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misc.kids.pregnancy Birth Planning FAQ (part 3 of 3)

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Archive-name: misc-kids/pregnancy/birth-plan/part3
Posting-Frequency: monthly
Expires: Fri, 18 Apr 1997 00:00:00 GMT
Last-Modified: 1995/10/06

See reader questions & answers on this topic! - Help others by sharing your knowledge
Here starts a section of new input from misc.kids.pregnancy

-Sabrina (9/94-8/95)
---------------------------------------------------------------------

I think one thing that should be included in a FAQ is the concept
that a birth plan is not a guarantee or contract.  It should be
considered a starting point for communication, both prenatally
with your doctor or midwife, and then again with the labor staff
at your hospital or birth center.  Just because you've written
in your birth plan that, for example, you don't want an episiotomy
is no guarantee that the dr on call read that paragraph, or, that
when the time comes he/she will remember it.  They may just pick
up the sissors as a matter of habit.  So you need to keep on
talking and expressing your preferences throughout, regardless of
whether you have a birth plan or not.

I also had a little section in my birth plan on baby care preferences
just in case the baby had to be in the nursery for some reason.  It
was detachable from the rest of the birth plan, and could go with 
the baby.  We ended up with our baby in the level II nursery, and
so I was glad I had prepared it that way.  

My own thoughts on sample birth plans is that I wouldn't recommend 
including them in a FAQ.  Once you, as a pregnant woman, have 
made list of preferences, considered your options, etc., as Sabrina
noted, then I think your should write it "on your own" without
using someone else's as a guide.  This makes sure that you get
your own ideas, not someone else's ideas that sound good but may
not be true for you.

---------------------------------------------------------------------------
: My own thoughts on sample birth plans is that I wouldn't recommend 
: including them in a FAQ.  Once you, as a pregnant woman, have 
 
I found reading other people's birth plans very helpful in writing my own.
I don't think any of the plans I wrote were not true to me.

For example, I hadn't thought much about preferences if I had a c. My 
midwife has a low c-section rate, and the hospital I plan to deliver at 
isn't that much higher (less than half the national average). By reading 
someone else's birth plan, I began to think about what my options were 
under this eventuality, and put in a brief section on c's.

Or another example: I had lots of stuff in my first birth plan about 
labor and delivery, but much less on post-partum and recovery care, or on 
baby care. If I had read other people's birth plans, I would have thought 
to include more on these areas.

Perhaps the best thing would be for someone to write the plan on her own, 
and then read other people's plans, for additional ideas and options. 
Then she could amend her plan if she wants, based on the new knowledge 
she may have gained.

----------------------------------------------------------------------
OK, here's my birthplan.  I did not use a textbook.  I ended up bein induced
(water broke and no contractions) and had an emergency epiosiotomy (though
my doctor was trying to avoid one).  Nonetheless it was still useful to
have the birthplan and I did deliver on my side.  I was told later that I
had "excessive blood loss" but I didn't need a transfusion.  (This bleeding
tendency was mentioned in my birthplan, but no one believed me until they
saw my blood readings.

Make sure you get your doctor to sign it.

*****************************************************************************
Page 1 of 2                     *** BIRTHPLAN***                      15-MAR-93
Patient: NAME                                            Doctor: NAME,  PHONE #

THINGS YOU SHOULD KNOW:
o I have a reconstructed left hip socket and find being on my side, either 
  side, for more than a few minutes to be uncomfortable.  I find
  "stirrup type" positions to be very uncomfortable.  I also have nerve
  damage in my left leg, on the left half from the hip to the knee, and
  cannot feel anything in this area, so cannot tell if its being injured.
  I prefer that my left leg not be handled or moved. 
o On 3 previous timed blood clotting tests (Fall'90 & Fall'91), prior to 
  sinus surgery, I've tested on the slow side of normal (twice approx.
  7 minutes and once 10+ minutes as I recall).
o I do not want any medical students or nursing students, or other 
  observers present at all for any part of my labor or delivery or recovery.  
o I do not want any procedures (like breaking my waters) done without 
  my knowledge and approval from myself and my doctor.  
o If it is not an emergency situation, and a procedure is suggested, I would 
  like 10 minutes to discuss it with my husband before deciding.
o We plan to use Children's Non-Separation Program and Rooming-In Program.

