Birth Plan

*Warning: You might not want to read this post if you are very squeamish about labor and delivery stuff.*

So, I am now about 27 weeks along, and I had one of my regular doctor’s visits today. I am seeing the midwife’s group at the new Hospital in Murray (where Michael works), and I’ve been pleased with them so far. There are about 6 midwives in the group, and your appointments are scheduled with whichever midwife is available each time so that you hopefully get a chance to know all the midwives in the group by the time the baby comes, and then the one who is on call will be there to deliver the baby. (I went to a similar group practice when I had Kolby, except they were doctors and not midwives).

Well, when I went in yesterday the nurse gave me a packet of papers that she said they give to every patient around 28 weeks. It was mostly routine stuff (information about tours of the labor and delivery area of the hospital, hand-outs promoting breastfeeding, info on Group B Strep, a schedule of different pregnancy classes, etc.) But the last few papers in the packet caught my attention. It was talking about writing a Birth Plan (something that I had never done before). As I read through it, they promoted the idea of writing a birth plan so that the doctor, midwife, and other medical staff would know your plans for labor and after the baby was born, and it had a list of common practices that occur at the birth facility (so that new parents would know kind of what to expect), and then it had a sample birth plan. I thought that this was a nice idea, especially for a mom who hadn’t had kids before, but that I definitely didn’t need to write out a birth plan since I have had 4 kids before and I feel like I pretty much know how all this stuff works by now.

Then I read their sample Birth Plan:

“Labor:
If everything is going well and normally, I would prefer:
• To labor at home until I am in active labor.
• To have an IV only if medically indicated.
• Intermittent check of heart tones with continuous electronic monitoring only if medically indicated.
• To eat and drink lightly during labor.
• No artificial rupture of the membranes.
• No artificial induction or augmentation of labor. I would rather try natural methods first, i.e.: nipple stimulation, acupressure, change positions, etc.
• Not have a lot of vaginal exams – perhaps limiting them to when there has been a change in my labor.
• No medication. I want to use other forms of pain relief including breathing, relaxation, massage, hydrotherapy, lots of support, etc. I would like the hospital staff to refrain from suggesting medication and instead, encourage me to try other forms of pain relief.
• Give me a choice about being cared for by students, including nursing and medical students.

Birth:
• Pushing positions I would like to try are squatting and semi-squatting and hands and knees.
• I do not want an episiotomy. I’ve done perineal massage and would like to try other measures to reduce the likelihood of having one, including massage and hot packs, controlled pushing for gradual stretching and positions that promote stretching. I would rather go ahead and tear a little if it’s only going to be small and require a few stitches, than to have an episiotomy.
• I would like (my partner) to help with the delivery of the baby, with help from the midwife if he so desires. No Pitocin given after the delivery of the placenta, unless medically indicated. I would prefer to use nipple stimulation, breast feeding, and fundal massage if needed.
• I would like to be shown how to massage my fundus and then do it myself.

Postpartum:
If everything is okay with me and the baby, I would like:
• Baby given directly to me.
• To keep the baby with us for at least an hour or so and delay eye treatment, weighing, measuring and performing tests during that time. When the routine things are being done, I would like them done in my roo if possible. If not, I would like (my partner) or both of us to take the baby to the nursery and stay with him/her.
• 24 hour rooming in with no supplements given to the baby.
• No circumcision if the baby is a boy.
• To go home as soon as my midwife and the baby’s doctor determine it is safe for us to do so.

If a Cesarean Birth is necessary:
• I would like to have an epidural anesthesia so I can be awake.
• I would like (my partner) and my midwife to be present.
• I would like my arms to be free to hold (my partner’s) hand and touch our baby.
• Option to have the drape lowered or a mirror if I want to see the baby being born.
• Permission for (my partner) to take pictures.
• Breastfeeding as soon as possible.
• If baby is healthy, quiet family time together as with vaginal delivery, including delaying routine newborn procedures.
• If baby has to go to the nursery right away, I would like (my partner) or my midwife to go with him/her and the other person to stay with me.
• Rooming in on a flexible basis.”

