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Can anyone give me advise on how to write a birthing plan and who I should give it to? What are all the different things to consider? What about preferences after the baby is born? I am so lost. I keep hearing "write a birth plan about your preferences" but I really don't know what all is out there and what my options are. With my 1st we were at a military hospital and they pretty much told me that they don't accept birthing plans and that we had very little say. It was a horrible experience and I don't want to go through that again. I'm still not sure what my options really are. Any suggestions, resources, examples?
 

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Here's my birth plan. I'm due in a couple weeks. Some people feel it should be worded strongly or else the nurse's will think there is room to work change, but I went with polite requests in hopes of keeping the nurses in a good mood.<br><br>
My first birth was horrible, my second was just what I wanted except for a few nurses who wouldn't stop bringing up things that I wanted to do/have, so this time I thought I'd write it down so they can read it and I can remind them of my plan without getting rude.<br><br>
Regarding the Labor of ********** and the Birth of Baby Girl or Boy<br>
Due Date: May 16th, 2007<br>
Patient of **********<br>
Scheduled to deliver at **********<br><br>
April 29, 2007<br><br>
To the Doctors and Nurses at *************:<br><br>
We are thanking you in advance for following our wishes. Yolanda has been through labor and delivery two times before, and we feel her body will tell her what to do. She has prepared herself for a natural birth.<br><br>
Please ask if you have any questions about our requests.<br><br>
Sincerely,<br><br>
**************<br><br>
Labor<br><br>
I will be moving around, walking, and changing position at will throughout labor.<br>
Please keep the number of vaginal exams to a minimum.<br>
I do not want an IV, unless I become dehydrated.<br><br>
Monitoring<br><br>
Please use a Doppler for fetal heart rate monitoring.<br>
I do not want an internal monitor for any reason.<br><br>
Labor Augmentation/Induction<br><br>
I will be changing position and using other natural methods (walking, nipple stimulation, birthing ball) before the amniotic membrane is ruptured.<br><br>
Anesthesia/Pain Medication<br><br>
I will be using self-hypnosis as my form of pain management.<br>
I realize that many pain medications exist. I'll ask for them if I need them, please do not ask me.<br><br>
Episiotomy<br><br>
I would prefer to tear rather than have an episiotomy.<br><br>
Delivery<br><br>
Even if I am fully dilated, and assuming my baby is not in distress, I want to wait until I feel the urge to push before beginning the pushing phase.<br>
Please place my baby on my stomach/chest immediately after delivery.<br><br>
Immediately After Delivery<br><br>
I would like the cutting of the umbilical cord delayed until it stops pulsing, and for my husband to have the honors.<br>
I would like to hold my baby while I deliver the placenta and any tissue repairs are made.<br>
I plan to keep my baby near me following birth, please hold the evaluation of my baby on my abdomen.<br>
I am refusing the eye medication as I do not have any STD’s.<br>
Please do not administer the Vitamin K shot to our baby. The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.<br>
We are aware of the risks and benefits of vaccination and have decided against it. Please do not administer any vaccinations to our baby. (See form attached.)<br><br>
Breastfeeding<br><br>
I plan to breastfeed my baby and would like to begin nursing immediately after birth.<br>
I do not wish to have any formula, glucose water or plain water bottles or pacifiers given to my baby.<br><br>
Photo/Video<br><br>
My husband will be taking photographs and a video recording during labor and the birth.<br><br>
Other<br><br>
Please restrict the amount of people in my room to essential personnel only.<br><br>
Feel free to copy it, if you wish.
 

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i googled birth plan creator which gave me the basics and i could just mark boxes from their i opened the finished birth plan from that in word and tweaked some wording and added a few new things of my own such as forskin care, vaxing baby, and that i wanted the double layer of stiching rather then single. ( i knew i was going to have to have a c/s and ds was going to be in the NICU for a long time so I had some special case things that needed to be in my birth plan.)
 

