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KLadyBugMama 01-25-2013 02:28 PM

Birth Plan for Hospital
 
Hi, I have researched about UC, Homebirths, and hospitals and decided it would be best/easier for me and for my future child to do it at Mercy hospital which have a natural childbirth option including water births!! So I'll do it there. However, I know hospitals can be.....an interesting experience so I was wondering if anyone had a hospital birth with a birth plan drawn up. I have written up one and will hand one to my OB when I become pregnant but I was wondering if any hospitals will follow your wishes?

I have attached my birth plan so criticism, and advice/tips are welcome!

Thanks!

BIRTH PLAN

I have prepared this Birth Plan to help you understand my philosophy and the kind of care I hope to have for the birth of my child. I wish for as natural a birth as possible, avoiding unnecessary procedures and medications. I would like to direct, but know I cannot control, my childbirth experience. When this Birth Plan is respected, then, if I need to deviate from its general guidelines, I will feel better about the change. Let me know right away if you think I need to change plans, and why the change is necessary. I would like to be part of the decision-making team and to be consulted about and asked for our consent before any medical procedure is performed. In addition, I would like any medical procedure explained as it is performed. I fully realize that emergencies can happen, and that in the case of an emergency, the health care team will take the best steps for me and my baby.

BIRTH TEAM

• It is important to me that me and the baby remain together at all times during the labor and delivery (vaginal or cesarean).
• While I understand and can appreciate the need for training and teaching, I highly value my privacy and would like to keep the birth team to the minimum necessary number, which excludes residents, trainees, and other nonessential personnel. The people that may visit are my immediate family members and selected friends.

PREPARATION
• ALLERGIC TO LATEX, PENICILLIN, CODEINE, SULFA, CODONE
• No routine enema
• No shaving or removal of pubic hair
• No IV’s/Hep Block

EARLY & ACTIVE LABOR

ENVIRONMENTAL CONDITIONS
• Lights dimmed
• Voices respectfully lowered, no loud signing
• Prefer option to film and/or photograph

POSITIONS
• Prefer freedom to choose positions and activity level in labor as long as cord prolapse is not an issue. No restricted activities unless medically necessary.


PAIN RELIEF
• Pain relief through breathing, massage, counter-pressure, changes in position, water (tub/shower) and emotional support.
• No pain medications to be offered unless requested. That includes epidurals.
• If available, I would like access to a tub, squatting bar, birthing ball, and rocking chair.

FOOD
• Unlimited eating/drinking preferred but ice chips or light beverages upon request. (due to food allergies, I will provide my own foods or request foods that I am able to eat (no dairy, casein, any nuts)

FETAL MONITORING
• External fetal monitoring only as required by the condition of the baby. No constant monitoring and that includes internal fetal monitoring unless baby is in distress.

EXAMS
• Internal exams for specific medical indication, when labor changes, or by request.

METHOD OF ELIMINATION
• Prefer to walk to the bathroom when needed.
• If catheterization becomes necessary, I prefer to have it removed as soon as possible after bladder is empty, but don’t offer.

LABOR AUGMENTATION
• As long as the baby and I are fine, I would like to be free of time limits and not have my labor augmented. DO NOT OFFER!
• If ROM occurs at onset of labor, I prefer to wait 12 hours or more before inducing if my condition permits.
• If necessary, I would like to try walking, nipple stimulation, and pelvic rocking.

PUSHING & DELIVERY

POSITIONS
• Position in pushing phase to be determined by me at the time (using gravity enhanced positioning if possible) includes the possibility of full/partial squatting positions—not flat on back). Preferred to do pushing phase in water is my highest priority.
• Pillows, wedge, elevated table back for support at delivery, if necessary.




PAIN RELIEF
• Pain relief through breathing, massage, counter-pressure, changes in position, water (tub/shower) and emotional support.
• No pain medications to be offered unless requested.

EPISIOTOMY
• Desire to try for intact perineum with massage, support, and hot compresses.
• If necessary, we prefer a pressure episiotomy when baby's head is crowning. (Small tear is preferable to a large incision.)
• Local anesthetic is permissible for performing & repairing an episiotomy.

