Birth plan...advice needed.

[kJad29]

Well, I'm pregnant with my first baby and am looking into writing my birth plan. DH and I are planning a homebirth with our wonderful midwife, but yeah, we'll need a contingency plan just in the very unlikely case we'll need to transfer. I don't know where to start. Like if you transfer for exhaustion (the most common reason as per my midwife's experience), do you still say you don't want an epidural? Or should you just go for it? Do you still request to not have directed, purple, people yelling in your face pushing, or do you need it now that you have the epi or a narcotic on board? And what about if there is a c-section for actual real emergency purposes. Can you request that you be with your baby provided s/he is doing well and still not want the baby to be bathed, or get shots, or eye gunk, or have you just lost all chance of that because of the transfer? I'm trying to write it just to get my wishes on paper in the event of a transfer mostly and then just put it away from my sight to release it and concentrate on the birth I want. Does anyone have a birth plan written that I could look at to get some ideas? Help!

[dogmom327]

If you have a MW who will go with you to the hospital and act as your doula/advocate, then I wouldn't worry too much about a written birth plan. The odds of you transferring are low and by the time you get to your birth, your MW and DP will be very familiar with what you want.

The only thing I told DP was that if I transferred for an emergency C/S that no matter what, I wanted him to stay with DS. Even if things went horribly wrong with me, I didn't want DS to be out of the sight of a parent at any time.

[JackieM]

Well, if you transfer to the hospital for exhaustion, odds are you will want an epidural so you can get some rest. They may give you IV fluids first to see if that revives you, but if it comes down to transferring to the hospital for exhaustion, the epidural is what you're gonna want by that time. If not, why transfer? The only help the hospital can offer for exhaustion that you can't get at home are an epidural, pitocin or a C-section. You can always have the epidural turned down or off once you've gotten some sleep and have enough energy to continue laboring on your own. But it's not like you're going to be able to rest better at the hospital than at home if your decline the epidural.

Transfer to the hospital occurs because of an emergent situation or because mom or midwife thinks the outcome will be better there than at home. If you're totally exhausted at home and unable to rest to gain enough energy to continue at home, transfer to the hospital can get you pain relief so you can sleep and continue laboring after you wake up. But transfer to the hospital almost always implies some kind of intervention; rarely does transfer result in the hospital doing no interventions. Make sense? It's like wanting to transfer to a birth center instead of a hospital. Doesn't happen. If you need to go to the hospital, it's because they have something you need that you can't get at home.

And at that point in labor, the birth plan pretty much goes out the window. Now, that doesn't mean that your wishes won't be followed, but you'll need to make them known, and telling staff verbally what you'd like is much better than having them read a piece of paper. You can keep a copy handy for your husband, to make sure your husband knows your wishes for birth in case transfer happens; the staff will listen to him, not your midwife/doula. If your midwife switches to doula role at hospital transfer, odds are she won't be conversing with staff other than to let them know your vitals and what's gone on during your labor so far. She's not in charge anymore, so her role is merely supportive at that point, not a vocal advocate -- that's where your husband can be your voice if you can't speak for yourself. I tell my clients that dad needs to be prepared to move into the "protector and defender" role at any time during labor to make sure mom's wishes are being followed if she can't speak for herself, and to help manage family and friends who interrupt/visit. Doulas can help mange the environment, but dad is the person with the most authority (after mom, of course).

Hope this helps!

[*MamaJen*]

Here was mine. I don't know how useful it would have been if push came to shove, but I think the useful part was thinking through the various scenarios. I agree in stressing to your partner that he should be your advocate if you transfer.
If you transfer, you still can refuse interventions like Vit k, eye ointment, Hep B, pacifiers and supplemental formula.


Hospital Contingency Plan

Mother: Me (my number)
EDD: December 28th, 2007
Father: Him (his number)
Midwife: her, her practice and number
Pediatrician: them, their number
Transfer Hospital: them, their number
Transfer physician: him, his number

Plan A: Homebirth
We are planning a homebirth, attended by a midwife. We have chosen this option after much research, because we believe that a homebirth—with an experienced midwife present and obstetric backup available nearby—offers the healthiest situation for our baby.

Plan B: Transfer to Hospital
Since our primary plan and preparation for the birth of this child is for a homebirth, this hospital contingency plan is designed with the understanding that something has gone wrong. For whatever reason, it is evident to us that homebirth is no longer the best course of action. We acknowledge that any or all of the following preferences may be affected by the specific circumstances that have forced us to seek emergency obstetrical care. We further understand that in the face of these unknown factors, it is especially necessary that flexibility, compassion, and mutual respect be maintained between us and the medical staff assisting us.

Vaginal Delivery:
As much as possible, I wish to maintain a natural delivery and avoid (unless medically necessary) interventions such as an epidural, episiotomy, continuous fetal monitoring, amniotomy, directed pushing and laboring in the lithotomy position.

C-Section Birth:
If a C-section becomes necessary, if it is possible, I prefer:
--Epidural anesthesia, with my partner present for the delivery
--To have the baby held by me or my partner as soon as possible after delivery.

