Birth Planning

Written and Maintained by Sabrina Cuddy

swnymph@fensende.com

Index

Part 1 - Steps


I would like to begin with a disclaimer that I was trained in the Bradley® method of natural childbirth - I do not have any training in the Lamaze method, so I can't say if there are things in this that are not applicable to that or any other method... I personally believe that most of the Bradley® method is very common sense, and that this will be useful to anyone writing a birth plan.

I do know that some MDs believe that Bradley® parents are too aggressive in asking for what they want - there is a fine line between being a good consumer and not letting your practitioner make critical decisions! I try to get good communication skills across to my students so that they will not close down the lines when they are talking to their medical team about their wishes!

I would also like to point out that some practitioners believe that birth plans are useless, or worse, that they are a directive to the practitioner, so they resent the interference! I prefer to think that they are a wish list to remind people of what you would like, in a perfect world. Try to get across to your practitioner and the hospital/birth center staff that you are flexible and that you understand that in an emergency they will have to make some decisions for you - that's why you picked this team/birth place, and you trust them to keep you and the baby healthy and safe! (If you don't trust them, see if you can find another practitioner/place to give birth - how can you have a good birth if you spend the whole labor in fear?)

-Sabrina

AAHCC Student workbook instructions for birth planning. (reprinted with permission (per Robert 9/26/94) - copyright 1989 AAHCC)

Step 1. Know Your Options

(you need to take some kind of class to know what the consequences of each of these is...)

Step 2. Examine your feelings

Both mother and coach need to decide what things are important to them and then discuss their feelings and make any necessary compromises.

Step 3. Consider your priorities

List your choices in order of priority - most important first. This is how most medical people think.

Step 4. Evaluate your situation

Are your choices realistic? Are most of your choices openly supported by your birth team? If not, will you compromise or make other arrangements?

Step 5. Meet with your medical professsional

Make an appointment for both mother and coach to sit and talk to your practitioner. Make a brief list of options to discuss based on things you already know your MD or midwife supports. Be sure to stress that this is a scenario for a normal labor situation. Let the person state feelings about your choices. Discuss emergency situations and find out how your provider would handle them.

Step 6. Prepare for a positive experience

Be sure to phrase your final birth plan in a pleasant and polite tone - do not present this as a list of demands. This can help everyone feel more confident and increase your chances of having the birth experience you want. Be sure to include your flexibility should and unexpected situation arise!

Step 7. Be flexible

A beautiful birth experience is important and will have a positive effect on the family which can last a lifetime. However, the health and safety of mother and baby come first. If an emergency does occur, crucial decisions effecting their lives and health must be made quickly, and will require cooperation, as you and your birth team work together.

The Cuddy birth plan for our first baby was a one page list of our preferences for normal labor/postpartum and a second page for complications. This was prefaced with a statement that we wanted a natural birth and had prepared using the Bradley Method®.

For our second birth, we planned a homebirth, and wrote a one-page plan for complications if we had to go to the hospital. It got a very good response when we transferred to the hospital and had a cesarean. We had a very family centered birth anyway!

-Sabrina swnymph@fensende.com

Part 2 - Sample Plans


This is a collection of responses that Laura Weaver received when she solicited examples of other people's birth plans.
Here is the summary of responses I received. Note that one of the responses was a summary someone else had done earlier this year. Hope this helps; I got a lot out of reading what others had included.

Laura laweaver@ralvm29.vnet.ibm.com

******************** Start of Summary ***************************************

BIRTH PLAN FOR _____ AND _______

We have prepared this Birth Plan to help you understand our philosophy and the kind of care we hope to have for the birth of our child. The pregnancy has gon e very well thus far. We have been careful to eat well and stay fit, and have done everything we can to prepare for a healthy and uncomplicated birth. We have chosen our obstetrician, Dr. ____, because she shares our desire for a low-intervention birth and respects our need for good communication. We wish for as natural a birth as possible, avoiding unnecessary procedures and medications. However, if medications or procedures become necessary, we ask that you discuss them with us in advance so that we can participate in the decision making.

It is important to us that we remain together at all times during the labor and delivery (vaginal or cesarean). We would like to have our labor coach, ____, stay with us throughout, as well.

We hope to avoid routine procedures (e.g., prep, enema), to delay introduction of an IV feed unless needed, and to keep the number of vaginal examinations to a minimum. If procedures or medications are proposed, we ask that you discuss them with us and suggest alternative therapies or comfort measures so that we can make well-informed decisions.

We would like to have the option of sucking on ice chips, and may also want to try walking, different labor positions, and perhaps a hot shower for pain relief in labor.

As long as things are progressing well, we prefer intermittent monitoring with an external fetal monitor. We very much want to avoid internal fetal monitorin g unless it is specifically medically indicated.

Because we want labor to progress at a natural pace, we hope to avoid artificia l induction or augmentation of labor (e.g., amniotomy, stripping of membranes, pitocin). We would also like to avoid an episiotomy and try perineal support o r hot compresses instead.

We would like to have a mirror placed so that mother can watch the birth, and, if things are progressing well, mother would like to be allowed to touch the baby's head as it begins to crown.

It is very important to us to hold and nurse our baby immediately after birth, and to have the weighing and bathing done in our room so that we can watch. If this is not possible, we would like to have father stay with the baby at all times. Also, we ask that you discuss any routine neonatal procedures with us before they are performed.

We plan to exclusively breastfeed our baby, and therefore request that s/he not be given bottles, water, or a pacifier without our prior approval. We also would like to have a private maternity room with 24 hour rooming in, and a cot or comfortable chair for father.

