 in one contraction.

Are you sure you want a shave?? I see you are in the UAE so that's fine if it's a common practice or something you want but it's not necessary and shaving has the *potential* to lead to infection. I thought shaving dropped off the scene when my mom had her first baby - in the 60s I think.

I might consider putting some of the if/then points into something like "If there is a need for ANY intervention my dh and I will be discussing our options before a decision is made barring a medical emergency."

I would like to be mobile during labour, and would prefer intermittent foetal heart monitoring rather than continuous. Also to keep me mobile, I do not want an IV drip. If an IV is necessary, I would like one with a heparin lock so I remain mobile. - I'd seperate these like:
*I will remain mobile during birthing
*Only intermittent fetal monitoring
*No IV drip, hep lock is preferable

I'm a wordy person myself so I understand the desire to communicate fully and set a friendly tone. I just don't want your plan to be dismissed b/c someone didn't feel like reading it thoroughly. I would just keep it simple "I want to breastfeed right away" "I want the baby to be laid on my chest immediately following the birth" "Newborn tests and exams will be postponed for mother/baby bonding unless medically indicated" Oh, and btw, I wouldn't put anything in about what kind of pain relief you want - I don't think it's necessary. If you want it, I'm sure you'll ask for it. Just put a quick little paragraph at the beginning stating your desire for an unmedicated, gentle birth and your gratitude to the staff for helping you accomplish it by meeting your needs.


HTH. Remember, I'm a homebirther so my perspective is different than most. I get heart palpitations thinking of birthing in a hospital

Which reminds me... are you sure you're okay with medical students coming in and out of your room while you're trying to have a low key, dimly lit, quiet birthing? Hmmmm. Think about it. You're trying to create a calm, peaceful atmosphere in a hospital - med students are going to add to the activity/noise level. And lack of privacy. It's great to educate drs. on natural childbirth but it's not something I'd allow (sort of hypocritical of me, eh?) but it's my birth. I don't need an audience.

Best wishes

[Barcino]

I tell everybody to have a backup csectionBIRTH plan just in case things don't turn the way you are planning them to. I wish I had done that with my first.
Good luck mama!

[kltroy]

I think you have the right idea, but I would try and keep it VERY READABLE and as concise as possible.

I have my birthplan divided into 3 sections, which you might consider. doing for readability. Also, as another poster suggested, reduce words/detail whenever possible to make it easy to read.

Here's mine (not that this is anything close to the gold standard, but it may give you some ideas of other things to consider and/or formatting to make it easy to read). My doctor has a copy, which is in my chart. I am also planning to bring 3 copies to the hospital: one to tape on the door, one to give to our nurse, and one to keep with us.

*******************
I wish to be treated as if my uterine scar does not exist. I am planning an intervention-free and natural birth. Residents/students are welcome to come in but please be respectful of my privacy by knocking and not turning on lights or making unnecessary noise. Assuming there are no medical complications, I request the following:

1ST STAGE OF LABOR
•In general, please leave me alone as much as possible. My body knows what to do.
•No complete IV line, heplock only
•If required, telemetered EFM so that I can move around as needed
•Pain relief and vaginal exams by my request only
•I do not consent to artificial induction or augmentation of labor
•All interventions consented to ONLY after a full verbal discussion of risks and benefits (rather than simply offering me a form to sign)

2ND STAGE OF LABOR
•No directed pushing, please
•Birth in any position I would like
•I would like to catch my own baby if I am in a position to do so
•Please offer Dennis the opportunity to dry off the baby

3RD STAGE OF LABOR and POSTPARTUM
•Delay cord-cutting for 5 minutes. Offer Dennis the opportunity to cut the cord.
•No active management of 3rd stage of labor unless medically necessary
•Delay routines, APGARS to be performed while baby is held by me
•I have tested negative for chlamydia; no erithromyocin in my baby's eyes please
•We will do the first bath, not the nurses
•If baby is a boy, he will not be circumcised

[Desert Rose]

Hi everyone, thanks for all the feedback! Yeah, I tend towards wordiness....You made me remember that half of the staff that may read this birth plan speak English as a second language, so yeah, the more concise the more likely it will get read and followed!

Well, the hospital is trying to eliminate routine enemas and pubic shaves, but I would like a shave, given that my bump currently obstructs safe hair removal! I personally know one of the ob/gyn's at Al Wasl and am trying to arrange it so that she can manage my case when I deliver--I will speak to her about no med students!

okay, better go and edit and prepare for my appt tomorrow. Thanks so much for your helpful suggestions!