Newborn Care:
Holding and nursing my baby right after birth is my top priority. If medically possible, my other preferences are:
Cord Care—Delay cutting to maximize baby’s blood volume. Please wait until cord stops pulsating.
Vitamin K—Postponed until after initial feeding. To be given only if conditions of the birth warrant. Please wait for our express consent.
PKU testing—Please warm the heel before performing the PKU testing. We prefer to wait approximately three days, until after breastfeeding is established, for this test.
Antibiotic Eye Ointment—We request erythromycin treatment.
Feeding—Exclusive breastfeeding is of utmost importance to the baby! Please, no formula, supplements (including water or sugar water) or artificial nipples (including pacifiers) at any time. If supplementation of any sort is medically indicated, please wait for our express, written consent.
Immunizations—We will decline all immunizations at this time. We will initiate immunizations for the baby a later time.
Temperature—If possible, we prefer to attempt kangaroo care rather than use of an incubator.
Above all else, please help us to avoid separation from our child. Please allow one or both parents to remain with the baby at all times, from birth until discharge.

Other Complications:
In case of stillbirth or neonatal death, we wish to see and hold the baby, and will make arrangements for a funeral.

If I am unable to make medical decisions for myself or our child, (my partner) is authorized to do so for me as my health care proxy. (See attached Medical Power of Attorney document.)

I am an organ donor. If I or my baby are declared brain dead, please do not take heroic measures to resuscitate or artificially prolong our lives. Please help us make arrangements for any transplantable organs to be used. My family is aware of and in agreement with this choice.

(signed)



attached:
--birth plan
--power of attorney
--insurance information
--contact numbers

[kJad29]

Thank you!!!!!! You have helped me tremendously! : I'll definitely go with your suggestions and now I can make my birth plan.....

[Jojo F.]

We just went and took a hospital tour. Now I know what is protocol for them like immediate skin to skin contact, immediate breastfeeding even after a C/S, I can give baby her first bath if I want, they provide a birth ball, a bar to hang on, etc., encourage rooming-in, sign waivers for any testing I don't want, have oral vit K, etc. They are very naturally minded which is AWSOME

The nurse also said that they do read and follow birth plans.

If for any reason my HB does not come into fruition I know that most if not all of my wishes will be followed and respected.

[shanahan]

wow MamaJen - that is fantastic!! I never thought to put a lot of your last stuff (about power of attorney, organ donation, etc.) into our birth plan last time and will definitely do so this time!

thanks for sharing, that was really helpful!

[MommyofHero]

Originally Posted by *MamaJen*

Here was mine. I don't know how useful it would have been if push came to shove, but I think the useful part was thinking through the various scenarios. I agree in stressing to your partner that he should be your advocate if you transfer.
If you transfer, you still can refuse interventions like Vit k, eye ointment, Hep B, pacifiers and supplemental formula.


Hospital Contingency Plan

Mother: Me (my number)
EDD: December 28th, 2007
Father: Him (his number)
Midwife: her, her practice and number
Pediatrician: them, their number
Transfer Hospital: them, their number
Transfer physician: him, his number

Plan A: Homebirth
We are planning a homebirth, attended by a midwife. We have chosen this option after much research, because we believe that a homebirth—with an experienced midwife present and obstetric backup available nearby—offers the healthiest situation for our baby.

Plan B: Transfer to Hospital
Since our primary plan and preparation for the birth of this child is for a homebirth, this hospital contingency plan is designed with the understanding that something has gone wrong. For whatever reason, it is evident to us that homebirth is no longer the best course of action. We acknowledge that any or all of the following preferences may be affected by the specific circumstances that have forced us to seek emergency obstetrical care. We further understand that in the face of these unknown factors, it is especially necessary that flexibility, compassion, and mutual respect be maintained between us and the medical staff assisting us.

Vaginal Delivery:
As much as possible, I wish to maintain a natural delivery and avoid (unless medically necessary) interventions such as an epidural, episiotomy, continuous fetal monitoring, amniotomy, directed pushing and laboring in the lithotomy position.

C-Section Birth:
If a C-section becomes necessary, if it is possible, I prefer:
--Epidural anesthesia, with my partner present for the delivery
--To have the baby held by me or my partner as soon as possible after delivery.

Newborn Care:
Holding and nursing my baby right after birth is my top priority. If medically possible, my other preferences are:
Cord Care—Delay cutting to maximize baby’s blood volume. Please wait until cord stops pulsating.
Vitamin K—Postponed until after initial feeding. To be given only if conditions of the birth warrant. Please wait for our express consent.
PKU testing—Please warm the heel before performing the PKU testing. We prefer to wait approximately three days, until after breastfeeding is established, for this test.
Antibiotic Eye Ointment—We request erythromycin treatment.
Feeding—Exclusive breastfeeding is of utmost importance to the baby! Please, no formula, supplements (including water or sugar water) or artificial nipples (including pacifiers) at any time. If supplementation of any sort is medically indicated, please wait for our express, written consent.
Immunizations—We will decline all immunizations at this time. We will initiate immunizations for the baby a later time.
Temperature—If possible, we prefer to attempt kangaroo care rather than use of an incubator.
Above all else, please help us to avoid separation from our child. Please allow one or both parents to remain with the baby at all times, from birth until discharge.

