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View Full Version : What is your birthplan for those who want to go natural but still be in a hospital?



moonsky
06-08-2010, 09:59 AM
Please share with me. TIA!

swissair81
06-08-2010, 10:14 AM
My plan is rather simple & I know it works because I've done it before.

-Heplock (but no running fluids)
-Nurse doesn't even mention pain, let alone medication
-Portable monitor (I will wear it, but if you bother me & fiddle with it too often, I will take it off)
-Laboring in position that suits me, with shower available if I want it
-Pushing in position that suits me
-No interventions unless there is a darn good medical reason for it (and I'm lucky, because I would know if there wasn't a rationale & my doctor knows it), second & third opinions if necessary.
-Monitor readings have to be backed up with other proofs (monitors are not all that accurate, there are other things that are far better in detecting fetal distress)
-I cut and clamp cord when it stops pulsing.
-Baby stays with me & I nurse ASAP.
-Nurse can give Vitamin K, but no eye ointment.
-Full time rooming-in (easy because there is no nursery) & exclusive breastfeeding.

I'm lucky. My doctor respects me & my knowledge. I respect him. He was my birth attendant with my last baby & I know that he comes in and sits with me, is cool & calm, doesn't rush me & is pretty darn natural for an OB (He let me use jellybeans for my glucose test because I showed him the NIH study. His only caveat was that I had to bring in a copy for him, so he could work on changing his office policy.) The hospital is more birth center than traditional L & D unit, with nurses that actually see natural childbirth. I am pretty happy with the whole setup (especially since I've been downgraded from high risk. I had a large subchorionic hematoma that is now resolved. Now if only my baby wouldn't be measuring SGA- small for gestational age, everybody would be happy.)

Tanya
06-08-2010, 10:54 AM
Obviously, you have to be willing to be flexible too. For example, my water broke at the beginning of both of my labors. I was nervous the first time and had back labor and I was afraid to tell the nurse NOT to mention pain meds, so she really annoyed the heck out of me constantly asking if I wanted something and how how the midwife had approved this and this whenever I wanted it. The next time, I handed over the birth plan easily. However, since my water had broken and my contractions weren't kicking in and my midwife was going off call the next morning and the OB I didn't care for was going on call, I did go ahead with pitocin after trying some other things first.

Anyway, here was my birth plan. I will have to modify it some for twins.

1st Stage
∑ Induction:
v If induction becomes necessary, I would like to try natural induction techniques first (with the guidance of my practitioner).
v If medical induction becomes necessary, I prefer to try (in the following order):
1. I.V.
2. Stripping membranes
3. Prostoglandin gel
4. Pitocin (minimum drip and removed once uterus naturally contracting)
5. Breaking waters
v If my water breaks, I would like to wait a minimum of 24 hours before being induced if there are no signs of infection.
∑ Monitoring:
v Electronic Fetal Monitoring: Intermittent external, no internal (in absence of fetal distress)
v Vaginal exams: minimal number of exams to avoid premature rupture of membranes or to reduce the chances of infection
∑ Heparin lock, no I.V.; Natural hydration preferred (ice chips, Popsicles, juices).
∑ No offer of pain relief medications unless requested.

2nd Stage
∑ Choice of positions (ie. Squatting, hands and knees, side lying).
∑ Prefer to tear than have episiotomy. To help prevent tearing, please use perineal support and warm compresses.
If episotomy necessary, discuss (if tearing up into labia, if baby distressed, if forcep delivery required, etc.)
∑ Prefer breathing or laboring down, no out loud directed counting for pushing.

Following Birth
∑ Baby to be placed immediately on motherís stomach and cover with a warm blanket.
∑ Baby to remain with mom for minimum of 1 hour.
∑ Would like to breastfeed within the first hour.
∑ Please delay all essential routine procedures on my baby until later. Any necessary procedures/exams can be performed while baby with mom.
∑ If baby in distress, father goes with baby.

∑ If boy, no circumcision.
∑ No bottles, formula, water, pacifiers, etc. Breastfeeding only.
∑ No Hepatitis B vaccine.
∑ We would like to give our baby its first bath. Please help direct us in this process at the hospital.

In case of C-section
∑ Father allowed in O.R. at all times.
∑ Father stays with baby.
∑ If baby healthy, I would like to hold and breastfeed baby as soon as possible.

moonsky
06-08-2010, 01:33 PM
My plan is rather simple & I know it works because I've done it before.