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Okay, I'm gonna kinda give you some opposite info/advice. I had a birth plan for my first birth and I really thought it was a great idea and that it would help me communicate with the staff but it didn't turn out quite that way. It gave me this false sense that the nurses on the unit were actually going to know it or pay attention to it, which wasn't the case. It was a full page with all of my preferences, and that was after I'd edited it down <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> I've read in some of the natural birthing books lately that birth plans aren't as useful as many moms believe and I know now why they say that.<br><br>
It was good for me to type out what I wanted so I could remember to discuss it with my mw (who delivered me at a hospital) but to be honest she didn't even seem to remember it at my delivery.<br><br>
As far as the nurses who care for you at the hospital, depending on the situation it isn't likely that they'll remember much of what it says. I'm a nursing student so I know they may glance over it when you come in but the plan is usually left in the chart at the nurses desk so they don't have it to read off of in intense moments or when they are in your room helping you.<br><br>
Okay, so that was long but here are my little bits of advice, keep the plan to just high lighting what is the MOST important to you because sometimes if it's mixed in with a lot of info it just gets lost (like dd got her vita K injection and eye goop because no one remembered by that point anything about my birth plan except that I'd planned to go natural and that I wanted my own music played etc). Also just remember that if you give it to the nurses you still might want to remind them of certain things as you go along and watch to make sure that they are sensitive to some of the things you desire because honestly they are really locked into a routine and will breeze past procedures without even meaning to ignore your wishes.<br><br>
Last bit here, on the ob unit alot of the nurses would joke when moms with birth plan came in to "go ahead and prep the OR for a c-section" simply because some moms are so locked into their plan that when things don't go accordingly or they get thrown for a loop they lose all bearing and can't seem to cope with what is going on and thus end up with the cs. So I guess its good to just remember to stay a little flexible<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/innocent.gif" style="border:0px solid;" title="shy"><br><br>
I hope that doesn't sound too preachy, I just know how disappointed I was when no one seemed to follow my plan in my 'mother friendly' hospital and wish I'd known before some helpful little tid bits. Best wishes mama!<br><br>
Oh yeah, and don't put "We wish to avoid ____ unless necessary" because they feel just about <i>everything</i> they do is necessary!
 

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<div>Originally Posted by <strong>bobbysmom</strong> <a href="/community/forum/post/8002385"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">... and they pretty much told me that they don't accept birthing plans and that we had very little say.</div>
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This makes me so sad...<br><br>
I'm sorry that you are going to have to fight for these things when you are in labor. Please make sure you really have a strong advocate there with you. It's too much for a momma to do when in labor.
 

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Discussion Starter #6
Thanks for all the advice. It looks like no matter what I do I might have a fight on my hands. Oh well. Can anyone tell me what the protocol in GA is after the baby is born? What screenings and tests and stuff do they automatically do? I heard they actually give a Hep B vaccine at birth!<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/confused.gif" style="border:0px solid;" title="Confused">: My son never had that done or even offered. What is the procedure for refusing? Do you have to fill out a form before your admitted or can you just refuse once the baby's born? I've heard in some states everything must be documented before or they will call child protective services. Thanks for all the help. I'm new to Georgia so I'm not really sure what all the rules are.<img alt="" class="inlineimg" src="/img/vbsmilies/smilies/dizzy.gif" style="border:0px solid;" title="Dizzy">: I've heard North Fulton Regional won't be so much of a fight for my wishes so hopefully it works out.
 

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Moodyred pretty much summed it all up, I guess. I just want to add it might be helpful to have your partner/DH/MW have a copy of the plan with him/her. My DH was so shocked at the course of events (my cozy homebirth evolved into an emergency CS) that he forgot to mention the no formula, which they promptly fed our dd while I was in recovery <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">:<br>
(poor dear, he wasn't even able to remember the name we picked for her <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> )
 

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Honestly, I always say a birthing plan is just a way to open communication with your provider. The ONLY way to get the birth you want is to pick a provider who is willing to GIVE you that birth. So......put together a few of your thopughts, and use them to "interview" providers. If they say "nope, can't do that, nope, that's not policy, well...maybe you could do that, but noone's ever asked that before.." etc etc....RUN and find someone else.<br><br>
If what you want is a low-intervention birth, you need to find a provider who, as a matter of his/her ROUTINE, gives low-intervention births. going to a doc who has a 50% section rate and 100% epidural rate and saying.."i want no Iv, no drugs, to move around and eat and no episiotomy"....well...GOOD LUCK, cuz it AIN'T gonna happen!!<br><br>
FIND SOMEONE whose own personal philosophy of birth is similar to yoursa, and who is going to be supportive about your choices. someone you have to fight and lie to and argue with all the time is NOT going to bbe a good provider for you.
 

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I think it's important for there to be a birthing plan AND a newborn care communication sheet.<br><br>
I have a sign that just says (for the area they will do the newborn procedures AND for the bassinet):<br>
-NO immunizations (Minn. Stat. § 121A.15 (2002) --Subdivision 3)<br>
-NO vitamin k shot (we will provide oral vitamin k)<br>
-NO prophylactic eye treatments (no silver nitrate eye drops, no erythromycin ointment)<br>
-NO formula (we are breastfeeding)<br>
-NO sugar water (we are breastfeeding)<br>
-NO artificial nipples (we are breastfeeding)<br>
-NO pacifiers (we are breastfeeding)<br><br>
In addition to a newborn care sheet: (that talks about my expectations for newborn care)<br>
In addition to my Birthing plan (that talks about my expectations for birthing)<br><br>
So that's FOUR sheets altoegether (birthing plan is one sheet, newborn communication sheet is one sheet, newborn sign is one sheet*2).....<br><br>
Reminding everyone who comes in your room about your birthing plan/newborn communication sheets is KEY.
 