EXPULSION TECHNIQUES
• As long as the baby and I are fine, I would like to be free of time limits on pushing.
• Prefer option of self-directed pushing to help ease the baby out slowly and avoid tearing the perineum.
• NO LAMAZE-TYPE PROMPTS
• If pushing is not progressing efficiently, I would like to be reminded that sometimes changing positions helps. I would like to be encouraged to try one or more of the following delivery positions: squatting, side-lying, standing
upright, hands and knees on floor, kneeling with arms resting on bed/chair, or semi-reclining on bed-knees pressed to chest with support person behind providing counter-pressure.
• Forceps preferable to vacuum extraction, but prefer to avoid as last resort.
• Mother would like to be allowed to touch the baby's head as it begins to crown if labor is normal.
• Mother would like to catch the baby if baby’s condition permits.

BABY’S ARRIVAL
• Baby placed on my chest upon delivery.
• Grandmother would like to cut the cord.
• Would like to nurse immediately after delivery.
• Prefer newborn procedures completed after initial bonding time.
• No eye agents such as silver nitrate or antibiotic ointments in eyes. Only breastmilk allowed.
• Prefer spontaneous placenta separation with breast stimulation/nursing the baby after delivery rather than inducing with pitocin, uterine massage or cord traction. If a procedure is necessary, please explain it to me.
• Perineum ice packs if requested immediately after birth.
• If fundal massage is necessary I'd like to try it myself, with someone else instructing how.
• Prefer freedom of movement after birth.
• No routine administration of pitocin after the birth unless told to.
RECOVERY/POST-RECOVERY
• Recovery with baby in private
• 24-hour rooming in
• Breastfeeding on demand with assistance only as requested
• Prefer to have person of choice in my room at any time of day
• I would like the option being discharged as soon as possible once my midwife has approved it.
• If the baby is a boy, there will be NO circumcision.
• No disposable diapers; I will bring and provide cloth diapers/natural wipes. I will bring a wet bag for dirty diapers.

IMMEDIATE CARE
• Prefer to postpone routine newborn procedures until I have had a chance to bond with my baby.
• Baby held by grandmother and nursed by mother.

FEEDING
• Breastfeeding exclusively on demand
• NO supplementation of any kind—pacifier, sugar water, formula, etc.

AIRWAY
• Suctioning if necessary, if not, DON’T DO IT!

NEWBORN PROCEDURES
• Prefer all routine procedures done in our room after initial bonding time.
• If this is not possible, I would like to have grandmother stay with the baby at all times.
• I prefer that the baby be gently wiped down with a soft cloth to remove fluids, and wrapped in a blanket.
• Please do not bathe, to allow our baby's natural vernix to continue to soften and protect the skin.
• No Vitamin K injections (oral is fine) (Will breastfeed which will provide natural Vitamin K), and No Hep B vaccine. PKU test is fine and beneficial for the baby.
• I ask that you discuss any additional newborn procedures with me before they are performed.

EYE CARE
• NO eye agents such as silver nitrate, or antibiotic ointments. Will use breastmilk.

WARMTH
• If warming is necessary, prefer mother holding baby, with soft cloth/blanket covering both.


CONTIGENCY PLANS

CESAREAN DELIVERY
• Please keep communication open. If at all possible, please wait for my express consent, or that of my mother, before initiating any procedure.
• It is important to me that my mother be present with me at all times during the birth.
• Ideally, I would like to remain awake and aware, avoiding general anesthesia if possible.
• Prefer regional anesthesia with little or no premedication or discuss further anesthesia options with me.
• I prefer that the anesthesia take effect before the catheter is inserted and that there are no "hot spots" (areas which are not yet numb) before the surgery begins.
• Prefer to have the obstetrician explains events as they occur.
• Please use a low-transverse incision on my uterus and abdomen.
• Please leave at least one of my hands free so I may touch our baby when he or she is born.
• Assuming the baby is well, I would like to hold our baby on my chest.
• Breastfeeding as soon as possible.
• I would like the baby's health to be judged on its own merits - no special nursery care unless necessary.
• Please remove my IV and catheter as soon as possible following our baby's birth.
• Please provide me with nutritious food and drink as soon as possible.

PREMATURE BIRTH/ILL BABY
• If my baby is not well, I would like to:
• accompany my baby, or have the grandmother accompany our baby, if transported to another facility.
• breastfeed exclusively, or provide my expressed milk for our baby.
• have unlimited visitation.
• hold, rock and care for our baby, if possible.
• Visit NICU as much as possible.
• Have all procedures explained before/as they are performed as our baby’s condition permits.
I thank you for taking the time to go over this Birth Plan, and appreciate your cooperation in getting the new family off to great start!


