Sunday, February 13, 2011

My Birth Plan

For my last three pregnancy's I didn't write a birth plan. They went well, but they could have been better. So in the event I'm ever pregnant again, I'm now prepared!

Birth Preferences

Relaxed environment.
Provided baby is not in distress, only myself, my partner, and midwife are to be in the room.
Closed door.
Dimmed lights.
Warm room temperature.
Classical music available (brought by me along with CD player).
Electrolyte drink available throughout labor (brought by me).
I'll wear a birth gown of my own.
My partner will be taking photo's throughout the labor.
If it's medically necessary to have other medical staff present at the birth, there is to be no students, interns, residents or non-essential personnel present at any time.

Provided the baby is not in distress, maintain a high level of privacy throughout birth.
At times, especially towards the end of the labor, I may:
Want only my partner in the room.
Want no one else in the room.
Want to be alone in the toilet.
In these situations please respect my privacy and only enter the room if I ask you to, or if there is an emergency.

Avoid pain medication.
Do not offer me pain medication.
Do not ask me to rate my pain.

Employ natural pain relief measures.
If I am in distress, please remind me to focus on relaxing with my contractions.
Otherwise, please do not talk to me or ask me questions during contractions.
My partner will apply heat packs, massage and acupressure where needed.

Provided the baby is not in distress, avoid any other interventions.
No vaginal exams.
No continuous fetal monitoring.
Check baby's heartbeat using a handheld Doppler every 30 minutes in the latent phase, every 15 minutes in the active phase, and every 5 minutes in the descent phase.
No syntocinon (also called pitocin). My partner will employ nipple stimulation to induce contractions if needed.
Allow placenta to deliver on its own, wait 30 minutes.
Do not inform me of my progress or lack of progress in dilation. I do not want to know.
No stretching of the cervix.
No artificial rupturing of amniotic membrane. Allow amniotic membrane to break on it's own.
No directed pushing. Leave me to push at my own discretion.
No stretching of the perineum.
No episiotomy. My partner will apply perineal caster oil massage and heat pack.
If any medical procedure is necessary, you will first get my informed consent, which includes discussing with me the reasons for it, and all possible side effects of it.

I will remain upright whenever possible throughout birth.
Please encourage me to:
Walk, dance, rock or sway between contractions.
Sit on birth ball and beanbag when needed.
Try to squat during contractions, and hold onto partner or a firm structure for support.

If baby is posterior please try these measures.
Apply diaphragmatic release.
Use lift and turn technique.
Change position - get on hands and knees, head down, bottom raised, and sway hips side to side or rock pelvis back and forth.
Partner will apply counter pressure on my back, apply back massage, or heat pack.

If baby is breech please try these measures.
External cephalic version.
Change position - get on hands and knees, head down, bottom raised, and sway hips side to side or rock pelvis back and forth.

Newborn care.
Baby's head is not to be pulled as it is crowning. Myself or my partner will cradle the head gently.
Myself or my partner will catch the baby.
My partner will announce the sex of the baby.
Immediately after birth, place nappy on baby, then place baby on my bare abdomen. Cover with a warm blanket. Leave there indefinitely. There is to be no separation of myself and baby unless expressly permitted.
My partner and I will clean baby and rub the vernix into baby's skin.
Evaluation of baby will be done on my abdomen.
Delay cord clamping until cord has stopped pulsating. My partner will cut and tie the cord.
Placenta will be saved and given to my partner to take home for encapsulation.
After the birth my partner will be staying with baby and I in the hospital for as long as we need.

Avoid any unnecessary newborn procedures.
Baby will not be receiving eye drops.
Baby will not be receiving a vitamin K injection.
Baby will not be supplemented with formula.
Baby will not be using a pacifier.
Baby will not be given a bath.
*Vaccinations are not routinely administered to newborns in NZ, though if they were I would be choosing not vaccinate my newborn either.

If you're wondering why I chose the above preferences, here's some links with useful information about a number of birth preferences mentioned above:

Why choose not to have coached pushing?
Pushing During Labor: Coached Pushing vs Physiologic Pushing
by ANDREA CROSSMAN, RN, BS, BA

Why choose to keep upright during labor instead of lying down?
Get off your back: references
by Stand and Deliver Blog

Why choose not to be induced with pitocin?
The Truth About Pitocin
by Elaine Stillerman, LMT

Why choose not to have an epidural?
Epidural Labor Side Effects
by Kim James
Side Effects of Epidurals: Research Data
by Janelle Durham
Protecting the mother-child bond
by Cherie Raymond

Why choose not to have interventions?
Labor and Birth Interventions
by Natural Birth and Baby Care Website
Cascade of Intervention in Childbirth
by Childbirth Connection Website

Here's some other birth plans to give you more ideas:
These are naturally focused, minimal intervention hospital birth plans.
Birth Plan 1
Birth Plan 2
Birth Plan 3
Birth Plan 4

Here is an automated birth plan creator I also found useful:
http://www.birthplan.com/create-birth-plan/

8 comments :

  1. I like the birth plan on Rixa's blog - http://rixarixa.blogspot.com/2011/02/my-birth-plan.html

    Out of curiousity, is your plan for giving birth in New Zealand? You may want to research NZ hospital policy, to put it in the right context. Eye drops and vaccinations aren't given at birth here. I wrote one for my 1st birth (planned homebirth but wrote a hospital one in case of transfer) and put stuff like "no pitocin" and "no eyedrops" and my midwife (very gently!) suggested I change them (its called syntocinin here) as the american jargon would suggest to the staff that I'd copied it off a website!