-Heplock (but no running fluids)

-Portable monitor (I will wear it, but if you bother me & fiddle with it too often, I will take it off)
-
-No interventions unless there is a darn good medical reason for it (and I'm lucky, because I would know if there wasn't a rationale & my doctor knows it), second & third opinions if necessary.
-I cut and clamp cord when it stops pulsing.
-Baby stays with me & I nurse ASAP.
-Nurse can give Vitamin K, but no eye ointment.


Thanks for sharing. What's wrong with the IV?
I haven't seen the portable monitor before. Is it available at all hospital? Is it heavy and cordless?
I think my OB is very accomodating but I am not sure about his partners. I haven't seen other OBs in the practice. How can you deal with those?
What's wrong with eye ointment?

Thanks so much.

moonsky
06-08-2010, 01:39 PM
∑ v If medical induction becomes necessary, I prefer to try (in the following order):
1. I.V.
2. Stripping membranes
3. Prostoglandin gel
4. Pitocin (minimum drip and removed once uterus naturally contracting)
5. Breaking waters

v Vaginal exams: minimal number of exams to avoid premature rupture of membranes or to reduce the chances of infection
2nd Stage
∑ Choice of positions (ie. Squatting, hands and knees, side lying).


I am surprised that breaking waters is #5 on your order. It is not better than others as it doesn't have any medication involved?

Do you let the OB perform vaginal exam during the visit to check the status(normally after 36wks)?

Dh doesn't feel it safe to use other choice of pushing position beside laying down on the bed? What is your thought? He is afraid that the OB/MW may miss catching the baby.

Thanks!

SnuggleBuggles
06-08-2010, 02:52 PM
(husband) and I are hoping to bring our son or daughter into this world without pain medications or unnecessary interventions. We understand that some things can't be predicted or planned for. In those cases then we would like to give our informed consent to any proposed interventions along with being offered alternatives.

I have a few requests that might not be standard.
*I would like me or dh to announce the sex of the baby*
-I am afraid of IVs. So, unless there is a true medical need I do not want an IV or heparin lock. I am willing to sign any necessary paperwork. If one becomes necessary and there is time I would like EMLA cream (or similar).
-We want to delay the cord clamping and cutting till the cord has stopped pulsing. No cord traction.
-I do not want the routine shot of Pitocin after the birth if all is well.
-We will be having the PKU and Hep B done at the pediatrician’s office. I ask that other newborn procedures be done but in the presence of mom and dad and after 1 hour has passed. No eye treatment; yes vitamin K; No circumcision.
-If distress is indicated (and there is time) I would like to have a fetal blood sample done before continuing with further interventions.
-If my blood pressure is abnormally high I would prefer to try an epidural to possibly lower my blood pressure rather than use a drug like Magnesium Sulfate.
-I would love to be able to give baby their first bath together with my husband.
-We would like to have baby’s footprint stamped into our scrapbook.

There are some special things I would like to use in my labor and would appreciate your help in making them available. They are: a birthing ball, rocking chair, mirror to watch the delivery and use of a bathtub or shower.

Please help me avoid any situations where I won’t be able to follow my body’s lead (laboring bed, continuous monitoring, and pain medications). I prefer limited activity and low lights/ voices.

Please do an internal exam before I accept pain medications. Low dose epidural is my preference if I chose pain medications. I would prefer to avoid intravenous pain medications.

When it is time for the baby to be born I would prefer perineal support, like warm compresses, perineal massage and controlled delivery of the head, and shoulders rather than an episiotomy. I would also like the 2nd stage to be unrushed if all is well. I hope to be able to be able to birth in a position that feels comfortable and right for me.

I will be breastfeeding. If it is a boy we will *not* be having him circumcised.
I would like to make our hospital stay short so that we can all go home and start our lives’ together. Thank you for your help bringing our son or daughter into the world.

SnuggleBuggles
06-08-2010, 03:01 PM
I am surprised that breaking waters is #5 on your order. It is not better than others as it doesn't have any medication involved?

Do you let the OB perform vaginal exam during the visit to check the status(normally after 36wks)?

Dh doesn't feel it safe to use other choice of pushing position beside laying down on the bed? What is your thought? He is afraid that the OB/MW may miss catching the baby.

Thanks!

Not the poster who wrote those but I may have something helpful...

