Share your birth intentions (birth plan)

ok well so far ive got

i want to try and do it without drugs and VE's they just made me dissapointed last time and i only had peth 4 hours before the birth

and i would love to labour in the shower on a fit ball i they dont provide it i will bring my own

i want to have the baby with me for as long as possible after the birth and things like weighing etc to be put off as long as possible and to try and have the first BF before anything like shower etc

and i want the immunisations but not til later on if thats possible

i'll have to come back later with a full list =] after i talk with the hospital

It would be nice if you could plan the time of day .. I don't want things to start at 3am this time! Being sleep deprived from day 0 is no fun, and the dawn sun coming in the patio door at 5am on a day that turned out to be 45+ degrees was glaringly bright. Of course it is winter this time ...

As to birth plans, I don't have one. Much the same as last time, just turn up and see what happens, and hope much the same as last time happens. But again, time of day matters - I don't know the night time midwives as well as the daytime ones.

Our hospital has policies as standard that are pretty good:

You get midwives not a doc - and they have a small staff, so the midwives that do your checkups are the ones you get at the birth. Last time the doc pretty much just popped in at the end to rubberstamp the paperwork.
One of the midwives is a lactation consultant wannabe (hasn't done the course yet). She runs the antenatal classes and does the hospital tours. Nice woman.
They're non interventionist and give you pamphlets on how bad cascading interventions from inductions are
They tell you they've got drugs in the cupboards but don't give them out unless you really want them
They don't usually monitor you (machine or lots of internals)
They leave you alone to do your thing, mostly. Or at least I barely noticed them last time.
They called the OR "that horrible room you don't want to end up in"
Bubs goes straight on your chest when born and they recommend letting bubs find the nipple themselves
The patio I mentioned is very nice and you can go out there and stomp around if you want. They also have a big bath you and partner can hop in, birthing balls, all sorts of fun stuff. And you get your own room afterwards.

The head doc is a Helga-esque country woman, very down to earth, and very proud of her hospital.

A mate of mine wants to add to her birth plan for next time:

For any vaginal examinations, she wants a doctor with small hands! :lol:

ok, so here's a rough draft of my intentions as per an uncomplicated labour that is progressing normally: (baby is being born at home)

darkened, quiet space, with my care givers and support people (DH and my Mum) in the room or within reach.
Labour without intrusion (no VEs...unless requested)
Encouragement from my midwives for DH in his ability to help me/us through this process
DH to 'deliver' baby in pool with me
Minimal if no contact with baby's head during her birth (following Leboyer's theory on this one)
DD to be included if she wishes
to be able to spend as much time as needed with just DH and I (and DD if there) just being able to hold and gaze at our new baby as we gently welcome her earthside...this means all weighing, dressing etc to be held off for quite some time.
baby not to be bathed for the first 24 hours.

hmmm that's it so far...will come back with more 'details' as we get closer. :)

:

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As to birth plans, I don't have one. Much the same as last time, just turn up and see what happens, and hope much the same as last time happens. But again, time of day matters - I don't know the night time midwives as well as the daytime ones.

---

Well it all went to plan (or lack thereof) and sure enough I got a young night-time midwife I hadn't met before. She had the room nice and dark and warm for us. Since she almost missed the birth, afterwards she quite duly asked about skin-to-skin time, vitamin K, when did I want the baby weighed/washed etc. They only took him away to do his apgar.

Can't say I was planning to have a baby on a blanket on the floor but hey, the floor and the blanket were both there for the using :)

Here's mine. I've left some things out that I would have put in if I was going to a different hospital, but I've been able to leave out certain things that are standard for my hossy like instant skin-to-skin and no washing etc.


Mother: **** Husband: **** Doula: **** Baby Due: 08 Sep 2010 Religion: ****

This document outlines our plans for our natural VBAC. We have thoroughly researched these choices & have taken into account our particular family histories & beliefs with a view of the long term, as well as the immediate consequences of these choices. We understand that some of our choices may need to change under certain circumstances. In the event of these circumstances, we request a concise and clear explanation be given. No medications (especially those that are animal or yeast derivatives) or procedures are to be administered without my prior consent, or in the event of my incapacity, ****'s. With all of the below, I reserve the right to change my mind and would appreciate, at all times, to be encouraged in a patient and supportive manner.

Please understand, this document is not designed to be idealistic or go against the spirit of collaborative care, but I have deliberately used closed language in order to protect my caregivers as well as myself because it avoids any ambiguity or miscommunication that may occur regarding different understandings of terms.

