Unmedicated Birth Plans for Hospital Birth

rubylovebug

I've done some looking around the board & haven't found a recent post on this, but if you know of one, please point me that way!

I'm 37 weeks pregnant with our first baby (a girl!) & we're planning an unmedicated birth at a hospital with a doula & HypnoBabies prep.  I was wondering if anyone had a birthing plan that they would like to share or if anyone has any recommendations on what we should add / take out of our current plan (below).

Any help or advice is greatly appreciated!

Our Baby Girl: Elliana Judith!

My birthing team: My husband & our doula

Thank you for helping us with our birthing and for taking the time to read our birthing preferences!  I am planning an unmedicated & joyful birth.  I’m a first-time mom &, although I am a little anxious, I’m also excited, hopeful, & determined. We appreciate & welcome all encouragement!

We understand that no one can predict everything that may happen over the course of labor & that that unforeseen situations may arise that could require changes to our preferences.  We sincerely appreciate your help in achieving the most natural birth possible under whatever circumstances arise.  Please allow us time to discuss and question medical interventions, unless it is an emergency.

During birthing time:

•       Please help us maintain a positive environment in my room. I’ll need to focus on my can-do attitude! Encouragement is welcome!

•       I have taken a HypnoBirthing class, but I’m open to anything you can suggest to help labor along naturally & for pressure management. I trust your experience!

•       Please gain consent or consult with us prior to any medical interventions.

•       Please refrain from offering me pain medication or asking me what my level of pain is.

•       I prefer a saline or hep-lock instead of an IV.

•       Intermittent monitoring is also preferred & has been approved by our doctor.

During Pushing:

•       I would like to push in whatever position feels right at the time.

•       I prefer my pushing to be intuitive, rather than directed with counting.

•       Perineal massage and other natural methods for helping baby out are welcome & appreciated.

•       I prefer to tear naturally rather than receiving an episiotomy.

•       I appreciate your patience for spontaneous detachment and birth of the placenta.

§   We are encapsulating my placenta, please do not let it leave our delivery room.  We have a cooler on hand to take it with us

If stitches are required, I am not opposed to local anesthetic after baby is born.

After Birth (with Elliana):

•           I would like immediate skin-to-skin contact with Elliana after birth.

•           Postpone all healthy newborn procedures (measurements, vaccinations, etc.) until after bonding / breastfeeding are established.

•           We would like clamping/cutting of the umbilical cord to be delayed until it has stopped pulsing.

§  We would like to bank any remaining cord blood left in the cord AFTER it has stopped pulsing.  Our kit is with us in the delivery room.

•           We would like to decline Elliana’s bath on the day of her birth.  We will bathe her tomorrow in the bathing class.

•           We would like non-separation & for Elliana to be in our room at all times.

PoppySeedWindsor

It looks pretty good to me. I am going over mine with my OBGYN this Thursday and will happily share what we come up with. 

One thing that kinda stuck out to me about yours -- I'm not sure how familiar nurses will be with hypnobirthing (or other natural birthing methods) so I wouldn't rely on them understanding what it means/what you want/etc. 

I know for mine (We're doing Bradley Method) we are being super specific about everything we want and don't want. One of the questions that my teacher/coach/mentor told my husband to ask the nurses/doctors when they want to do something is whether or not what they'll do will change the course of how things are progressing or if it will benefit me or the baby. If it's not going to, there's no need for it (it being extraneous check ups or any medications). 

I'd also make sure you're super specific about how you're going to work through pain management. PROVE to the hospital you've got everything covered and do NOT need any of their medical interventions. I think you'll feel way more empowered and in control of your labor.

How exciting!

Cheers.

macof3

HI, Im  new to this board but your post drew me in b/c we JUST had a childbirth class with our MW this past weekend and discussed birth plans.  You should also list any allergies you have.  Dont know what research you have done about perineal massage but our MW suggested saying that you would like Mineral Oil while pushing rather than the massage.  The massage could cause swelling with the continuous motion and may not help with the stretching necessarily.

Otherwise, my MF also suggested going over it with your OB or MW at your next appt to make sure there isnt anything missing that they would recommend.

I need to get started on mine now!

cecilyandgautam

One tip I was given: keep your birth plan to one page. Practically speaking, the birth team likely won't have time to read (or remember) more. A lot of hospitals now have delayed cord clamping as the default practice, so confirm with your practice & on the hospital tour - you may find you don't need to take up space on your birth plan with things they're going to do anyway. 

