Need some help with birth plan - does this sound OK?

[Trillian]

Birth Preferences

This is my fourth child and I want to have an active natural birth with a physiological third stage. I understand that I have to have IV antibiotics for medical reasons (heart murmur and Group B Strep carrier) but I wish for the actual birth that it stay as natural as possible. If there is another woman labouring at the same time, I wish to stay in my room to birth to allow me to have no time constraints on birthing the placenta.

The onset of labour – the First stage.

• I understand that upon my arrival at hospital I will have an IV canula inserted for antibiotics. I want to have this placed in my arm and not my hand.
• I do not want ARM or any other induction methods used. I need for this birth to be intervention free to lower the risk of another retained placenta and PPH.
• I am happy for intermittent monitoring to occur but I do not want a scalp monitor placed on the baby once my waters have broken.
• I am choosing not to use pethidene for pain relief. Instead I would like to be encouraged to use the shower/bath and positional changes to help me manage the contractions.

The Second stage

• I do not wish to be on my back for the birth of my baby. I ask that I be allowed to birth in a kneeling or all fours position.
• I do not want the cord to be clamped until the cord has stopped pulsating. There are many proven benefits to the baby by doing this. However if there is an urgent medical reason for not doing this then so be it.
• My baby is to be placed immediately to my breast after the cord has stopped pulsing (gravity aids in the blood flowing to the baby and not away from him)

The Third stage

• I want to birth the placenta myself. I DO NOT under any circumstances want to be administered oxytocics to deliver the placenta. I will breastfeed my baby to encourage my body’s natural oxytocics to do that for me.
• I am however, willing to compromise and if the placenta does not look like coming away on its own after xxx amount of time, or I start to bleed, I will consent to the oxytocics being used.

The baby

• I would like for all checks and measures of the baby to be done after the cord has stopped pulsating and he has been on the breast unless there is a medical reason preventing this from happening.

IN CASE OF A RETAINED PLACENTA AND PPH

• If this occurs I understand that it will be necessary to transport me via ambulance to Wagga Base Hospital for a manual removal.
• I want my baby and my husband to come with me unless there is a medical reason for our baby to stay behind. If so, in this time I DO NOT want our baby to be given formula feeds. I also want my husband to stay with our baby at all times.

IN CASE OF AN EMERGENCY CEASARIAN BIRTH

• If this occurs I understand that it will be necessary to transport me via ambulance to Wagga Base Hospital.

• If possible I DO NOT want to be placed under a general anaesthetic.
• I want my husband to be with me when our baby is born.
• I want the cord to be left to pulsate unless there is a medical necessity or danger to the baby.
• I want to BF my baby while I am being stitched up.
• I want my Husband to stay with our baby at all times.
• While in recovery I DO NOT want our baby to have formula feeds.
• As soon as I am out of recovery, if my health permits I wish to be transported immediately back to Temora Hospital.

I'm not foolish, so I am willing to be flexible about it when the time comes if I have to - I just want the best outcome for my baby and myself. I think it is all achievable considering my first two births were very straight forward with only using ARM (spontaneous start of labour though)

So is there anything that you think might need a bit of tweaking? this is the first time I have put a plan down on paper so I'm not sure if some of what I want is unrealistic? Also what is a reasonable time frame to allow the placenta to come on it's own? And I have no idea on how to prepare for a c/s birth either, so I may have some of that wrong too.

[Beach Mama]

Hi there - great birth plan! Mine was fairly similar but ended up in c/s - things you mght like to add for a c/s even though it will depend on your hospital are:
that your partner may be able to cut the cord once it has stopped pulsating,
that you can have bub with you in recovery - I did and was able to have about 40 minutes of skin to skin contact and was able to b/f - during stitching time my DH just held her close to my head because i had drips and cords attached etc.
Good to be open to changes too - my whole plan was v/birth, no drugs, bath and shower, no induction or c/s....induction led to c/s and i called for an epidural! Good luck with it all - hth!

[Pandora]

Are you going to have a private midwife, or do you know whether the midwives at the hospital are at all experienced with physiological third stage?

Just asking becuase I wanted that too, I put it in my birth plan. none of the midwives had ever been present at a physiological third stage, and they had to look it up on the day to find out about what it was.

so, if it were me I would give them plenty of warning.

I reckon I got less than 3 minutes, there was blood, they freaked, and jabbed me with drugs. When I read my birth notes, they estimated 300ml blood loss in total - which is a lot less than the 500ml they usually intervene at.

OT - Tan, which hospital did you birth at?

[Morgaine]

So is there anything that you think might need a bit of tweaking? this is the first time I have put a plan down on paper so I'm not sure if some of what I want is unrealistic? Also what is a reasonable time frame to allow the placenta to come on it's own?

Women do not have unrealistic expectations of birth. It is the careproviders that often have unrealistic expectations of women and birth. Women just want to be treated with courtsey and have their wishes respected, and not be treated like a piece of meat on a conveyor belt!

Placentas can take anywhere from 5-10 minutes after birth to a few hours after birth. It is up to you how long you would like to wait. Careproviders especially hospital ones aren't really happy about waiting a few hours for the placenta as they want the birth over and done with. Like birthing babies, birthing placentas is different for each and there is no 'reasonable' time to wait. They will come, when they come!