GENERAL ITEMS
• Only essential staff in the birthing space. This can include one student midwife. No male caregivers except in emergency. No other medical students.
• No routine and arbitrary time limits are to be placed on any stage of my labour. This, in particular, includes having to submit to the Friedman’s Curve.
• No participation in the taking of pain scale information.
• No vaginal examinations.
• No administration of antibiotic medications to either mother or baby.
• No forms of induction/augmentation during labour, especially ARM are to be conducted.
• My husband is not to be asked to leave me at any time.
• No continuous monitoring. Monitoring may be conducted intermittently with a doppler with the sound turned off.
• In cases of complications (i.e. malpresentation) all the most natural and least invasive options are to be explored first.

DURING ACTIVE LABOUR / 1st Stage
• Please do not offer me pain medication.
• If pain relief is requested, please suggest passive options (i.e. water injections) or removable options first (i.e. gas and air). - No morphine or epidural.
• I plan to eat and drink as desired.

DURING BIRTH (2nd Stage)–
• I would like a water birth if bath is available.
• I ask for a general hands-off approach to this stage. I plan on pushing instinctively without coaching.
• **** will apply warm, wet cloths to the area around the vagina prior to delivery if needed.
• No episiotomy.
• In the unlikely event that an instrumental assisted birth is needed (this is not to be based purely on time limits, but must be due to substantiated fetal distress ONLY) vacuum in preferred to create negative pressure that makes pushing more efficient, it is not to be used to pull the baby out.
• No fundal pressure is to be applied during this stage.
• **** or I would like to “catch” the baby.
• Do not clamp or cut of the cord until after the placenta has been delivered and the cord has stopped pulsing.
• No suctioning, even in the case of minor meconium if baby is vigorous and showing no signs of distress.

AFTER BIRTH -
• I desire a physiological expectant 3rd stage. No active management except in the case of a true PPH.
• Please conduct immediate evaluations while baby is on my abdomen/chest.
• All other newborn procedures are to wait until after we’ve had time to bond, and should be conducted in my or ****'s presence.
• No internal investigation of the scar is to be conducted.
• No Vitamin K, oral or injection.
• No Hep B Vaccination!!
• No formula, bottles, artificial teats or pacifiers.
• I plan to breastfeed

C-SECTION:
In case there is a need for an emergency c-section:

• **** is to remain with me until after the birth, at which time he is then to remain with the baby at all times.
• A lower transverse incision is to be used.
• Unless prevented by medical emergency, I would like the baby’s father to hold the baby immediately if I cannot.
• A Lotus birth is initially required. Please remove the placenta fully and place it in a sterile bowl while still attached to the baby via the umbilical cord and allow the cord to stop pulsating before clamping and cutting.
• Please use a double layer suture in closing the section wound.
• I would prefer to maintain the opportunity to breastfeed our baby in recovery. Unless prevented by only the most serious medial reasons, I give permission for my husband and doula to attach the baby to my breasts even if I am still under the effects of a general.

Signed: ________________________________ Date: ______________

I have read and understood these choices:

Signed: Signed:
Name: Name:
Date: Date:
Position: Position:

:

---

ok, so here's a rough draft of my intentions as per an uncomplicated labour that is progressing normally: (baby is being born at home)

darkened, quiet space, with my care givers and support people (DH and my Mum) in the room or within reach.
Labour without intrusion (no VEs...unless requested)
Encouragement from my midwives for DH in his ability to help me/us through this process
DH to 'deliver' baby in pool with me
Minimal if no contact with baby's head during her birth (following Leboyer's theory on this one)
DD to be included if she wishes
to be able to spend as much time as needed with just DH and I (and DD if there) just being able to hold and gaze at our new baby as we gently welcome her earthside...this means all weighing, dressing etc to be held off for quite some time.
baby not to be bathed for the first 24 hours.

hmmm that's it so far...will come back with more 'details' as we get closer. :)

---

ok, thought to update this a wee bit....

GOT IT ALL!! :dance:

in the end DD2 didnt get a bath for about 4 days :lol: (but then again she was born in the water soooo....).

Been reading through these, lots of excellent awesome plans.

I think mine is going to be pretty rough. I had great support last time and am returning to the same hospital with the same ob.

At home:

1. Stay at home for as long as possible/sensible. Don't forget how long it now takes to get to the hospital
2. Utilise the shower as pain relief.
3. Call mum to come and look after DD.