We thank you for taking the time to go over this Birth Plan, and appreciate your cooperation in getting our new family off to great start.

Patient ________________________ _________ Coach ________________________ _________ Physician ________________________ _________

Birth Plan

[my name (husband's name)]

Obstetrician: name Doula: name Hospital: name

My husband, _____ _____, and the doula, _____ _____, should be present with me throughout labor and delivery.

Corrective Lenses: I need to wear contact lenses or glasses at all times when conscious, as my vision is so bad that being without corrective lenses is unbearably disorienting. This should not be a problem, as my contact lenses take very little time to remove in the event of an emergency, and furthermore are extended wear, so there would be no problem if they were left in my eyes for an extended period of time, up to a week, including periods of sleep. My husband will have my glasses in case I need to remove my lenses.

External Fetal Monitoring: We do not wish to have continuous fetal monitoring unless required by the condition of the baby. We expect that there will be a period of being monitored by the external fetal monitoring upon first arriving at the hospital, and afterwards monitoring will be intermittant as long as everything looks ok.

Prep: I would prefer to avoid an enema or extensive shaving of pubic hair.

Free Movement: I wish to be able to move around and change position at will throughout labor. I would like to be allowed to choose the position in which I give birth, including squatting.

IV: I do not want an IV unless I become dehydrated. If necessary, I will accept having a device (heparin lock?) inserted into a vein so that an IV can be started up quickly when needed, but without the IV being connected until it is needed.

Artificial Rupture of Amniotic Membrane: I do not wish to have the amniotic membrane ruptured artificially before the birth unless signs of fetal distress require an internal monitor. I do not want the internal monitor unless the baby has already shown some sign of distress.

Fluids by mouth throughout first stage of labor.

Anesthesia and Pitocin: I do not wish to use any anesthesia unless I request it during labor. I will want local anesthesia for repair of tears or of episiotomy, of course. I do not want routine pitocin to be used; we should be allowed to try position changes and nipple stimulation before pitocin is used.

Episiotomy: I do not wish an episiotomy unless required to avoid an extensive tear. I would prefer a medium-sized tear to an episiotomy, although I imagine that it may be hard to judge how much tearing will occur. I intend to take all possible measures to avoid the need for an episiotomy.

Birth: I would like to be allowed to hold the child immediately after birth. We would prefer that the cord not be cut immediately, but given a few minutes to cease functioning first.

Caesarian: If a caesarian is necessary, I wish to have an epidural for anesthesia, and to have my husband and, if possible, [the doula's name] present for the birth. The child, if he is not in distress, should be given to my husband.

Circumcision: We do not wish to have circumcision performed in the hospital. (Better to go to a specialist who uses local anesthesia, if you want this done.)

Breastfeeding: I intend to breastfeed the infant and do not wish to have any bottles given to him, including glucose water. [This was not followed, which caused big troubles!!!]

Rooming-in: We would like to have the baby remain with us in our room. We do not want the baby to be taken away from us unless he requires medical treatment, or unless we request to have him taken to the nursery. We would like to have the baby examined in our presence.

Below is a summary someone else compiled recently.

Laura Weaver

***************** Original article **********************************

I would like some net.wisdom about birthing plans. I know some people will make a written statement about their wishes and desires during labor and take this to the hospital. I have a friend who is about 30 weeks pregnant at the time and she didn't have a nice experience last time. So now she is trying to get it better by talking about things beforehand. I think she really would be helped by hearing how other people handled their birthing plans. So I have a bunch of questions for you.

What topics did you cover in the birthing plan?

When in your pregnancy did you discuss it with your ob/gyn/midwife?

When you have delivered already: did the birthing plan work out, did things go as you would have wanted them to go? Do you think you missed some topics in your birthing plan you might like to add next time?

If you have an electronic copy of your birthing plan, would you mind sending it to me, so she can see how an actual birthing plan looks?

Are there things I forgot that you would like to tell about your birthing plan?

I will summarize the reactions on the net, so if you not want to be included in this summary, tell me in your email.

*************************** Reactions *****************************

Thanks to all who responded. I got a lot of reactions. My friend really liked all the replies she got. It was her first encounter with the internet and misc.kids and it really was a positive one. The replies gave her a lot food for thought. She already started last week by discussing some things with her gyneacologist.

I ordered the reactions by first giving the general reactions, at the end the birth plans. A lot of people wanted their names omitted, so I decided to omit all names.

My birthing plan covered such topics as:

All this was written in a way as not to irritate my doctors. A disclaimer was written allowing for complications - If something was terribly wrong I would get an IV or fetal monitoring, etc. as the doctor saw fit - but only after discussing it with us.

I presented my birthing plan as soon as possible and showed it to all my doctors (I belong to an HMO). Some did not appreciate it - they knew what was best for me! Another one told me if I went against doctors orders, I would not be covered by my insurance.

What actually happened: I did not get an IV nor did I take any drugs. I was allowed ice chips only but that was enough to get me through all those long hours! I had an external fetal monitor on for most of my labor but I didnot really notice it - plus it showed when my baby was being deprived of oxygen so it was ok. I was allowed to have 4 very close friends help me give birth and share my experience. I did not need an episiotomy but I did tear slightly. My husband did not cut the cord nor did I get to hold my baby immediately because the cord was wrapped around her neck thus requiring immediate medical intervention. I couldn't room-in because my baby was in ICU for a week.

All in all, the birthing plan gave me and my doctors an idea of what I wanted in the best case scenario. Although everything did not go as planned (do they ever?) I was quite happy with my birthing experience. Good luck! 