PHYSICAN/ DATE


MOTHER/ DATE

newmom98118 01-25-2013 02:40 PM

Re: Birth Plan for Hospital
 
I think it's great you know what you want and have articulated it well on paper. My main reaction is that it's way too long. I don't know if the nurses/docs will have the time to read it. My recommendation is that you shave it down to one side of one page. Bullet points are good, I'd stay away from paragraphs. I had a birth plan for my hospital births (2 of them)...my OB gave me a form. It was one side of one page and even then there were nurses who never looked at it. The longer version above is great to talk about with your partner/doula/support person. That's my 2-cents! Good luck!

gingerpeachee 01-25-2013 03:43 PM

Re: Birth Plan for Hospital
 
Keep the long version for your support person.
Go over the long version with your OB and delete everything that is then found to be standard at the hospital you're delivering at.
Then chop it down to one page of things that are really important to you.

Also, just a teeny tiny little thing, its called a hep lock or a saline lock, not a hep block. :goodvibes:

KLadyBugMama 01-25-2013 04:07 PM

Quote:

Originally Posted by gingerpeachee (Post 16205852)
Keep the long version for your support person.
Go over the long version with your OB and delete everything that is then found to be standard at the hospital you're delivering at.
Then chop it down to one page of things that are really important to you.

Also, just a teeny tiny little thing, its called a hep lock or a saline lock, not a hep block. :goodvibes:

Heh heh.. Will change it, thanks!!!

How do you find out what is the standard procedure at the hospital?

MDever 01-25-2013 04:26 PM

Re: Birth Plan for Hospital
 
Yes, your birth plan for the nurses and doc during delivery needs to be very susinct or they will not read it. This is my current plan but not the final draft:

We politely request the following.

For Labor:

-To have my husband present at all times
-To decline routine IV prep(hep lock)
-To wear my own clothing
-Low lighting
-Minimal cervical exams
-Open access to drinks
-The use of the labor tub
-Only intermittent monitoring of baby’s heart rate
-Freedom of movement and position
-To decline discussion of pain tolerance and levels or offers for pain relief
-No internal monitoring in the absence of fetal distress
-To be fully informed and consulted before the introduction of any medical procedure.

For Delivery:

-Low lighting
-Perineal massage
-Freedom of position
-Self directed pushing(no counting please)
-My husband to “catch” the baby
-**Both clamping and cutting of the umbilical cord are to be delayed until pulsing has stopped** I do not give permission for clamping or cutting to be done with out my express verbal consent.

For Baby

-Baby to be placed directly on mother and for newborn assessment to occur there
-That vernix be allowed to absorb into baby’s skin please do not rub or remove the vernix
-That breastfeeding begin immediately
-To decline eye ointment
-To decline vitamin K injection
-To decline any and all vaccines
-To decline circumcision
-The baby will remain in the room at all times unless accompanied by a parent.
-No pacifier, bottles, formula, or sugar water be offered to our baby
-To decline to have the baby bathed
-The baby will wear only cloth diapers which will be provided by parents.

Mercy is a great option for "crunchy" folks in our area but I have VERY precipitus births and I live in Harford County so there is no way I would make it and park(parking there is not the best). Have you considered any independent birth centers? There are a few AMAZING places near you. I think you would be much happier in that type of setting based on your birth plan. Also keep in mind that some of the requests you made may be against various hospitals policies. The doctor will not be present for 99% of your stay so the nurses are who will really be helping implement your wishes.

You Tell 'Em 01-25-2013 04:32 PM

Quote:

Originally Posted by faithfulorangekids

Heh heh.. Will change it, thanks!!!

How do you find out what is the standard procedure at the hospital?

Your doc/midwife should be able to tell you. :goodvibes: Even then, like with my OB, he's more NCB friendly than the hospital policies would be so most of what is in my birth plan is already how he does it, how the hospital expects his patients to be, so as long as there aren't new/unfamiliar nurses it's not a big worry for me.

KLadyBugMama 01-25-2013 04:42 PM

Quote:

Originally Posted by MDever (Post 16206018)
Yes, your birth plan for the nurses and doc during delivery needs to be very susinct or they will not read it. This is my current plan but not the final draft:

We politely request the following.

For Labor:

-To have my husband present at all times
-To decline routine IV prep(hep lock)
-To wear my own clothing
-Low lighting
-Minimal cervical exams
-Open access to drinks
-The use of the labor tub
-Only intermittent monitoring of baby’s heart rate
-Freedom of movement and position
-To decline discussion of pain tolerance and levels or offers for pain relief
-No internal monitoring in the absence of fetal distress
-To be fully informed and consulted before the introduction of any medical procedure.