I would personally choose AROM over pitocin. But, I am not a big fan of AROM (artificial rupture of membranes) because you are then on the clock to deliver depending on your careprovider and some have ridiculous, unnecessary time tables. Also, there is the risk of infection but that is usually an issue if you have internal exams. I also don't like AROM unless positive that baby is very low and perfectly positioned. You don't want to break the water and jolt baby lower into place if they are in a less than ideal position (like posterior) because there isn't as much wiggle room when lower down. Finally, if baby is still high there is a risk of cord prolapse...but one would hope that the care providers wouldn't do AROM if baby was high enough for that to be a risk.

I declined internal exams. What was I really going to gain from them?? They can't tell me when the baby was going to come. And they couldn't tell me how long labor would be. I could be 0cm, 0%, and way high but go into labor 2 hours later and have a short easy birth. Or I could walk around 4+cm, 90+%, and real low for weeks and then go into labor and have a slow labor. The information gained from the internal exams isn't worth the discomfort (though I didn't find them that bad), risk of infection or having my careprovider sweep my membranes without my informed consent (I know people who have had it done w/o their ok). With ds2 I did have an internal + sweeping at 41+ weeks but I hadn't asked for the stats, she just told me...I had asked for the sweeping b/c I was ready. :)

I think that your dh isn't birthing the baby and doesn't get to decide. You will have less risk of tearing if you push in almost any other position. You could appeal to his sex drive and say that you might be able to have sex again sooner pp if you push in a better position. I wound up side lying with both boys though I did some all 4's with ds2. They are birth professionals and they will catch the baby. Don't forget that baby is attached to you still too via the cord. :)
eta- eye ointment...if you don't have an STD then the baby doesn't need the meds is one school of thought. Also, the ointment blurs baby's eyes and can interfere with bonding. Best to at least have hour where baby can gaze at you without anything messing up their already not so great vision.

Beth

swissair81
06-08-2010, 03:12 PM
Thanks for sharing. What's wrong with the IV?
I haven't seen the portable monitor before. Is it available at all hospital? Is it heavy and cordless?
I think my OB is very accomodating but I am not sure about his partners. I haven't seen other OBs in the practice. How can you deal with those?
What's wrong with eye ointment?

Thanks so much.

I don't like having to drag a heavy pole & pump around. That is the major reason.

Not all hospitals have the telemetry units, but I know my hospital does. So did my previous hospital. They are not that heavy & the band they use is supposed to hold the monitors in place better.

I understand that my Dr joined this new practice (he moved since my last baby) because they are more similar to his own philosophy than his previous one. The L & D RN I know who works there tells me that I won't have a problem with my birth plan with any member of the group. There's only him & 2 lovely female OBs. I can deal with that.

The eye ointment is unnecessary antibiotics. The rationale for it is: in case mom has gonorrhea & the baby gets exposed while emerging, the baby won't go blind. I have no problem signing a waiver for that particular unneeded intervention.

Oh and the only concession my dh got is that I am birthing in the hospital. He doesn't get any other considerations. I can't believe your dh thinks lying on your back with your feet in the air is safer. That is so archaic. Do you know what the source for that is? King Louis the Somethingth of France requested that particular position so he could sit behind a curtain and watch his mistress giving birth, for his own entertainment. I think that's a great medical reason. Coupled with the fact that it goes against gravity to push that way and it makes you much more likely to tear, it becomes a downright wonderful reason.

Katigre
06-08-2010, 03:15 PM
http://www.childbirthconnection.org/pdf.asp?PDFDownload=PMPS

Birth Plan for _______, EDD _________
Scheduled to deliver at XXXXXXX Hospital: K, CNM & P, CNM

