Help with a birth plan???

[thixle]

I don't know where this belongs! I am getting prenatal "shadow care" from an OB. He doesn't know I'm planning UC, he is fairly natural in his approach, most everything in the birth plan we've talked about during prenatals... so, I'm trying to get a birth plan printed out (um, yeah, my due date is only in 8 days, lol)... and I'm having a really hard time. I just used a template, and everything sounds so WHINEY-- and I'm using the least whiney template I could find.

I really want to put this in the emergency hospital bag, in case I do transfer, and I want to appear to have been planning the hospital all along. *sigh* It's not that I feel weird "lying" it's that my last birth plan at the same hospital (the only one available) was completely ignored, and turned out to not be a legally binding paper because the attending physician didn't sign it. The nursing staff has all changed, I have a different doctor (no suprises, it will be him), so I do expect this one will be honored, but really... I hate ASKING to be able to move around. ASKING to not have electrodes screwed into my baby's head. ASKING to go to the bathroom (I pissed on the attending nurse with DD, she had me literally strapped to the bed and wouldn't let me up).

So, I'm posting this in Trauma, but I'd really like some perspective and feedback from UCers that wrote a "just in case" birth plan... without sounding like a "just in case" transfer plan... I'd like it to sound like an actual birth plan Actually, I'll take help from anyone, especially those that have had a traumatic birth in a hospital and went on to do it again... But I'm really sick of how birth plans freaking sound!

Statements like this: "I want to be informed of any procedures in advance, and to be allowed the chance to give informed consent." are really getting to me! Coming form the perspective of someone who had waters broken and an electrode placed in DD's scalp, when the doc said only "Let's check and see how far along you are... 6 cm." then walked out of the room, stopping at the door long enough to say, "oh, I thought you had an epidural" when I held up the wire and asked "WTH?" Well, I feel the need to say SOMETHING about it.

This is emotionally exhausting... I like my new OB. I completely expect him to treat me as a human being if I need his help. He's completely happy to wait for the cord to stop pulsing, happy to wait for the placenta to come out on it's own (with a dose of pit on standby). Unsure about different birthing positions, but only because he's new and never done it before, but willing to go with it. He's completely against episiotomies, happy to *allow* me to walk around as much as I want.

I'm completely leary of the nursing staff at the hospital. Completely terrified that I'll go through the same thing again with them. Completely terrified that I will be assaulted, again, with no legal recourse if I don't bite the bullet and get all this on paper.

So, mamas-- help me with some empowering language that wouldn't be off-putting to nurses I have never met!

(and I feel the need to add, I am not planning a UC because of past experience, I wanted a UC with DD because i do believe birth is natural and just another part of life, but was "young" and naive and wanted the hospital just in case something went wrong, there are no midwives or homebirths here-- Dh was terrified of birth because the only one he had seen was epidural/forcepts, so his anxiety made me anxious and I went in...)

[kltroy]

Birth plans are great because they give you a chance to discuss your expectations ahead of time with your HCP, but it is as much up to YOU to have the followed as it this hospital staff.


Ok so you're planning a UC - I suggest that you probably won't end up at the hospital unless things don't go as you plan right? Who will be with you? Can you give whoever your labor support is the role of reminding you and hospital staff of key parts to your birth plan WHEN THEY BECOME RELEVANT? For example, I wanted to catch my baby during my recent hospital VBAC. This was in my birth plan but I'm 99% sure everyone (including myself) owuld have forgotten this detail except that my mom, who was acting as my doula, reminded us all, "Karen, do you still want to catch your baby?" once the head started to appear. This was exactly the sort of thing that helped the hospital staff follow my birth plan 100% and helped me have a fabulous birth.

I think you'll probably also find that lots of what you're asking for you'll already get. Intermittant monitoring shouldn't be a big deal unless you have some other risk factors. Moving around too. (And if you transfer, you may not be feeling up to moving around much). I never had to ASK to go to the bathroom - I asked my nurse once to show me how to unplug the monitor (they had some legit concerns about my baby, so I was ok with that) and after that I just did it whenever I needed to go. At some point they threw out the idea of an internal monitor and I told them no. My point is, YOU need to empower YOURSELF as much as you need to inform people of what your plan is.

