Birthing Plan Suggestions

G.,
I have copied and pasted in my birth plan for you to give you some ideas. They do NOT have to take the baby at all. It's YOUR baby, YOUR choice. I was the first person to touch my baby and held him for over an hour, nursed, and bonded - they didn't weigh him or anything until I was ready. It is important for baby to go right to mama to bond! They don't need to be wiped down and made to look nice - they need their mamas! We didn't even have him wrapped up - I put him naked on my chest and covered both of us with a blanket to keep us warm. The important thing to remember is, it's your body, your baby - don't let them bully you into doing things you don't want!

I included a section in my birth plan for "just in case" of a c-section. I did Hypnobirthing and it's very rare for a hypnobirth to end up requiring a c-section, but it does happen once in a while so I wanted to be prepared. Hope this helps!

My husband and I are looking forward to sharing our birth experience with you. We respectfully ask that those in attendance at our birth please follow the guidelines outlined below, based on the Hypnobirthing method of childbirth. We realize that as labor ensues, we may change our preferences and wish to feel free to do so. We also understand that these choices presume a normal birth. Of course, should an emergency situation arise, you will have our cooperation after we have had an explanation of the medical need and had time to discuss the suggested interventions between ourselves before giving consent.
Please review and attach this to my prenatal records; we will provide copies to be distributed to those present at our birth.
Thank you for your support and understanding.

Sincerely,
M. Corey and Jonathan Knock
LABOR
• I am willing to have one vaginal exam to check presentation; otherwise, no vaginal exams unless medically necessary (i.e. if labor fails to progress)
• Please do not suggest breaking of water (unless medically necessary) and be careful not to break water during internal exam(s).
• My husband will be coaching me; others, please refrain from coaching unless requested.
• Please use hypno-birthing terminology as follows: rather than “contractions”, use “surges” and rather than “pushing”, use “breathing the baby down”.
• I plan to snack lightly and self-hydrate throughout labor, as desired.

EPISIOTOMY
• I would prefer not to have an episiotomy unless absolutely required for the baby's safety.
• I am hoping to protect the perineum. I am practicing ahead of time by squatting, exercising, and doing perineal massage.
• If possible, I would like to use perineal massage and warm oil compresses (I will provide my own oils) to help avoid the need for an episiotomy.
• I would like a local anesthetic which I will provide (compounded lidocaine) to repair a tear or an episiotomy. I have a vulvar skin condition (lichen planus) that can make healing from a tear or episiotomy very difficult. Please be considerate of this and consult me before placing ANY topical or injected agents in the vulvar area.

DELIVERY
• I would like to be allowed to choose the position in which I give birth, including squatting.
• I would like the chance to touch the baby's head when it crowns.
• I would like my husband to receive the baby, if possible, along with the CNM.
• Even if I am fully dilated, and assuming the baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the “breathing down” phase.
• I would like to have the baby placed on my stomach/chest immediately after delivery.
• We request that room have low lighting and be as quiet as possible at the time of birth for our baby’s gentle entry into the world.
• I would like to use the tub for laboring and/or water birth if desired at the time.

IMMEDIATELY AFTER DELIVERY
• I would like to have my husband cut the cord if so desired.
• We would prefer that the umbilical cord stop pulsating and placenta be delievered before the cord is cut.
• We would like to hold the baby while I deliver the placenta and any tissue repairs are made.
• We would like to hold the baby for as long as possible before he is photographed, examined, etc.
• Allow vernix to be absorbed into skin - delay cleaning/rubbing and use only soft cloths (not terry cloth) if cleaning is necessary.
• No suctioning of nose/mouth unless medically necessary, please.
• We plan to keep the baby near us following birth and would appreciate if the evaluation of the baby can be done with the baby on mother’s abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
• If the baby must be taken from me to receive medical treatment, my husband or some other person we designate will accompany the baby at ALL times.
• I would prefer to hold the baby rather than have him placed under heat lamps.
• We would like to see the placenta after it is delivered and plan to take the placenta home with us. Please no use of formaldehyde or other chemicals in placenta.
• We would like natural methods to assist in placental expulsion - breastfeeding, gentle uterine massage, nipple stimulation, etc. Please no cord traction!

