We have a midwife appointment today and were told to bring our birth plan.
I'm not entirely clear if it's supposed to be a formalized sort of contract as you would take to a hospital, or simply a list of our preferences. The midwife put out the suggestion that we decide whether or not Sam wished to catch the baby, for instance.
It prompted me, when sorting through our home birthing supplies, to keep out the birth plan we wrote for Mikko's birth, to see what we could adapt.
Inspired by Missy at a work in progress…, I thought I'd post our original birth plan here, along with notes on how we did or didn't follow it.
And then I'll speculate as to what we'd like to change this time around.
If you take our names out and think through your own situation and preferences, you can adapt this for your own use as you wish. I copied portions from so many online birth plans that I don't even know where to give credit at this point. A lot of this language is common to birthing plans, so let's all not sweat copyright issues, yes?
At a somewhat large font (probably around 12 or 13), this is two pages typed, so we printed it double-sided so it fit on one sheet of paper.
Lauren Wayne & Crackerdog Sam's Birth Preferences
Dear hospital staff:
We didn't have a formal birth plan for use with just our midwives. We intended this plan to be taken with us in the event of hospital transfer, but I think it would have been most useful if we'd transferred earlier (say, transferred care to an OB in advance of labor due to pregnancy complications, or transferred early in labor). As it was, we had only three hours total in the hospital before Mikko was born, and our birth plan never made an appearance. I don't think this was a bad exercise to think through, but it never fulfilled its purpose.
I was very skeptical of birth plans, in terms of whether hospitals would respect them, but lately I've heard several stories of hospital births that went well because of a well thought-out birth plan that was delivered to hospital staff and put on file in advance. So if you're planning a hospital birth, I do now wholeheartedly recommend creating and passing along a birth plan to everyone involved in the labor. If you're planning a birth center or home birth, it's still worth going through the process and having something prepared — and then actually bringing several copies with you to hand out if you transfer. Wow, we're not even one sentence in, and I've written a page o' comments. On with the plan…
We thank you in advance for attending our child's birth and appreciate your support and encouragement. Best to start off on a friendly note. We intended a home birth, and what follows is our ideal birth in a hospital setting. In an emergency, we will yield to life-saving interventions, upon the briefest of consultation. We're reasonable, see? Otherwise, we ask that you refrain from interventions, seek informed consent for any procedure, and accommodate our preferences below.
ROOM ENVIRONMENTI will be performing various techniques of self-hypnosis. Start with the weirdest thing first, and bold it. I would like:
- To bring soft music
- To dim the lights
- To ask that the staff kindly use a low voice, avoiding references to "pain," "hurting," or "hard work" and not offering pain medication
- To address questions to my partner or midwife when I am focusing inwardly
- Only my practitioner, nurse, and guests present Ha. I'm pretty sure there was a circus in the hospital room with us. This is one of those hindsight things where I wish I'd had the wherewithal to clear out about half the people milling around and distracting me.
- My attendants allowed to stay with me at all times: Sam (partner) and midwives [Names] and/or midwifery students (as doulas) Our attending midwife and the students were indeed allowed to stay on in a doula function. The midwife had specifically chosen this hospital and the nurse-midwife practicing there (we drove past a nearer hospital to get there) because it was homebirthing-friendly in terms of not regarding transferring home birthers suspiciously.
- To eat if I wish to I did at home, but this wasn't an issue by the time I got to the hospital.
- To stay hydrated by drinking fluids instead of having an IV This ship had also sailed. I'd thrown up so many times that I was seriously dehydrated, and getting more IV fluids was one reason we transferred. I wouldn't be surprise if water was available to me, though, but I couldn't keep anything down.
- To have a heparin or saline lock if needed It was needed, so I had one. Fortunately, one brilliant nurse was able to find the one vein that could still be found and fix that needle in place with about a roll of tape.
- To move around and assume positions as I choose Hmm. Well, yes but mostly no. With the monitoring belt, I couldn't go anywhere but the bed. I tried hands and knees for awhile, but it was messing with the stupid belt getting a good reading. I really hated that belt. That said, I wasn't forced to lie flat on my back or use the stirrups — although I did end up in more of a reclining position and the stirrups came in handy. Who knew.