I realize that a birth plan is a list of preferences and that things don't always go as planned. My primary request is to be fully informed and part of the decision-making process. In general, we prefer minimal medical interference with the birth process.
-------------------------------------------------------------------------------
First Stage Labor
* A heparin lock without the IV attached unless I become dehydrated
* Intermittent fetal monitoring and to stay out of bed during monitoring
* No continuous or internal fetal monitoring unless medically necessary
* Fluids and soft foods by mouth throughout the first stage of labor
* Dimmed lights and voices respectfully lowered
* Internal vaginal exams kept to a minimum
* Freely walk around, use the shower, birthing ball from home (will sign waiver) and change position at will
--------------------------------------------------------------------------------
Labor Augmentation
* As long as the baby and I are fine, I would like to be free of time limits and labor augmentation
* Prefer to allow the amniotic membrane to rupture naturally
* Changing position, walking or nipple stimulation before the amniotic membrane is ruptured or pitocin is given
--------------------------------------------------------------------------------
Anesthesia/Pain Medication
* We are striving for a drug free childbirth, please do not offer pain medication. I'll ask for it if I need it and will make such a decision together with my husband, doula and midwife
--------------------------------------------------------------------------------
Cesarean
* If a Cesarean is necessary, to be fully informed and to participate in the decision-making process
* My husband present at all times if my baby requires a Cesarean delivery
* Leave one arm free to touch baby when born
* Blue sheet lowered during delivery so that I can see the birth
* Double-layer suturing of the uterus (not single layer suturing)
* If not in distress, my baby should be given to my husband and myself immediately after birth
* Breastfeed as soon as possible after a cesarean delivery
--------------------------------------------------------------------------------
Second Stage Labor & Delivery
* I would like to choose my birthing position, including squatting with a bar or on hands and knees
* If I am unmedicated, to wait to push until I feel the urge, even if there is a delay after full dilation
* Baby placed on my stomach/chest immediately after delivery
* Hold my baby while I deliver the placenta and any tissue repairs are made
* Deliver the placenta naturally without a pitocin injection or cord traction
--------------------------------------------------------------------------------
Episiotomy
* In the absence of fetal distress, I prefer to tear rather than have an episiotomy
* Change pushing positions and see if that helps before having a episiotomy
* Prefer a longer pushing stage over an episiotomy
* Guidance and perineal massage when pushing so the perineum can stretch naturally
--------------------------------------------------------------------------------
Postpartum
* Baby evaluated and bathed in my presence
* Delay antibiotic eye drops and Vitamin K shot for 1-2 hours after birth so that bonding time is not interrupted
* We decline the Hepatitis B vaccine for our newborn
* Leave our baby intact and NOT circumcize if it is a boy
* Full-time rooming in with baby and no separation unless medically required
* My husband to accompany our baby at all times if it must be taken to receive medical treatment
* If bili lights for jaundice are required, please bring them to my recovery room instead of baby going to the nursery
--------------------------------------------------------------------------------
Breastfeeding
* I will be breastfeeding exclusively and would like to begin nursing very shortly after birth
* Do not give my baby anything by mouth (pacifier, glucose water, formula) without my expressed verbal consent

Tanya
06-08-2010, 06:30 PM
I am surprised that breaking waters is #5 on your order. It is not better than others as it doesn't have any medication involved?

Do you let the OB perform vaginal exam during the visit to check the status(normally after 36wks)?

Dh doesn't feel it safe to use other choice of pushing position beside laying down on the bed? What is your thought? He is afraid that the OB/MW may miss catching the baby.

Thanks!


Once your water is broken, there is usually a deadline to deliver the baby within (some allow 24 hours...other OBs like mine were less time) and there is a risk of infection.
However, my water broke both times at the beginning, so that was somewhat irrelevant for my birth plan. But for my second daughter, my contractions/labor didnt' kick in. We tried nipple stimulation and walking for hours. Nothing was working and I had that deadline along with the switch from my midwife being on call to the OB I didn't like. So, I took the pitocin.

My midwife didn't do a lot of internal checks at prenatal visits, but I will say that the last appointment I had for my second daughter DID have an internal check and after I sat up, I was wet. Very wet. She doesn't think she broke my water, but it certainly did break either during the exam or when I sat up. My labor didn't kick in, so I truly believe that she must have helped my water break since my body didn't seem all that ready for labor and I ended up with pitocin. Also consider that my first baby came in 7 hours from my water breaking and even with pitocin, it took 17 hours for my second.
Oh, and while we seem to be anxious for if we're getting close to being in labor, the checks usually don't tell us much if anything. Everything could change in a very short time.

Well, I would say that being on your back is the absolute worst position for labor and for pushing. I naturally wanted to be on my hands and knees and wouldn't move out of that position even to be checked when I had back labor with my first. I yelled at the nurse. The midwife agreed to check me on my hands and knees, the nurse didn't know how. After pushing on my hands and knees for a long time, the midwife did have me lie on my side as I pushed my first out.
For my second, I labored on my side for awhile, then up on my hands and knees and my midwife just had me go up a bit more (I don't remember if I squatted or was still on my knees) for pushing my second out.
I had a minor tear (just through the skin) with my first that at first the midwife said didn't even need stitches, but then she gave me 3 tiny stitches "for cosmetic reasons".
I didn't tear at all with my second.