PLAN A - Routine Birth
o Husband and aunt present.
o I would like a birthing room.
o No shaving or enema.  
o Internal exam only once per hour, unless otherwise needed.
o Allowed to videotape the birth.
o Allowed to wear socks and bra.
o Allowed to eat lightly, in early stages of labor.
o No IV, as long as I can keep down ice chips and clear liquids by mouth.
o Attach the automatic blood pressure cuff intermittently, 
  not for entire labor.
o Allowed to walk, in room and hallways, during labor and to take
  warm showers during labor.
o Walk to the bathroom for as long as possible during labor.  Try to
  avoid catheter.
o If labor is not progressing as desired, I would like to walk, 
  take a warm shower, or other method before stripping the membranes 
  or artificial uterine stimulation is performed.  
o Intermittent (external) monitoring preferred over full-time monitoring.
o If a full-time (external) monitor is necessary, I would like it disconnected
  periodically so I can walk, unless there are obvious problems.
o I won't know until the time comes what type of pain medication I
  might want.  I plan to try for an unmedicated birth, but might 
  want a painkiller or epidural.
o Don't break the bed down for delivery.
o Allowed to use any position I find comfortable during labor.
o Allowed to use any position I find comfortable during delivery.
  (I probably will choose a side-lying position.)
o Allowed to choose the breathing method most comfortable for me (and
  it probably will not be Lamaze style).
o No "directed" (yelling and bossing) coaching.  
o I want a calm and quiet atmosphere with no distraction unless its relevant.
o NO EPISIOTOMY.  Unless baby is in *genuine* distress and must get out fast.
o I *do* want massage, support, and hot compresses on my perineum.


Page 2 of 2                     *** BIRTHPLAN***                      15-MAR-93
Patient: __________			Doctor: Dr.__________ 

o I would like to view the birth using a mirror.
o Husband allowed to cut the cord (or Aunt, if husband can't deal with it).
o Hold the baby and try to have it suckle as soon as possible after delivery.  
o Deliver the placenta spontaneously, encouraged by breast stimulation from 
  the baby suckling.
o If fundal massage is necessary I'd like to try it myself, with someone
  else instructing how.
o I'd like pain medication after the birth.
o Father allowed to give baby the bit of water given for testing purposes,
  (after that breastfeeding only).

PLAN B - Caesarean Delivery:
o Husband and aunt present.
o Have the "anti-nausea" shot after surgery.
o NO STIRRUPS.
o Allowed to videotape as much as the doctor will allow.
o Allowed to see the baby after delivery and again as soon as possible
  after recovery.
o Have father accompany the baby for any tests or procedures.
o Father allowed to give baby the bit of water given for testing purposes,
  (after that breastfeeding only).
o Allowed to breastfeed as soon as possible after delivery.

----------------------------------------------------     ---------------
        DOCTOR'S SIGNATURE                                DATE

----------------------------------------------------     ---------------
        PATIENT'S SIGNATURE                                DATE
-----------------------------------------------------------------------------

here's some more info:

Planning your baby's birth
by:
The pennypress
1100 23rd Avenue East
Seattle, WA 98112

for $0.50

it's the *best* info on birthplans i've found. we got ours from
our bradly instructor. the "Choices in Childbirth" section lists just 
about all the different choices there are. i used it to "cut and paste"
for our birthplan.

the pennypress puts out some top quality books as well (well, at least two
that i've read)! 
-------------------------------------------------------------------------

The instructor for the birth class that my husband and I attended gave
us a list of "informed consent questions."  This was a list of 7
questions that we were supposed to ask the midwife or doctor when
changes to our birthplan were suggested.  The birth class instructor
strongly recommended that everyone take the list to the labor/delivery
room since it is hard to keep a clear head and remember the questions
when you are in the middle of labor.

