Monday, July 23, 2012

Getting Ready for Baby Pt. 2: Creating a Birth Plan

So I'm about 32 weeks and some-odd days along and I'm getting antsy. Aside from nesting, I am really just wanting to make sure that I am totally prepared for whatever this kid can throw at me. I'm a list-maker, and the making of lists is in full-force, my friends. I decided to blog it all in a few different parts so my fellow pregos and pregos-to-be might benefit from my obsessive-compulsiveness.

This is Part 2 - Creating a Birth Plan

[See Part 1 - Visiting the Hospital or Birthing Center]

I think it's important for everyone to have a birth plan. A lot of people don't take the time to make one because they think it's something that only "crunchy" parents or those who are aiming for a more natural birth do. But that's not true! A birth plan can just as easily express your wishes to get an epidural ASAP as it can share your desire to not receive any kind of medication. A birth plan helps to outline your wishes for all stages of labor and delivery as well as post partum care of yourself and baby. This post outlines things to think about when creating a birth plan and I've even included a "graphic" birth plan option! The graphic birth plan is something that was shared with me by a friend  - it's a "quick look" birth plan and I really love it! I'll be doing a full written birth plan AND a graphic one to post in my room for quick reference. (Please note that the following is not my birth plan. These are just things to consider.)

I felt the need to include a "birth philosophy" at the top of our birth plan. Here is what mine says:

We hope to have a natural, vaginal delivery (VBAC). This birth plan expresses our desires and preferences for the birth of our baby. We have educated ourselves before making these choices, and we understand that there may be situations in which our choices may not be possible. In such instances, we ask that the practitioner discuss with us any procedures or medications prior to administration and that we be allowed the chance to question such procedures before giving informed consent. 

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You may want to note any special situations so nurses and other staff are aware. These "special situations" may include things like:
  • Trying for a VBAC
  • Gestational Diabetes
  • Preeclampsia
  • RH incompatibility with baby
  • Group B strep

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There may be specific wishes you'll want to convey concerning your environment. Things like:

The people you'd like in the room with you -
  • Your partner
  • Parents
  • Other children/siblings
  • Doula

Other requests -
  • Lighting (dim lights?) and temperature
  • Minimal interruption
  • Music
  • No loud noises
  • No students or residents
  • To be allowed to take pictures/record video

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I have VERY specific wishes for my labor experience. We are trying for as natural a birth process as possible. There are some doctors and nurses who are completely supportive of this. There are also some that think I'm ridiculous for refusing medication - in their eyes, medication will only make the experience more relaxing and pleasant. Here are some things you may want to address for your first stage (labor):

I hope to have a -
  • Vaginal Delivery
  • VBAC
  • Cesarean Section
  • Water Birth

I'd like to wear -
  • Contacts
  • Glasses
  • My own clothes

I prefer -
  • That my partner not be separated from me at any stage of childbirth
  • Infrequent vaginal exams
  • Not to have my labor augmented as long as my baby and I are fine
  • That my membranes not be artificially ruptured

If my labor needs to be induced or augmented, I prefer -
  • Natural methods
  • Stripping of membranes
  • Prostaglandin gel
  • Pitocin
  • Rupturing of membranes

I'd like to spend the first stage of labor -
  • In a bathtub
  • In a shower
  • Lying down
  • Sitting up
  • Walking around
  • On a birthing ball

I do/do not want the following -
  • Enema
  • Shaved pubic area
  • IV line
  • Urinary Catheter

I'd like my baby to monitored -
  • Continuously
  • Intermittently
  • Internally
  • Externally
  • With a doppler only
  • At practitioner's discretion

I'd like to be given pain medication -
  • Only if I request it. Please don't offer it to me.
  • If I seem uncomfortable
  • As soon as possible

I want to manage my pain in the following ways -
  • Breathing techniques
  • Meditation
  • Acupressure
  • Distraction
  • Hypnosis
  • Massage
  • Epidural
  • Walking epidural
  • Demerol
  • I want to decide during labor

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This is where people can get suuuuper detailed and picky. Or not at all. Some people just want to get the baby out whatever way possible. These are things to think about and maybe include in your birth plan for you second phase (delivery):

When pushing, I'd like to try the following positions -
  • Squatting
  • Semi-reclining
  • Side-lying
  • Leaning on my support person
  • Using people for leg support
  • Using foot pedals for leg support
  • Using a birthing bar over the bed for support
  • On hands and knees
  • Standing
  • In a bathtub
  • On a birthing stool
  • Let me decide then

I'd also like to -
  • Push when I feel like it (spontaneous pushing)
  • Push when directed by nurses/coach
  • Have no time limits on pushing (as long as my baby and I are fine)
  • Have the epidural wear off before pushing
  • Continue with a full-dose epidural while pushing
  • See the birth in a mirror
  • Touch my baby's head as it crowns

Concerning episiotomy -
  • Use perineal massage, warm compress, and positioning first
  • I'd rather risk a tear than have and episiotomy
  • I'd rather have an episiotomy than risk a tear
  • Have an episiotomy only as a last resort
  • Have an episiotomy at the practitioner's discretion
  • Use no local anesthesia; I prefer a pressure episiotomy
  • Use local anesthesia only during repair

