My birth Preferences... Your thoughts?

Ok - well i know there is a thread for birth plans, BUT i would very much like your opinions / thoughts. Am i being reasonable? Have i made enough room for movement, so to speak?
The plan is a combination of Kelly's example, but in response also to the questions outlined on the form i was given by Lisa, my midwife.

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Birth Preferences

Our names are Ashlea-Jayne ###### and Anthony #######.
We prefer to be called Ashlea and Anthony.
We are expecting our first child, and his EDD is 26/02/2008.
I have requested that Anthony be my support person for the duration of my labour.
My mum, Tania, and/or close friend, Sarah, may also be there with me.

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, should the need arise. We would then like the opportunity to contemplate our options without the presence of any medical staff. We would like the birth experience to be respectful and private as we know this is conducive to a successful birth, with minimal interruptions, quiet voices and dimmed lighting.


I hope to use the following things to aid relaxation during labour.
Music
Massage

We?re hoping for a natural childbirth without unnecessary interventions or the use of drugs. I am aware of the pain relief that is available, but please do not offer it. If I ask for pain relief in the transitional stage please remind me how close we are to the end and let me reconsider. If, and when I request any pain relief, please encourage me to further discuss it with Anthony, as he knows me better than any medical practitioner and is best aware of my wishes.

I would highly appreciate access to a bath if it is feasible and can be provided. I use it as a tool for general pain management, and feel that it will be highly beneficial to my progress in labour. I also think that it will assist with my state of relaxation, and ability to cope with pain / without drugs for a longer period of time. If a bath is not available I would like full access to the shower.

I am uncomfortable with the idea of medicine or midwifery students in attendance during my labour. I understand that they need to learn, and how else can they; but as I am anxious enough about giving birth as it is, I do not wish to have any students present. Maybe next time.
I would prefer if we can be left alone as much as possible, as I feel the continued presence of medical personnel will raise anxiety and cause undue psychological stress, and hence the probability of also hindering my progress.

I will be happy to have intermittent fetal monitoring, with a portable device. I do not wish to have continued fetal monitoring, especially as I would like as much access to bath/shower as possible, and as active a birth as possible. However in the event that it becomes medically necessary, please discuss this with us further.

I am completely uncomfortable with vaginal examination. If and when an examination is required to be performed, I would like them to be kept to a bare minimum. I would firstly like to be informed of what he/she hopes to ascertain from the exam, if it will at all benefit me, and whether it is medically necessary for it to occur. I feel the tension caused from this sort of procedure may be detrimental to my progress.

I wish to be free of time limits and not have my labour augmented unless in a medical emergency, in which case this is to be further discussed at the time. Please read below for further preferences regarding Induction and Augmentation.

I?d like the freedom to choose positions, use the shower or bath and walk around in labour as desired. I do not at any time wish to be confined to the bed.

Please allow adequate time for the perineum to stretch naturally. I?d only like and episiotomy if there is a genuine medical emergency, and this can be further discussed at the time.

As stated previously, we?re hoping for a natural childbirth without unnecessary interventions or the use of drugs. However if complications arise, and an assisted birth becomes medically necessary, please inform us of all our options and give us time to discuss privately.

No, I do not require a mirror to view the baby?s head, but I would like to be informed of when is an appropriate time for me to touch his head, so at the time I can decide. The gender of our baby was determined at our ultrasound, so there is no necessity to keep the information quiet.

Presuming baby and I are well, we would like for Anthony to be given the opportunity to ?catch? the baby, and for him to cut the cord if he wishes. I would like to wait until the umbilical cord stops pulsating before clamping, to allow my baby to receive the valuable blood and iron stores. Because we will be delaying the clamping of the cord, no, we will not be donating the cord blood.

I am happy to have the syntometrine injection for third stage management. I would like this to be given after the cord has been clamped and/or cut.

I would like Anthony to place our baby on my chest immediately after birth. I would like the opportunity to facilitate breastfeeding as soon as possible. I would like for all newborn procedures (weighing and measuring) to wait until I have had time to bond with and breastfeed our baby. Yes, I plan to breastfeed and request that only breastmilk be given to our baby.