- To use any equipment that might help my comfort, such as a birthing ball, birthing stool, squatting bar, and/or shower They laughed at me when I asked to shower — there wasn't one. There was a therapy tub, but I wasn't allowed in till after the birth. They did have a squatting bar that they were almost eager to bring out and set up on the end of the bed, as if to prove how helpful they were for natural birthers. It was kind of sweet and amusing. The problem with squatting, for me, was that I could no longer feel the contractions to push with them — the pressure was so intense in that position I couldn't stop pushing. I abandoned that method and they raised the back of the bed so I was semi-reclining instead.
- To use a birthing tub during labor I don't know how many birthing suites at this hospital had birthing tubs, if any, but ours didn't. I'm not sure what their policy was about water births, either.
- To record our baby's birth with still photographs and/or video No one stopped us.
As long as the baby and I are doing fine, I'd like:
- To have intermittent rather than continuous fetal monitoring Ugh. I was under the misapprehension that if you didn't have the type of internal fetal monitoring where they screw an electrode into your baby's scalp that any other, external fetal monitoring would be intermittent. For instance, the midwives used a handheld doppler at regular intervals to check in on the baby's heart rate (and all was well throughout the labor and birth). But the hospital had that stupid stretchy belt; I naively thought they'd get a pattern from it and then take it off, but no. They wanted it on constantly, and the nurse got agitated any time my movements disrupted the readings. If I were planning birth in the hospital or find myself transferring again, I'd be more insistent that they remove it once they'd gotten a baseline, and use it only for occasional check-ins.
- To limit vaginal exams I really should have insisted on this one with the midwives, and maybe put something in about Sam and me not wanting to know the numbers if we did have any. Hearing over and over that we were "only halfway" there was so discouraging. One reason I chose our current midwife (our former ones are on hiatus at the moment) was her hands-off approach to vaginal exams – she still hasn't done one on me, and she says with second-time moms she usually doesn't bother unless they request one when they're feeling pushy to make sure they're complete. At the hospital I was feeling pushy, so I actually needed the feedback of a vaginal exam, and the nurse-midwife's help at pushing some tissue aside to make me complete, so that was fine.
Please allow our birthing to proceed naturally, in the absence of complications:
- Without restriction to time
- Without artificial oxytocin That was actually the other main reason we had transferred, to try to augment the long, slow labor. As it turned out, though, we didn't have time. Phew.
- Without artificial stripping or rupturing of the membranes The midwife did this at home, as a last-ditch effort to avoid transferring. Next time, I'd like to avoid it and even the thinking that terms interventions as "last-ditch efforts to avoid transferring." I'd like to remind myself that staying put is always easier than leaving, so this time: Stay put, Lauren.
When it's time to push, I'd like to:
- Push instinctively, using positions I find effective. Please do not direct me in how to push unless an emergency arises. I need to rewatch my birth video. I don't remember any coaching on how to push, just encouragement to keep it up. The nurse-midwife was solicitous of making sure I was pushing only when contracting. It all felt very instinctual to me.
- Allow the pushing stage to progress free of stringent time limits
PAIN RELIEFI will be using the following pain-management techniques:
Please don't offer me pain medication or inquire about my level of pain.
VAGINAL BIRTHI'd like:
- The room to be as quiet as possible Yeah. No.
- To have no episiotomy — I would appreciate warm compresses and olive oil massage of the perineum if needed No episiotomy. I know the nurse-midwife was supporting things with her hands, though I don't remember any special compresses or massage.
- My partner or me to "catch" our baby when possible. This did not happen. Is this even possible in a hospital? If not, please do not pull on the head or use forceps or vacuum extraction except in emergency. That part was fine.
After birth, I'd like:
- To hold my baby right away skin to skin, putting off non-urgent procedures This did happen, and I was pleased.
- To breastfeed as soon as possible Yup. My midwife, who is also a lactation consultant, was there to remind us all to give it a go right away.
