Calling for Birth Plan Thoughts!

In article ,
Larry McMahan wrote:

I don't know how much hlep this is going to be, but here is a copy of
Monika's birth plan. since it is written "bullet" style, maybe you
will find silver one among them. :-)

I'm more surprised at what you had to include! Enemas, shaving, choice of
clothing, position for delivery, ambulation, circ, silver nitrate, suction,
roooming-in and so on are non-issues here, AFAIK. I think there were only one
or two vaginal exams during my labour (the mw preferred to go by demeanour),
and consent was obtained for every procedure before it took place (apart from
the emergency stuff when I was unconscious).

That is not to say things are perfect here; my delivery hospital has a rule
that women whose waters break need to come in ASAP, which is certainly not
evidence-based (and was not policy at my last hospital). They exclude
children from the delivery rooms (not that I care, but some people might) and
don't like people eating anything substantial (in part because the rooms don't
have toilets, I think!). Juice, barley sugar and so on is fine.

Consent in the event of incapacity is covered by legislation here. I remember
signing a consent form for the Vit K injection, and possibly the Guthrie test
too.

Third stage here is interventionist (IM oxytocin, early cord clamping), but
that does have medical evidence behind it (and DHs may choose to cut the
cord/pray/whatever at this point). I wasn't conscious for it, so I don't know
if cord traction was used. Our hospitals tend to be reasonably BF-friendly,
though: SOP is to plant the baby on the mother after birth and cover them
both with a blanket. They ask you to specify feeding method ahead of time and
I was certainly asked when the staff felt DS needed supplementing on about day
3 for jaundice + dehydration. He must have been fed in the special care
nursery, though -- he was there about 12 hrs for *my* sake; the staff felt
that rest and quiet was the best thing for me. That's why I didn't go to ICU
despite the seizure; a mw stayed to monitor me in the delivery room instead.
I'm glad they did -- being surrounded by beeping machinery and other sick
people would *not* have helped!

I should mention that I didn't use a Birth Centre, but a standard maternity
unit in a small, old, low-tech suburban hospital. Some larger/newer hospitals
have Birth Centres where a home-style birth can be had, with technology just
up the corridor if anything goes wrong. A friend delivered all 5 of her
children in one of these and was very happy with the system.

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"In Melbourne there is plenty of vigour and eagerness, but there is
nothing worth being eager or vigorous about."
Francis Adams, The Australians, 1893.

Larry - I was interested to read Monika's birth plan - I'm so glad to
see such a well-thought-out contigency plan for possible hospital
transfer; the one woman I know who did have to be transfered was so
anti-hospital that she had refused to admit of the possibility of
going, and hadn't prepared for it at all.

That said, I have to say I'm even more pleased with the hospital where
I had ds, and the one where I will have #2 (2 different hospitals in
the same city).

Here's why:


I do not want to be shaved.

I do not want to have an enema.

Hospitals here won't do either of the above.


I want to labor in my own clothing.

I want the option to give birth nude.

No problem for either of these.


I do not want to have my membranes stripped.

I do not want to have my waters broken without my prior
consent.

Both of these will be suggested by the doctor only if she really feels
it might be helpful, and the mother's choice will be respected - I know
b/c I was offered the first and accepted; a friend of mine was offered
the second and declined it.


I want to eat light food and drink juices or water of my
choice at any time during the labor.

Hmm - clear liquids are fine; I was "snuck" food by the nurses at my
first birth. The hospital's policy is no food, but the staff are
rebelling and it is on its way out.


I do not want to be placed in the lathroscopic position (on
my back) for exams or at any other time during labor or
delivery.

I wish I'd thought of this the first time around - not for delivery,
but for exams. I'm sure if I'd mentioned it they would have been fine
with it.


I want remain ambulatory and labor in any position of my
choice. I want to give birth in the position of my choice,
including, but not limited to standing, squatting, or
all-fours.

No problem.


I do not want an episiotomy. I would rather risk a natural
tear.

Episiotomy is a bad word among the baby doctors around here.


I want my husband Larry N. McMahan and my midwife H
P to be with me during the entire labor and delivery.

We can have whoever we want present.


If I am incapacitated so that I am not able to give medical
consent, I want medical concent to be obtained from my
husband, Larry N McMahan before undertaking any medical
procedure.

They won't do anything w/o the woman's consent or, failing that
possibility, the birth partner's.


I do not consent to EFM (electronic fetel monitoring) at any
time during labor and delivery, except for cause and with
consent. All routine monitoring should be done with
fetoscope or doptone.

CFM is not generally done; even once I was on pitocin (my choice), they
got me rigged up with a portable monitor slung over my iv pole, so I
could continue to labour wherever I wanted to, go to the bathroom as I
wanted, etc.


I do now want to have routine vaginal exams to monitor
progress. Exams will be for cause and with consent only.

I am waaay too curious and was on board for a bunch of exams, esp. b/c
labour was taking so long.


I do not want to be prepped for IV (heparin lock inserted)
unless there is a medical necessity. This will be done for
cause and with consent only.

Routine approach is no IV unless required.


Pain relief medication will be administered with consent
only. If I want any I will ask. Please don't suggest it to
me.

The information package on the maternity ward expressly says medication
is not routinely administered and will not be offered to labouring
mothers, although it is available if we request it.


Absent other medical indications failure to progress will
not be considered a cause to induce labor. Induction will
be done for cause and with consent only.