If an assisted birth becomes necessary, I'd rather -
  • Have forceps
  • Have vacuum extraction
  • Have it be at the practitioner's discretion

Delivering the baby -
  • My partner would like to catch the baby
  • I would like to help catch the baby
  • My partner would like to suction the baby

If a cesarean becomes necessary -
  • I would like to be conscious
  • I would like my partner to be with me at all times
  • I would like the screen lowered so I can see the baby coming out
  • I would like to be able to touch the baby; Please leave my hands free
  • Please explain the surgery to me as it happens
  • I want _____ to cut the cord
  • I want to begin breastfeeding immediately (or as soon as possible)

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There are just as many (if not more, depending on the person) details to consider after delivery as there are during labor and birth. These are some of the things you may want to mention in your birth plan concerning post partum care:

The umbilical cord -
  • My partner would like to cut the umbilical cord
  • Wait until the umbilical cord stops pulsating before clamping/cutting
  • I have made arrangements for donation of the cord blood
  • I have made arrangements to privately bank the cord blood

The placenta -
  • I would like to deliver the placenta spontaneously and unassisted
  • I would like to see the placenta after it is delivered
  • I do/do not want pitocin to be administered after delivery

I would like to hold my baby -
  • Immediately after delivery; Please place the baby on my abdomen
  • After suctioning
  • After weighing
  • After he/she is wiped clean and swaddled
  • Before eyedrops or ointment are administered

I would like to breastfeed -
  • Immediately after delivery
  • Before eyedrops or ointment are administered
  • Later
  • Not at all

I would like family members to -
  • Be able to join us and the baby in the room right after delivery
  • Be able to join us and the baby in the room later
  • See the baby in the nursery only

Newborn procedures -
  • I'd like my baby's medical exam to be performed in my presence
  • I'd like my baby's medical exam to be performed only after we've had a chance to bond
  • I don't need to be there
  • My partner would like to be there
  • I'd like my baby to have a heel stick for newborn screening tests
  • I do/do not want my baby to receive a vitamin K shot
  • I do/do not want my baby to receive a Hepatitis vaccination

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There is still a lot that you may want to regulate or request after all the hubbub of labor and delivery are over. The first hours and/or day or two (depending on how long you're at the hospital or birthing center before being discharged) are very important when it comes to bonding and forming habits and early skills, etc. These are some things you might want to think about specifying in your birth plan:

My baby's first bath -
  • I'd like to be there
  • I don't need to be there
  • My partner would like to be present
  • I prefer to give the first bath

Feeding -
  • I plan to exclusively breastfeed
  • I plan to formula feed
  • I plan to breastfeed and formula feed
  • I plan to feed on demand
  • I plan to feed on a schedule
  • I would like the help of a lactation specialist

Please do/do not offer my baby any of the following -
  • Formula
  • Sugar water
  • Pacifier

I'd like my baby to be -
  • In my room 24 hours
  • In my room only during the day
  • In my room only when I'm awake
  • In the nursery except at feeding time

I'd like my partner to -
  • Have unlimited visitation
  • Have limited visitation
  • Sleep in my room

I'd like my family to -
  • Visit only at these times
  • Have unlimited visitation

I'd like baby's older sibling(s) to -
  • Visit only at these times
  • Have unlimited visitation

If my baby is a boy -
  • I want him circumcised
  • I want him circumcised with anesthesia
  • I don't want him circumcised
  • I'd like to be present for the circumcision
  • My partner would like to be present

I'd like my stay in the hospital/birthing center to be -
  • As short as possible
  • As long as possible
  • I'd like to decide after the birth

I'd like the following medications to be offered to me after delivery as needed -
  • Extra-strength acetaminophen
  • Percoset
  • Stool softener
  • Laxative

If my baby needs special care, I'd like to -
  • Accompany or have my partner accompany the baby to the NICU or another facility
  • Breastfeed or provide expressed breast milk for my baby
  • Hold my baby whenever possible

So that's what I've got! Did I forget anything? There may be some things that don't make sense or seem silly to some people - if that's the case, this is a good time to take a look at all the different things that happen or *can* be done and why. There are pros and cons to everything, and I encourage everyone to do some homework!

One last thing: the graphic birth plan. Please note that I did not make this - a friend made it and I applaud her!

4 comments:

  1. I love this! I don't think that all moms need to have natural, unmedicated births, but I do wish that more moms would educate themselves about their options and the various procedures that can accompany childbirth. If you don't know your options, you have none. If you choose an incredibly medically invasive birth, that's great. Just make sure that you chose it rather than got pushed into it because you were uneducated. Okay, getting off of my soap box now. Also, I LOVE the graphic birth plan!

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  2. I feel so uneducated! Good thing I have plenty of time for research!

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  3. I agree that everybody should have a birth plan. That being said, it is important to prepare yourself for every possibility and not be "do or die" set on your birth plan as that can cause problems with postpartum depression if things don't go the way you want them to. With S's birth we had a very detailed birth plan, but things slowly got crossed off due to uncontrollable circumstances. So have your plan but be flexible! :)

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  4. @ Jess - yep! Same thing happened with Gabe. That's why we included the "birth philosophy" at the top ;-)

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