Tuesday, July 19, 2011

Birth Plan

38 Weeks


As promised, here's my birth plan! Kind of.

For the purposes of this post I'm combining a few separate birth plans. I've written one for my doula (not really represented below) so we could discuss what I anticipate as her role in my labor/delivery and give her insight into my head and what I'm requesting of the doctor and hospital staff. Another version was written specifically for my doctor, to be reviewed prior to the birth so she knows what I'm hoping for and we can discuss any divergence from local hospital policy and get the waivers (going against medical advice) signed if need be. The third (shortest) version is for the hospital nursing staff, whom I will meet for the first time hopefully late in labor, so they have an overview of what I've already discussed with the doctor, and I can share with them how best to assist me in my labor and the short time I'm there postpartum.

So far I've shared these plans with my doula (and made some changes based on her suggestions and experience) as well as my family practitioner (the doctor and nurse versions, anyway).  Reviewing them with my doctor was incredibly interesting. We had a great conversation and some points I thought she might question didn't make her blink (such as eating and drinking during labor, which I've since removed from the plan anyway since I'll eat/drink if I want to and won't if I don't but I don't feel like I need it in the plan itself) while other things (like not wearing the fetal monitoring belt continually--assuming no distress was picked-up by intermittent monitoring--and delaying automatic pitocin injection post labor--assuming no hemorrhaging) led to detailed discussions about hospital policy.

(I don't think I've mentioned this yet on my blog, but my provider has since decided she could not provide me the care I hoped for--mostly to do with my refusal to let my delivery plans be decided by the results of fetal weight ultrasounds, not the items on my birth plan--and I, at 37 weeks, have been forced to search for a new prenatal and labor care provider. And found one! But that's a different story for another time.)



So, here you go, a mix of the lengthier plan I've written up for the doc and the shorter plan for the nurses.

My Birth Plan: 

  • I plan on laboring at home for as long as possible, transferring to the hospital only in advanced labor (8-9 centimeters at least).
  • Justin (husband) and Hannah (doula) will be present with my throughout the labor as my birth partners.
Environment / Pain Relief / Medical Assistance
  • I will be attempting deep relaxation akin to self-hypnosis. I prefer a quiet environment with dim or natural lighting. Please allow me to focus inwardly during contractions an avoid references to pain.
  • Alternatively, if I abandon the self-hypnosis/relaxation method, I may decide that to best manage my pain I need to vocalize. If this is the case I anticipate it may get quite loud! (Please allow me my voice.)
  • I intend to move about during labor as I feel the need. I may avoid the hospital bed entirely, laboring and delivering instead on the couch, floor (I'll bring a "sit-upon" and/or use towels), birthing stool, toilet, and/or shower/tub.
  • I will wear the clothing I brought--no need for a hospital gown.
  • My doula and spouse will support me in non-pharmaceutical comfort measures (showers, baths, birth ball, movement, changing positions, etc.)
  • I am aware of my pain medication options--please do not offer pain meds unless I ask for them. If I do ask, please note whether I am asking in the middle of a contraction and, if so, wait until after the contraction, provide encouragement, and see if I was making a true request (versus just vocalizing).
  • I am receptive to an initial 20 minute monitoring/strip of the baby's heart rate and regular intermittent doppler checks of the baby and monitoring of my blood pressure thereafter. Please check vitals wherever I am laboring (versus asking me to move to the bed).
    • I may consider continuous fetal monitoring if a mobile monitoring unit is available that will not restrict my movements.
  • Please ask my permission before every routine procedure including internal examinations, medication or interventions such as AROM. If it is not an emergency situation I will consider my options and review the alternatives before consenting to routine procedures.
  • If I am unable to keep swallowed liquids down and it is determined I'm dehydrated I'd appreciate a saline lock placed somewhere that allows me to freely bend my hand so I'm able to move around between IV sessions as needed and crouch on hands/knees for pushing.
  • I look forward to freedom of movement and the ability to change positions frequently during labor, including going on walks, talking showers/baths, bouncing on the birth ball, slow dancing with Justin, etc. I'd also appreciate suggestions for pushing positions if I need them. It's my understanding that many unmedicated women instinctively move into squats or onto hands/knees when it's time for pushing, but that they're also highly suggestible. Please suggest I stay off my back.
Time to Push!
  • In the interest of opening my pelvis as wide as possible I intend to totally avoid the lithotomy position; instead I would like to be encouraged to push while seated on the birthing stool, while using the squatting bar or my spouse or doula for support, or in a hands/knees position.
  • I would like to push instinctively and as gently as possible. Please do not announce a time to push--I want to follow my body's prompts. I'd appreciate support (not stretching!) of the perineum if needed, but it's not required if things are going smoothly without. 
  • I prefer to tear over an episiotomy.
  • I might like to assist in catching my baby if possible and if I feel comfortable with it in the moment. I would appreciate support and direction at that time.
Afterward
  • Please allow me to learn my baby's sex on my own.
  • Please do not cut the umbilical cord until after it stops pulsating.
  • I plan to hold the baby skin-to-skin immediately after birth.
  • I am open to vitamin K being administered to the baby once we have had time to snuggle. Please administer this while baby is in my arms and weigh the baby next to me at that time. Please, no other routine post-birth interventions for my infant (including blood draws, eye ointment, Hep B vax, or bath).
  • I would like to allow my body time to expel the placenta naturally, with no immediate injection of pitocin. At the half-hour mark I would like to discuss with you what other measures (besides continuing to wait) may be possibilities. 
    • I plan to take my placenta home with me--please do not dispose of it.
  • If baby is a boy:  no circumcision.
  • The majority of my/baby's post birth care (bilirubin and blood sugar watches, weight checks, PKU, etc.) will be completed by a nurse midwife at my home. I will keep my and my baby's hospital visit very short in order to return home soon after the birth so this care can begin.

