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Old 01-25-2013, 07:51 PM   #11
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Re: Birth Plan for Hospital

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Quote:
Originally Posted by faithfulorangekids View Post
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.

^^ Make that short and simple, not a paragraph. Here are our wishes, we are flexible, please discuss with us before anything is done (basically).


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. If you want to include this, shorten to a simple statement - "no unessential staff please"



PREPARATION
• ALLERGIC TO LATEX, PENICILLIN, CODEINE, SULFA, CODONE
• No routine enema This is an almost archaic practice, I wouldn't worry about including it.
• No shaving or removal of pubic hair Same here - only instance where a shave would be needed is if pubic hair extended to the incision area if a c/s were needed. Wouldn't include this.
• 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

I wouldn't include any of this. If you want dim lights, have them dimmed - no need to tell the staff. If you and your support partners are using quiet voices, 9 times out of 10 the staff will follow. I wouldn't include it though simply because it lengthens the birth plan. Also wouldn't include anything about photographs - just ask your OB ahead of time if there are any specific requirements for that - most likely there won't be apart from the in OR if a c/s in needed


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.

Again, no need to really include this. You change positions if you'd like to!



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.

All of this is good, easy to understand, concise info


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)

Fine to include if you want but they most likely will tell you 'no' - if you choose to eat and drink, just do it 'without permission'.


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.

Would just put "Intermittent monitoring unless indicated otherwise"


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

Saying medical indication, labor changes, ect can be so hard because YOU may not think it's needed but staff does, ect.. Maybe just say 'minimal vaginal exams'


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.

Unless you have an epidural you *probably* won't have a cath unless you aren't emptying your bladder. If you don't have continuous IV fluids this probably won't become an issue because they won't be comparting input to output that closely (ml's/ml's as they often due when IV fluids are given).


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.

IMO saying things over and over like DO NOT OFFER come off very harshly to the staff and may put animosity where there need not be any, KWIM? Maybe just say if labor stalls you'd like to try non-pharmaceutical methods such as walking, nip stim, ect before pitocin is discussed.



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.

All good! Maybe request birth stool, squat bar, ect if you'd like



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.

I wouldn't cover this again since you already covered it up above


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.

All good


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. You may want to mention you'd prefer no one counting, ect as simply saying 'self-directed pushing' doesn't always get the message across.
• NO LAMAZE-TYPE PROMPTS I'd leave this out. Again - especially the caps just puts alot of unneeded animosity-type feelings IMO.... Also this is covered above with self-directed pushing, no counting, ect..
• 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. Maybe discuss this with your provider before labor as many providers aren't using forceps except for a total last resort and prefer vacuum as they feel it's less invasive. There are a few local OBs who don't even use forceps ever. Just may be a good thing to talk about before labor.
• 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. I'd just say "we are declining the eye ointment"
• 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. This is always a given at every single delivery I've attended, so I wouldn't really bother including.
• If fundal massage is necessary I'd like to try it myself, with someone else instructing how.
• Prefer freedom of movement after birth. Not necessary to include really.
• No routine administration of pitocin after the birth unless told to. Wouldn't include since you already mentioned this a few bullet points back

RECOVERY/POST-RECOVERY
• Recovery with baby in private This is most always a given so I wouldn't include it.
• 24-hour rooming in Check with your hospital as this is standard at many hospitals now.
• Breastfeeding on demand with assistance only as requested
• Prefer to have person of choice in my room at any time of day No need to include, pretty standard
• 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. Already covered this above
• Baby held by grandmother and nursed by mother.

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

AIRWAY
• Suctioning if necessary, if not, DON’T DO IT! Deep suctioning isn't typically done (locally) unless there's mec. standard suctioning of the nose/mouth is often done at the perineum or immediately after birth on mom's chest - you may want to clarify if you want zero suctioning or 'deep' suctioning. Also 'if necessary' probably means one thing to you and another to the staff - to them it may be necessary to suction all babies, you know? So you may want to clarify what 'necessary' means.

NEWBORN PROCEDURES
• Prefer all routine procedures done in our room after initial bonding time. Again, already covered.
• If this is not possible, I would like to have grandmother stay with the baby at all times. Already covered.
• I prefer that the baby be gently wiped down with a soft cloth to remove fluids, and wrapped in a blanket. They will wipe baby down with a blanket and wrap automatically so no need to include
• 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. Already covered this above

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

I'd definitely try to condense it to one page of bullet point info. SO often a staff just disregards plans when they are TOO detailed or TOO long. Think about what's most important and have a support person or doula or someone to cover the rest.

Consider separating your plan into a "labor/delivery" plan and a "baby care" plan. Oftentimes the baby care wishes get overlooked because your nurse that you'll most likely give your birth plan to has nothing to do with your baby - the peds nurse/peds team/baby nurse does and she may never even see your birth plan. I like to take a separate 'baby care' plan and put a copy in the bassinet that they bring in before delivery - that way they'll be sure to see it....

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Hi, I'm Amber. Wife to an amazing man
Mama to
Ava {12.20.08}, Levi {8.19.10},and Aspen {7.11.13}.
Expecting Paisley Rayne or Oakley Lennon in March 2015!
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