- To wait until the umbilical cord stops pulsating before it's clamped and cut The hospital collected the cord blood for their own use, which was fine with me, but it made me nervous that they weren't waiting till the cord stopped pulsing. My midwife assured me, though, that it had stopped. I was the one who got to cut it, which seemed nicely symbolic to me — setting my baby free. Assuming no one's collecting the blood this time, I'd like to wait longer to be sure the baby's finished using the cord.
- To deliver the placenta without the use of traction unless a complication arises. A pitocin injection is allowed if needed. The placenta came out easily enough (like birthing a jellyfish), but it was so big — the size of a triplet placenta — that pitocin was needed, along with other measures.
C-SECTIONIf a c-section becomes necessary, I'd like:
- My partner present at all times during the operation
- The screen lowered a bit so I can see my baby coming out
- Regional anesthesia (an epidural and/or spinal block as needed)
- The baby given to my husband immediately if in good health
- To breastfeed my baby in the recovery room
POSTPARTUMAfter delivery, I'd like:
- All newborn procedures to take place in my presence They were all done in my room. I'd have liked it even better if they had been done on the bed where I could see. I kept having to reiterate my wishes to, say, skip the Hep B vaccination, and that made me nervous.
- My husband to stay with the baby at all times if I can't be there
- I will breastfeed exclusively
- Please don't offer any bottles, pacifiers, artificial nipples, or artificial formula Well.
- I will feed my baby on demand
- The baby will be rooming in with me 24 hours To their credit, the hospital not only allowed rooming-in as the norm but turned a blind eye to cosleeping.
- If our baby's a boy, we do not want him circumcised. Fortunately, I did not have to fight this.
Thank you so much for your respect and care during our birthing.
[signed by both Sam and me]
Home Birth Plan for Lauren Wayne & Crackerdog Sam
- We'd like to give birth at home. (Might as well start with the obvious.) We will set up the bedroom for that purpose.
- I will be performing Hypnobabies birth hypnosis. I'd prefer a quiet environment with my hypnosis tracks or soft music running in the background and dim or natural lighting. Please allow me to focus inwardly during contractions and avoid references to pain. (I'll just say I feel silly insisting that other people use the Hypnobabies terms of "pressure waves" and "birthing time" instead of "contractions" and "labor," but I will do so in my own head.)
- Sam will be present with me throughout the labor as my birth partner. I don't require the continuous presence of other attendants, though I am open to intermittent monitoring and conversation as I'm able.
- We plan to have Mikko downstairs with his aunt (this is what we've finally decided on as our first preference, after a lot of talking through the options and discussing it with Natalie and having her clear it with her employers), although we'll make alternate arrangements if needed. Mikko is free to be present in the room with us or not as he wishes. He's indicated a preference to steer clear of the birth, so we're respecting that. Natalie has a tendency to become, unconsciously, very loud and converse and play boisterously, so anyone is free to remind her to keep things low-key as needed. We will leave out several quiet activities for Mikko to do, and Natalie is free to take him outside as well if either of them needs the break, or to put him to sleep in the other bedroom. (This is assuming we clear enough space in there for a mattress! Eep.)
Last time I had a great deal of back labor, and Sam provided counterpressure on my lower back throughout each contraction. If the same happens again, I'm sure he'd appreciate temporary spelling of his duties if someone else would like to step in from time to time to allow him a rest.(Sam says this isn't necessary to include — that he can ask for help if he needs it. I was trying to be nice, but apparently he's tougher than I would be in the same situation.)
- I'd like very few if any vaginal exams, and would not like Sam or me to hear any of the numbers, unless I'm confirming that it's time to push.
- I plan to eat and drink during labor. However, last time, I could not keep any food or drink down and needed several bags of IV fluids. I have veins that are hard to find in the best of circumstances, and which can be nearly impossible to locate when I'm dehydrated. If the same situation seems likely to present itself, I'd appreciate a heparin lock placed as soon as possible so that I'm free to move around between IV sessions as needed.