POSTPARTUM
• Unless required for health reasons, I do not wish to be separated from my baby.
• Due to closely held religious beliefs, our child will not receive the Hep. B vaccine, oral or injected Vitamin K, or any sort of eye ointments. I do not suffer from any sexually transmitted diseases or engage in risky behaviors which would warrant the vaccine or antibiotic treatment and we do not believe in subjecting our baby to the potentially harmful side effects of any of these procedures.
We will provide our own oral Vitamin K solution for administration to the baby.
(Please refer to attached waivers.)
• If baby needs to be transferred to Beverly Hospital or other hospital, mother will be transferred as well.

BREASTFEEDING
• I plan to breastfeed the baby and would like to begin nursing very shortly after birth.
• Unless medically necessary, we do not wish to have any bottles/pacifiers given to the baby (including glucose water or plain water), and not without our knowledge and consent.

CIRCUMCISION
• We do not plan to have the baby circumcised.

PHOTO/VIDEO
• We would like to take still photographs during labor and the birth.
• We understand that videotaping is not allowed during birth but would like to take video during other stages of labor and after delivery.

OTHER
• We would like other support people to be present during labor and/or delivery upon request. This will include our birth doula, Donna JoAnn Gates.
• We would prefer that no students, interns, residents or non-essential personnel be present during my labor or the birth.

MONITORING (in case of transfer to Beverly Hospital)
• I do not wish to have continuous fetal monitoring unless it is required by the condition of the baby.
• I do not want an internal monitor unless the baby has shown some sign of distress.
• I wish to be able to decline the taking of pain scale information.
* Please limit vaginal exams to the extent medically possible.

LABOR AUGMENTATION/INDUCTION (in case of transfer to Beverly Hospital)
• I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
• I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) of labor augmentation before pitocin is administered.
• I would like to delay artificial induction for a reasonable period after release of membranes, if there are no signs of infection.
• If induction drugs are needed, we request that they be removed once uterus is naturally thinning and opening.
• I would like a nurse preferential to natural birthing methods, if available.

ANESTHESIA/PAIN MEDICATION (in case of transfer to Beverly Hospital)
• I realize that many pain medications exist; I'll ask for them if I need them. Please, no references made to "pain" or offer of medication unless we bring it up first.

CESAREAN (in case of transfer to Beverly Hospital)
• Unless absolutely necessary, I would like to avoid a Cesarean delivery.
• If the care provider determines that a Cesarean delivery is indicated, I would like to obtain a second opinion from another physician if time allows.
• If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.
• I would like my husband and birth doula present at all times if the baby requires a Cesarean delivery.
• So I can view the birth, I would like a mirror made available just before delivery of the baby. Please deliver baby slowly and leave cord intact for a few minutes so baby continues to receive placental oxygen supply.
• If the baby is not in distress, the baby should be given to my husband (no cleaning unless medically necessary) and I immediately after birth for skin-to-skin contact.
* If baby must be removed from my presence, my husband will stay with the baby; the birth doula will remain with me.

http://www.childbirth.org/interactive/ibirthplan.html
Here is a pretty good birth preference handout.
The key to any preferences you have is to first find a careprovider who has the same philosophies about birth as yourself and your husband. That means when you find a practitioner talking to them early and often about what your ideal birth looks like and see if it is inline with how they already practice (that is very important). You can ask for instance if you don't want an episiotomy what there rate of them are or c-sections ask them what their c-section rate is. Also hospital c-section rates are available to you as well at http://www.mass.gov/Eeohhs2/docs/dph/research_epi/birth_r...
You can talk about the possibility of a c-section and that you want the baby to stay with you and dad at all times afterward. Remember this is your birth yout body and your baby. Unless there is truly a medical reason why baby needs to go to the nursery they can monitor him/her right in the same room as you. Talk about that in the beginning and then put it in your preference sheets and move on focusing on a healthy labor, baby and birth. Don't ponder on it because you don't want a c-section to become your reality. I see your in RI. If you email me at ____@____.com I can suggest some practitioners based on your philosophy, if you have not found one already. Best of luck to you.

G.,

I think having a Birth Plan is a great tool for it can help a mother feel like she has some type of control of how her birth will go.

I filled out my Birth Plan sometime back. I printed the Birth Plan Form from the hospital website of where I'm having my baby.

