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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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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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Old 01-25-2013, 08:04 PM   #12
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Re: Birth Plan for Hospital

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Originally Posted by cinderella08 View Post
My comments are in PINK
what she said! I'm a nurse (although I don't have much experience in labor & delivery) and I really highly doubt the vast majority of nurses would read this (and, in particular, remember it), it's very extensive and gives off a bad vibe.

My advice is do what you want, refuse what you don't. If you need you think you'll need help having the birth you want, hire a doula.

ETA: I had a natural birth at a hospital without a doula that was not stressful at all thanks to a wonderful nurse. Unfortunately the demeanor and helpfulness of the staff will likely be luck but I think the birth plan in it's original format may start you off on the wrong foot. I had a birth plan but it was much more for me and my hubby.
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Old 01-25-2013, 08:16 PM   #13
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Re: Birth Plan for Hospital

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what she said! I'm a nurse (although I don't have much experience in labor & delivery) and I really highly doubt the vast majority of nurses would read this (and, in particular, remember it), it's very extensive and gives off a bad vibe.

My advice is do what you want, refuse what you don't. If you need you think you'll need help having the birth you want, hire a doula.

ETA: I had a natural birth at a hospital without a doula that was not stressful at all thanks to a wonderful nurse. Unfortunately the demeanor and helpfulness of the staff will likely be luck but I think the birth plan in it's original format may start you off on the wrong foot. I had a birth plan but it was much more for me and my hubby.



"start you off on the wrong food" is the perfect word - it just (IMO) gives a vibe and feels like you aren't flexible at all.... Like it puts up a total wall between you and the staff. I've found that staff members are often willing to bend over backwards to accommodate requests if you ask very nicely and are willing to compromise, you know?
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Old 01-25-2013, 08:19 PM   #14
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Re: Birth Plan for Hospital

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I had a birth plan but it was much more for me and my hubby.
I think this is a good point. Really, especially if you are in labor so long that your nurses change several times (23+ hours for me)...

but if you write it out to remind yourself, that's good. Because when you're in the crux of labor, sometimes you forget exactly why you didn't want this or that. And sometimes afterwards, you're so exhausted, you can't remember 'was I okay with the vitamin k?', etc. Of course, there's the adrenaline that'll come and give you a boost, but a lot of times, your exhaustion can depend on what time of day labor started and how long it was. My last one started at the end of the day, so I was already worn out before things even got really exhausting.
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Old 01-25-2013, 08:22 PM   #15
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Re: Birth Plan for Hospital

If it helps at all, here's my birth plan from my last delivery (a VBAC induction due to blood pressure issues). My labor was 9 hours from start of pit to baby on my chest so I didn't have a nurse change or anything. My midwife, labor nurse, and baby nurse all read the birth plan and all were happy with it and commented it was pleasant and short enough to understand yet long enough to convey my wishes. It was about 3/4 page typed.


I understand that labor and birth are both very unpredictable and ultimately want the safety of both baby and I to take precedence to any of my desires. I do have a list of preferences that I would like taken into consideration and followed barring any medical emergency.

Labor
• Please allow my water to break on its own – no AROM unless labor has stalled please.
• I would like to have intermittent monitoring as long as the baby appears to be tolerating labor well (this changed since I was induced and had CEFM)
• I am planning a med-free birth, and would appreciate if pain relief is not offered. I am aware of my various options and will request pain relief if I need it, as I am aware that my opinion may change during labor!
• I would love to have the option of laboring in the tub or shower.
• I would prefer vaginal exams to be kept to the bare minimum

Birth
• I would ideally like to be able to only push when I feel the natural urge rather than automatically begin the pushing phase as soon as I am fully dilated.
• I prefer to tear instead of having an episiotomy, but understand if a life-threatening condition arises where baby needs out ASAP, an episiotomy may be warranted.
• I would like to be able to push in any position I feel is most comfortable at the time – hands and knees, laying down, semi-sitting, squatting, ect.
• I would like a mirror available to view the delivery. I would also like to be able to reach down and feel my baby’s head upon crowning, as well as reach down and pull my baby out and up onto my chest.
• Please allow the cord to completely stop pulsating before it is clamped. I would like my husband to cut the cord.