We had 3 versions of our birth plan and just handed over the version that was most relevant when we arrived. Version 1 - things are going well, most of our wishes can be safely accommodated. Version 2 - some kind of complication in which case we'd agree to an intervention we otherwise were planning to avoid, like an epidural, or continuous monitoring. Version 3 - emergency c-section, in which case I wanted a "family friendly" one, the opportunity to have face-to-face snuggle time with the baby asap, to keep baby in the room (assuming she doesn't need to go to the NICU), etc. 

I figured we didn't need to bog the nurses down with our wishes for every possible outcome so just handed over our wishes that were relevant to the situation we found ourselves in. Each version was one page or less. 

aylafsu88

cecilyandgautam said:

One tip I was given: keep your birth plan to one page. Practically speaking, the birth team likely won't have time to read (or remember) more. A lot of hospitals now have delayed cord clamping as the default practice, so confirm with your practice & on the hospital tour - you may find you don't need to take up space on your birth plan with things they're going to do anyway. 

Yes. When you arrive there is a lot for the nurse to do and the last thing she has time to do it read pages of a birth plan. Keep it to one page with simple concise sentences. Also, everything after LO is born does not need to be in the birth plan. As long as your H is aware of what you want he can advocate for your LO if you cannot. Most of the times the  nurse that does the bath/procedures/vaccinations is different than your delivery nurse. So your delivery nurse does not really need that info.

Also, I do not think you need the part about local anesthetic for stitches. The OB/MW will sew you up and they will let you know that they are about to inject the anesthetic. 
Also when you check into the hospital you can request a natural birth friendly nurse.  I did and ended up with a great nurse.

sschwege

It looks good, but I would trim it down.  Your goal is to have your plan be read and remembered by staff who may be very busy.

Here are some ideas:

I would eliminate those first two paragraphs, and just say something like, "Our goal is a low-intervention birth, thank you in advance for your careful attention to our wishes"

I think those first two bullets can be condensed to one short statement something like, "We will be using Hypnobirthing and request your help in keeping our environment calm and encouraging." 

I would check with your practice and see what their stance is on episiotomies, if they only do them in urgent situations, that can be left out.

I would also leave out the part about stitches, they should know to numb you up beforehand, but if they don't you can always tell them to.

Other than the part about immediate skin-to-skin, I would leave off the rest about baby care.  You can always express your wishes later or you husband can.  

Have you considered writing a separate c-section birth plan just in case?  I did it the second time around, fortunately it just collected dust in my chart, but I was glad I made one just for the piece of mind. 

cmb2

Hi! Just went over my birth plan w/ my midwife last Thursday and mine is super similar to yours (fellow M14 mom!).

She said to leave everything as is, and the nurses always take time to skim over it (or you could always make slightly shorter bullets rather than whole sentences). She also said it doesn't hurt to have some things in there, even if they're standard practice, for just in case.

Also, it was suggested to me to go ahead and add info for in case of a c-section.

I'm using hypnobabies as well and I think their info sheet for the nurses is a little wordy - but I planned on adding a short bit of information regarding the different phrasing to use - "pressure" vs. "pain" etc.

PoppySeedWindsor

sschwege said:

It looks good, but I would trim it down.  Your goal is to have your plan be read and remembered by staff who may be very busy.

Here are some ideas:

I would eliminate those first two paragraphs, and just say something like, "Our goal is a low-intervention birth, thank you in advance for your careful attention to our wishes"

I think those first two bullets can be condensed to one short statement something like, "We will be using Hypnobirthing and request your help in keeping our environment calm and encouraging." 

I would check with your practice and see what their stance is on episiotomies, if they only do them in urgent situations, that can be left out.

I would also leave out the part about stitches, they should know to numb you up beforehand, but if they don't you can always tell them to.

Other than the part about immediate skin-to-skin, I would leave off the rest about baby care.  You can always express your wishes later or you husband can.  

Have you considered writing a separate c-section birth plan just in case?  I did it the second time around, fortunately it just collected dust in my chart, but I was glad I made one just for the piece of mind. 

That might not *always* be true. I was asked by my OBGYN during my 30 week check up what anesthesia options I wanted and that was one of them. While he made note of it in the system, he also suggested that I put it in my birth plan. 

Everyone's suggestions are great though and I'm definitely taking note. 

Out of curiosity, has anyone used the template provided by the bump?

cecilyandgautam

PoppySeedWindsor said:

Out of curiosity, has anyone used the template provided by the bump?