For Delivery:

-Low lighting
-Perineal massage
-Freedom of position
-Self directed pushing(no counting please)
-My husband to “catch” the baby
-**Both clamping and cutting of the umbilical cord are to be delayed until pulsing has stopped** I do not give permission for clamping or cutting to be done with out my express verbal consent.

For Baby

-Baby to be placed directly on mother and for newborn assessment to occur there
-That vernix be allowed to absorb into baby’s skin please do not rub or remove the vernix
-That breastfeeding begin immediately
-To decline eye ointment
-To decline vitamin K injection
-To decline any and all vaccines
-To decline circumcision
-The baby will remain in the room at all times unless accompanied by a parent.
-No pacifier, bottles, formula, or sugar water be offered to our baby
-To decline to have the baby bathed
-The baby will wear only cloth diapers which will be provided by parents.

Mercy is a great option for "crunchy" folks in our area but I have VERY precipitus births and I live in Harford County so there is no way I would make it and park(parking there is not the best). Have you considered any independent birth centers? There are a few AMAZING places near you. I think you would be much happier in that type of setting based on your birth plan. Also keep in mind that some of the requests you made may be against various hospitals policies. The doctor will not be present for 99% of your stay so the nurses are who will really be helping implement your wishes.

Yes I have considered/researched it.. they are still on my list, however my insurance will not cover it. I have Kaiser Medicare. I'm looking through it.. if they will cover it or even some percentage, it's #1 on my list! Special Beginnings do not cover it.

EmilytheStrange 01-25-2013 05:05 PM

Re: Birth Plan for Hospital
 
Quote:

Originally Posted by gingerpeachee (Post 16205852)
Keep the long version for your support person.
Go over the long version with your OB and delete everything that is then found to be standard at the hospital you're delivering at.
Then chop it down to one page of things that are really important to you.

Also, just a teeny tiny little thing, its called a hep lock or a saline lock, not a hep block. :goodvibes:

yes :)

you can talk about most of these things with them to find out what's standard. Some things, you might simply not have a choice - like with the unlimited eating/drinking. Some things, they might SAY are standard procedure - like handing you your baby right away, but may or may not really be standard.

Most hospitals have a birth tour/class. I highly recommend going. For one, I decided against one of the hospitals when they told me it was standard procedure for all babies to go to the nursery for about 30 minutes every morning to be seen by a pediatrician. Parents could go with them, but that was just part of the procedure. This is something they covered in our tour, but not something that I ever would have thought of because my last hospital and the hospital I chose this time do not have nurseries and never take the baby from your room.

It's very nice to go, listen to their schpeal, see the rooms, see the NICU, see everything. And ask all your questions that aren't already answered or atleast find out the person you can sit down with at a later time to answer them. OBs and Midwives are great, but often, they don't schedule a lot of time into regular prenatal appts for great lengthy discussions. But hospitals do have people who work there who do make the appts to talk about all these things.

and yes.. 1 page, very succinct and bulleted is best :)

EmilytheStrange 01-25-2013 05:09 PM

Re: Birth Plan for Hospital
 
hehe, and all this vernix talk is funny to me.. my LO came un-cheesed. I guess because my water had been broken for so long :) just never seen so many birth plans mention it.

WannaBeGreen2011 01-25-2013 08:28 PM

Just like PPs, I suggest one page max. We broke ours down into pre-labor, birth, and post-care. I also had a small section about c-sections. I limited my info to my most important points that I knew I would not change my mind about. My hubby knew all the other points and knew what to say. Our birth didnt go perfectly like I thought it would and I had to give in on some of my points, but my main goal was "healthy baby, healthy mama" so that was always what guided my decisions.

I think others are more receptive to short and sweet, but if you truly feel like you need every word of this, I would be sure to underline or bold your main points so they can quickly be seen at a glance. I put my birth plan in chronological order, but if I had a long birth plan like that, I'd probably so it in order of importance. If no circumcision is important, I'd put that on page 1 in big letters. That's what I did. That's an irreversible action..I didn't want anyone to forget/not know that my baby should stay intact. I was surprised to see that at the end of your list, I assumed I wouldn't see it at all. If a doctor never made it to that page, your baby might end up circ'd because its standard procedure. Just my .02!

From my iPhone, probably while BF'ing.


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