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I would share my birth plan but it's on my other computer. Mine is an opening paragraph (about 3 sentences, introducing myself, my doula... just an intro) and then I have a bulleted list of only the points that are most important to me. There are maybe 5-6 points. Each one is only one or two sentences long at the most. Then, I have a closing paragraph (again, maybe 3 sentences or so) thanking the staff for taking the time to read my birth plan and for their help in delivery of my son. I signed it "With Thanks, " And then my name under that. At the very top of the page is says "My Name's" Birth Plan in a pretty blue font.<br><br>
I kept it reasonably short because if you get one of those online things and just start checking every little box and end up with a full page or 2 or even 3 it's not going to get read. The most important things to you will get drowned out by every little option.<br><br>
I showed it to my doula and she said it's an excellent birth plan, one that is polite but makes my wishes known, and isn't ridiculously long. She said it would be paid attention to. I also showed it to 2 of the midwives, and they both agreed it's a wonderful birth plan and put it in my medical folder.<br><br>
I think the key is making your wishes known without overdoing it. I just listed things in order of event and importance.<br><br>
Good luck!
 

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Discussion Starter #11
Okay, after considering everything everyone has said, here is what I've come up with. My midwife is fine with everything mentioned, it's really the hospital staff I am more worried about. I tried keep it simple and to just pick out what was most important to me. What do you all think?<br><br><div style="text-align:center;"><span style="text-decoration:underline;">Birthing Plan</span></div>
<br>
Regarding the Labor and Delivery of *****<br>
Due Date: June 8, 2007<br>
Patient of ****<br>
Doula*****<br><br>
We would like to thank everyone in advance for helping us bring our second child into this world. We would like to keep the labor and delivery process as natural as possible. If you have any questions or concerns arise, please discuss these with us.<br><br>
LABOR<br><br>
* Please do not whisper about me, if there is an issue please communicate it with me<br><br>
* I would prefer no IV during labor unless I become dehydrated<br><br>
* Please keep vaginal examines to a minimum<br><br>
* I would prefer intermittent external fetal monitoring, no internal fetal monitoring please<br><br>
* Please do not offer pain medications, I am aware of my options and will ask for them if I need them<br><br>
AFTER DELIVERY<br><br>
* Please place the baby on my chest immediately after delivery for bonding and nursing<br><br>
* Please allow the cord to stop pulsating BEFORE clamping it and allow my husband to have the honor of cutting it<br><br>
* Please do not remove the baby from my room for any reason other than an emergency<br><br>
* Please do not give our baby any formula, sugar water or pacifiers as she will be solely breastfeeding<br><br>
* We are REFUSING the routine Vitamin K shot, Eye Medication, and Hepatitis B Vaccine, Please do not administer any of these.<br><br>
We recognize that birth can be unpredictable and that situations can arise that may make some of these requests not possible. Thank you again for helping us bring our new baby into the world.
 

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Looks good, but it's a nice idea to keep the post-birth stuff on a separate page - the baby will have his/her own chart at the hospital, and if you have a separate page to go in the baby's chart, it's more easily communicated.<br><br>
I'm also a proponent of the bulleted list. We have a bulleted list for in case of transfer this time (assuming emergency c-section, there would be no other reason for transfer) for me, and one for baby. When we gave birth in hospital, the quick list was easy for nurse to refer to, and my midwife already had a clear idea of what I wanted, but it made it easier for the time between when we got there and she got there.<br><br>
Clients of mine who have used the birth plan generators have had their plans completely ignored. This isn't surprising, since the first item on many of these is (check one box) - I do / do not wish to have shave and enema upon admittance to hospital. Around here, those haven't been standard practice in over 20 years! No wonder no one is looking at them seriously.
 