I am yet to decide completely on my preferences for visitors. I would like for Anthony and I to be left alone as long as possible to optimise bonding with our child. My other support persons, Tania and Sarah, will be permitted to visit, and mother in law, Fiona. I will be advising them to call first, to get an OK, and any other visitors may be discussed further at the time.


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 (Patient)

________________________________ Name ______________ Date


________________________________ Signed (Practitioner)

________________________________ Name ______________ Date



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 medically necessary at any time, I'd like to start with the least artificial means first - i.e. nipple stimulation, acupuncture, massage or a stretch and sweep 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.

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

I am absolutely terrified of having a caesarean, but if it becomes medically necessary?

I would like for Anthony to be present at all times. I would like the ability to use my hand held music player during the surgery, to block out any noise. And I would prefer if I could have the option of being blindfolded for the procedure.

I would like to be able to choose whether the screen is up or down at the time, and if I am to be blindfolded, Anthony can make that decision so he can choose to watch. I request for all discussion to be respectful and minimal - only what is required medically and to inform Anthony and myself of what is happening. This is to reduce my fear if I do happen to listen.

Unless prevented by medical emergency, I would like my baby to be placed on my chest while you complete the procedure. I would like the operating surgeon to ensure that a double layer suture is used and not a single layer in order to improve my chances for a future VBAC.

Again, we wish for the cord to stop pulsating before clamping for reasons aforementioned.
I also wish to have the opportunity to breastfeed our baby in recovery.

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It sounds like a beautiful plan hun. BUT, and i only have experience within the UK system, i think it'd be almost impossible to get in a hospital setting over here. They would just say the 4-hourly dilation checks were medically necessary, the fetal monitoring was medically necessary, the augmentation because it's going slower than 1cm/hour dilation is medically necessary. Have you considered a homebirth? It might be MUCH easier to get everything the way you want it...? Will Lisa be delivering you?

Other than that i think your plan is great but i would shorten it a good bit. They don't have much time to read and the shifts might change as you're getting close to birth - the person who signed might not be there... So things like:

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I am uncomfortable with the idea of medicine or midwifery students in attendance during my labour. I understand that they need to learn, and how else can they; but as I am anxious enough about giving birth as it is, I do not wish to have any students present. Maybe next time.
I would prefer if we can be left alone as much as possible, as I feel the continued presence of medical personnel will raise anxiety and cause undue psychological stress, and hence the probability of also hindering my progress.

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I would shorten to:

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I do not consent to medical students or midwifery students being present.

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Your reasons are not relevant and none of their concern really.

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I am completely uncomfortable with vaginal examination. If and when an examination is required to be performed, I would like them to be kept to a bare minimum. I would firstly like to be informed of what he/she hopes to ascertain from the exam, if it will at all benefit me, and whether it is medically necessary for it to occur. I feel the tension caused from this sort of procedure may be detrimental to my progress.

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Could be covered with:

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Unless there is a medical emergency, i do not consent to vaginal examinations. If i wish to have the progress of my dilation checked, i will ask.

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So for each little paragraph, maybe try to shorten to a bullet point containing only the information you need to convey:

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• I do not wish to be offered pain relief. If i ask for pain-relief drugs i would like to be reminded that i wanted a natural birth.
• I would like to use warm water, massage and music to help me deal with pain. I would like access to a bath/shower.
• I do not consent to continuous fetal monitoring except in medical emergency. I am happy with intermittent monitoring.
• Except in medical emergency i do not consent to vaginal examinations. If i wish to have the progress of my dilation checked, i will ask.
• I do not consent to medical augmentation except in an emergency.
• We wish to be fully infomred at all times, please discuss everything which is happening with us.
• During crowning i would like to be offered the chance to feel the baby's head.
• I would like to be able to move freely and assume the positions i choose in order to deal with the pain.
• Unless there are medical reasons why he cannot, we would like Anthony to "catch" the baby and place him onto my chest.
• I plan to breastfeed and would like to have the opportunity immediately after birth....