If a C-Section Is Warranted
• I do not consent to a cesarean section unless the life or me or my daughter is in jeopardy. If there is a true emergency, I will not hesitate to be the first to agree to a cesarean, but for non-emergent reasons, I plan to avoid another cesarean.
• I would like my arms to remain free so that I can touch my baby. I would also love some sort of skin to skin contact while in the OR – even if just a shoulder or upper chest area.
• I would like my husband to be able to do a “ceremonial cutting of the cord” – a length left by the OB so that my husband can still cut the cord.
• I would like photographs to be allowed to be taken.
• Please allow my baby in recovery immediately if all is well with us both so that I can begin bonding and immediate breastfeeding.

Baby Care
• Please do all exams in my room
• I do not consent to the Hepatitis B vaccination, Vitamin K injection, or erythromycin eye ointment
• I plan on exclusively breastfeeding. Please no bottles, pacis, formula, water, ect to be given unless medically indicated.
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Old 01-26-2013, 02:55 AM   #16
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Thanks so much! I didn't realize it was too long and restricted. I'm more flexible apparently than what it looks like lol. I'll modify the birth plan and post it up here. I have been researching on a doula and I think I will get one.
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Old 01-26-2013, 04:33 AM   #17
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Re: Birth Plan for Hospital

I agree that it is long and difficult to follow.

First off, I absolutely would take a hospital tour and find out what is standard for your hospital. If you were to birth at the hospital where I gave birth, you could cut out almos 1/3 of your written plan immediately because much of it was standard even 12 years ago.

Find out if the hospital is a teaching hospital. If so, you may have little choice regarding having medical and nursing students. Teaching hospitals are just that -- focused on teaching the next generation.

Your plan has medical and nursing requests in the same document. Your nurse has no control over the medical end and the doctor doesn't control the nursing end. Asking your busy nurse t read and remember how you want the doc to stitch you up means less of her focus on other aspects of your care. I would talk to your doc beforehand about forceps v. Vacuum. Honestly there are different indications and some docs are better with one over the other. Do you really want your preference or does it make more sense for the doc to assessed the situation and her own skill art and make that decision? This coming from a mama who had one vacuum extraction, on forceps and. One precipitious delivery.

Keep it under a page. Find out what is standard before you write it. Be ready for baby to decide how Mich you get your ideal birth
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Old 01-27-2013, 07:45 AM   #18
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Re: Birth Plan for Hospital

c-section rates in MD

Although not the highest in the state, Mercy is still reasonably high.

I think a few of the things you're wanting won't be honored due to "hospital policy", especially the IV. You have to have that in place, even if they aren't pumping anything in to it.

I think the plan is great and awesome and I hope you get it, but please be prepared to fight for it. It was long, I didn't see anything about a doula (but may have missed it) and I think getting a doula would help you get there.
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Old 01-29-2013, 07:46 PM   #19
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Re: Birth Plan for Hospital

Having worked on an L&D floor in a couple of relatively natural birth friendly places, I promise you will not want to hear what they will be saying about you behind closed doors if you hand them this. Even if they totally support what you're asking for, the tone is all wrong. Also you're not really asking for anything that's unusual for a lot of people having natural births so they won't be too surprised by any of this if you say you want to go natural.

What I've found being on both sides of labor is that the way to have the most success is to see yourself and all your caregivers as being on the same team. Yes sometimes we have to advocate for ourselves and yes there are a lot of unnecessary interventions we need to keep from happening but seriously, kill em with kindness. Bring cookies for the staff when you show up to deliver. Smile and ask nicely and talk about how strongly you feel about your baby and what is best for him or her. Put your foot down when you need to but otherwise be as nice as a laboring lady can be! I don't mean to sound dismissive but I've seen the same birth plans get fought vs get accepted completely based on the tone of the patient.

Also, definitely get a doula. Look for one that recognizes what I said above and you'll get the birth you want.
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Old 01-29-2013, 07:51 PM   #20
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Re: Birth Plan for Hospital

Kate has a great point. I was a very nice pain in the butt and put my foot down when i was miscarrying Simon. I did not want a lot of the things that the doc wanted to force on me, but I was super nice to my nurse who was an angel.

The new nurse came in at shift change and talked for a few minutes with me and then she laughed and said "when XXX was going over the charts, she said 'now I know that the notes make her seem like a total pain, but she's a real sweetheart' and I see what she meant" and the nurses were great about turning a blind eye when I ate or did whatever I wanted to do. I'm naturally nice, and my annoyance was with my doctor not them, so I definitely kept that from my interactions with the nurses and got a lot better results (also cause the nurses weren't tattling on me to my doctor).
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