>  It seems to me
> that somehow in the rush to avoid "needless interventions" we are setting
> ourselves up as peers of the medical establishment, able to make and execute
> competent and rational decisions that will always result in a perfect outcome

I would tend to agree. Months before labor started looming, I had filled my head with horror stories I'd heard and read about dealing with involuntary administering of "twilight sleep" (some of the stores were pretty OLD), being strapped down like a crucifix with legs spread eagled and forced to push flat on my back, while a class of medical students, just passing through at an opportune time decide to stay for the birth and take notes (all against my wishes). Oh, and the obligatory "here is your IV, Demerol and epidural we're supposed to give you because WE know what's best for you". Not to mention the routine episiotomy.

But in birthing class, the nurses explained to us what hospital policies are these days in the two hospitals up here that do births. The one I was going to allowed the mother to walk freely during her labor, no obligatory IVs or drugs, and laboring women were allowed ad librium clear fluids, even during an induction, even during the pushing stage.

I had control and was going to be treated with dignity. I backed down from my previous stance of "I'd rather give birth at home in a toilet than let these guys near me when the time comes". I discussed all my concerns with my doctor who was also of the minimal-interventionist school, and we discussed his protocols for deciding when to do an episiotomy, an induction, a C-section, etc. I mentioned my concern for the "med school class" scenario, and he told me I had the final say on what non-essential personnel are allowed at the actual birth, as well as labor.

As it turned out, nothing went according to my little idealized plan. My water broke early, I entered the hospital at that point as per my doctor's instructions (to make sure the cord had not prolapsed), I walked around for 20 or so hours in "woosy" labor (I watched 3 Star Trek epsodes during that time in the scrub room), agreed to an induction after it was determined that in all that time I was still only 3 cm and 80% effaced, lived through the induction for 10 hours and ended up with a monster of an episiotomy after 2+ hours of pushing because the baby just wasn't making it that last cm or so. After a failed suction attempt. With no drugs as per my choice.

And yet I was quite pleased with the whole business.I gave it my best shot. After the birth, contrary to my plan of getting the heck out of there as fast as possible, all I could think of was "please, please let me stay here even one more day to recuperate".

Oh but I'm rambling. The take home messages: talk to your caregiver beforehand, discuss the birth plan but don't be confrontational, learn his/her protocols and that of the hospital's (you might not need to include all your points), and remember that even the best laid plans can go awry, just do the best you can with whatever hand nature deals out to you and don't feel guilty. You never know how you're going to feel until you're acutally there. 

>> 3.  No drugs to be offered even if I scream for them
>> 9.  To be release from hospital the next day unless told in detail why I
>> couldn't
>> 10.  I wanted a private room after birth plus rooming-in.
>> 11.  No episiotomy

In our birth plan, we had similar, though simpler, wishes than she (i.e. "no drugs" rather than "even if I scream for them"). But, we also stressed to our obstetrician that the birth plan was basically our articulation of what we would like in an *ideal* labor and delivery situation. We went into labor and delivery with our eyes wide open, knowing full well that the chances were pretty good that the ideal wouldn't actually happen. But, our birth plan gave us a good starting point, and it let our medical providers know generally that we were well-informed consumers, and had thought about the whole process. We got a lot of positive comments from the nursing staff about our birth plan, BTW. By reading it, they were able to get a pretty good sense of the type of birthing experience we were after. That doesn't mean, of course, that the experience was dictated by the plan, but it was a good guide.

While I agree with ___ that making rules like "no drugs even if I scream for them" seems a bit severe, educating oneself and not writing anything down is a little lax. I followed this approach, was very educated, but ended up not being able to think clearly due to all the drugs and Csection required by my preeclampsia. I wish I had written down things like "rooming in" & "bring the baby immediately" so that someone might have at least brought her to show me though I was too weak to think of asking for her.

Also I wanted to see all the products of conception--placenta, cord, etc.--it would have helped make sense for me where this baby came from-- also to see it emerge. This would have been possible--if someone had asked me if I wanted to see I would have said yes, or videotaped--but because I could not think clearly I couldn't make these wishes known as they were forgotten in the heat of the moment. Maybe if I'd written it down folks still might have forgotten but maybe not.

(oh well. I swear if there is a next time I want to SEE IT ALL even IF I have a section).

I think the most important thing is to understand your doctor's attitudes and the reasons for them. In my opinion, the best way to do this is with direct questions to the doctor about what s/he will do in particular situations. The ideal is a doctor whose general philosophy is similar to your own. Then, you can pretty much let the doctor be in control of the whole birth experience (which makes it mentally easier for you).

It's important to ask the doctor a lot of questions now (I started this at my first visit). The best thing to do is to write a list of questions (at least 5 per visit) and then ask them to the doctor at the end of the appointment. Try to be non-confrontational about things. If you think you don't agree with something, consider the doctor's reasons carefully before challenging it, and then try to get your point across without making it sound like you think the doctor has a dumb idea.

Most doctors have a "standard" birthing plan. My doctor had it written down. In your birthing plan, you should discuss things not covered in the doctor's, or things that are a little out of the ordinary. (Like, I specifically asked her not to break my water unless it was medically indicated.) You should discuss everything in your birth plan orally before showing your doctor a written copy. Bring a copy or two to the hospital with you for the nurses and others there, in case they don't have it.

Just make your plan flexible. My OB doesn't like to make a birth plan because he says you never know what will happen. He is very open and we talked about how I wanted it to be and his basic philosphy fit my needs. I did end up with an episiotomy and a forceps delivery after two hours ouf pushing. Make sure you take into considerations all the What ifs.

Also, if the doctor you normally see might not do the delivery make sure certain things are stated well. A friend's plan said she wanted no medication. The baby came very fast and she had a lot of tears. The OB on call took her no meds literally and gave her no local while he stiched her up.

