I have 2: one for the birth center (planned) and one for the hospital (in case of transfer). The hospital one is very long (2 pages), but most of it would probably be moot--we would likely only transfer in case of an emergency, at which point we'd be beyond many of the stages listed. We divided it into sections for this reason--i.e., so the hospital could skip whatever did not apply. In any event, let me know what you think.
Birth Plan for NYCVeg and PapaVeg (at birth center)
We are extremely grateful to the midwives and staff at [Birth Center] for their support!
First stage labor
We wish to:
·be offered the option to labor in water when labor is well established
We wish to avoid:
·AROM or other medical methods of induction; please suggest alternatives
·vaginal exams
·visitors or phone calls until after the birth
Second stage labor
Perineal support: Although I (obviously) do not wish to tear, I would like to avoid touching or manipulation of the perineal area/vulva as much as possible. I do not wish to have a "vulvar sweep" or any hands/fingers inside my vagina to massage the perineum. I believe I will stay more relaxed if my skin is simply allowed to stretch slowly and naturally, without interference, and that I will have greater freedom to choose a comfortable pushing position if I am not worried about providing "access" to this area. It is possible I may want a warm compress, oil, or counter-pressure on the outside of my perineum (ideally, PapaVeg would provide these); please suggest it if you feel it would be helpful, but do not apply either without my consent.
NYCVeg would like to:
·wait to push until she feels the urge and avoid "coached" pushing (e.g., counting)
·allow PapaVeg to catch the baby.
Birth and Post-Partum
We would like to:
·delay cord cutting/clamping until cord has stopped pulsating and/or placenta has delivered; PapaVeg would like to cut the cord
·allow placenta to expel naturally (no pulling on cord, pressing uterus, etc.)
·rub vernix into baby's skin after birth; avoid bathing
·breastfeed as soon as possible after birth
·test baby's cord blood for ABO incompatibility (I'm O+) and c-reactive protein
·If stitches are needed for a tear, please use local anesthetic.
We would like to avoid:
·antibiotic eye ointment
·vitamin K shot, except in the case of a very long pushing stage or obvious birth trauma; please discuss this with us after the birth
--In the event we choose to receive vitamin K, we would like baby to receive 0.5 mg (the lowest recommended dose), rather than 1mg
Please see other side for transfer instructions; separate hospital birth plan attached.
In case of transfer to Inova Alexandria Hospital
·We wish to remain together at all times
·We do NOT give consent for students or other unneccessary personnel to be present
·No procedures/medications are to be administered without explicit consent
·If baby is transferred to nursery or NICU due to emergency, Mike will stay with her at all times and for all procedures
·We wish to breastfeed exclusively and as soon as possible
Please see separate hospital birth plan
* * * * *
Birth Plan for NYCVeg and PapaVeg (at XXXX Hospital)
·Our birth assistants are XX and XX. We request that they, and/or a midwife from XX Birth Center, remain with us at all times.
·Please do not perform any procedures, including routine procedures, on NYCVeg or baby with first receiving informed consent from NYCVeg or PapaVeg. This includes the administration of any medications. We thank you in advance.
Labor
NYCVeg would like:
·to remain with PapaVeg at all times
·to be consulted before any procedures (including routine procedures such as IV and EFM) are done; PapaVeg will provide/deny consent if NYCVeg is unable to
·freedom of movement throughout labor, including walking and changing positions
·to birth in whatever position is most comfortable (squatting, hands and knees, etc.)
·low lights, quiet, minimum disruption during labor (no students or visitors please)
·to eat and drink, as desired, during labor
We would like to avoid:
·Pitocin: we will try natural methods of labor stimulation
·continuous external fetal monitoring and/or any internal monitoring; we prefer that monitoring of baby's heart rate be done with fetoscope or doppler
·pain medications: please do not offer any; if we ask for medication and/or it becomes medically necessary, we prefer epidural anesthesia and wish to avoid narcotics
·artificial rupture or stripping of membranes
·any vaginal exams
·IV fluids; if IV prep is necessary, we prefer a heparin lock to allow movement
·other medications, except in case of medical emergency/necessity, and then only with express consent; under NO circumstances is NYCVeg to be given Cytotec
·unnecessary visitors: please, no students or unnecessary personnel at any time
Birth
NYCVeg would like:
·to push only when/as she has the urge…no counted or coached pushing please
·to slow pushing during crowning to allow the perineum to stretch naturally
·delayed cutting/clamping of cord; we do not wish to clamp or cut the umbilical cord until it has stopped pulsating; PapaVeg would like to cut the cord
·to deliver the placenta naturally, encouraged by breastfeeding
NYCVeg would like to avoid:
·episiotomy: do NOT perform except in case of medical emergency and then only with express consent
·forceps or vaccum delivery
·assisted delivery of the placenta (e.g., by pulling of cord, pressing uterus, etc.)
·routine administration of Pitocin after birth; please use Pitocin only in case of hemmorhage, and then only with express consent of NYCVeg or PapaVeg
After Birth
NYCVeg would like:
·baby placed on chest (skin-to-skin contact) immediately after birth
·to breastfeed as soon as possible, ideally within ½ hour of birth
·to stay with baby at all times
We would like to avoid:
·any separation of baby and parents; we do not wish for our baby to be removed to the nursery or to a warmer
·any artificial nipples or baby food; please, NO formula, pacifiers, bottles, or sugar water; our baby will be exclusively breastfed (if baby must be taken to NICU for any reason, I would like to provide pumped milk)
·bathing of baby after birth; please gently towel off baby and rub vernix into skin
We respectfully DECLINE:
·Hepatitis B vaccine
·antibiotic eye ointment
·PKU testing (this will be done by baby's pediatrician)
·routine administration of vitamin K shot, except in case of obvious birth trauma or prolonged pushing stage, and then only with express consent
In the event of a cesarean section
·NYCVeg gets very claustrophobic/panicky when face-covering oxygen masks are used; she would strongly prefer tubes that fit in the nostrils to deliver oxygen
·Please sew incision with a double row, rather than a single row of stitches
·One parent is to remain with baby at all times and for any procedures; please do not perform any procedures (including administration of vaccines and eye ointment, PKU testing, etc.) without express parental consent
·NYCVeg would like to hold the baby as soon as possible and to breastfeed as soon as possible
·NYCVeg would like to room-in with baby
·In the event that the baby must go to the NICU due to medical emergency, PapaVeg will remain with baby at all times and for any procedures
Many thanks for your cooperation with the following. We sincerely appreciate your assistance and support in the birth of our baby.