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and so on.

I'm not sure about the signatures, i don't know if my midwife would have signed it because she represented the hospital (even though it was a home birth) and she was not qualified to make promises or enter contracts on their behalf. It might be fine in Aus or if you have a provate MW though?

It sounds like a great birth. I hope all goes to plan.

Bx

Ash, it's very good, very thorough.

I think Hoobley has done a great job editing too. Do take it under consideration that it's more likely to be read properly if they an get the general idea quickly.

It's good to write it out for yourself too I think, puts your head in the right mode iykwim?

good stuff

I think you've done a fantastic job and been really thorough - and I think the process of writing a plan like that is a really positive one because it allows you to really think through your ideas and understand why you want what you do. That's so important!

But I'm going to have to agree with Bec - it is definitely FAR too long hun. If you want them to read it (and refer to it during labour) it has to be cut down majorly. Bec's editing tips are good, I'll add a few other ideas to cut the length down.

* Aim to get it down to 1 - 1.5 pages tops and get the layout uncluttered (point form is good as it's easy to read and forces you to be concise).
* You don't need tell them the reasons you want/don't want something. They don't need/want to know and it just adds unnecessary bulk ;) For example the point about medical students - just say you don't consent to them being present and leave it at that.
The part about pain relief at the beginning -

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If I ask for pain relief in the transitional stage please remind me how close we are to the end and let me reconsider. If, and when I request any pain relief, please encourage me to further discuss it with Anthony, as he knows me better than any medical practitioner and is best aware of my wishes.

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This is something to discuss with DH/support people beforehand. It's their job to look out for you here, the midwives generally won't ask you to think about it a bit longer before you have pain relief. You need to depend on DH for this so I'd take it out and make sure he's aware of your wishes.

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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 medically necessary at any time, I'd like to start with the least artificial means first - i.e. nipple stimulation, acupuncture, massage or a stretch and sweep 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.

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If you're already in hospital in labour this is all going to be a bit of a moot point since however it happened, labour has started. All the stuff about natural induction, I'd take out since you'd be doing that at home, of your own accord and that has nothing to do with medical staff. The point about breaking your water - they can't do that if your cervix is completely closed, it has to be at least a little bit dilated for them to be able to get to your bag of waters.

Something else you could think about which you often see in birth plans - "I don't want xyx unless medically necessary". When you think about it, the midwife/ob will not do anything that they don't think is "medically necessary". So leaving it up to their discretion with that phrase is basically saying "do what you like". If you feel strongly about no VE's (which are never medically necessary if you have a good midwife ;) ) then say "I do not consent to VE's during labour". The word "consent" conveys your meaning very clearly.

One more thing - think about staying home as long as you can during labour, because then alot of the things you've put in here you won't even have to fight with them about ;)

Good luck! :)

wow what a wonderful plan, you have certainly put a great deal of thought into it :)

I would agree that point form is more user friendly...and you will have a higher probability of the birth plan being read if it is one page or so in length

also the midwives will not sign the birth plan...it would become a legal document that could be used in court and open them up to personal liability

re the vaginal examinations...you can refuse them if all is going well...and of course if things are going pearshaped you still have to consent

re the synto drip for induction...hospital policy has a set guidelines for the safe administration of the drug...and the reason the amount of the drug is increased half hourly is to give you the best chance to labor and birth vaginally...if the amount is not increased on a regular basis you do have an increased risk of c/s due to failure to progress and fetal distress.

I hope this helps

good luck

xx yogababy

Ash, I agree that you have done a great job and I agree that point form will get you a better result. You have done a great job of researching labour and birth and I am sure that will be a huge help. A pain relief free birth is possible, but you need to be sure you can do it. By that, I mean that when you are in the throes of contractions you will not be thinking clearly (or much at all!), so don't go in to the hossy thinking "I might need drugs I'll wait and see". That is the surest way to go off track. Go in there thinking "I can have a drug-free birth". I know you can do it hun. Ensure DH is clear on what you do and don't want, then go and have that minimal-intervention birth you want. GL.