I suggest Sheila Kitzinger's book _Your Baby, Your Way_ for information on putting together a complete birthing plan.

My doctor had a sample birth plan. I talked about everything from drugs to jacuzzis. If I had a questions or wish, I talked it over with the doctor. My biggest request was for her to let me know what she was doing and why. She explained everything before she began anything. I had an episiotmy ( sp?) and I still tore extremely bad (inside). I did not have a spinal or epideral. My husband was able to cut the cord, the nurses took pictures for me. I had rooming in. For this to be my first child it was relatively easy. The only thing I would change and suggest for your friend is to have ALL your calls held once you go into hard labor. My whole labor/delivery only lasted 11 hours, but the doctor had to sew me up for about 2 hours. During that time the phone kept ringing with well-wishers (sometimes people just don't use common sense). My parents were at the hospital and they could have watched if they had wanted. I didn't have any restrictions on who was allowed in and I had a mirror so I saw everything myself.

It really was the MOST amazing experience of my life. I'd love to have a hundred kids. Although I was really scared during pregnancy that I would be able to go through it. Every time I'd read some info, I'd start crying and tell my husband I couldn't do it. Then I stopped and thought, that if it was something SO outrageous that we'd be able to have babies some other way. I'm a Christian and I finely said a little prayer to the extent of "Lord, don't let it be anything I can't handle". Then I just quite worrying about it. I remained calm and never got excited or tense.

My daughter was 8lbs and 10oz. The doctor was amazed that I pushed her out so "easily". My hard labor only lasted 3 hours. I was very lucky and I wish everyone could have an experience like mine. 

> This kind of stuff is probably what gives me the negative impression I
> have when I read most "birthing plans" that end up on the net as models.
> FOR MYSELF, I preferred to go into the labor/birth without some
> kind of rigid framework of rules like that.

The point that you seem to be ignoring is that you ARE going into the labor/birth with just such a rigid framework of rules, regardless of whether you have any sort of birth plan. The protocols of the hospital and the doctor are what you will get. How rigid they are, and what they consist of will probably be completely unknown to you unless you ask. And you certainly won't know what is subject to modification.

The apparent rigid and absolutist tone to some birth plans is perhaps explained by the difficulty of dealing with most of the medical pro- fession. Doctors and hospitals are used to, and prefer, the passive and accepting patient. Any questioning of normal procedure must usually be done forcefully or it will be ignored.

Of course there are many exceptions, and everyone must do what she feels most comfortable with. My personal preference is to stay at home, thus avoiding all medical protocols for a non-medical situation. If a normal birth hits difficulties and becomes a medical situation, then it's time to bring out the previously-prepared plan. The plan is prepared just as much to ensure that you've considered all the issues and know what you want and care about, as it is to guide the medical professionals. 

>> This kind of stuff is probably what gives me the negative impression I
>> have when I read most "birthing plans" that end up on the net as models.
>> FOR MYSELF, I preferred to go into the labor/birth without some
>> kind of rigid framework of rules like that.

FOR MYSELF, I've noticed several things which worried me in the various birth stories I've read in this group, and I'm wondering whether some kind of planning in advance (such as having a birth plan and bringing some sort of extra support person of my own who has already been through this and is familiar with dealing with doctors and nurses) could avoid some of the things which worried me. For example:

1. If I need a C-section, I would like, if possible, to be able to have an epidural. Most of all, I want to avoid general anesthetic except in a real emergency, because general anesthetic *terrifies* me, more than childbirth itself, more than a C-section. And I understand that it is rare nowadays, even in the case of C-section, and probably the standard procedure would be to put me under only if it were a real emergency. *But*, I read where one woman had to argue her doctor into letting her stay awake during a planned C-section, because he didn't understand why she would want that. So, I wouldn't just want to read up on things, I would want to check that at the hospital I would use, staying awake during a C-section is standard procedure. And if there was any doubt about it, you can bet I'd want that in a birth plan.

2. Some of the birth stories seemed to describe situations where the women really didn't seem to be watched or coached all that closely. (I remember one case where it took considerable argument to convince staff that an epidural was not on, and another where a woman tore various devices out because she was finding the pain too much and didn't have any medication.) Hearing things like that, I'm not sure I just want to expect the hospital to take care of everything (this is why the idea of an extra support person is starting to sound good).

3. Some people described babies being mysteriously whisked away. I'd like to be able to hold my baby first, or, if there's a medical reason why I can't, I at least want someone in my family to be able to keep track of what is happening with the baby and let me know (and still be alert enough to do this - another reason why I'm leaning toward the idea of more than one support person - but I guess this is a separate issue than birth plans).

4. I found ___'s story worrisome. I hate the idea that my obstetrician and I could make one plan, and then I could discover that what I am getting is something completely different, not because medical circumstances have changed, but simply because I wound up getting a different doctor for delivery. Maybe a birth plan would make this less likely? I mean, if my doctor's approval for something medically reasonable were in writing, it would have more weight than just me saying that my doctor had approved it. Or is there something else that can be done to avoid this kind of situation?

I don't know whether a birth plan is the answer to my concerns, but I know I'm not altogether satisfied with the idea of doing a lot of reading as my only preparation (maybe I'm just too much of a control freak).

(By the way, though I currently hope to try without drugs first, I have *absolutely no intention* of writing a plan which involves "no drugs even if I scream for them." Not with my hips.) 