Oh boy. Wow, so when I got to the second or third bullet under “Labor” I knew right away that this wasn’t going to be my kind of Birth Plan. I got thinking about it, and figured that there were many women who saw the midwives who were really into all natural births, and that this example birth plan was geared towards them. (Those of you who know me know that I think that having any unnecessary pain is, well, unnecessary, and I think that epidurals are a great thing, especially since they have worked so well for me with past pregnancies. And when I first went to this midwife’s group I made sure that they were totally supportive of my decision NOT to have a natural birth (or else I would have switched to a different doctor), and there has been no problem with this.

But then I got thinking about going into the hospital when this baby arrives (and thinking about how quickly my last couple of babies have come, and how that might not leave much extra time for explaining my views on labor and delivery to each doctor, nurse, or other medical staff who might enter the room). And also considering that by that time I may or may not have even met all of the midwives in the group and may or may not have had time to get to know them so that they understand my views on this, even if I had had an appointment with each of them before the baby is born. And then I wondered if this was their example Birth Plan, then maybe the midwife delivering me would assume that I wanted something similar (or some other medical staff person would assume this since I was being seen by a midwife instead of a doctor). I know, I’m probably way over-thinking all this, and I will go in and have a “normal” labor, just like with all my other babies at different hospitals.

But I decided to write down a Birth Plan, even if it was just to give a copy to the midwife next time I go in and discuss it to make sure that none of those incorrect assumptions would be made. I thought about my past deliveries and what I had liked (getting an epidural as soon as I arrived at the hospital since I am usually dilated to about a 7 or 8 when I arrive, having Michael count for me between pushes if needed, having the doctors and nurses explain things to me before they did them, being able to see the screen and watch the contractions after I have gotten the epidural and before I start pushing, being able to hold the baby and nurse him soon after birth, having Michael take pictures and video AFTER the baby is born and while they are weighing and measuring him in the room, etc.) and the things that I would have changed (having an epidural that worked fine when I had Camden but then having the epidural wear off before I started pushing and having the resident tell me that epidurals were not perfect and not doing anything about it, being woken up early in the morning by students who just wanted to see how I was doing after having a baby and then being up most of the night, having a little too much help from nurses with breastfeeding after I’d already breastfed a couple babies before, having a nurse tell me that I would “have to” give the baby formula if he didn’t take a certain number of ounces of the breast milk I had pumped for him within a certain number of hours after his birth, being told that I had to leave the IV in my arm during my hospital stay just in case it was needed later and then having my 1-yr-old pull on the IV when he came to visit the new baby, feeling like the nurse thought I wasn’t doing the right thing when I let my newborn sleep for about 6 hours through his first night after he was born without waking him to feed him, etc.)

So, here is my birth plan (don’t laugh at some of the silly things I included). I actually Googled birth plans to see what some other people had written in theirs, and there were some things that were even more ‘out there’ than the sample one that I got at the hospital the other day (and some that had good ideas that I added to mine). (Of course, mine is longer than the sample one – I know, I can be rather wordy sometimes. Oh well).

“Labor:
If everything is going normally, I would prefer:
• To have an epidural as soon as I arrive at the hospital once it is confirmed that I am in labor. As long as I am in labor and am dilating as I should be, I request that the anesthesiologist be called and the epidural be given as soon as possible, especially since I have had short labors with my last couple babies.
• If at any time during labor my epidural begins to wear off, I request that I get another dose as long as time allows before the baby’s birth.
• My husband is an intern at this hospital, and I request no medical students, interns, or residents be present at my labor, or during my postpartum care or throughout my stay at the hospital.
• I expect to have a vaginal exam when I arrive at the hospital to see how dilated I am, and then after that as needed.
• I expect that doctors and hospital staff will discuss all procedures with me before they are performed.
• My husband will be present. I would like my mother (or any other female family member that I or my husband approve) to be present.
• To have intermittent check of heart tones with continuous electronic monitoring. To have internal monitoring if my midwife/doctor thinks this is a good idea. I would prefer that the computer screen be turned towards me so that I can watch the progress of the contractions before I start pushing if possible.
• I am fine with rupture of the membranes if/when my midwife/doctor approves.
• Artificial induction of labor (with Pitocin) if deemed necessary by my midwife/doctor.Please discuss options/plans with my husband and myself if assistance (such as forceps or suction) is needed.