Hospital

1. Soft music and lighting when possible
2. Be as mobile as I can
3. Use the shower/bath for pain relief
4. Rely on DH and midwife for physical/emotional support
5. Avoid labouring on back unless I absolutely have to (ie - in the instance of a vaginal examination)
6. Avoid drugs. I know what is available but not one worked previously. NO epidural as a back injury makes it virtually impossible to get it into my back.
7. Episiotomy okay in the instance of a forceps delivery but like previous birth, I insist on prior warning. Please warn DH if incision is to occur. ;)
8. DH is to announce the baby's gender upon birth and cut the cord.
9. Skin on skin contact immediately after birth. If I am unable to have contact due to medical emergency reasons, please allow DH skin on skin contact
10. I plan to breastfeed
11. If I am unable to hold baby or baby must leave me in the case of a medical emergency, please allow DH to remain with baby at all times. If the time we are separated is prolonged, please call my mum to assist me.

Notes to DH:

- In supporting me, I give you permission to refuse an epidural if I am unable to say so and you believe it is in my best interests to avoid one.
- Remind me that I can do this. I have done it and we have a beautiful daughter waiting to meet her brother/sister.
- Remind me that I should use all of my breath to push baby out (well, we all have our duh moments)
- Have the camera ready and get the photo just like you did with DD - of the midwife handing her to me

I might come back to update this, but so far feeling pretty comfortable. I had great support in birthing DD and I have complete faith in returning to the same people.

:

---

Here's mine. I've left some things out that I would have put in if I was going to a different hospital, but I've been able to leave out certain things that are standard for my hossy like instant skin-to-skin and no washing etc.


Mother: **** Husband: **** Doula: **** Baby Due: 08 Sep 2010 Religion: ****

This document outlines our plans for our natural VBAC. We have thoroughly researched these choices & have taken into account our particular family histories & beliefs with a view of the long term, as well as the immediate consequences of these choices. We understand that some of our choices may need to change under certain circumstances. In the event of these circumstances, we request a concise and clear explanation be given. No medications (especially those that are animal or yeast derivatives) or procedures are to be administered without my prior consent, or in the event of my incapacity, ****'s. With all of the below, I reserve the right to change my mind and would appreciate, at all times, to be encouraged in a patient and supportive manner.

Please understand, this document is not designed to be idealistic or go against the spirit of collaborative care, but I have deliberately used closed language in order to protect my caregivers as well as myself because it avoids any ambiguity or miscommunication that may occur regarding different understandings of terms.

GENERAL ITEMS
• Only essential staff in the birthing space. This can include one student midwife. No male caregivers except in emergency. No other medical students.
• No routine and arbitrary time limits are to be placed on any stage of my labour. This, in particular, includes having to submit to the Friedman’s Curve.
• No participation in the taking of pain scale information.
• No vaginal examinations.
• No administration of antibiotic medications to either mother or baby.
• No forms of induction/augmentation during labour, especially ARM are to be conducted.
• My husband is not to be asked to leave me at any time.
• No continuous monitoring. Monitoring may be conducted intermittently with a doppler with the sound turned off.
• In cases of complications (i.e. malpresentation) all the most natural and least invasive options are to be explored first.

DURING ACTIVE LABOUR / 1st Stage
• Please do not offer me pain medication.
• If pain relief is requested, please suggest passive options (i.e. water injections) or removable options first (i.e. gas and air). - No morphine or epidural.
• I plan to eat and drink as desired.

DURING BIRTH (2nd Stage)–
• I would like a water birth if bath is available.
• I ask for a general hands-off approach to this stage. I plan on pushing instinctively without coaching.
• **** will apply warm, wet cloths to the area around the vagina prior to delivery if needed.
• No episiotomy.
• In the unlikely event that an instrumental assisted birth is needed (this is not to be based purely on time limits, but must be due to substantiated fetal distress ONLY) vacuum in preferred to create negative pressure that makes pushing more efficient, it is not to be used to pull the baby out.
• No fundal pressure is to be applied during this stage.
• **** or I would like to “catch” the baby.
• Do not clamp or cut of the cord until after the placenta has been delivered and the cord has stopped pulsing.
• No suctioning, even in the case of minor meconium if baby is vigorous and showing no signs of distress.