> 4. I found ___'s story worrisome.  I hate the idea that my
> obstetrician and I could make one plan, and then I could discover
> that what I am getting is something completely different, not
> because medical circumstances have changed, but simply because
> I wound up getting a different doctor for delivery.  Maybe a
> birth plan would make this less likely?  I mean, if my doctor's
> approval for something medically reasonable were in writing, it
> would have more weight than just me saying that my doctor had
> approved it.  Or is there something else that can be done to
> avoid this kind of situation?


Anybody you have arranged things with might be unavailable when needed.


The best way I know of to get what you want is:


	1. Know as best you can what it IS you want.  This means
	   doing a lot of reading so you know what the choices are,
	   Know thyself.
	   

	2. Ask a lot of questions so you know what your helpers
	   (spouse, midwife, doula, doctor, hospital) intend to
	   happen by default in all circumstances.
	   

	3. Write down what you want, in all circumstances you can
	   think of (a birth plan), concentrating on those areas
	   where you are in disagreement with others or want some-
	   thing unusual.
	   

	4. Seek out helpers who agree with your decisions or at
	   least will respect them.
	   

	5. Make sure that your helpers have backups (or that you
	   have backups for your helpers), that are reasonable,
	   that you have met, and that you have discussed your
	   plans with.  This reduces the possibility of ending
	   up with an incompatible helper.


All this takes work.  If what you want is to not work, and let the
experts take care of things, then you should do that.  The most
important thing is that you feel comfortable with what you are
doing.


******************* Sample birthplans *************************


        How it worked out? Great! We were lucky and everything
was as uneventful as you may possibly wish for. To increase the
odds of everything going well we hired a private midwife, who
came to our house during the labor and did not let us go to the
hospital (7 minutes away) until I was ready to push. My daughter
was born 2 1/2 hours after our arrival at the hospital. I
did not take any medication, I did not have an episiotomy and my
perineum did not tear, I think for two reasons: I did a lot of
perineal massage, for at least 5-6 weaks, and my daughter was
quite small, 6lb 4oz, and had a relatively small head for a
newborn. She was in a great shape, a few tiny bruises on her
head, her face was pink, eyes wide open, she was too interested
in her surroundings to nurse. They cleaned her in our room, she
roomed in with us the whole time. We had a most wonderful
experience you can imagine.


        To sum it all up, a normal course of labor and delivery
is essential to have a good experience in childbirth. However, it
is up to you to make sure that if your body is doing all the
right things nothing gets in the way of the natural wonder
unfolding. I think that the $600 spent on my labor-support
midwife was the best investment I've ever made (her hands on my
lower back during transition performed miracles). The attitude is
also important---you want to be taken very seriously by your OB
team. It might help to bring up these issues early on, it makes
you a more active participant in your regular visits. You also
need a doctor who is willing to listen and is not a control
freak. I am sure some of the doctors in my OB's practice thought
I was a pain, but the attending OB sure did everything exactly
the way the plan said. I could go on for ever, I better stop with
the advice I give to my pregnant friends: to maximize the odds of
everything going well, minimize the exposure. I hope the plan
helps.


Dear Dr. _______ and Birth Center Staff,


	We are very pleased to be sharing our birth experience with you.
We have worked very hard to make this pregnancy healthy and low risk and
to prepare for the birth of our first baby: we attended a comprehensive birth
class; read a number of books about pregnancy, labor, delivery, and child
rearing; ___ religiously did her 200 Kegel exercises every day, along with
tailor sitting, pelvic rocks, squatting, and other exercises recommended
during pregnancy; she faithfully ate 80-100 g. of protein daily, as well as
deep green and orange vegetables, a quart of milk, lots of high-fiber and
vitamin C foods, wheat germ, and even some things she had never heard of
before; together we practiced relaxation techniques for each stage of labor,
as well as laboring and pushing positions.  As you can see, we did all that is
in our power to give our baby a good start in life.  Now, as the pregnancy is
approaching its final weeks, we are eager to share with you, our birth team,
our hopes for a natural and trouble-free birth of our baby.


	We hope for a normal, natural birth, and we feel well prepared and
look forward to it. Any help you give us will be most appreciated.  Of
course, we realize that unusual circumstances may arise. It is for that reason
that we chose excellent professionals like you.  However, if the course
nature takes appears to be within the limits of the ordinary, we do have
preferences regarding routine hospital procedures for the mother and the
baby.  These preferences are expressed in the following Birth Plan, which
we wrote along the guidelines given in the brochure "Your Guide to a
Healthy Birth", which we obtained from your office.


        Birth Plan for [names of parents]
	

	Birth Team
	

	We would like to be part of the decision-making team and to be
consulted about and asked for our consent before any medical procedure is
performed.  We highly value our privacy, so we would like to keep the birth
team to a minimum necessary number, which excludes residents, trainees,
and other nonessential personnel.


	Labor and Birth
	

     We respectfully request that there be as little intervention as possible
unless an emergency arises.  This includes: routine IV, electronic fetal
monitoring, use of medications for pain or labor augmentation, amniotomy,
frequent vaginal exams.  We would like to have the freedom of motion and
a free choice of laboring positions, particularly in the second stage (this
includes the possibility of a full or partial squatting positions).


	We ask kindly that a fetoscope be used for monitoring the baby's
heart rate.


	We would like to avoid a routine episiotomy; if one is deemed
absolutely necessary, we would like to try for a pressure episiotomy when
the baby's head is crowning.  We would prefer not to use any medication
for labor augmentation or anesthesia.


	Baby
	

        ___ would like to breastfeed our baby as soon as she/he is born.
We kindly request that the cord not be clamped or cut before it has stopped
pulsating.  We prefer that there be no or as little separation from the baby as
possible, particularly in the early hours after birth. In the case such
circumstances should arise that the baby must be separated from the mother
for a period of time, we would like ___ to be with the baby at all times.
We plan that the baby be breast-fed exclusively, so we kindly request that
no formula or any other kind of supplement be given to our baby in the
hospital.