************
And that's that. Now, whenever a woman discusses her birth plan inevitably someone starts in saying, "But what about if you pass out or change your mind about the drugs or the baby is in distress?" or "You can't plan something like a birth so why write-out anything?" or "This is what the nurses are for, so you don't have to think about these kinds of things." And I mostly understand what they're saying. Generally they mean well. But I nevertheless totally disagree with them. 

I think it's essential that you talk about these sort of things, from the mundane and perhaps not even all that direly important to you (I want to wear my own clothes but I'm not going to go all gladiator style on someone if they toss me a hospital gown) to the your preferred method of pain meds (whether you were hoping for an epidural as soon as you crossed into triage or whether you hope to soak yourself in a warm tub for hours to cope) to the big and bad (few to no cervical checks! No AROM! [I've personally decided to leave these firm 'no's off my plan, though I believe I'll refuse checks and artificial rupture of membranes. I'll just keep my legs together and say no at that time if that's how I'm still feeling.]) 

This is the stuff that a woman can remember and may make/break the memory of her child's birth (one co-worker just mentioned to me that the nurse at her son's birth pulled her hands away from feeling his head at crowning. 18+ years later that still bothers her. It was her baby and her body and she was denied that moment. And it makes me sad that that happened to her and still lingers in her mind.)  So when possible I think it's good for these things to be discussed by a woman and her providers (and at least the quick notes written down for the labor attendants). So we all know where we all stand. 

And if things change because circumstances change, they do. Hopefully, by that point, we'll have enough knowledge of each other's leanings that no one will be surprised by anyone else's stance or reaction to the changes. Going in with an understanding of the other, essentially. What else can you do when you're facing something as amazing and as unpredictable and as important as the rite of passage of giving birth? Prepare and believe. 

Prepare and believe.

1 comments:

the grumbles July 19, 2011 at 8:07 AM  

you are prepared! you will be great! kudos for finding a new provider at the last minute. the hoops they've been making you jump through have been kind of ridiculous anyway. keep us posted!

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