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I totally agree with bobandjess99!!!!<br><br>
Remember that your care provider is working for YOU! A birth plan is a great forum for communication. But labor and birth is NOT the place for confrontation. So, it's essential to find someone you trust to do it the way you want. The ones to trust are the MW's and OB's who do it your way for nearly everyone! If they believe in episiotomies, you're going to get one or get talked into one. If they believe in routine external fetal monitoring, you're going to get that or get talked into that. Sometimes midwives who work out of hospitals have no choice but to do the not-mother-friendly protocols.<br><br>
It's a fact: our midwives and doctors are in business. You need to be an educated consumer and trust your instincts. Just as you wouldn't go to McDonald's expecting organic health food, don't go to a hospital with a 30% c-section rate expecting a natural birth experience.<br><br>
Another option: if you're locked into a certain health care provider for one reason or another, hire a doula you trust and who isn't afraid to fight your fight while you're in labor and delivery.
 

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The big thing I would keep in mind at N. Fulton is that their standard protocol is to take the baby to the nursery for one to two hours following birth. My understanding is that it's not a big deal, at all, to inform the nurses that you don't wish for that to happen, but you do have to take that step.<br><br>
Keep in mind that the nurses don't necessarily have control over some things. Even if you say 'minimal vaginal exams,' for example, if they're told by someone in a position of authority over them to do a vaginal exam, they aren't going to put themselves on the line over your birthplan, kwim? So I would be sure that everything on a birth plan for nurses is something that the nurses have authority over. This may mean doing two different birth plans - one for your midwives' files and one for the nurses.
 

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I delivered at North Fulton. I did not have a birth plan. I do not look all that "crunchy granola" on the outside---I didn't come to the hospital in my patchwork maternity dress (though I do own one <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> ) with my hair in dreads, organic juice in my cooler. That's just not my style. Just a disclaimer to say that I don't think I was treated "differently" by the nurses.<br><br>
I had a really long labor. My midwife was respectful and honored my decisions, even when she didn't agree with them. (I asked for an epidural before she thought it necessary--turns out she was right, and we turned it off, took it out, and I got up and labored some more later. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> ) I had the epidural replaced, the first anesthesiologist had trouble placing it, and after trying for 45 minutes, my midwife went and called the head of anesthesia AT HOME after 5:00 on the Friday of Labor Day weekend. He CAME IN and was able to place my epidural.<br><br>
I am a loud, loud, loud laborer. The nurses kept closing my door, my mother was wigging out because "they weren't doing anything" for me--um, not sure what they should have done, but anyway, so she kept opening the door. They put up with my mother. That right there should deserve a freaking medal.<br><br>
I had a c-section. My music was played in the OR. My dh announced the sex of the baby. My dh went to the nursery with the baby (I was exhausted and thankful for the chance to take a nap). The baby was quickly bathed under the warmer, never lost any temperature, got his hearing screen, and was back to me the minute I came to recovery. The nurse asked my dh before she did Vit K or erythromycin, and it was no big deal to refuse both--we just signed a form. The baby stayed with me pretty nonstop, despite the fact that I was there alone the first night after a c-section. He just stayed in my bed and nursed. They did check his blood sugars 3 times because he was big, but I was asked first, and I agreed to it. He never got (nor did they suggest) formula or a pacifier. He had a PKU done, but again, I was asked, and I agreed to it. I think the doctor asked about circumcision, but it was no big deal, and it certainly wasn't asked over and over (and, no, he did not get accidently circ'd while we were there). The pediatrician saw him in my room. The nurses were nice, kept my water filled, and brought me pain meds every 4 hours (remember the c-section).<br><br>
I went home at 36 hours. I think if I had asked, I could have gone home at 24, but I thought 36 was good. For my first solid food meal, I got dh to go get Mexican. It was the best enchiladas I ever ate. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"><br><br>
So, sure, be prepared. Go into labor knowing what you want. But, I'll bet you are pleasantly suprised at North Fulton.
 