	If the baby is a boy, we do not want him circumcised.
	

	Special Cases
	

	In the case that a cesarean section needs to be performed, we would
prefer a regional anesthesia that would allow the mother to be awake and
alert for the birth and the father to be present.


	If the baby should need special care, we want to be involved in that
care as much as possible and want the baby breast-fed or given expressed
mother's milk from a bottle.
	




	"What topics did you cover in the birthing plan?"  Everything I
could think of -- I started with the list in Pregnancy, Childbirth, and
the Newborn (I'm sorry, I don't remember the authors, but it's still in
print so it should be in Books in Print by title) and added a few others.  See
attached birth plan for what we included last time.  (By the way, it's not
necessary for a birth plan to be as detailed as this one.)


	"When in your pregnancy did you discuss it with your ob/gyn/midwife?"
It's been different for each child, but usually about 3 months before the
due date.  If you're not sure how your doctor/midwife is going to react,
earlier is better, so you can find another caregiver if necessary.


	"Did the birthing plan work out, did things go as you would have
wanted them to go?"	Yes, definitely.  A lot of the credit goes to my
doctor, a family practitioner, who didn't agree with everything I wanted, but
who was willing to let me make the decisions after he outlined the risks
involved.  In the US, having your doctor on your side makes all the difference
when you're doing something that isn't standard hospital policy (such as
skipping electronic fetal monitoring).


	"Do you think you missed some topics in your birthing
plan you might like to add next time?"  I didn't miss the topic, but my
doctor *and* my husband forgot last time that I didn't want to deliver
half-sitting with my feet in stirrups.  (I was too busy to say anything at the
time.)  I intend to stress the point more in advance this time.  That brings
up the point that it's important that the coach be willing and able to remind
the doctor and nurses about what's in the birth plan, esp when the mother is
busy giving birth.





                              BIRTH PLAN


         [names of parents and children]



LABOR:


Enema:  None


Prep:  None


Presence of family:  Coach (Dad) present at all times.  Children and their
   adult friends present at parents' discretion.


Position for labor:  Whatever works at the time.


Onset of labor:  Spontaneous.  If late or other complications, will discuss
   other options at the time.


Hydration/fluids:  Drinking water and juice until no longer tolerated, then
   ice chips.


Food:  Anything reasonable until no longer tolerated.


Monitoring fetal heart:  Stethoscope or Doptone.


Pain relief:  Relaxation, breathing, comfort measures.


Speed up labor:  If necessary, walking, nipple stimulation, pelvic rocking.
   If complications, will discuss other options at the time.


To empty bladder:  Walk to the bathroom.



BIRTH:


Position:  Squatting, or if that doesn't work, hands and knees.  If neither
   of those two work, try whatever.


Expulsion techniques:  Bearing down with contractions.


Speed up birth:  Gravity-enhanced positions.  If complications, will discuss
   other options at the time.


Bed for birth:  Mother's choice of floor, bed, or whatever else is available.


Cleanliness of perineum:  Undraped, mother touches baby during birth.


Care of perineum:  Try for intact perineum with massage, support, and hot
   compresses.


Presence of family:  Coach (Dad) present at all times.  Children and their
   adult friends present at parents' discretion.


Handling of baby:  Mother gets to hold baby immediately, with father helping
   so baby doesn't accidently get dropped.  Suctioning or whatever done
   while baby is in mother's arms.  (Of course, if complications, will
   discuss other options at the time.)



AFTER BIRTH:


Delivery of placenta:  Spontaneous or encouraged with breast stimulation
   and nursing the baby.


Cord cutting:  Clamp and cut after it stops pulsating.  Father cuts cord.


Presence of family:  Father and other children present at all times.


Discharge of mother and baby:  As soon as possible.  If medically feasible,
   within 24 hours of admission to enhance insurance coverage.



BABY CARE:


Airway:  Baby coughs and expels own mucus.  Suctioned only if necessary.


Warmth:  Baby skin-to-skin with mother, with blanket covering both.


Immediate care:  Baby held by parents and nursed by mother.  Observed in
   parents' arms.  If parents need a break, baby is kept nearby in
   bassinet.


Eye care:  Nonirritating agent, such as erythromycin or tetracycline, as
   late as possible, so baby has a chance to look at her family.


First feedings:  Breastfeeding on demand.


Contact with baby:  24-hour rooming in.


                           BIRTH PLAN (PROBLEMS)



C-SECTION:


Rationale:  Unless emergency prohibits, confirm fetal heartbeat indicators
  with fetal scalp blood oxygen readings.


Partner's presence:  Father present.


Anesthesia:  As little as possible depending on circumstances.  No general
   unless absolutely necessary.


Participation:  Screen lowered at time of delivery.  Events explained as they
   occur.


Contact with baby:  Held by father immediately after birth, where mother can
   touch and see.  Breastfeeding as soon as possible.


Discharge of mother and baby:  As soon as possible.


SICK INFANT:


Contact with baby:  Parents visit and care for baby as much as possible.  If
   baby must be transferred to another hospital, mother goes, too; if that's
   not possible, father goes with baby.


Feeding:  Mother nurses baby.  If that's not possible, parents feed mother's
   expressed milk to baby.  If neither is possible, will discuss other
   options at the time.


Contact with support group:  Yes.







>When in your pregnancy did you discuss it with your
>ob/gyn/midwife?




At 30 weeks, once I had gotten out of the hospital for preterm labor.