[thixle]

here's what i have so far- fits on one page

Regarding Labor and Birth for ****
Due Date: 10/31/08
Patient of Dr. *****
I understand that there may be situations in which my choices may not be possible, but I hope that you will help me to move toward my goals as much as possible and to make this labor and birth a great experience. I believe that birth is a natural event, but that sometimes medical intervention is necessary for the safety of the mother and baby. Please feel free to ask if you have any questions or comments. Thank you!
Labor
I expect that doctors and hospital staff will discuss all procedures with me and obtain consent before they are performed.
I would like to be free to walk, change positions and use the bathroom as needed or desired.
I will remain hydrated by drinking moderate amounts of fluids (water, juice, ice chips).
So I can stay as mobile as possible, I would prefer a heparin lock instead of an IV.
As long as our baby is doing well, I prefer that fetal heart tones be monitored intermittently with an external monitor or doppler, even if the membranes have ruptured.
Please allow me to vocalize as desired during labor and birth without comment or criticism.
I would like to try alternative means of labor augmentation, like walking or nipple stimulation, before pitocin or artificial rupture of membranes is attempted.
Please do not rupture my membranes artificially unless medically indicated.
Anesthesia/Pain Medication
Please do not offer anesthesia/analgesia unless I ask for it.
If I ask for pain relief, please feel free to offer nonmedical choices first for coping and/or remind me how close I am to the birth.
Cesarean Section Delivery
I feel very strongly that I would like to avoid a cesarean delivery
If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making.
I would like my husband to be present during the surgery.
Please explain the surgery to me as it happens.
I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery.
If possible, please do not strap my arms to the table during the procedure.
If conditions permit, I would like to be the first to hold our baby after the delivery.
If possible, I would like to breastfeed my baby immediately after the birth.
Please lower the screen just before delivery so I may see the birth of the baby.
I would like my plans outlined here for after the birth to be followed as closely as possible.
Perineal Care
I would rather tear than have an episiotomy.
Please suture tears only if necessary.
Delivery
Even if I am fully dilated, and assuming our baby is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase.
I would like the freedom to push and deliver in any position I like.
I would like a soothing environment during the actual birth, with dim lights and quiet voices.
Please do not announce the gender of the baby. We would like to find out the surprise on our own.
Immediately after the birth
Please place baby on my stomach/chest immediately after delivery.
I would like the option to breastfeed immediately.
Please allow the umbilical cord to stop pulsating before it is cut.
My husband would like to cut the cord.
I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.
I would like to keep the placenta, if everything looks normal and it is not needed for testing.
Newborn Care
I would like to hold baby skin-to-skin during the first hours to help regulate baby's body temperature.
I would like to hold baby through delivery of the placenta and any repair procedures.
If possible, please evaluate baby on my abdomen.
If our baby must go to the nursery for evaluation or medical treatment, my husband, myself, or someone I designate, will
accompany baby at all times.
I would prefer to bathe baby myself, at my discretion.
I would like to waive the administration of eye antibiotics.
I would like to waive the administration of routine Vitamin K, unless medically indicated (excessive bruising or trauma).
Baby, if a boy, is NOT to be circumcised. Please, do not offer.
I would like to waive the administration of the Hepatitis B vaccine.
Postpartum Care
I would like to have our baby room-in with me at all times.
I would like my daughter to have free visitation access. She will be accompanied by a caregiver.
Assuming I feel up to it and our baby is healthy, I would like to be released from the hospital as soon as possible following the birth.
Breastfeeding
Please do not give our baby any supplements without first informing me of the reason(s) and seeking my or my husband’s consent.
No pacifiers, please.



So, how does it look/sound? Too much, not enough?

[kltroy]

I think it's maybe a bit too wordy? I dont' know whether this will help, but here is the birth plan I used, which sounds similar to yours. One thing I did was to find out what hospital ROUTINES were, and not to bother to ask for those things, since it clutters up my paper. Feel free to borrow any parts of it.
*****************
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

[thixle]

Originally Posted by kltroy

Ok so you're planning a UC - I suggest that you probably won't end up at the hospital unless things don't go as you plan right? Who will be with you? Can you give whoever your labor support is the role of reminding you and hospital staff of key parts to your birth plan WHEN THEY BECOME RELEVANT?
...
My point is, YOU need to empower YOURSELF as much as you need to inform people of what your plan is.

Yes to these points. That was a big mistake I made with #1. It was JUST me and DH, and I underestimated how uncomfortable/terrified he would be... He would take a break (food, smoke) and that is when the nurse or doc would come in... I made the mistake of taking staydol before I was even in pain (I was just scared) so I was groggy and high by the time I was actually hurting and couldn't keep up with what was happening.