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This is a copy of our birth plan from the last baby. We will probably be using the same thing edited for this baby. The hospital doesn't allow videotaping of the birth, but the midwives have said that they and most of the nurses don't have a problem with it and will allow it, but not to put it into the birthplan so as not to agitate the powers that be. (Hospital attorneys IMHO) We told them that this was pretty much a dealbreaker issue and we would UC if necessary. We have all our other births videotaped. None of them cares, and they know I am not lawsuit happy.<br><br><br>
Request For Our Child’s Birth<br><br>
Parents:<br>
Due Date:<br>
Practitioners: Certified Nurse Midwives<br><br>
We are deeply committed to a philosophy of birth that wholly relies on the normal and natural physiological process of labor and delivery, and helps ensure the safest beginning for our child. Thus we fully expect our child’s birth to be normal and free of medical interventions. In the unlikely event that complications occur we will confer with our CNM whose medical judgment we respect and trust. Therefore we ask that routine interventions be withheld from our child’s birth.<br><br>
LABOR<br>
•Use of LDRP with birthing tub requested<br>
•Husband to remain with mother<br>
•No routine prep, enema, I.V., or artificial rupture of membranes<br>
•Only periodic external fetal monitoring as minimally as possible<br>
•If labor is rapid, no straps to hold monitors<br>
•No labor stimulants<br>
•No medication or the use of medication offered (If I want it I’ll ask for it!)<br>
•Minimum of internal exams<br>
•Mobility unrestricted<br>
•Full use of bathroom and birthing tub<br>
•Videotaping permitted<br>
•Clear liquids and light snacks as needed during labor<br><br>
TRANSITION<br>
•Husband present<br>
•Minimum of talking to or touching mother during contractions<br>
•Minimum of talking or noises in the room<br>
•Absolute minimum of electronic monitoring<br>
•Right before pushing may need to give mother a quick “pep talk”<br><br>
DELIVERY<br>
•Husband present<br>
•Flexibility in delivery position; would like to try full or partial squat<br>
•Would like to be in birthing tub<br>
•No routine episiotomy (would prefer a small tear)<br>
•Use of perineal massage and warm compresses to help limit tearing<br>
•Mother may need strong coaching to slowly deliver the head. (I tend to push hard & fast!)<br>
•Remind mother to look down to see the baby coming out (may need a firm reminder)<br>
•If at all possible, mother to gently lift baby from body<br>
•Father to cut the umbilical cord<br>
DELIVERY(continued)<br>
•Videotaping allowed<br>
•Immediate and sustained contact between baby and parents<br>
•Breastfeeding immediately to facilitate 3rd stage<br>
•Placenta to deliver spontaneously (No pitocin)<br>
•Allow vernix to remain<br>
•No medications offered<br>
•Husband present if anesthesia administered<br>
•Baby placed on mothers abdomen and as much post-birth evaluation done there as possible.<br>
•Baby warmed by mothers body heat<br>
•Would like to consult with pediatrician before eye prophylaxis and vitamin K are administered.<br><br>
RECOVERY AND POSTPARTUM<br>
•Breastfeeding on demand<br>
•24 hour rooming in<br>
•Nothing by mouth for baby: including formula, water, and pacifier, although we would like one to go home with.<br>
•We will not be circumcising if we have a boy<br>
•Would like a visit from lactation consultant<br>
•Older siblings allowed full access<br><br>
IF CESAREAN IS NECESSARY<br>
•Husband present<br>
•Low transverse incision on abdominal wall and uterus, if possible<br>
•Shaving only as necessary<br>
•Videotaping allowed<br>
•No curtain to obstruct mothers view or a mirror so she can watch<br>
•Mothers hands free (or at least not strapped down)<br>
•No organs removed from her body and all layers sutured separately, please.<br>
•Contact with the mother and father as soon as possible<br>
•Breastfeeding as soon as possible<br>
•I.V. and catheter removed as soon as possible<br>
•Special Care nursery only if absolutely necessary<br><br>
IF BABY REQUIRES SPECIAL CARE NURSERY<br>
•Husband to go along<br>
•Baby to receive only mother’s pumped breast milk and begin breastfeeding as soon as possible<br>
•Parents visits unrestricted<br><br>
IF COMPLICATIONS ARISE<br>
•Father not asked to leave at any time<br>
•Both parents fully informed; not sheltered from bad news or problems<br>
•All previous requests honored to the extent possible<br>
•Midwife fully involved and main liason with parents<br>
•I do not wish to be a teaching patient, except for midwifery students. (I had a very bad previous experience)
 

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Oh, and I make 15 (or more!) copies and hand them out like gum!
 

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My mom made up a list of things to talk with her doctor prior to her VBAC with my little brother. She was planning to use the results of the conversation as the jumping off point for writing up her birth plan, so the list was phrased very bluntly. The doctor asked to see it, glanced over it, said "no problem, I'll add this information to your chart as doctor's orders." (This being the doctor who has also said "I get paid just the same whether I do things or sit and drink a glass of orange juice.")<br><br>
So I'd recommend getting your doctor/midwife to put everything possible onto your chart, then whatever's left will make for a shorter list.<br><br>
My little brother's chart (made before he was officially a "he") had "No procedures are to be done on this infant without the express written permission of the parents. There is NO standard protocol for this infant. A parent or the infant's older sister must be with the infant at all times."<br><br>
I'd also request that to only have one nurse at a time. Not one nurse through the whole labor since it's unfair to have someone have to work past their shift, but it should be possible for one nurse to be the one to come in and do whatever nursy things they feel are necessary and then, when her/his shift is over to introduce you to the next nurse and so forth. It's a lot easier to educate one person on your preferences than a half dozen.
 
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