Thanks for all the feedback guys, i'm going to edit it and chuck it in again.
In regards to them signing, it's actually something on their form. But, it may just be a signature to say that it has been discussed with me, as opposed to them signing they agree???

Also... I think i made a lot of explanation so i felt that was i thought was justified - which is good for myself, if nothing else. But medically speaking, if i say 'i do not consent' does the following paragraph 'sum up' - 'please medically advise me further when necessary...' IYKWIM

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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, should the need arise. We would then like the opportunity to contemplate our options without the presence of any medical staff

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I think the main thing to remember is that a preference is something you would like and consent is a different thing. If you shout "But i'd prefer to birth vaginally!" on your way to theatre they will hear someone distressed at their labour going the way it is. If you shout "I do not consent to this!" they will have to stop what they're doing.

My birth plan in full:

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Birth Plan

 We are planning for a straightforward home birth. We aim to approach the birth with confidence and are not anticipating problems. If problems do arise, we?d like to deal with them at the time, with the guidance of our midwives.

First Stage:

 My birth companion is my partner. We?d like it if he was active and he?d welcome tips from the midwives on things which might help him support me in each stage.

 I would like to use breathing, warm water, massage and aromatherapy to help me deal with pain. I intend to go into labour fully informed on my choices for pain relief drugs, and don?t want to be offered them. I will ask if I feel I want them, and if I DO ask for them, it?d be good if anything else we could try was tried first (like a change of position, or massage or whatever, so that I only get drugs at the point when every other option has been exhausted). I really DON?T want the drugs but I expect I might forget this at the peak of contractions especially if labour is drawn out.

 I would like to be active during labour and adopt any positions my body tells me to. I would like internal examinations to be kept to the minimum necessary. I?d like the mood to be kept light and jokey and not too serious. Please feel free to joke with me and remind me that though it might be painful and difficult, it?s not the end of the world. We may play some music, we?ll decide in the moment.


Second Stage:

 I?d like to remain upright or on my knees to push, and let gravity help me. I would appreciate any suggestions the midwives have of positions which might help my individual labour.

 I?d rather tear than be cut, and if I do tear I?d like to be stitched unless the tear is really tiny.

 We?d like the baby to have skin-to-skin contact as soon as it is born. If for any reason I cannot do this, then DP should. I intend to breastfeed and would like to have help getting baby latched on as soon as s/he is interested.


Third Stage and the baby:

 I?d like a physiological third stage if possible but will remain flexible. DP would like to cut the cord when it has stopped pulsing. If for any reason the cord has to be cut before this and/or by a midwife, this is also fine, as is a syntocin injection if the midwife feels it medically necessary.

 We?re happy for the baby to have the vitamin K injection.

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And even THAT they didn't have time to read! My hospital birth plan was different though, a few quotes...

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 During the pregnancy I have come to know and trust the midwives. I am confident in their ability to help me safely deliver my baby. I don?t want medical intervention unless my baby or I are in real and immediate danger.

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I consent to an episiotomy only if my baby or I am in immediate and real danger.

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Because i felt i needed to be more defensive about my choices if i ended up in hospital. What i said about the midwives was true but i felt i should say it, they would know i trusted them and they would be better able to defend me against impatient obs that way.

Bx

What do we think now???

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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, should the need arise. We would then like the opportunity to contemplate our options without the presence of any medical staff. We would like the birth experience to be respectful and private as we know this is conducive to a successful birth, with minimal interruptions, quiet voices and dimmed lighting.

We’re hoping for a natural childbirth without unnecessary interventions or the use of drugs.


• I would like to use warm water, massage and music to help me deal with pain. I would also like access to a bath/shower.
• I am aware of the pain relief that is available, please do not offer it.
• I do not consent to the presence of medical or midwifery students.
• I do not consent to continuous fetal monitoring except in a genuine medical emergency. I am happy with intermittent monitoring.
• Unless there is a medical emergency, i do not consent to vaginal examinations. If i wish to have the progress of my dilation checked, i will ask.
• I do not consent to medical augmentation except in an emergency.
• I would like to be able to move freely and assume the positions i choose in order to deal with the pain.
• I consent to an episiotomy only if my baby or I am in immediate and real danger.
• I do not consent to an assisted birth. Please discuss all options with me at the time.
• During crowning i would like to be offered the chance to feel the baby's head.
• Unless there are medical reasons why he cannot, we would like Anthony to "catch" the baby.
• I would like to wait until the umbilical cord stops pulsating, before it is clamped and cut, by Anthony.
• I consent to having the syntometrine injection for third stage management. I would like this to be given after the cord has been clamped and/or cut.
• I would like Anthony to place our baby on my chest immediately after birth.
• I would like for all newborn procedures to wait until I have had time to bond with and breastfed our baby.
• We would like to be left alone as long as possible to optimise bonding with our child.



In the event that a caeserian becomes medically necessary –

• Anthony is to be present with me at all times.
• I will be using my music player during the surgery.
• I would like the screen to be down so that we can witness the birth.
• All discussion is to be respectful and minimal - only what is required medically to keep us informed.
• Unless prevented by medical emergency, I would like my baby to be placed on my chest while you complete the procedure.
• I would like the operating surgeon to ensure that a double layer suture is used and not a single layer in order to improve my chances for a future VBAC.
• Again, we wish for the cord to stop pulsating before clamping for reasons aforementioned.
• I also wish to have the opportunity to breastfeed our baby in recovery.

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Do things such as ...until the umbilical cord stops pulsating... contradict ...placed immediately on my chest... or will they get the point??
Also how else can i word... "I do not consent to an assisted birth. Please discuss all options with me at the time."
Would something similar to what Bec quoted aboved (about no medical interventions) be suitable?

just a question regarding having the baby on your chest for bonding and breastfeeding while witholding newborn procedures, isnt the APGAR test done at 1 minute and 5 minutes of the baby's life. Is it ok for these to wait? Sorry, I dont know, I was wondering if they are ok to wait for some test etc.

Prama, the apgars are bascially a visual thing so can be done with bub on the chest. Anyway, the bonding with bub is more important than any number. Having an apgar score isn't exactly going to do the baby any real good other than to classify it as born healthy, or need further care. Most hossys seem to do the weighing etc before bub can bf, but it's not necessary, and I think Baby Friendly hossys are happy to wait. Really, it is ridiculous how much intervention we consider normal with regard to labour and birth. And then we wonder why bfing goes astray. What happened to it being a natural process?

i think its pretty straight forward of what you want and what you dont!!

great birth plan!!

Ashlea,
I'm sure you are having bubs at a hospital near my house :), I know plenty of woman that was birthed there and had no problems with the staff following birth plans. But what would be a good idea is to get it laminated and stick it on the back of the door. That way different staff can glimpse over it and read it before they ask questions..often they birth plans can go walk about especially at change of shifts. As for Agpars one fellow bb member had her little one in the shower and nursed while the cord pulsvated with the midwifes observing agpars but giving space to the patient and partner. Weight and stats can be done later.
Are you going through the birthing centre or hospital?
Bec

ETA I didnt have DD there but did my Anti natal classes there and became friends with all of them who did

Just in the hospital - it's with their young approach to pregnancy and parenting midwife (all my pre-natal care) so i'd really like if she could do the delivery as well, but i know there's no guarantee.
Thankfully mum's longets labout was me, only seven and a half hours - so i have my fingers crossed i follow suit :)

Fingers Crossed it does, good luck with it all.
I'm sure you are well educated in what you want and dont, its getting everyone to know your wishes is the hardest.

mantaray - thanks for that! Gee, that is true, often all the formalities seem much more important than the bonding.
Can we request to have our partner's name on the name tag or is that standard procedure?

Ash - I'm hoping I have my mum's labour times too. 4 hours for both my brother and me!!

My mum had quick labours and so did I - so good luck girls. It could certainly be true for you too.

Lookin great hun! That's brilliant - is it possible you actually have MORE information even though it's a much shorter document? Certainly seemed so!

I really hope it all goes to plan.

Bx