This probably depends on the doctor, not the hospital, but my doctor
for #1 only suggested augmentation b/c of the growing risk of infection
(PROM) and the fact that I was near exhaustion. She never suggested I
was failing to progress, just that it was going slowly (and it was) and
that this would probably help (and it did). After mentioning it, she
offered me 2 or 3 more hours, both to consider what I wanted to do next
and talk it over with dh and doula, and to see if I would progress
enough that I wouldn't need it.


I do not want forceps or vacuum extraction to be used for
delivery unless there is a medical necessity. If necessary,
then consent must be obtained at the time.

Hospital policy not to use these unless it's an emergency.


I do not wish for cord traction to be used for removal of
the placenta. I also do not wish to have any drugs
administered without my permission in order to deliver the
placenta. I wish to use nipple stiumlation, primarily by
breastfeeding to encourage the placenta to detach and
spontaneously deliver. Any change to this point must be
done only for cause and with consent must be obtained at the
time.

I have no idea - I was so busy with the baby I honestly don't have a
clue what happened after he was out. Someone showed me the placenta and
I said, "oh," thinking, "so? BABY!!"

I consented to the pitocin shot in the thigh and will do so again, b/c
women in my family tend to be post-partum bleeders (and I'm no
exception - I saw the look on the doc's face right before she said,
"get another 50ccs of pitocin in that drip," and I saw the look on ds's
face when he saw the blood, too). But it is something you need to
consent to in advance.

If a Complication Requires a C-Section
--------------------------------------

I want my husband, Larry N. McMahan, and midwife H
P to remain with me in the operating and recovery room
before, during and after the procedure.

I want the procedure to be done using a local anesthetic
only, no general anesthetic.

I do not want to have a screen placed so I cannot see the
birth.

I want to hold the baby, and if possible attempt to
breastfeed the baby immediatly after the birth.

I want the baby to be seperated from me the minimum time
possible.

These are all in the hospital's policy statement on c-section; although
they acknowledge that very rarely general anaesthetic is necessary, but
that the mother's doctor will discuss this with both her and the spouse
in advance. I only know one woman who has had a c-section at either of
the baby hospitals here - and every mother I know here has had her
babies at one or the other, if they haven't birthed at home. That
c-section was an unnoticed breech. Even the two twin mothers I know had
their babies vaginally, which is apparently unusual for a lot of
hospitals.


Procedures Regarding the Baby -----------------------------


I want either myself, my husband, or the midwife to remain
with the baby at all times after the birth.

Hospital policy.


Absent medical complications, I want my baby to be examined
and his Apgar evaluated while he lies on my stomach.

Done with #1, will be done with #2.


Absent medical complications, I do not want my baby placed
in an isolette or on a warming table. I want my baby to be
held by myself or a family member at all times.

Standard practice is not to put baby on a warming table but first to
mom, then to dad, then back to mom to nurse skin-on-skin.


If my baby is a boy I do not want him circumsized.

Circumcision is not covered by health care or insurance here and must
be arranged later by parents and paid for out of pocket ($200 5 years
ago - not sure what the going rate these days is for a foreskin!).


I do not want the baby to be fed formula, glucose water, or
to be given a pacifier at any time after the birth.

Hospital documentation says they don't do this; they have banked bmilk
on hand, and they tell you to bring your own soothers if you want them,
since they don't provide them.

We had a lot of trouble in the beginning with bfing - the hospital
worked their butts off to help me, getting me a pump, teaching us to
syringe feed my pumped colostrum, providing the banked milk, bringing
in a LC; I was very impressed.


I do not want my baby to receive a vitamin K injection. It
may be given orally.

He got a shot. I didn't know at the time that an oral dose was
available - I'm going to ask my doctor!


I do not want my baby to receive silver nitrate eyedrops.
Erithromycin ointment may be given, but only after the first
two hours.

Erithromycin is given here, but you can opt out.


I do not wish to have my baby's airway routinely suctioned.
It will be done for cause and with consent only.

Quick suction is routine, but very cursory - ds ended up puking up gunk
he'd swallowed during delivery hours after being born . I don't have
trouble with it.


I do not want the baby's cord to be clamped before it has
stopped pulsating. Absent medical necessity, I do not want
the cord clamped or cut until after the placenta delivers.

I believe this is routine. They were in no hurry to clamp or cut with
ds.


If complications require the baby's hospitalization, I want
to breastfeed or express breastmilk to feed the baby. I do
not want supplemental feeding without consent.

I had a friend whose baby had to stay at the hospital, and she was
going in every x hours to bfeed. Generally, if possible, mom will be
kept at the hospital if baby must be kept in.


If complications require the baby's hospitalization, I want
to visit or stay with the baby at any time.

Understood as the only way to go.


If complications require the baby's hospitilization, I do not
want the baby to be fed by bottle. The baby may be fed by
gavage, cup, or syringe.

This is up to the parents, and syringe is preferred to bottle by both
hospitals.

My first birth plan greatly ressembled Monika's, although in some areas
I was less informed than she was, and my doctor slashed half of it out,
saying, "we don't do that! We wouldn't do that!" over and over again .
.. . gotta say so far I've had nothing but wonderful caring care from my
baby doctors!

Melania
Mom to Joffre (Jan 11, 2003)
and #2 (edd May 21, 2005)