>When you have delivered already: did the birthing plan work out,
>did things go as you would have wanted them to go? Do you think
>you missed some topics in your birthing plan you might like to
>add next time?





Things worked out somewhat differently, but that was because I was
induced and didn't get to start labor on my own, so I was in the
hospital the entire time.  But other than that, it went just about how
I had planned.  My membranes were stripped and my water was broken, but
otherwise it was basically what I had planned for.



>Are there things I forgot that you would like to tell about your
>birthing plan?




My birth plan was for a very high risk delivery, so it included
every intervention I could think of.  You may not need such a
complete plan.  Mine was also for a twin delivery, so it is in
the plural.



___'s Birth Plan


Preparation 




Labor  




Birth 




After Birth 




Recovery 





Post Recovery 





C-Section 





Premature Birth 




Postpartum 





Birth plan


I am very happy with the prenatal care I am receiving at ______
_______, and was very pleased with the labor and delivery I had at ____
_______ about two years ago. I felt the staff  highly respected
my birth plan, and I think that this respect contributed to the degree of
satisfaction I have about my previous childbirth experience.


I want to direct, but know I can not control, my childbirth experience. I
see this written birth plan as a way to ensure that I have as much
ability to set the course of my labor and delivery as possible. When this
birth plan is respected, then, if we need to deviate from its general
guidelines, I will feel better about the change. Let me know right away
if you think we need to change plans, and why the change is necessary. I
realize that emergencies can happen, and that in the case of an
emergency, the health care team will take the best steps for me and our
new baby.


Labor and Delivery


Use of medication for pain relief: I would like to have as unmedicated a
birth as possible. I will use breathing, visualization, self-hypnosis,
and other mind-body techniques to cope with labor pain and discomfort. In
my last labor I found a great deal of relief from the hot tub, and we can
use it again if needed. I do not want to be offered medication for labor,
and if I request it, I want to discuss it with the midwife at the time.
Use of Novocain to repair a tear or for episiotomy is okay (see section
on episiotomy).


Use of medication for labor induction:  my last labor was very long. I
expect that this one will most likely be shorter. I do not want to use
pitocin for labor induction, and generally shouldn't be considered except
at my initiation. We can try other means of induction, including nipple
stimulation, and movement.


Positions for labor:  I am very open to suggestions the staff may have
for labor positions. I expect I won't need an I.V. and prefer not to have
one unless necessary, and so will be free to move around during labor. I
went through transition last time in a rocking chair, and have positive
feelings about using the rocking chair during labor. Upright and
semi-upright squatting positions make a lot of sense to me, especially
toward the end.


Electronic fetal monitoring: occasional electronic fetal monitoring is
fine. I don't expect you will be doing continual monitoring unless it is
necessary.


Food and drink: I will do my best to eat lightly but well before I get to
the hospital. I would like to have water and other drinks (I remember
very clearly a glass of grape juice with lots of ice last time that was
offered that was marvelous) available during labor. If I haven't eaten in
a long time, I may be very hungry for food after delivery, even if it is
not the regular hospital meal times. I hope I can still get food anyway.


Visual and aural aids:  We plan to bring some tapes from home. A friend
has developed a kit for laboring women and is working on a revision. We
will try to bring it with us and test it out. To maintain a pleasant
atmosphere, we'd like the lights not too intensely bright, particularly
after the baby is born.


I won't be embarrassed, so I hope you won't be: (1) if I yell, sing, or
chant during labor. If the noise is disturbing others, let me know. (2)
if I poop or pee during labor or delivery. (I don't want an enema.) I
figure you've dealt with it before, and can clean up for me. (3) If I am
naked during any part of this. I am not particularly modest, and worrying
about such things during labor and delivery seems silly to me anyway.
Remind me to cover up for photos after the baby is born so I can show the
snaps to a mixed audience (see section on photography.)


Episiotomy: I prefer not to have an episiotomy. However, if I had a
choice between a big tear and a smaller neat incision, I'd prefer the
incision. Still, I'd like to remain as intact as possible. We will be
working on perineum massage for a couple of months before the due date,
as we did last time. Last time the midwife continued massage through the
delivery, and I only had a very small tear.


C-section: If a c-section is necessary, I would like my husband to
accompany me. I do not want general anesthesia unless it is an emergency
and is necessary.


Who will be there:  I expect that my husband will be with me through all
phases of labor and delivery. Depending on the time of day or night, it
is possible that my two-year old daughter and my parents will be milling
around the waiting room. Of my family, I prefer that only my husband be
present until after the baby is born. Then, anyone can come in who wants to.


Photography: we will do our best to remember the camera. I expect we will
only be taking pictures after the baby is born. Remind me to cover up a
little for pictures if I have a breast or suchlike exposed. If Group
Health staff is otherwise unoccupied, it would be nice if someone could
take a picture of all of us.



The new baby


Immediately after delivery: after the baby is born, I would like her (at
least what the ultrasound tech thinks it's a girl) placed on my belly
through the recovery period. I'd like to try to breast feed a little
after delivery. Although I had a very successful breastfeeding experience
with Rose, I feel a little "rusty", and will welcome suggestions and
advice from the staff. I'd like as long a delay as possible before we do
the routines of weighing in, and so forth.


Eyedrops: We would prefer the use of erythromycin, and if possible, we
would like to hold off on the eyedrops for about an hour after birth so
that the baby can see clearly (as she can) when she enters the world.


Sugar water/bottles/pacifiers: when the baby is in the nursery for
observation, we prefer that she not be given sugar water or artificial
nipples unless medically indicated. If she wakes up and needs to be fed,
please bring her to me for breastfeeding.