Other Complications:
In case of stillbirth or neonatal death, we wish to see and hold the baby, and will make arrangements for a funeral.

If I am unable to make medical decisions for myself or our child, (my partner) is authorized to do so for me as my health care proxy. (See attached Medical Power of Attorney document.)

I am an organ donor. If I or my baby are declared brain dead, please do not take heroic measures to resuscitate or artificially prolong our lives. Please help us make arrangements for any transplantable organs to be used. My family is aware of and in agreement with this choice.

(signed)



attached:
--birth plan
--power of attorney
--insurance information
--contact numbers

awesome-- thank you for this. pretty much sums up everything. (i think)

[*MamaJen*]

Wish I could take credit for it, but I mostly cribbed it together from various birth plans of other mamas in my DDC! MDC is such a great place to share information. One homebirthing lawyer mama in my DDC was really adamant about the importance of doing a power of attorney document. It takes like two seconds and it can save you a lot of grief.

[Kim919]

Originally Posted by *MamaJen*

Here was mine. I don't know how useful it would have been if push came to shove, but I think the useful part was thinking through the various scenarios. I agree in stressing to your partner that he should be your advocate if you transfer.
If you transfer, you still can refuse interventions like Vit k, eye ointment, Hep B, pacifiers and supplemental formula.


Hospital Contingency Plan

Mother: Me (my number)
EDD: December 28th, 2007
Father: Him (his number)
Midwife: her, her practice and number
Pediatrician: them, their number
Transfer Hospital: them, their number
Transfer physician: him, his number

Plan A: Homebirth
We are planning a homebirth, attended by a midwife. We have chosen this option after much research, because we believe that a homebirth—with an experienced midwife present and obstetric backup available nearby—offers the healthiest situation for our baby.

Plan B: Transfer to Hospital
Since our primary plan and preparation for the birth of this child is for a homebirth, this hospital contingency plan is designed with the understanding that something has gone wrong. For whatever reason, it is evident to us that homebirth is no longer the best course of action. We acknowledge that any or all of the following preferences may be affected by the specific circumstances that have forced us to seek emergency obstetrical care. We further understand that in the face of these unknown factors, it is especially necessary that flexibility, compassion, and mutual respect be maintained between us and the medical staff assisting us.

Vaginal Delivery:
As much as possible, I wish to maintain a natural delivery and avoid (unless medically necessary) interventions such as an epidural, episiotomy, continuous fetal monitoring, amniotomy, directed pushing and laboring in the lithotomy position.

C-Section Birth:
If a C-section becomes necessary, if it is possible, I prefer:
--Epidural anesthesia, with my partner present for the delivery
--To have the baby held by me or my partner as soon as possible after delivery.

Newborn Care:
Holding and nursing my baby right after birth is my top priority. If medically possible, my other preferences are:
Cord Care—Delay cutting to maximize baby’s blood volume. Please wait until cord stops pulsating.
Vitamin K—Postponed until after initial feeding. To be given only if conditions of the birth warrant. Please wait for our express consent.
PKU testing—Please warm the heel before performing the PKU testing. We prefer to wait approximately three days, until after breastfeeding is established, for this test.
Antibiotic Eye Ointment—We request erythromycin treatment.
Feeding—Exclusive breastfeeding is of utmost importance to the baby! Please, no formula, supplements (including water or sugar water) or artificial nipples (including pacifiers) at any time. If supplementation of any sort is medically indicated, please wait for our express, written consent.
Immunizations—We will decline all immunizations at this time. We will initiate immunizations for the baby a later time.
Temperature—If possible, we prefer to attempt kangaroo care rather than use of an incubator.
Above all else, please help us to avoid separation from our child. Please allow one or both parents to remain with the baby at all times, from birth until discharge.

Other Complications:
In case of stillbirth or neonatal death, we wish to see and hold the baby, and will make arrangements for a funeral.

If I am unable to make medical decisions for myself or our child, (my partner) is authorized to do so for me as my health care proxy. (See attached Medical Power of Attorney document.)

I am an organ donor. If I or my baby are declared brain dead, please do not take heroic measures to resuscitate or artificially prolong our lives. Please help us make arrangements for any transplantable organs to be used. My family is aware of and in agreement with this choice.

(signed)



attached:
--birth plan
--power of attorney
--insurance information
--contact numbers

Thanks for posting this. I'm expecting my 1st baby any day & planning a HB but had decided not to do a written emergency transfer plan because I felt like my MW & DP know my preferences & if I was to go to the hospital things would be out of my hands for the most part anyways.

Your notes at the end for organ donation really touched me (I'm a big advocate of organ donation) but the idea hadn't crossed my mind. I will definatly be taking some time today to write out a simple emergency transfer plan. I also haden't taken the time to think about additional documents that DP might need (power of attorney, ins. info, etc.) and will make copies to attach to the birth plan.

Thanks again for sharing your foresight!