[Trillian]

Thanks for your input everyone. Morgaine, that's why I put that I want to birth on the bed in my room if there are other women in labour so there is no pressure on me to hurry and get it done kwim? I think DH is a bit worried that it could be hours though. Last time freaked him out a fair bit and I think he is worried that it could happen again. I have read that being upright for this part can help as gravity helps out with it coming down - is that right?

Tan, thanks for the tips on the c/s. And Rachel, I think they would know about it as they are a pretty open minded bunch over there. And I get one who doesn't know I'll make sure I fill them in on the details.

[Pandora]

Sherie, that sounds great! Maybe I will have my next baby there! *LOL*

Good luck with your birthplan & your birth

[Edensmumma]

hey sherie, sounds good... was thinking about it in bed last night...
One of the things i had to include in my birth plan was whether we wanted bub to have vitamin K injection... and also whether you want bub to be immunised for hep B at birth- we chose to wait to two months...
Just a couple of things i thought id mention, dont know if you need to tell them? Best of luck girl, its so exciting...

[PinkPalace]

Sherie there are only 2 things i would comment on with your birth plan.

Firstly there is a reason why you are cannulated in the hand prior to the arm and this is due to the break down or collapse of veins. the further up a vessell you are cannulated the higher risk you have of having less options if the cannulation tissues or burst the vessells - deeming all lower peripheral veins useless.

Secondly you do not want an emergency c-section under a general. Depending on the reason for your emergency status this is usually the safest way to ensure that you as a mother is not threathen by your life! If it is for the babies sake you should be able to have a spinal anaesthetic however if it is your sake then it is often necessary to be put under a general anaesthetic to prevent cardiac or respiratory arrest in the mother if this is a threat.

You seem very definate in your birth plan which is great but i think you need to talk to your ob a little more to have a better informed decision regarding medical procedures so that you are not so dissapointed if this does occur.

Best of luck with the birth

[Trillian]

Gill, I have already signed consent forms for the Vit K and Hep B injections at the hospital, so that is why it isn't included in the plan. We have always had the kids done at birth for both injectionsso we don't see any reason to change.

Princessmya, I have had them in my arm previously so I know it isn't an issue to have one put there, but it is only on my wrist anyway not further up the arm kwim. Not having them in your hand also allows a bit more freedom/ease of movement. As for the GA, I put if possible I don't want one. I do understand that sometimes it is necessary to have a GA for it.

[PinkPalace]

No probs Sherie - I hope you didnt take things the wrong way.
Yes your wrist is a must better option than in the bend of your elbow (this is where i thought you were mentioning).
Hope all goes well for the rest of your pregnancy.

[Trillian]

thanks Princessmya, and I didn't take anything the wrong way I think having it too far up your arm would be just as cumbersome as in your hand.

And good luck for the rest of your pg too - I hope your birth goes well.

[Yael]

Sherie - i had it in my hand too last time - so annoying the whole day, and it ached and ached by the end... It bled a bit around it also, just from moving so much. This time i'm also requesting it in my arm.

And i'm terrified of GA's, and stating unless life or death basically, i don't want one.

Think i might borrow a few other things from your birth plan

[Edensmumma]

cool sherie, just thought id mention it, u are so thorough i shoulda known you'd already considered that....
well good luck anyway babe. xoox

[August]

Hi Sherie, I think you have done really well with your birth plan as you have clearly stated what you wish/do not wish, and given your past experiences, it shows you are informed and reasonable.

Its interesting about the cannula and where to have it inserted. I'm being induced at 37wks due to medical reasons (my Baby's) so will no doubt end up on a drip.

I thought that if they inserted it into your arm that it would actually be in your forearm, like somewhere just under your elbow or further down like near your wrist.
I guess I had thought this as I saw my brother have countless numbers of drips during years of treatment for cancer and this is where they'd put them. But this could have also been as there were no veins left in his hands unfortunatley, or his elbow for that matter..Hmmm. I will be finding out about this one for sure.

[Trillian]

August, when I have had them in my wrist, it has always been just above where your wrist joins your hand, so you still get plenty of hand movement and it doesn't get anywhere near as sore either, like Yael said.

[mrmoo]

All sounds reasonable Sherie. Having achieved my own VBAC last year, I'd like to let you know that you can say no to the belts and have the midwife listen with the hand held trumpet thingy. The doctors and midwives will turn into raving lunatics but stand your ground and explain that it is essential that you be allowed to move around freely without the belts. It can be done, I know, I've done it. Do make room for intervention, even if it's help with breaking the waters. I too wanted absolutely no interference but when I was 9cm I did say yes to the waters be artificially broken. I wanted to stand or squat during pushing but my little guy was hard up against the pubic bone and I just couldn't get him to move without me being placed on the bed. The midwives were really great and soon my little guy wooshed out and completely covered the midwives and the room with blood. They even had to clean the light! Hahahaha! The only person in the room not covered in blood was my dh, he stayed up by my head.

Good luck to you and stand your ground on some issues and stay positive. It's all worth it!