Rooming-in: At this time we would prefer the baby to room in with me,
unless my condition or the condition of the baby warrants otherwise.





Birth Plan for ____ and ____ _____


This birth plan is intended to express the preferances and desires we have for
the birth of our baby.  It is not intended as a script.  We fully realize that
situations may arise such that our plan cannot and should not be followed.
However, we hope that barring any extuating circumstances, you will be able to
guide us toward the birth experience we desire.


If procedures or medications are proposed, we ask that you discuss them with us
and suggest alternative therapies and comfort measures so that we can make
well-informed decisions.  We are striving for flexibility on our part, as well
as on the that of the birth team.


We plan to have a doula, ______, present during labor and delivery
as a primary support person.  We plan for her to give comfort, encouragement,
and generally support us.


Early and Active Labor




Birth




Contingency Plans


C-Section


We want to discuss any problems and the associated risks unless there is a
medical emergency.  If we require a C-section, we want the father and doula to
be present unless there is an emergency.  We would like to use an epidural
anesthesia rather than general unless there is an emergency. We prefer that the
anesthesia take effect before the catheter is inserted and that there are no
"hot spots" (areas which are not yet numb) before the surgery begins.  We would
like to hold the baby after delivery if she doesn't need immediate medical
attention.


Ill Baby


If complications arise with the baby, we would like to remain as involved in
her care as possible.  If possible, we still want to hold and nurse the baby
as soon after delivery as is reasonable.


*************************** End of Summary **********************************


Here starts a section of new input from misc.kids.pregnancy


-Sabrina


 


Newsgroups: misc.kids.pregnancy


Date: 24 Sep 1994 19:39:10 GMT


I think one thing that should be included in a FAQ is the concept
that a birth plan is not a guarantee or contract.  It should be
considered a starting point for communication, both prenatally
with your doctor or midwife, and then again with the labor staff
at your hospital or birth center.  Just because you've written
in your birth plan that, for example, you don't want an episiotomy
is no guarantee that the dr on call read that paragraph, or, that
when the time comes he/she will remember it.  They may just pick
up the sissors as a matter of habit.  So you need to keep on
talking and expressing your preferences throughout, regardless of
whether you have a birth plan or not.


I also had a little section in my birth plan on baby care preferences
just in case the baby had to be in the nursery for some reason.  It
was detachable from the rest of the birth plan, and could go with 
the baby.  We ended up with our baby in the level II nursery, and
so I was glad I had prepared it that way.  


My own thoughts on sample birth plans is that I wouldn't recommend 
including them in a FAQ.  Once you, as a pregnant woman, have 
made list of preferences, considered your options, etc., as Sabrina
noted, then I think your should write it "on your own" without
using someone else's as a guide.  This makes sure that you get
your own ideas, not someone else's ideas that sound good but may
not be true for you.





Newsgroups: misc.kids.pregnancy


Date: 24 Sep 1994 21:45:20 GMT



: My own thoughts on sample birth plans is that I wouldn't recommend 
: including them in a FAQ.  Once you, as a pregnant woman, have 




I found reading other people's birth plans very helpful in writing my own.
I don't think any of the plans I wrote were not true to me.


For example, I hadn't thought much about preferences if I had a c. My 
midwife has a low c-section rate, and the hospital I plan to deliver at 
isn't that much higher (less than half the national average). By reading 
someone else's birth plan, I began to think about what my options were 
under this eventuality, and put in a brief section on c's.


Or another example: I had lots of stuff in my first birth plan about 
labor and delivery, but much less on post-partum and recovery care, or on 
baby care. If I had read other people's birth plans, I would have thought 
to include more on these areas.


Perhaps the best thing would be for someone to write the plan on her own, 
and then read other people's plans, for additional ideas and options. 
Then she could amend her plan if she wants, based on the new knowledge 
she may have gained.





Newsgroups: misc.kids.pregnancy


Date: Sun, 25 Sep 1994 13:08:00 GMT


OK, here's my birthplan.  I did not use a textbook.  I ended up bein induced
(water broke and no contractions) and had an emergency epiosiotomy (though
my doctor was trying to avoid one).  Nonetheless it was still useful to
have the birthplan and I did deliver on my side.  I was told later that I
had "excessive blood loss" but I didn't need a transfusion.  (This bleeding
tendency was mentioned in my birthplan, but no one believed me until they
saw my blood readings.


Make sure you get your doctor to sign it.




Page 1 of 2                     *** BIRTHPLAN***                      15-MAR-93


Patient: NAME                                            Doctor: NAME,  PHONE #


THINGS YOU SHOULD KNOW:


PLAN A - Routine Birth






Page 2 of 2                     *** BIRTHPLAN***                      15-MAR-93


Patient: __________			Doctor: Dr.__________ 






PLAN B - Caesarean Delivery:




        DOCTOR'S SIGNATURE                                DATE


        PATIENT'S SIGNATURE                                DATE



here's some more info:



Planning your baby's birth

by:

The pennypress

1100 23rd Avenue East

Seattle, WA 98112


for $0.50


it's the *best* info on birthplans i've found. we got ours from
our bradly instructor. the "Choices in Childbirth" section lists just 
about all the different choices there are. i used it to "cut and paste"
for our birthplan.


the pennypress puts out some top quality books as well (well, at least two
that i've read)! 





The instructor for the birth class that my husband and I attended gave
us a list of "informed consent questions."  This was a list of 7
questions that we were supposed to ask the midwife or doctor when
changes to our birthplan were suggested.  The birth class instructor
strongly recommended that everyone take the list to the labor/delivery
room since it is hard to keep a clear head and remember the questions
when you are in the middle of labor.


Informed Consent Questions: