My birthplan is pretty long since I am having to deliver my twins in the hospital, and most likely in the OR. My OB's practice has 4 different doctors, therefore there is no guarantee that my doc will actually be helping deliver my babies, so I had to make it a bit more detailed than most.
Birthing Preferences Cover Sheet
Dear Dr....,
I have chosen you, our medical advisor, and you, our birthing facility staff, as the people I want to attend me when my babies are born. I have chosen the HypnoBirthing method of quiet, relaxed, natural birth. From all of our prior discussions, I truly believe that you will do your utmost to help me attain my wish for a joyous, memorable and most satisfying natural birth possible.
The information that follows is a copy of my birth preferences. I have given careful consideration to each specific request in the plan, and I feel that it represents my wishes at this time. I realize that as labor ensues, I may choose to change my thinking and wish to feel free to do so. I understand that these choices presume a normal pregnancy and birth. Should a situation arise that constitutes a medical emergency, please know that you will have my complete cooperation after I have had an opportunity for an explanation of the medical need and have had sufficient time to discuss the decision with my birthing companion. I wish to have clear explanations of all suggested procedures, of the progress of labor is it is assessed, and of any possible special circumstances if they occur. In the absence of special circumstances, I ask that the following requests be honored.
Please attach this to my prenatal record and make it available to all physicians/staff who may be attending the birth should you not be attending us.
Your support and understanding are very much appreciated.
Birthing Preferences
For Hospital Admission
I request:
The patience and understanding of caregivers to support my wish to refrain from having any practice or procedures that, in the absence of a medical emergency, could unnecessarily stand in the way of my having the most natural birth possible.
The opportunity to discuss my birth preferences with my assigned nurse
To self-hydrate and decline routine IV prep upon admission.
Natural means of inducement, moving to minimum doses of artificial induction only if medically urgent.
To have an LDR room with a shower, subdued lighting, music and quiet tones.
To have only intermittent monitoring of FHR after the mandatory twenty-minute strip at admission.
To have the following persons present during my labor:
-Doula
-Sister
-Parents
To have the following persons present during birthing:
-Doula
-Sister or mother
To have no telephone calls relayed - only messages
To respectfully decline to participate in the taking of pain scale information.
During First-Stage Labor
I request:
The patience and understanding of caregivers to support my wish to refrain from having any practice or procedures that, in the absence of a medical emergency, could unnecessarily stand in the way of my having the most natural birth possible.
To have only necessary hospital staff.
That staff refrain from references to "pain, hurt, etc…" and any offer of medication or labor-enhancing procedures unless requested.
To be free of blood-pressure cuff between readings.
Manual intermittent monitoring after pattern is established.
Internal monitoring only in the event of medical urgency.
Nutritional snacking if labor is prolonged.
Freedom to walk and move during labor.
To change positions and assume labor positions of choice.
Minimal number of vaginal exams - with permission - to avoid premature rupture of membranes.
That labor be allowed to take its natural course without references to "moving things along" or "augmenting labor".
To use natural oxytocin stimulation in the event of a slow or resting labor, and to be accorded the privacy to do so.
To be fully apprised and consulted before the introduction of any medical procedure - augmentation, amniotomy, membrane stripping, etc…
To enjoy the shower.
To forego epidural if both babies are head-down.
If special circumstances arise warranting epidural, to delay the insertion of the epidural catheter as long as possible and to keep the catheter un-medicated until necessary.
During and Following Birthing
I request:
The patience and understanding of caregivers to support my wish to refrain from having any practice or procedures that, in the absence of a medical emergency, could unnecessarily stand in the way of my having the most natural birth possible.
To birth in the LDR room absent a medical necessity requiring a transfer to the OR.
If transfer to the OR becomes necessary, to have an LDR bed available in the OR if at all possible.
That natural expulsive pulsations of the body be allowed to facilitate the gentle descent of the baby, with mother-directed Birth Breathing to crowning. Birth companion will offer prompts. No coaching.
Use of HypnoBirthing breathing techniques - not other methods.
To assume birthing position of choice that will least likely require an episiotomy.
Episiotomy only if necessary, and only after discussion.
That I or my birth companion receive the babies if at all possible.
Cords to be clamped and cut only after pulsation has ceased.
To be allowed the opportunity to immediately breastfeed Baby A upon his birth, while delivering Baby B.
To be allowed the opportunity to immediately breastfeed Baby B upon her birth to assist placenta delivery.
A wait for natural placenta delivery.
No cord traction, manual removal or use of pitocin for removal of placenta unless necessary.
That companion be allowed to remain with mom in the operating and recovery room in the event of a C-section.
That companion hold the babies after c-section birth and bring baby to mom for viewing and eye contact. In absence of urgency, companion continues to hold the babies.
For Babies
I request:
Babies to remain with mother and birth companion after delivery
Delay use of ointment in baby's eyes to allow optimal sight for bonding.
Do not circumcise baby boy.
Do not administer vitamin K absent a medical necessity. If vitamin K becomes necessary, discuss with myself and/ or birth companion first, then oral vitamin K to be used rather than an injection if available.
That babies stay with mother during recovery and throughout the hospital stay.
Breastfeeding several times during the first few hours of babies' lives.
Breastfeeding only. No bottles, formula, pacifier or artificial nipples.
If babies are delivered premature and a feeding tube is required, that babies only be given mother's breast milk.
If one or both babies require placement in the NICU, to keep both babies together and in one isolette/ crib if possible.
To be fully apprised and consulted before administering any medicine or tests to either baby.
I thank you in advance for your support and kind attention to my choices. I know you join me in looking forward to a beautiful birth and celebration of these new lives.
