Here is a list of some things to you might want to consider when preparing your birth plan. Please remember a birth plan is no a list of demands, it should be viewed as a wish list, or a loose set of guidelines of thing that you would like to have, or not have, in order to personalize the birthing experience for you. The birth of a child is something you will remember forever and reflect on as each birthday passes. Birth plans should be kept simple, and brief. No longer or bigger than an 8.5x11 sheet of paper, printed on one side.
Environment:
Dim Lights, Peace and Quiet, Music, Wear my own clothes, Minimal vaginal exams
Freedom of movement
Maintain complete mobility (Walking the halls, rocking, up to bathroom, sitting on the birthing ball), Freedom to move in bed only (up to the bathroom), Mobility not important (catheter, used with regular epidural)
Hydration & Food:
No restrictions on fluids (clear fluids like 7-Up, Ginger ale, Gatorade, water, sparkling mineral water),
Ice Chips/Popsicles, Heparin/Saline Lock or IV (May be required to administer antibiotics, pain meds, or other medically necessary drugs), would like to be able to snack on small simple food items to keep my energy up(energy bars like Luna or Tiger bars, crackers, grapes, etc)
Monitoring:
You may choose intermittent or continuous monitoring.
Intermittent Monitoring
Doppler (handheld unit), Fetoscope, External Electronic Monitor (usually you will be hooked back up every hour for a period of 15-20 minutes if you are doing intermittent monitoring)
Continuous Monitoring
External Electronic Monitor, Internal Electronic Monitor (this is a small electrode that is attached to the babies head internally. This requires your membrane to be ruptured and will require you to remain in bed for the duration of your labor.)
Pain Relief Offers:
Trying for drug fee, Only if I ask, Offer if uncomfortable, My partner/doula will advise you if I want them, Offer as soon as possible
Pain Relief Options:
Doula & Partner support, Relaxation, Positioning, Water (Shower or tub), Heat or Cold Therapy, TENS therapy, Massage,
Acupressure,Hypnosis, Laughing gas (not all hospitals offer this as an option)
IV pain medication
Stadol, Nubain, Demerol, other
Spinal Block, Walking epidural (not many hospitals offer these anymore), Classical Epidural
General Anesthesia (Extremely rare now for a vaginal birth)
Induction/Augmentation:
Induction: Natural Methods (Walking, nipple stimulation, sex, etc.), Prostaglandin gel (Recommended if you have an "unfavorable cervix."), Pitocin IV Drip (Pitocin is a synthetic oxitocin hormone to strengthen contractions. Contractions brought on by the administration of Pitocin are typically much more painful than 'natural' contractions.), Amniotomy or AROM (breaking your bag of water), Herbal Inductions (Cohoshes, etc.)*** I personally do not recommend the use of Herbal tinctures unless you are personally familiar with how your body responds to them. They may cause GI distress and diarrhea which can lead to sever pain and dehydration. Consult with your physician before taking anything.***
Cytotec (Oral or vaginally inserted tablet.) *** This drug has many very dangerous side effects and I personally would not recommend using this drug for labor augmentation. I would consult with your physician and ask about a Prostaglandin gel/Pitocin combination if labor augmentation is required.***
Augmentation
Walking
Nipple stimulation (Nipple stimulation releases natural oxytocin which will produce contractions.), Amniotomy or AROM (Breaking your bag of water), Striping your membrane (done in the last week of pregnancy at your prenatal visit.) This can be a very effective an minimally invasive way of helping to get labor started.
Pushing/Delivery
Choice of positions (Certain positions are better for encouraging a baby to come down.)
Prolonged Length (There are still "time limits" in some places, where you will have a cesarean/forceps delivery if time is up.), Spontaneous Bearing Down, Directed Pushing, Prefer to use people for leg support (As opposed to stirrups or foot pedals.), Foot Pedals (These are at the foot of the bed and allow you to sit up straight while pushing, as opposed to laying back with the stirrups.), Squat/Birth Bar, Stirrups (Used in long second stages and with epidurals.), Birthing chair, I would like a mirror to watch the baby be born
Delivery
I would like to reach down and pull my baby out, my partner would like to 'catch' the baby if the cord is not around neck, finding out the sex -- we have been waiting to find out the sex of our baby until after delivery -- please don't announce it when the baby delivers, we want to discover it for ourselves.
Perineal Care:
Episiotomy, Pressure Episiotomy (Done without anesthesia, although you cannot feel it due to the pressure from the baby's head.), Prefer No Episiotomy (Massage, compresses, positioning, to avoid tearing, perineal support to allow gradual stretching), Prefer to Tear (Massage, compresses, positioning), Local Anesthesia (for repair)
Baby Care
Cord Cutting:
Immediate (Sometimes done because the cord is around the neck or because the parents have no preference.)
Delayed (Some parents prefer that the cord not be cut until after it has stopped pulsating so that the baby receive all of the blood from the placenta.), Partner to cut cord
Eye Care:
None (In some states it is the law, in others it isn't, or if you sign a waiver.), Delayed (Most parents prefer to have the procedure delayed until after the initial bonding time is over, so that the baby can see clearly. It also depends on the types of medications used.), Immediate
Feeding Baby:
Breast feeding only (please do not offer any pacifiers or artificial nipples, this includes sweeties and glucose water), Would like to meet with the hospital lactation consultant, Bottle feeding only, Combination feeding, No pacifiers or glucose water
Separation:
None, Delayed (after recovery period), Partial Rooming-In (Baby with mother during day, but not night.), Nursery (baby brought to you on your schedule. This can interfear with maternal-infant bonding and can be detrimental to establishing milk supply which is accomplished with on-demand feeding)
Circumcision:
None, Do not retract the foreskin, In the Hospital, Parents Present, Use anesthesia (Depends on the practitioner), Our pediatrician is going to perform it at our first apt., our Rabbi is going to perform it, etc.
*** I have witnessed two circumcisions and I would highly recommend allowing your doctor or pediatrician to administer local anesthesia (Novocaine type) before performing a circumcision on a baby boy and waiting at least until the first 24 hours has past. The use of numbing gel as the only source of pain relief is not very effective. ***
Other Baby Care Requests
Footprints taken for baby book, mom/dad would like to give baby first bath, Baptism by family priest or hospital Chaplin
Delay of all noncritical measures (this includes apgar, weight and measurements, PKU, eye antibiotics, vitamin K shot, HepB shot) This option of immediate postpartum skin to skin contact for the first hour postpartum is known as (kangaroo contact.) Research has shown the first hour after birth of uninterrupted care is crucial to maternal-infant bonding both physically and emotionally and allows infant to start breastfeeding right away.
Complications & Cesareans
Should an emergency arise and a Cesarean Surgery become necessary I would like:
Spinal/epidural anesthesia, General anesthesia, Partner Present, Doula Present, Video/Pictures, Screen lowered to view birth, Description of surgery, Touch the baby, Partner to cut cord, Breast feeding in recovery room
If my baby is sick and needs to go to the NICU I would like:
Breast feeding as soon as possible (if my baby is unable to breastfeed I would like arrangements for a breast pump so I can begin pumping my milk for when my baby is ready), Unlimited visitation for parents, Handling the baby (kangaroo care, holding, care of, etc.), If baby is transported to another facility my husband/partner accompany the baby