Birth:
• While pushing, I plan to be in a traditional laying-down position using stir-ups.
• It is helpful for my husband to count for me while I push, so I would appreciate it if the nurse or midwife could instruct him in doing so if needed.
• I would like my husband to be given the opportunity to cut the cord.
• I plan to have Pitocin post-delivery.
• If stitching is necessary for an episiotomy or tear, please use local anesthetic if the epidural has begun to wear off.
• Permission for my husband or other family member to take pictures or video after the baby is born.

Postpartum:
If everything is okay with me and the baby, I would like:
• My husband is an intern at this hospital, and I request no medical students, interns, or residents be present during my postpartum care or throughout my stay at the hospital.
• I would like to hold the baby immediately after his birth. And my husband should be able to hold the baby at this time too.
• After we get a chance to hold the baby, I would like him to be weighed and measured and then cleaned off in our room. After this is done, I would like to have time to breastfeed him.
• Please give the baby and me a chance to work on breastfeeding on our own. I will request breastfeeding help or suggestions from a nurse, midwife, or lactation specialist if needed.
• After I have been able to breastfeed, please do any treatments or testing on the baby in our room. If he needs to go to the nursery for these things, please let my husband go and stay with him.
• I would like the baby’s first bath to be given in our room, if possible. If it needs to be in the nursery, then my husband should be able to go with him for this too.
• With this being my 5th baby, I am assuming that the contractions after the baby is born will not be pleasant. I would like to have the strongest doses of pain killers possible for this, please. • I would like to have my IV removed as soon as possible after the baby is born. I understand that there is a possibility that I could need an IV later on, and I would prefer having the IV removed after the baby’s birth and having to have a new IV put in later if necessary than leaving the IV in longer than necessary after the baby is born.
• I plan to try to exclusively breastfeed the baby, so please do not introduce bottles, formulas, or pacifiers without permission from me or my husband first. We will be using a pacifier at a later time, but since some of my other babies have had trouble breastfeeding, I plan to not introduce a pacifier at all until the baby is a week or two old and has become totally successful at breastfeeding first.
• We plan to have our baby circumcised before we leave the hospital. Please allow my husband to be with the baby during this procedure.
• This baby is our 5th child. At home, we have a 5 year old, a 3 year old, a 2 year old, and a 1 year old. As you can imagine, things will be very busy for us when we take our new baby home from the hospital. My sleep during the stay at the hospital is extremely important for a quick recovery, so please, please, please do not wake me or my baby up for anything that is not absolutely necessary. Please! My view is that a healthy baby should never be woken up during the night, especially in the first day or two after birth when a baby sleeps so often and may not be eating much yet. And the more sleep I can get at the hospital at night and in the early morning, the better. I do want to have my baby in my room with me, and I will breastfeed him if he wakes at night, but please do not come in and wake us up at night to breastfeed or to ask how we are doing, etc. Thank you for respecting my wishes on this matter.
• We prefer that our stay at the hospital be extended to the longest our insurance will allow so that the baby and I may recover fully before returning home. We ask that my husband and our baby both room in. We ask that our other children be allowed to visit.

If a Cesarean Birth is necessary:
• I would strongly prefer to have a vaginal birth as long as this does not pose a danger to the baby or myself.
• If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making.
• I would like to have an epidural so I can be awake.
• I would like my husband and my midwife/doctor present. I would also like my mother (or any other female family member that I or my husband approve) to be present too.
• I would like my arms to be free to hold my husband’s hand and to hold our baby.
• I would like the option to have the drape lowered or a mirror if I choose to see the baby being born.
• Permission for my husband or other family member to take pictures or video after the baby is born.
• I would like to hold the baby immediately after his birth. And my husband should be able to hold the baby at this time too.
• I would like to breastfeed the baby after he is measured and weighed (please measure him and weigh him in the room if possible, or allow my husband to go with the baby if he needs to go to the nursery for any reason).
• We prefer the baby and father remain in the recovery room with the mother.”

I don’t know if it will matter much anyways, but I figured I could have it written down and at least go over it with the midwife at my next appointment so that someone other than just myself and Michael would know what my plans were (and that I didn’t want to try some of the things that I consider to be rather strange from their sample birth plan).

Well, that’s probably more information than most of you wanted to know about me and my ideas about labor, but this is my “journal,” so I figure I get to write whatever is on my mind. So there you have it.