This time around, I have several people "on-call"-- one is a giant of a man, who is a legal aid and well known around here. He has a very short list of things to remember if SHTF and he is not one to panic

I think you'll probably also find that lots of what you're asking for you'll already get. Intermittant monitoring shouldn't be a big deal unless you have some other risk factors. Moving around too. (And if you transfer, you may not be feeling up to moving around much). I never had to ASK to go to the bathroom -

This is where the mental block and turmoil is coming in for me. I was literally strapped to the bed. With a lock on the EFM. I was told at that point that if I signed out AMA, I would not be seen again/readmitted if I wanted to come back. There was absolutely nothing wrong.
When the doc did the internal monitor, he didn't say a word to me about it. Dh had just finally gone to get a bite to eat (he was gone all of 10 minutes). When he came back, the nurse was unlocking the EFM, and Dh thought that meant I could get up. I just showed him the wires and cried.
The doc cut an episiotomy while I screamed no, after I had told him between contrax that I would rather split in two than be cut.

It was hellacious and it's really hard to believe that the experience would go differently if I were planning on delivering there again. When I have lived through it, it's hard to see it a different way, kwim?

If I transfer, it will be for an emergency, or a feeling of something not right. And I AM thankful that there is medical help available. My OB knows I want a natural, gentle birth. I want the nurses to know that, too.

[thixle]

Originally Posted by kltroy

I think it's maybe a bit too wordy?

One thing I did was to find out what hospital ROUTINES were, and not to bother to ask for those things, since it clutters up my paper. Feel free to borrow any parts of it.
*****************

•All interventions consented to ONLY after a full verbal discussion of risks and benefits (rather than simply offering me a form to sign)

Oh, I know mine's too wordy
The hospital routines are... archaic to say the least. It's enough to make your head swim. So, yeah...
Snippets from their site:
*Initially, the baby will be placed in an infant warmer while he/she is observed. If everything is "go", baby will be handed back to you within a matter of moments.
*routine baby feeding times are 5 a.m., 9 a.m., 1 p.m., 5 p.m., and 9 p.m
*You may choose our rooming-in program and have your baby with you from 9 a.m. until 10 p.m.

I really like the bolded part.
I'd love to just hand them a list of things i do not consent to...

[AutumnAir]

Your previous birth experience sounds absolutely awful. I'm so sorry
IMO you should get not only your OB but also as many people as possible to sign your birth plan. Act as though you were definitely going to be giving birth in the hospital and give it your all to make sure your wishes will be respected.
Can you get a standard hospital consent form now? If so you could alter it to read something like 'I do not consent to any of these procedures without fully informed consent at the time that they are deemed to be medically necessary' Sign it and bring it with you if you have to go and give it to them. Then there is a legal record of your 'non-consent' at least.
I totally understand how you feel. I'm too terrified to get pregnant again after what happened to me in a hospital last time, but if I ever do get pregnant again I'll be UCing but with shadow care so that if I do really need to transfer that I can pretend like I was going to go there all along. (Last time I had a planned homebirth in a country extremely hostile to homebirth, transferred and was 'punished' by the doctors in the hospital - I'll never risk that again).
HTH and wishing you a very happy healthy and healing unassisted birth.

[thixle]

Originally Posted by lisabeeprague

Can you get a standard hospital consent form now? If so you could alter it to read something like 'I do not consent to any of these procedures without fully informed consent at the time that they are deemed to be medically necessary' Sign it and bring it with you if you have to go and give it to them. Then there is a legal record of your 'non-consent' at least.

to you, too!

Yes, I preregistered at the hospital Tuesday. The receptionist handed them to me and said, "oh, you really don't have to read them, it's just standard admitting forms, one for you and one for the baby" Uh-huh. Yep. Learned my lesson the first time, thanks..

The first line was something like "I give my consent to any and all procedures deemed necessary by hospital personnel and/or private physicians." I crossed it out and wrote "any and all procedures must have signed consent from myself or my spouse." And the one for the babe, too. What if an attending physician deemed it necessary to circumcise, or pump my kid's stomach? Makes my blood boil just thinking about it. It shouldn't be legal for them to word the paper that way.

[kltroy]

Originally Posted by thixle

*Initially, the baby will be placed in an infant warmer while he/she is observed. If everything is "go", baby will be handed back to you within a matter of moments.
*routine baby feeding times are 5 a.m., 9 a.m., 1 p.m., 5 p.m., and 9 p.m
*You may choose our rooming-in program and have your baby with you from 9 a.m. until 10 p.m.

Whhhaaaaattt??? Wow that's INSANE!!! I didn't think there were hospitals like this anymore. Are you in the United States?

In any case, I think altering the consent document for admission is smart - I just wrote "SUBJECT TO MY WRITTEN INFORMED CONSENT AT THE TIME" before my sig. If they give you crap about that then carry a piece of paper with you to the hospital that states "I hereby withdraw my consent for any and all procedures. I will consent to each individual procedure after a full explanation of the risks and benefits associated with it." [sign, date] - and stick it in your doctor's hands.

Anyway, it sounds like you know what you want and you're on the right track to get it. I truly hope everything goes well for you. I took my 4-month old daughter for a WBV today with the family doc who attended her birth, and again I was reminded how pleased I was with my birth experience.

[paintedbison]

Originally Posted by thixle

Oh, I know mine's too wordy
The hospital routines are... archaic to say the least. It's enough to make your head swim. So, yeah...
Snippets from their site:
*Initially, the baby will be placed in an infant warmer while he/she is observed. If everything is "go", baby will be handed back to you within a matter of moments.
*routine baby feeding times are 5 a.m., 9 a.m., 1 p.m., 5 p.m., and 9 p.m
*You may choose our rooming-in program and have your baby with you from 9 a.m. until 10 p.m.

Wow... they have feeding times? That is crazy! I would shorten the birth plan to just include labor/delivery. That will make it more easily readable. After you have delivered you will be in a better spot to argue for how you want things done postpartum. I think it would be more likely to be read/followed that way.

[thixle]

Yep, I'm in the USA, smack in the middle of the heartland... with state of the art birthing rooms and like 90% epidural and circumcision rates... Most people don't try to bf, even in the hospital-- everyone gets the "breastfeeding support bag" full of formula, even if you refuse, they still hang it off your wheelchair as you leave DD was forced a bottle of glucose water, without consent, because she was "starving" on day 2.

As you can see, I have no love for the hospital policy here, but it's my only option. Last resort option, mind you... At least my doc is good. I've only heard good things about him, even at the WIC office-- One of the L&D nurses was there, complaining because he messes with their routines (like giving baby to mom instead of letting them "do their job"... and supporting the decision to go drug-free, and calling in his own nurses when his patients complain)... So, I do have the support of my doctor, and I feel really good about that.

I think I'll split the birth plan into a Labor/Delivery and Infant Care/Postpartum... Front and back, with room for signatures. Is there anything else I need to know in prep for a c-section?

If they give you crap about that then carry a piece of paper with you to the hospital that states "I hereby withdraw my consent for any and all procedures. I will consent to each individual procedure after a full explanation of the risks and benefits associated with it." [sign, date] - and stick it in your doctor's hands.

... and something like this tacked onto the bottom, too.

[Doula Dani]

I imagine you're not planning on having a doula at your UC- but can you speak to one about coming if you need to transfer to the hospital. I think that would be a good way to be sure that your voice is heard regarding your birth plan.

[heidirk]

Our birth plan was quite emphatic, narrowly skirting rude, probably!

It ran something like,

Mom and baby are healthy, and we ask to be allowed to labor on our own as long as possible. (that was the only part worded as a request!)

The rest was bullet pointed. . .

Do not offer pain relief

Do not pull on or turn the baby's head during crowning

Intermittent fetal monitoring only

and my favorite; 'Absolutely NOTHING to be administered to mother or baby without our EXPRESS consensent.'

We had it organized into topics, with three or four points to each block. It was neat, short, and easy to understand.


They're going to treat it as a request anyway, so you might as well use emphatic language. Start from a place of strength!

[Ks Mama]

I don't know if you've had your baby already or not...

But your birth plan is really long & detailed. No one will have time to read it in the hospital.

Regardless of whether the document is signed or not, it may not get read, even if its read it may not be followd - remember if you're in a regular hospital, there are many women having babies at the same time with all different levels of needs, emergencies, etc. Nurses don't have the time to read each person's very detailed plan, and even it they did - things happen during birth that don't follow a "plan".

It sounds like you want your birth plan to be like a play book for delivery - but in reality, a birth plan is less that & more a document to help you organize your thoughts - and to help your doctor understand - PREVIOUS to delivery, what your hopes would be for an "ideal" birth.

I'd think of a handful of things that are uber-important to you - whatever they are. and make sure your doctor, EACH & EVERY nurse that you encounter, your DH, and your doula or birth coach are intimately familiar with those few things, and are ready to advocate for you. You can also make up a couple of cards with those few things written on it - and you can put one on your bed, on your hospital room door, on your baby's basinette - I'm talking like 1 - 3 things bulleted, just for exampe:

- Do not offer pain meds
- No pacifiers/bottles
- No separation from mother

Your DH, your doula, and yourself, NOT your birth plan are what will get you what you need/want in a hospital. Get the nurses on your side - be kind yet emphatic.

There are lots of rules & regulations in hospitals - but the people that work there, ime, are willing to bend those rules when there is good reason.

Good luck mama.