Birth plan.

[rivka]

By popular acclamation, here's a copy of our birth plan. We originally had a longer one that was much more polite and expressed much more flexibility, but several people pointed out to me that, although my midwife might read the long version, no one else at the hospital would. So this is one page, in snappy bullet points. It's still technically a draft - comments are welcome.

Birth Plan (Draft)

Names: rivka and curiousangel
Due date: 4/3/05
Primary caregiver: Kathy Slone Associates
Hospital: Mercy Medical Center

Additional people to be present during labor:
saoba (doula)
Pat (rivka's mother)

We recognize that no birth is predictable and that medical necessity may require significant changes to our plan. We trust our providers to help us make informed decisions during labor and delivery.

Pertinent medical background:

• Spinal fusion from T10-L2 performed in 1987.


• Artificial right hip due to congenital hip dysplasia – painful response to pressure and limited range of motion. Please do not put pressure on rivka's right leg or move it abruptly.


• Uncomplicated pregnancy, no known fetal abnormalities.

Preferences for normal labor and birth:

• We are planning an unmedicated birth but may ask for medications if delivery is unusually difficult or prolonged. Please do not offer pain medication.


• We would like to have access to a birthing tub during labor.


• rivka would like freedom to eat and drink throughout labor, as tolerated.


• Prefer to move freely during labor – no IV or continuous fetal monitoring.


• Student observation is okay – please, no internal exams by students.



• Prefer to push according to spontaneous impulse rather than being directed.


• Will accept a perineal tear if necessary, rather than an episiotomy.


• curiousangel does not want to catch the baby or cut the cord.


• Please delay cord cutting until the cord has stopped pulsing.

Preferences for unexpected events:

• Induction and/or artificial rupture of membranes only in response to fetal distress.


• At first consideration of C-section, we would like to consult with the anesthesiologist about feasibility of spinal anesthesia post rivka's 1987 spinal fusion.


• We will bring spinal fusion X-rays with us to the hospital.


• curiousangel to be present for C-section.


• Baby to remain continuously with curiousangel following C-section, if her health permits.

Preferences for the postpartum period:

• Baby to stay continuously with one or both parents, unless separation is medically necessary.


• Please delay routine infant care until after bonding and initiation of breastfeeding.


• Baby will be exclusively breastfed – please do not supplement with formula, sugar water, or a pacifier.


• If the baby is a boy, we will not want him circumcised.

Comments

[zencuppa.livejournal.com]

1) You might want to say how many people you want in the room during the birth. This is to avoid a bunch of nurses or students driving you nuts *wry grin.*

2) Maybe state your preferences about pelvic examinations by the nurses or resident physican (I did my best to keep them at a minimum, etc.)

3) Are you planning on playing music during the delivery and do you want to use a mirror to gauge your progress?

4) Your preference regarding the use of forcepts or suction on the baby during delivery.

5) You might want to findout if the hospital has wireless continuous fetal monitoring. I only say that because during my first delivery Nick's heartbeat would drop quite low during each contraction and I *wanted* me and the doctor to know what was going on.

6) Feasible alternatives to the birthing tub, if it's not available at that time (you never know how many babies will be born that night . .. )

7) If your midwife isn't a staff member of the hospital, include her name and contact information on the birthing plan.

There, that's my two cents .. Good luck!!

[rivka.livejournal.com]

Wow, thanks for all the detailed comments!

You might want to say how many people you want in the room during the birth. This is to avoid a bunch of nurses or students driving you nuts *wry grin.*

Huh, that might be a good thought. I should ask my midwives how many hospital staff members are likely to be there.

Maybe state your preferences about pelvic examinations by the nurses or resident physican (I did my best to keep them at a minimum, etc.)

A resident shouldn't be showing up at my birth unless something has gone very wrong - my midwives have full staff privileges at the hospital, and residents only assist OBs. I think pelvic exams are only done by the midwife, and not by L&D nurses, but that's another good thing to ask about. I know that my midwife will be physically present for the vast majority of my labor, so that should cut down on interventions by other hospital staff members.

Are you planning on playing music during the delivery and do you want to use a mirror to gauge your progress?

I don't want a mirror - the examples of crowning I saw on childbirth class videos was more than enough for me. I think I do want music, but we'll bring our own player, so there's nothing we're asking the hospital to provide.

Your preference regarding the use of forcepts or suction on the baby during delivery.

This is one of those things that I'm essentially trusting my providers about. I'm seeing midwives, and they'll have to go get an OB if a vacuum delivery looks necessary. I think that pretty much assures that it won't be suggested unless there's a genuine need. So honestly? I don't want a forceps or vacuum delivery, but I'm not going to argue if my non-interventionist midwives say I need one.

You might want to findout if the hospital has wireless continuous fetal monitoring.

They don't. Their standard of care is intermittent monitoring, twenty minutes on arrival and then frequent checks by fetoscope during labor.

Feasible alternatives to the birthing tub, if it's not available at that time (you never know how many babies will be born that night . .. )

The only feasible alternative I can think of is a birthing room without a tub. :-) I'm not putting all my coping eggs in the birthing tub basket, so to speak, because I know that not every woman actually likes it. So it's just one of the coping strategies I'm planning on.

If your midwife isn't a staff member of the hospital, include her name and contact information on the birthing plan.

Fortunately, the midwife practice has full staff privileges and is responsible for a significant percentage of the births at the hospital. So the hospital is used to midwife deliveries, and they expect the midwife to run the show - not the doctor.

[janetmiles.livejournal.com]

I think I do want music, but we'll bring our own player, so there's nothing we're asking the hospital to provide.

Even so, it probably wouldn't hurt to mention "will bring own music and player" -- will it be battery-operated, or will you need an outlet?

[hobbitbabe.livejournal.com]

wireless continuous fetal monitoring

Okay, can I just say that this catches my imagination? Like you put a little antenna in your belly button? Or you get a USB port installed on your tummy?

[rivka.livejournal.com]

Those would be pretty cool, but actually you wear a monitor on a belt. Alas.