    My plan this time round is basically "leave me alone to have my baby unless I'm obviously not coping, then you may suggest helpful strateiges such as position change, water, heat, swaying etc". If I need to go to hospital my plan is "obtain full informed consent from me before any procedure"! I trust my midwife to go into bat for me if I need to go to hospital, and I know she'll be advocating for all the nitty gritting things for me, such as imediate skin-skin, delayed clamping if able etc etc.

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  2. Thanks Jenn!

    Yes this is for an NZ birth. I haven't talked to my midwife about it, but like yours I'm sure she'd correct anything that's needed. Thanks for the heads up, I'll definitely research the NZ procedures and drug names, so I don't look like an arse.

    I can't be absolutely sure, but it seems in NZ the hospital protocol for birth is not quite so rigid and disempowering. Midwives hold a lot more sway, which is fantastic. I'm sure there's a fair share of horror stories, but generally, the whole process seems a little gentler.

    It's great you've got a midwife you can trust to have your back, and that you have the confidence to maintain your autonomy, and control over your own birth. Good for you mama.

    All the best for you and bub!

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  3. Jen,

    I love the birth plan on Rixa's blog. I originally used it for inspiration, but then couldn't remember what the link was, so it's great you posted it.

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  4. Thanks so much for this, it's brilliant!! I am going to steal and adapt it :-P

    I *wish* so much I was going to give birth at home in NZ. I am in Aussie and pregnant with my first and kind of horrified at the system over here. Have ended up forking out thousands for a private midwife and homebirth to try and get the birth I want.

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  5. I'm sorry you've got to fork out, but it will be so worth it! A natural birth has so many advantages, here's a few other posts that might be of help:

    Big List of Natural Pain Relief Measures:
    http://naturalmamanz.blogspot.com/2011/02/natural-pain-relief-during-childbirth.html

    Document explaining the care you should be receiving from your midwife:
    http://naturalmamanz.blogspot.com/2010/12/international-motherbaby-childbirth.html

    Having an orgasmic birth (the ultimate natural birth):
    http://naturalmamanz.blogspot.com/2010/12/orgasmic-birth-our-birthright.html

    The incredible importance of creating an immediate bond immediately after birth:
    http://naturalmamanz.blogspot.com/2010/10/protecting-mother-child-bond.html

    Natural birth, when all goes well, can be like a drug. It is so amazing, you are pumping with so many amazing, intense hormones, nothing in your life compares. The high at the end, when you see the first glimpse of your babies face, will be imprinted in your mind forever.

    But it's not always possible, and I don't want to get your hopes up. All we can do is implement all our knowledge to do the best we can. I have no doubt you've been studying, and all your hard work will indeed pay off no matter what direction your birth goes in.

    I'm really excited for you (and anyone who has babies, it's so wonderful!) Best of luck for you and the family, I'd love to hear how it all goes :)

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  6. Great birth plan! The only thing I would add is your preferences for your care during the third stage of labour and the care of your birthed placenta (.i.e.would you like to keep it?). I am sure you are aware from your research that the gold standard is for the cord to be left intact at the bare minimum, until the placenta has been birthed.

    I am new to your blog, so perhaps you have stated the answer to my question already but how did you come to the decision that the hospital would be your chosen location of birth since hospitals offer everything you do not want? Or is this an in case of transfer plan?

    If you are planning on birthing in the hospital I've heard that it is a good idea make sure that your midwife signs your birth plan; keep a copies in your handbag/car; take a do not disturb sign for the door; make sure that your husband/partner has the pre midwife edited copy (to remind them of small details they may forget during your labour and hire a doula. Many mums also recommend bring commercially made edible treats for your nurses as they are the ones that you'll ultimately have the most contact with.

    I hope everything goes well with your birth.

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  7. Oh I am so silly, I just reread the first paragraph of your post... This is a hypothetical plan!! I guess I should change my question to be whether or not you would choose a hospital birth even with this plan/educated perspective?

    I hope everything goes well any possible future births. :)

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  8. Hi Michelle,

    Thanks for pointing out important things that should be in the birth plan. Yes I'd definitely like to leave cutting the cord until the placenta has stopped pulsing, or have a lotus birth (leave the cord and placenta attached to baby until it breaks off naturally, for those that haven't heard of it), and encapsulate the placenta (cooking, drying, powdering & encapsulating the placenta as a daily supplement). I'll definitely add that in there.

    I've had 3 natural births in hospital, with the same wonderful midwife. Here in NZ the midwife is the lead maternity carer, not an OB, so births are generally quite intervention free. I never actually saw a nurse or doctor while I was giving birth, just my partner, mother and midwife in the room.

    Because I've had great experiences in hospital I'm inclined to have my next (possible) birth there, just because of the small possibility of complication.

    I know the situation is quite different in the US, where OB's are normally the lead maternity carer, and can push unwanted interventions on mothers. In that case I'd opt for a birth center.

    When I wrote this birth plan I'd just fallen pregnant but soon after miscarried. We have no plans for anymore children, but you just never know what the future holds!

    :o)

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