- I intend to use a birthing tub (either my own or the midwife's rental — we have to talk about this at the appointment today) during labor. I am open to having a water birth but will consider my own preferences at the time. Due to our small water heater, we will likely need help keeping water heating on the stove, electric kettle, and crockpot to add to the tub.
- I would strongly prefer not to transfer to the hospital this time except in case of emergency. Even if the labor seems long to you, please don't suggest a hospital transfer unless I convey to you that I am in distress, or birth monitoring indicates an emergency situation.
- I am receptive to intermittent doppler or stethoscope checks of the baby's heart rate, and intermittent monitoring of my blood pressure.
- We would love any photos or videos of the labor and birth. There are no angles I'd feel uncomfortable having photographed or filmed. We understand you have jobs to do and don't expect anyone to be dedicated to providing photography services for us, but we will have our cameras out and free for use if we're too busy to record anything. Anyone who wants can take as many pictures as desired (including of yourselves!). (We took no pictures of the midwives or hospital staff last time!) We hope to set the video camera on a tripod to make it hands-off, but the still cameras will need manual operating. (We were so alternately focused and discouraged during labor with Mikko that we took almost no photos. I was so happy after the fact that the midwife and one of the students shanghaied our cameras in the hospital [where they were acting as doulas at that point] and took copious photos and video of the birth. Otherwise, we seriously would have had nothing! I know it's not the midwives' job to take pictures, but I do hope somebody will feel the shutterbug urge if we forget again.)
- I'd like the freedom and encouragement to change positions frequently during labor, including going on walks, taking showers, bouncing on the birth ball, slow dancing with Sam, etc. I'd also appreciate suggestions for pushing positions if I need them.
- I would like to push instinctively and as gently as possible. I'd appreciate support of the perineum if needed, but it's not required if things are going smoothly without.
- I might like to assist in catching the baby if possible and if I feel comfortable with it. I would appreciate support and direction, however.
Please don't announce the sex, as Sam would like to announce our new baby's name.(This was Sam's idea last time, but Sam says he doesn't care so much this time. Never mind.)
- Sam would like to cut the cord after it stops pulsating.
- I plan to hold the baby skin to skin and breastfeed as soon as possible after birth. (Side note: Oh, my gosh, we're having a baby! Oh! Sometimes I forget that part.) We'd appreciate a continuation of the peaceful environment. Again, Mikko is free to come to us to meet his new sibling as he wishes. (And, again, Natalie will likely need to be reminded to keep it down and back off from stealing the baby away. Sigh. I won't direct the midwives on that one — I'll just put it in my list-of-things-for-Sam-to-do.)
- I am open to vitamin K being administered to the baby. In the absence of any risk factors (of which there are none currently), I'd rather the baby have no other post-birth interventions.
- I had a great deal of postpartum hemorrhaging last time. I'd like assurances that there are adequate preparations and supplies for stopping postpartum bleeding, and I am open to any measures that are necessary, including uterine massage, pitocin injection, suppositories, and other methods.
- I'd love for the weighing and checks of the baby's wellbeing to be done next to me on the bed if possible.
All right, that was kind of a lot, but I really am quite flexible about the specifics of how the birth will go. I figure it's worth thinking things through and writing them down while I'm still coherent!
I don't think I'll present the above as a formalized plan to the midwife unless she requests it, but just write the suggestions down and discuss each one with her at the appointment.
Beyond that, I'd keep the same birth plan as Mikko's for another hospital birth, but I'd add some pain-management techniques, put in language that I don't want to know the results of any vaginal exams, change the language about Sam or me catching the baby, and change the wording of "we do not want him circumcised" to "we wish for our son to remain intact" — not for political reasons, but because I was nervous even at the time that someone would glance over and see the word "circumcised" and miss the bolded "not." And just, in general, I would like to be a little more insistent. You know, actually follow the birth plan.
Well, we'll see. The best-laid plans of birthing women and all that…
I wrote this yesterday as I was doing the "homework" for my appointment and did end up turning in the preferences and going over them all with my midwife. The responses I received were illuminating, to say the least, so more on that tomorrow!
Did you or will you have a birth plan, and how did it work out? What do you think are the essentials to include, and what's not worth the bother?