FYI I made copies of my Birth Plan and gave one to my OB and I plan on giving one to the nurses who will be attending to me and one for my family to follow.

The hospital where I'm having my baby encourages Birth Plans for they truly want your birth to be all you dreamed of this is assuming no emergency arises which in deed will change your Birth Plan experience.

In my Birth Plan I have who I want in the room with me, lights to be dimmed, music to be played, video and camera usage, not to be confined to the hospital bed, so on and so forth. I thought of everything and anything that would make my experience the most comfortable for me and of course my family too.

My Birth Plan has since changed for I do have to have a c-section BUT I have another Birth Plan in place to accommodate a c-section experience.

Remember whats so wonderful about a Birth Plan is... it's all about what you desire and need to ensure you have the experience you feel is right for you. Your Birth Plan can be a mixture of ideas and thoughts regardless if you focus on the don't verses the do's or if you want to address all desires and concerns.

Good Luck
J.

Hi G.,
I have been blessed to have 7 natural, unmedicated deliveries, and a good hospital experience overall, which certainly was the ideal I had in my mind. However, I didn't put pressure on myself so i went in with the idea that if I felt I needed drugs, it was OK, and that even if I ended up having a section it would work out fine. That helped me relax. Also, I learned that I needed to be more assertive with the nurses, who are used to doing things a certain way, ie. making me lie down with the fetal monitor strapped to me for 20 minutes when I first came in. I had to insist, my hubby had to insist, and even my midwife, that this did not have to happen. It made me crazy to be laying down. Also, I decided that I did not want my baby to receive the vit. K, the Hep B. shot, or the eye drops, which are often just routinely done, so I also had to specify that ahead of time and again in the hospital. I found that being in a hot bath made my labors progress very quickly, and more bearably. I was able to specify that I wanted to wait a few minutes to cut the cord to allow the baby to retain more of the cord blood. And, most importantly, I realized that whoever was coming into labor with me needed to know exactly what I wanted so he could speak up when I was unable to. I spent no time in the bed until the actual birth, and even then was on my side and not my back, which I found much better. As far as an emergency C-section, I'm sure in that case they have to take the baby briefly to make sure that both Mom and baby are stable after the "emergency." I'm sure it's also eaiser for them to stitch you back up correctly without the distraction of the baby being there, especially as nursing stimulates uterine contractions, which could make it a little tricky. Anyway, sorry to ramble. I wish you the best as you prepare for your April delivery. I'll be thinking of you, as I too am expecting again in April.

They do not HAVE to take the baby away after a c-section. That happened after my second section. I didn't get my daughter until she was over 2 hours old. Caused me no end of grief and I am still angry that they wouldn't bring her to me. She was healthy and had no problems. They just wouldn't bring her to me!

With my 3rd I made it very clear to my OB that the baby had to stay with me after she was born. He was okay with it and said that the nurses usually take the baby away because it's easier and because no one tells them not to!
This time I told the nurses before my section and then during and then after the baby was born that she had to stay with me. They brought her to me right in the OR and then my husband didn't let her go. He just held her and I don't think the nurses dared to try to take her away from him!!

Once we were settled back in the room, he went with the baby down to the nursery for a check and a bath. If I hadn't felt comfortable with that I would have insisted they do that in my room too.

You just have to remember that the baby is YOURS. You make the decisions. As long as your baby is healthy there is no reason why they have to leave your side at all. Stick up for yourself and be vocal about it right from the start.

-S.

One of the things I really enjoyed during my labor, if you can enjoy any part of labor, was the jacuzzi bath that our hospital had. I actually fell asleep between contractions in that (it was the wee hours of the morning). It was wonderful. Another thing that surprised me was that I had an overwhelming urge to squat during contractions. Although I felt a bit primitive doing it, that position helped move things along. The nurses will pretty much let you do whatever works for you and gives you a comfort level. Don't hesistate to tell them that you don't like something, or that you want to try something different. The L&D nurses are awesome! Good luck

Have you researched vaccinations? I would recommend doing that - lots of times newborns are vaccinated with a Hep B shot at birth. If you do not want your child vaccinated against this (you can decide to delay or to not do it at all) I would have it in writing.

What are the risks?:
http://insidevaccines.com/wordpress/vaccine-efficacy-how-...