AFTER BIRTH -
• I desire a physiological expectant 3rd stage. No active management except in the case of a true PPH.
• Please conduct immediate evaluations while baby is on my abdomen/chest.
• All other newborn procedures are to wait until after we’ve had time to bond, and should be conducted in my or ****'s presence.
• No internal investigation of the scar is to be conducted.
• No Vitamin K, oral or injection.
• No Hep B Vaccination!!
• No formula, bottles, artificial teats or pacifiers.
• I plan to breastfeed

C-SECTION:
In case there is a need for an emergency c-section:

• **** is to remain with me until after the birth, at which time he is then to remain with the baby at all times.
• A lower transverse incision is to be used.
• Unless prevented by medical emergency, I would like the baby’s father to hold the baby immediately if I cannot.
• A Lotus birth is initially required. Please remove the placenta fully and place it in a sterile bowl while still attached to the baby via the umbilical cord and allow the cord to stop pulsating before clamping and cutting.
• Please use a double layer suture in closing the section wound.
• I would prefer to maintain the opportunity to breastfeed our baby in recovery. Unless prevented by only the most serious medial reasons, I give permission for my husband and doula to attach the baby to my breasts even if I am still under the effects of a general.

Signed: ________________________________ Date: ______________

I have read and understood these choices:

Signed: Signed:
Name: Name:
Date: Date:
Position: Position:

---

:clap:
Mind if I steal most of this?? Amazing.

I've changed mine from Liebling's birth to what I'm going to have for Stormy's birth. I think my original plan was polite, considered, open to change and a good plan for someone who was being provided with care during her labour. (And I've started thinking about birth again as I recently found out that where I am, over 5 years between last pregnancy and current one - which still hasn't happened for me - means you're treated as a dim-witted first-timer who doesn't even know what her own body is doing.)

My new plan, based on my experiences, is this:

EXPLETIVE OFF. You touch me, you come in my home, I call the police to have you removed. I will press charges.

I think that one will work a lot better for me and I wish I'd had that for Liebling's birth.

TFB- i think something more immediate might have more effect, i'm not usually a fan of violence but promises of immediate physical injury might be more effective than future charges.

other than that, i like it!

My first birth plan (birth centre birth)


Birth Preferences

Our names are xxx
We like to be called xxx
Our Birth Attendant’s name is xxx

We’re hoping for a natural childbirth without unnecessary interventions or the use of drugs. We have asked a Birth Attendant to be present at the birth to help us work towards this. We appreciate your support with our birth preferences.

This plan represents our preferences; however we recognise that in the event of unforeseen difficulties it may need to be re-negotiated. Please discuss all options with us, in the presence of our Birth Attendant. We would then like the opportunity to contemplate our options without the presence of any medical staff.

ACTIVE BIRTH

We would like the birth experience to be respectful and private, with minimal interruptions and quiet voices.

We would prefer all examinations and monitoring to be kept to a minimum, with intermittent external fetal monitoring unless continuous monitoring is medically necessary.

I’d like the freedom to choose positions, use the shower or bath and walk around in labour as desired.

Please don’t offer drugs (including gas); I am aware of the options for medicated pain relief and will ask for it if needed.

I have discussed with my support team my desire to be encouraged and supported in achieving a natural birth, including during times when I may struggle and ask for interventions

I wish to be free of time limits and not have my labour augmented unless in a medical emergency.

Please allow time for the perineum to stretch naturally or tear. I’d only like an episiotomy if there is a genuine medical emergency.

I would prefer to follow my own urges to push. Please ask if I would like directed pushing before proceeding to this, unless it appears that I need to be reminded of some needs, such as to slow down during crowning.

INDUCTION / AUGMENTATION

If baby and I are well, I would like my baby to decide his/her own due date. I am happy to discuss a plan should my pregnancy reach the end of term at 42 weeks. Should labour induction become necessary at any time, I'd like to start with the least artificial means first before a medical induction. I would like time to allow the natural inductions work.

If this is unsuccessful and a medical induction or augmentation becomes medically necessary I’d like:

To only have my waters to be broken at first instance if my cervix is open. I would like to be given a generous amount of time for labour to establish upon rupture of membranes (i.e. more than just a few hours) before other forms of medical induction / augmentation. I would like to go home if all is well, until labour is established.

If I require Syntocinon, I would like a very low dose, to be increased gradually and slowly. Once my labour is established I would like to choose to stop the dose being increased, lower the dose or stop the drip to allow my body to continue to labour without artificial oxytocin. Please put the cannula in my arm and not my hand so I have more freedom of movement.

CAESAREAN

If a caesarean becomes necessary I’d like:

For my husband to be with me. We’d also like to have our Birth Attendant with us, who has been present in caesareans previously and is there to help enhance our experience of birth, no matter what form it takes.

For discussion to be respectful and minimal - only what is required medically and to inform me of what is happening.

For the cord to stop pulsating before clamping, to allow my baby to receive the valuable blood and iron stores.

My baby to be placed skin to skin on my chest without wrapping while you complete the procedure, unless prevented by medical emergency.

To be sure that a double layer suture is used and not a single layer in order to improve my chances for a future VBAC.

