Birth plan: What am I leaving out?

[longtallsally05]

I'm posting this in the lounge b/c I need input ASAP (my appointment is tomorrow morning).

I'm seeing my OB again Wednesday morning and I need to hand in a written birth plan so everyone in the practice is aware of my wishes during labor & delivery. I just want a basic natural childbirth experience; I've never written a "birth plan" before and there is no form to fill out nor template to follow. Based on childbirth experiences #s 1 & 2 I have thought of the following things that I want for childbirth #3. What, if anything, do you think I've left out that I should consider including in the written birth plan?

Natural childbirth: no pain meds except local anesthetic for stitching up perineal tears after delivery.

DH present as my birth partner.

Saline lock (not continuous IV fluids).

Diflucan with my IV antibiotics (per my OB's standard of practice, I have to have antibiotics b/c DS was born GBS positive. I'm very prone to persistent thrush in my milk ducts and I'd like to skip the thrush/plugged ducts/mastitis cycle this time around).

Intermittent external fetal monitoring.

Freedom to move around/assume positions comfortable during labor and delivery, including walking, kneeling, squatting etc with the use of a squat bar, birth ball, birth stool etc. Hospital policy will not allow for water births or use of a tub during labor (showers only).

No amniotomy, episiotomy, vacum, or forceps without my consent.

Freedom to drink liquids during labor.

No bright lights or loud noises.

No eye ointment for the baby until after opportunity for breastfeeding at least 1 hour. Bedside assessments are okay.

Breastfeeding only: no pacifiers, no bottles, no glucose/water/formula.

I've already asked about delayed cord clamping and was told no, not in their practice. I was hoping that if we delay cord clamping there would be less "active management" required for delivery of the placenta (always uncomfortable, in my experience). My babies have never had problems with jaundice or anemia. I don't plan on cord blood banking.

What else should I consider including? I've probably forgotten something, I'm just not sure what. Thanks!

[o_mom]

Do you have an opinion on bathing right away vs. next day/later?

[misshollygolightly]

circ/no circ if boy?
other fam/friends ok to come visit (and when)?
rooming in or baby to nursery at night?

[cdlamis]

Not that you'll need it but what about your preferences in case of a necessary c-section? I wrote up a detailed birth plan with DD#1 and wished I researched C-section policies in case I had one (which I did). Since it all happened so quickly, I didn't get a chance to clearly express my wishes (like letting DD come to me on recovery room table to start nursing, staples vs. sutures, etc).

[marymoo86]

I don't understand this delayed cord clamping refusal - You are paying them out of pocket or via insurance for a service.

Even if it was only for a couple of minutes they can do it.

[Jo..]

For me, the most helpful thing with Adam was just kicking everyone out and being alone with my DH and doula. We ate and drank and played cards and listened to music. I fired my doctor when he tried to coax me into a c-section, and he left in a huff. Never saw him again.

Leah was so quick (30 minutes) that my birth plan was moot. But I FREAKED out when they clamped her cord right away against my wishes, and it took away a lot of my joy. I just don't get why they can't wait a minute. I was so upset I was ready to cry, and then I looked at her little sleeping face and all of the fight went out of me.

[american_mama]

I put some positive in my birth plan: what *did* I want in terms of comfort measures, encouraging statements, DH's role? Something to help the nurses' know where I was coming from.

It never occurred to me to do this until my third baby, but I'd give some thought to what if the unexpected occurs and you need a c section. SnuggleBuggles here gave me that idea: birth plans aren't just what we wish for, but also a chance to think through a less ideal situation.

I did write such a plan, I think, but I forgot to bring it the hospital with me, so take all my memories with that in light. I think I mentioned things like having DH with me, DH cutting cord if possible, having DH announce the gender, double stitching the uterus (standard for my ob anyway), bizarre request but I loathe on baby shows when the ob makes the baby wave at the camera or say "Hi Mom!" like a newborn baby is a puppet or comic relief. When I saw the midwife's backup ob in my 7th month, I specifically asked him to never do that and I put it in the birth plan! I also asked about some technical details.. stitching vs. stapling, length of time of the surgery, who was normally in the room, photography in the OR, opportunity for de-briefing if a surprise c section happened.

Other people might mention music during a c section (if that's even an option for an unscheduled one), whether they want conversation or a blow-by-blow during the surgery, breatfeeding assistance during the recovery period, I don't know what else. I've never had a c section, so am not a pro.

I think the greatest value in putting some stuff about a c section in your birth plan is that *you* have thought through the possibility. After two straightforward all-natural births, I knew I would have been shocked and confused if I'd needed an unexpected c section for my third, so I needed to think that through a little in advance.

[SnuggleBuggles]

I did do multiple birth plans. I felt much better walking myself through the unknown and unexpected. I wrote a birth center birth plan (my 1st choice), a hospital birth, an induction and a c-section. I put a lot of thought and research into the options available.

Beth

[bostonsmama]

Ditto octmom. We did delayed bath until the 2nd day and no HepB vax. First-hand experience with breastfeeding (among lac consultants at my hospital) showed that babies nursed better and had less of that deep sleep "trauma" from having the amniotic fluid smell washed off of them. Our lac consultants even suggested washing everything BUT the baby's hands if they insist, but we waited, and boy did the hospital staff NOT know what to do! They had to find someone, find a room (since we were moved to mother/baby ward from L&D), and find supplies! But it was so worth it!

FWIW, right before transition, all I could focus on was that darn botched IV on my left hand! It hurt worse than some of the ctx! Make sure you get an experienced phlebotomist at intake so the heplock is as cozy as possible.

[lalasmama]

Do you want them to offer pain medicines at all? If you reach that point in transition when you feel like you can't do it anymore--you're going to break in two, last time never hurt this much, etc--do you want them to mention "a little something to take the edge off"? If you don't want them to do this, make a BIG note of it--"Please do not offer any pain medications--I will tell you if I feel I need them. Likewise, please wait 5 contractions if I request a pain med" (to see if you feel the same in 5 contractions)....

[longtallsally05]

Thanks for all the ideas. I really need to do some research regarding C-sections in case something goes wrong. I had forgotten to put in the bits about DH cutting the cord, having the baby skin-to-skin right away, no circumcision & no music. I also forgot to list my preference for IV placement (not in the hand, and not where tubing will interfere with me bending my wrists)! I hadn't thought about delaying the bath, but it makes total sense when you think about newborns & temperature regulation. I'm also adding "no purple pushing". I think I know when I'm having a contraction, thank you very much. I don't want someone telling me to hold my breath, push and count to 10, as they aren't the ones who'll have to live with hemorrhoids after delivery. My last labor was less than 5 hrs, and I only had to push for 5 minutes. When I thanked my last OB for just presenting info and letting me decide what to do with it during L&D, he said I was very effective, no matter what I did. I find it hard to believe that this birth will be much different in terms of what my body will do, but I'll look into c-sections anyway!