Links:
http://www.nvic.org/Vaccines-and-Diseases/Hepatitis-B.aspx

Good luck! I really wish I had starting researching earlier than I did.

HI G.,
You need to discuss procedures with your OB. Why do they remove the baby? Is it possible for her to stay and nurse while the ob sews you up? Is it for monitoring for a specific period of time? Can the monitoring be done in your room?
Here are a couple of excerpts from my plan...
"Our goal is to have a healthy, unmedicated, natural birth. This plan is for a best-case scenario. In the unlikely event that medical complications occur, we would like to be informed of the best choices, and will follow the doctor’s recommendations. :
"Delivery procedures- We have discussed with Dr. Stevenson her normal procedures for delivery and agree with her choices concerning placement of baby, cord cutting, suctioning of nose, eye prophylaxis and vitamin K injection. All of these procedures may be performed according to Baylor Hospital policy. Dr. Stevenson will be performing the circumcision.
Thank you for keeping the baby in the room with us as much as possible (Kangaroo Care) and allowing us to take part in newborn procedures when possible. "

If you want people to read it, keep it to one page. Also staple a small bag of m&m's to the top!

You will find that your birth plan is that, a plan. Plans change. Your doctor needs to understand your wishes and you need to understand why they choose certain procedures.

What would I have done differently? In the bit above, you will see mention about Vit K shot. This is important for clotting. What I didn't know was that my labor would be so quick that I wouldn't get two rounds of GBS(strep) antibiotics. This meant that they had to draw blood from my newborn son's hands...after they gave him a clotting shot! It was terrible!!! Next time, I will stipulate and tell them that all blood draws need to occur before the VitK shot.

You will have a great birth- good luck!

I don't actually have any advice on birth plans, I didn't have one and ended up with an emergency c-section so it probably would have been a moot point anyway.

I am just writing about the comment about taking the baby away when you have a c-section. I hadn't heard of this. I had an emergency c-section and my son was never taken out of my sight (obviously he was born healthy). They did their little tests right their in the room with us, my husband held him while they put me back together, and he left the OR in my arms. So, double check with your hospital, but I can't see why, if the baby is born without any complications, they would have to take him/her away from you.

I created a birth plan and it was a really nice way to think about what I wanted and what I didn't want for my labor and birth. It is also a good way to dialogue or communicate with your OB or midwife. I had a great labor and birth and didn't need to "use" the birth plan but I'm really glad that I went through the process and used it as a discussion tool with my OB.

Put me on the record as one who successfully delivered a baby without a birth plan at all. Just hours before my 32-week appointment at which we were going to establish my birth plan, my water broke. When I asked about a birth plan, I was told that in high risk deliveries like mine, the chances are low that I'd have much say in what happened. I did have an unplanned c-section and I was not able to hold the baby - and believe me, when they take your baby away without immediately, you know that it's in the baby's best interest and you don't care about anything else but giving your baby the immediate care she needs. When you're in the moment, and your baby's life hangs in the balance, issues like immediate bonding really fly out the window. In the weeks afterwards, I couldn't hold her because she needed to be in an isolette to keep warm. In addition, because she was so early, she needed extra calories from her milk, and so instead of nursing her I had to pump my milk and feed it to her through a bottle. Happy ending, once she got bigger and stronger, my baby and I bonded wonderfully. She is now almost 6 years old and we have a wonderful relationship. We are living proof that it is possible to bond with your baby even if you a)have a c-section; b)have the baby whisked away from you immediately after birth; and c)can't breastfeed.

I am SO glad I had a birthing plan. I know FOR SURE they would not have done what I wanted otherwise. I did not insist to have everything go as planned, but the plan saved the day in many aspects. Because you will be in a state when you don't want to have to explain your wishes to every nurse and doctor. I even wrote an article about it!
http://www.eco-babyz.com/2009/02/natural-birth-at-hospita...

My advice is leave it open because like you said nothing goes as planned and trust your doctor's advice. If something should go wrong don't be stubborn, they need to do what they need to do to protect you and your child! In my experience they take the baby away no matter what whether it is a vaginal or c-section to make sure all the baby's vitals are good, only if there are problems do they take it out of the room. No matter what, you will get your baby back. Remember in an emergency c-section something has gone wrong so there will be a reason for you and the baby to be separated temporarily, but remember when everything is fine you will be together again!