Thursday, February 4, 2010

Birth Plan

One of the things that helped me in preparing for my birth was looking at birth plans online, and then researching the different options out there to see why people asked for and made the choices that they did. I finally reviewed mine with my new midwife today [yes I'm switching, but that will be a later post], and everything looks OK, so I'm posting it here for reference. This is as approved - the irony is it was totally rejected by an OB at another hospital as "too unrealistic and demanding", so that's where choosing a provider who's on the same wavelength as you can make a big difference. Erythomycin is required in my state, and vitamin K is usually grouped with it and required by the hospital so I am not able to opt out of those, but it was the only change we had to make.


Birth Preferences            Patient Name: name  
Midwife/OB: name (practice/office name phone #)             Due Date: date

I realize that a birth plan is a sharing of preferences and ideas for birth, and not a contract or binding agreement. I understand that labor and birth are unpredictable and ultimately want the health and safety of both the baby and I to take precedence, and that unexpected situations may result in my plan for labor having to change to support activities needed to prevent or decrease complications or risk to myself or my baby. When possible, I request that procedures be explained thoroughly (benefits and risks) and also, when possible, I would like to be included in the decision-making process. I appreciate my physician’s, and the hospital staff’s, commitment to my health. All of these requests are for a normal labor, birth and postpartum period.

During Labor I prefer:
•    Freedom of movement & positioning, to possibly include walking during early labor, use of alternative [non-lithotomy] labor positions, & use of the shower or birth pool [self-supplied] during labor.
•    Intermittent fetal monitoring, & would prefer Doppler/ auscultation, if available, while in birth pool.
•    No IV, but if IV access is required I strongly prefer a saline lock [“hep lock”] only.
•    Not to have my membranes “swept” or artificially ruptured, or to be artificially induced.
•    Minimal vaginal/cervical exams, especially after rupture of membranes
•    To sip clear liquids &  eat light snacks as desired.
•    To have the lights dim &  the television off, unless I request otherwise.

Medication:
•    I prefer to request medication, rather than to be offered it, including epidural anesthesia.
•    If there is time limit to get an epidural, I would like to be reminded once while it is still possible to request it.
•    I do not wish to be given any medications, including Pitocin or Cervadil, without my specific consent.
•    I do not consent to Cytotec (misoprostol or prostaglandin E1) in any circumstance.
•    I would prefer waiting as long as possible before using any sort of artificial augmentation of labor.

During Birth I prefer:
•    To have the following support people:  [husband],  [doula], & [mother]. I want at least one of the above with me at all times, including in case of surgery.
•    I strongly prefer a tear to an episiotomy, and wish to use positioning, compress, etc to avoid one.
•    To use spontaneous pushing, not to be directed when to push, & to try a variety of positions.
•    To deliver the placenta spontaneously, with no Pitocin or cord traction unless there are complications.
•    To have immediate skin-to-skin contact with the baby, and attempt to breastfeed immediately.
•    To delay the bath & newborn assessment until after the first breastfeeding.
•    For my husband to give the baby his first bath, and to cut the cord if possible & if he wishes to.
•    To delay cutting the cord for at least 5-10 minutes or until it stops pulsing [whichever comes first].
•    If a C-Section should be medically necessary:
     o    I would like at least one support person, preferably my husband, with me at all times.
     o    I would like to remain conscious.
     o    Please use a low-transverse [horizontal] incision, and double layer sutures to repair my uterus.
     o    I would like to keep my baby with me & to breastfeed as soon as possible during recovery.

For my Baby, I prefer:
•    No vaccinations at this time, including Hepatitis B.
•    Please delay Erythomicin, vitamin K, & weight as long as possible, to allow for bonding time.
•    Pulse Oximetry screening to detect congenital heart disease, along with the standard newborn assessment.
•    To nurse, if possible, while the PKU [“heel stick”] test is done, to lesson discomfort to my baby.
•    No circumcision at this time.
•    To breastfeed exclusively, with no pacifier or bottles given.
•    To have my baby in the room with me at all times, or accompanied by my husband if out of the room, including for medical tests or procedures.

Reviewed by: signed by midwife or OB            Date: date signed

2 comments:

  1. Interesting post and good luck with your upcoming birth!

    I would say about 25% of women I work with in labor and delivery make actual birth plans that they bring with them for delivery. Midwife patients, GP patients, OB patients. They are handwritten or computer printed out and usually guided from a well meaning website.

    The one thing that I see over and over again is the true disappointment women feel post partum if their birth goes differently than their plan. The prenatal educators I work with like to get women to focus more on creating a 'wish list' versus a 'plan'.

    The other thing that I find is that most of the computer generated birth plans are just plain outdated. I work in Canada and no one gives routine episiotomies or shave prep but we still see that on birth plans all the time.

    Good luck with the last bit of your pregnancy and enjoy your midwife focused care too!

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  2. Thanks. I'm trying to be open to things because I know they can change; I was just surprised how much originally was disallowed by my previous care provider and hospital that seems to be normal for the one I switched to. I am hoping everything goes "to plan", but am going to try and keep an open mind and not be too disappointed if things change, because I realize it's not any sort of personal failing or whatever if there are problems.

    I have noticed a lot of the templates for birth plans are outdated or don't conform to what local hospitals have available, that's why I looked at a bunch, then checked with the hospital and my provider before making my final draft. There are things like shaves/enemas they just don't do anymore, and also things some birth plans mentioned that a lot of hospitals will not allow [auscultation only instead of EFM, no eye ointment, delayed cord clamping].

    I think part of it is women are trying to educate themselves and plan on their own, but a lot of the providers don't really offer much input of guidance on what to put in a birth plan, other than "plan for a healthy birth", possibly because they're afraid of disappointment or anger towards them if things don't go according to plan.

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