The opportunity to breastfeed our baby in recovery. If you do not have the staff to enable this, I wish to have my Birth Attendant with me so I can breastfeed in recovery.

BIRTH AND SOON AFTER

Presuming baby and I are well, we’d like:

For my husband and I to ‘catch’ our baby and determine the sex then for us to hold our baby immediately after the birth.

To wait until the umbilical cord stops pulsating before clamping, to allow my baby to receive the valuable blood and iron stores.

For all newborn procedures (weighing and measuring) to wait until I have had time to bond with and breastfeed our baby and then for them to be performed in our presence.

Not to have the routine Syntocinon injection to help deliver the placenta, unless medically required.

For our baby to have vitamin K as an oral dose.

For baby to be given only breastmilk – strictly no water or formula.

To defer Hepatitis B injections at birth, until baby’s first vaccinations.

Please sign our birth preferences in good faith that it has been read, will be treated respectfully and that we have your support in all of the above.

________________________________ Signed

________________________________ Name

My second birth plan (just in case of hospital transfer as I had a HB)

Birth Plan: xxx

Husband: xxx
Midwives: xxx

Labour & Birth
I do NOT consent to vaginal exams.

I do NOT consent to artificial rupture of membranes.

I do NOT consent to an episiotomy.

Do not offer pain relief medications. I am aware of my options and will ask for them if desired.

I am reluctant to undergo an instrumental delivery and would like to discuss further options should forceps or ventouse be required.

I would like to discuss all interventions in private with my support team before making a decision.

My husband and I wish to discover the gender of our baby.

I wish to have a physiological third stage and do NOT consent to the use oxytocics unless life is at stake.

I wish to delay the clamping of the cord until it ceases pulsating and I wish to cut the cord myself.

If stitches are required I wish for them to given by a consultant only. Having suffered previous trauma from stitches I may decline to be stitched and wish to discuss this further at the time.

Baby Care
I do NOT consent to the administration of vitamin K or Hep B vaccine.

I do NOT consent to the use of formula. If baby needs feeding my milk is to be expressed, even if unconscious.

Written consent must be obtained from us before ANY procedures are carried out on baby.

Caesarean Birth
My partner and midwife are to accompany me into surgery and recovery.

I wish to have a spinal block, as opposed to a general anaesthetic.

Baby is to placed skin to skin on my chest immediately after birth, while still in theatre, and we are not to be separated unless life is at stake.

I wish for my uterus to be stitched with double-layer uterine stitching.

I wish to establish breastfeeding while in recovery.

If baby needs to be taken to special care then baby’s father, xxx, is to remain with baby at all times.

Ok it's 4am and I cant' sleep so I am organising my birth preferences.
I am delivering at a hospital which is staffed mostly by midwives, has birth pools and as far as I know supports active birth. My two sons were born in a hospital which did (one was in the birth centre but we didn't get to use the pool because of his speedy arrival, I was directed to push before I had the urge).
I would appreciate any feedback!


Hello, We are Jessica and JJ and this is the birth of our third baby.
We're hoping for a natural childbirth without unnecessary intervention or the use of drugs. We appreciate your support with our birth preferences.
This plan represents our preferences; however we recognise that in the event of unforeseen difficulties it may need to be re-negotiated. In this eventuality please discuss all procedure options with JJ first who can discuss the options directly with Jessica.
Thanks for taking time to read this!
These are Jessica’s preferences for birth:
• I support active birth principles so if any monitoring is necessary I would to remain as active as possible throughout, I do not wish to use a bed for labouring.
• It would be wonderful if a Birth pool or a bath is available for me to use for pain relief during labour!
• I would like to be left to labour without being timed or examined internally unless I request it, I would also request that I am not directed to push or otherwise.
• Once delivered please let me have my baby with me for as long as feels appropriate to me without cleaning, weighing or checking agpar scores.
• We do not want our baby to receive a Vitamin K Injection or Hepatitis B vaccination as neither of us have been exposed to Hep B and I am not a carrier.
• As I am hoping to deliver the placenta naturally so would request cord clamping be delayed until this has occurred.
• A physiological third stage is my preference so I ask that I am allowed time to birth the placenta naturally if all other things are progressing well. If I have not birthed the placenta after 30 minutes I may wish to use Syntocin to assist.


IN THE CASE OF AN EMERGENCY NECESSITATING A CESAREAN DELIVERY.

• I would request that JJ remains with me
• That skin to skin contact commences as soon as possible after delivery either with myself or if not possible with JJ.
• That the incision is stitched in double layers only