Informed Consent Questions:
1.  Is this an emergency or do we have time to talk?
2.  What would be the benefits of doing this?
3.  What would be the risks of doing this?
4.  If we do this, what other procedures or treatments might
    we end up needing as a result?
5.  What else could we try first or instead?
6.  What would happen if we waited an hour or two before doing it?
7.  What would happen if we didn't do it at all?
----------------------------------------------------------------------------
		 Birth Plan for [mother] and [father]

Our goal is to have a totally natural birth, free from any medical
interventions. We have tried to prepare ourselves to achieve this
goal. However, we understand that complications do occur. We trust our
physician, [obstetrician], and [hospital] to help us deal with any
complications that may occur during the birth of our baby. If there is
a need for any deviation from this birth plan, we request that any
medications, procedures, or other interventions be discussed with us
prior to administration if at all possible.

Labor and Delivery

- It is important to us that we remain together at all times during
  labor and delivery (vaginal or cesarean). We would like our labor
  assistant, [doula], to be present at all times as well.

- We prefer than no pain relief medication be used. If requested or
  recommended, we would like the pros and cons of any medications to
  be discussed with us prior to administration.

- [mother] would like to be free to move around during labor and
  delivery. She would like to try different positions, including
  squatting.

- We prefer that no episiotomy be performed. We would prefer if our
  physician could attempt alternative methods (hot & cold compresses,
  massage, different position for delivery, etc.) to preserve the
  perineum. In the event that an episiotomy is necessary, we request
  that a pressure episiotomy be performed as the baby's head is
  crowning.  We request that [mother] have the option of self-directed
  pushing to help ease the baby out slowly and avoid tearing the
  perineum. We prefer that a local anesthetic be used after delivery
  to repair the perineum if necessary.

- We prefer intermittent external fetal monitoring. In the event that
  continuous fetal monitoring is necessary, we would like the option
  of using telemetry. We would like to avoid internal monitoring
  unless there is a specific medical need for it.

- We prefer that no IV be administered. In the event that an IV is
  necessary "just in case", we request that a heparin lock be used. If
  continuous fluid administration is necessary, we request that the IV
  be portable so [mother] can remain mobile.

- We prefer that the amniotic sac not be ruptured artificially. We
  would like to keep the number of vaginal exams to a minimum and done
  gently to avoid rupturing the amniotic sac.

- We prefer that labor be allowed to progress at a natural rate with
  no artificial time constraints on any stage of labor. We prefer that
  the labor not be artificially stimulated with pitocin, amniotomy,
  stripping of membranes, etc.

- We prefer to wait for spontaneous placenta separation and delivery.

- We would like to have a mirror positioned so [mother] can view the
  birth.

- We prefer that no enema be administered or any pubic shaving be
  done.

- [mother] would like the option of using the shower.

- We would like the option of listening to music.

- [mother] would like the option of having light food and drink during
  labor.  

Postpartum

- [mother] would like a private room with absolute non-separation.  We
  do not want the baby to spend any time in the nursery. We request
  that all procedures and examinations be done in the LDR or in
  [mother]'s room. We understand that there is an eye exam that must
  be done in the nursery and that [mother] may be present.

- We would like to have the baby placed on [mother]'s abdomen
  immediately after birth.

- [mother] plans to breastfeed the baby exclusively. Please do not
  give any bottles, pacifiers, sugar water, or formula without prior
  consent.

- We prefer that [mother] holds the baby rather than have it placed
  under the heat lamps.

- We would like our daughter [daughter] (2 1/4 years) to be able to
  visit her new brother or sister in the hospital.

- We prefer that the umbilical cord not be cut until after it stops
  pulsating.

- We would like the option of [mother] and the baby being discharged
  as soon as possible once it has been approved by [obstetrician] and
  our pediatrician, [pediatrician].

- If the baby is a boy, we would like him circumcised by
  [obstetrician].  

Cesarean

- We would like to avoid a cesarean unless absolutely necessary. If
  possible, we would like to participate in the decision process to
  perform a cesarean.

- We prefer than an epidural be used and that [mother] be awake for
  the delivery.

- We would like [father] and [doula] (our labor assistant) to be
  present.

- We would like the screen lowered at the time of delivery so we can
  view the birth.

- We would like the baby's health to be judged on its own merits -
  no special nursery care unless necessary.  

Ill Baby

- In the event that the baby is not healthy, we would like to be as
  involved as possible with his or her care.

- We prefer that [mother] nurse the baby exclusively. If this is not
  possible, we would like the baby to be fed expressed breast milk
  exclusively.

[mother] 
[father] 
[obstetrician]                             

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