On your back is usually because someone has the epidural or for the OB's convenience. It felt unnatural to me and it truly would be pushing uphill and will increase your chances of tearing and needing interventions. I think you have to listen to your body and get to a comfortable position. You won't care what others think at that point. YOu just want to do what is right for you.

My hospital insisted on the Hep-lock. It was in case they can't quickly find a vein in an emergency. If you have the IV, you are also stuck with a pole which can limit your mobility.

The eye ointment wasn't a huge deal to me, but I suppose it can interfere with your baby's vision and being able to see you, etc.


Tanya

nfowife
06-09-2010, 02:12 AM
Honestly I think the MOST IMPORTANT thing to have when you are looking to have a natural delivery in a hospital setting is a provider who supports you in that effort. Without a supportive provider it will be very difficult.
With my first I took the Bradley Method coursework and had a very cooperative OB- he was based in a freestanding birth center. Unfortunately I did end up having intervention as DD was posterior and would not come out without the vacuum.
With my 2nd (different location) I used a hospital-based midwife practice and they were great. At my 36 week appointment I remember bringing up a birth plan and she said "your birth plan is that you have me as your provider". :)
That time was just a much easier and quicker labor and delivery and I was only in the hospital for 45 minutes before DS arrived, so no time for any interventions anyhow (not even an IV).
With this one, I am not sure what provider I will be using (we are in the process of moving back to the states so I will get a new provider around 20 weeks). I am tempted to go back to my midwife as I really liked her and the care I got. But at the same time if it is going to be as easy as it was last time I might go for the nicer hospital instead. The midwives are at the huge teaching hospital which is not very "cushy" and kind of in the boonies.

moonsky
06-10-2010, 02:24 PM
Once your water is broken, there is usually a deadline to deliver the baby within (some allow 24 hours...other OBs like mine were less time) and there is a risk of infection.
However, my water broke both times at the beginning, so that was somewhat irrelevant for my birth plan. But for my second daughter, my contractions/labor didnt' kick in. We tried nipple stimulation and walking for hours. Nothing was working and I had that deadline along with the switch from my midwife being on call to the OB I didn't like. So, I took the pitocin.

Tanya

I recently talked to a new mom who got pitocin during the labor. She told me that pp who got pitocin normally ended up with epidural. From watching the Business of being born, pitocin and epidural may cause the fetal stress and increase risk of C-section.

SnuggleBuggles
06-10-2010, 03:15 PM
I recently talked to a new mom who got pitocin during the labor. She told me that pp who got pitocin normally ended up with epidural. From watching the Business of being born, pitocin and epidural may cause the fetal stress and increase risk of C-section.

Any intervention you introduce can cause risks. But, sometimes the risks outweigh the benefits. That is whay we should always give informed consent to any interventions. We are supposed to legally be give the risks, benefits and alternatives to proposed medical care and make the decision. So often Dr.s and even midwives can play on mom guilt to influence the outcome and get mom to agree to interventions. No mom wants to do something risky and the way options are presented, you may be led to choose something that isn't necessarily better and safer. Unfair but true that moms need to do the leg work on birth options.

Have you read "Creating your Birth Plan" by Marsden Wagner? I highly recommend it. That plus "The Thinking Woman's Guide to a Better Birth" by Henci Goer carefully review the pros and cons of the choices out there.

Beth

Tanya
06-10-2010, 07:26 PM
I recently talked to a new mom who got pitocin during the labor. She told me that pp who got pitocin normally ended up with epidural. From watching the Business of being born, pitocin and epidural may cause the fetal stress and increase risk of C-section.

Well, I didn't get an epidural, but I do think the contractions were harder on pitocin. However, I doubt that I know what a regular old contraction feels like! I had back labor with my first and the pitocin contractions sure didn't seem *that* bad. I hardly felt my contractions with my second...until the pitocin kicked in. Transition is always the hardest and is when I'm the closest to wanting pain relief, but I also am able to remember that transition is a relatively short period of time, so I make it through it without drugs.

And, I was going to end up having some kind of intervention anyway since I was running out of time from when my water had broken and the OB was coming on call. My midwife warned me that he wouldn't let me go the full 24 hours like she would have. I had already tried walking and nipple stimulation for hours. Nothing was making a difference.

I wouldn't voluntarily want to be induced with pitocin though. I was already in labor and just needed some help moving it along. At least my body was doing something on its own beforehand.