Well, I give TheBump credit for updating the list they had two years ago. Looks a lot more modern and with a wide variety of options included. I think it's a good exercise for you to go through but I wouldn't turn that 6 page document over as your birth plan. Decide your priorities, then efficiently present them on one page - skipping over the stuff that's your hospital mandates any way (like immediate skin to skin unless baby needs meconium suctioned out, for example - mandated policy at my hospital).

stephl3055

I would probably take out the first two paragraphs.  When I was going through your birth plan I automatically skipped over that part and got down to the details.  Also, some of it seem a bit more wordy than necessary. 

Here is my birth plan, just for reference (ours seem similar):

Please note –
• I am RH negative (O-) and received the Rhogam shot around 28 weeks
• I have gestational diabetes that is diet-controlled
• I am allergic to sulfa
• I have vasovagal syncope and have fainted in the past due to low blood pressure

Attendants –
• DH
• Doula

During labor I would prefer –
• Not to be offered any pain medication; I will ask if I feel I need something
• Not to have labor augmented (ex: breaking my water, stripping my membranes, or Pitocin)
• Minimal internal checks (once at arrival and once prior to pushing)
• To drink and/or eat as I choose
• No IV; I am open to a heparin lock if required
• To move, walk around, or shower as I choose
• Intermittent external monitoring; no continuous electronic fetal monitoring

While pushing/during delivery I would prefer –
• To push/deliver instinctively and in whatever position I feel most comfortable (ex: not on my back) 

• To avoid an assisted birth (vacuum or forceps)
• To tear naturally as opposed to getting an episiotomy
o If I do tear, I would prefer a numbing agent be applied prior to getting stitches

After delivery I would prefer –
• To wait until the umbilical cord stops pulsating before cutting it
• DH to cut the umbilical cord
• Immediate skin-to-skin contact (I wish to put off any medical tests for the baby that aren’t urgent)
• Breastfeed as soon as possible
• To deliver the placenta spontaneously, without any manual intervention or drugs

Postpartum I would prefer –
• My husband or I should be with the baby for all procedures or tests
• No formula, sugar water, or a pacifier should be given to the baby
• Guests are not allowed in our room until I say I am ready for them

kindacrunchy

I agree with the others about trimming it down a bit. To be honest I didn't even read all of that first big paragraph, sorry.

Also, you will have to decide between delayed cord clamping and cord blood banking. We had extensive conversations with our Dr about this last time and I did a bunch of research and it is one or the other, you can't do both.

cecilyandgautam

scooter028 said:

Have any of you put anything about pitocin after the placenta is out in your birth plan? That's one thing my OB it's insistent on.

This is a good point. The pitocin for delivering the placenta is meant to deal with hemorrhage but most women don't need it - I think about 1/4 of the women in the practice I'm with get it. I'd put that I agree to it *if* I'm hemorrhaging, but otherwise not. 

fyi - even the home birth midwives in my neighborhood carry pit around with them for this exact reason. They don't administer it while you're in active labor but they can administer it to treat hemorrhage if that comes up. 

margaritachikita

As PP's said, I would discuss it with your doctor, and trim it down to reflect your specific hospital's policies/procedures. Find out what is routine or not routine, then you can adjust your plan accordingly. 

Also, I would change this sentence:

"Please allow us time to discuss and question medical interventions, unless it is an emergency."  --Instead of "question", I would use "understand" or something like that -  using "question" may cause them to prickle because they think you are questioning their decisions. 

Overall, it looks great! Best of luck for a wonderful birth!!!

rubylovebug

Thank you everyone for all of the great suggestions!! We incorporated a lot of them into our birth plan, especially making the language as friendly as possible.  We spoke with our doctor about it on Friday (with your comments added in) & she was very happy with it.

For those who recommended doing a back up plan for a c-section, what are things you would put in it?  Obviously a preference to be awake & not fully under, still immediately placing the baby on the chest, having my partner in the room - all of those are standard at my hospital.  I was just wondering if there was anything anyone would add.

The one thing I do want to note is that there is no reason you can't attempt to delay clamping as well as bank cord.  We've also done considerable research, spoken with our bank, & our doctor - we've made the choice that delayed clamping is more important to us, so our preference is on delayed clamping.  However, banks have certain cell amounts that they would need to consider a sample "viable" (for example, 100 million cells).  Average samples include 4x as much, so delaying clamping by 60 seconds should still provide a viable sample - & even if it doesn't, the only costs incurred (at least with our bank) is for delivery ~$150.  We also get to make the final decision on whether we want to bank the sample regardless of size (who knows what will be able to be done with even 1 million cells in the future) or facilitate it's donation.

ETA: Adding C-section question.

sschwege

AMarinucci said:

Thank you everyone for all of the great suggestions!! We incorporated a lot of them into our birth plan, especially making the language as friendly as possible.  We spoke with our doctor about it on Friday (with your comments added in) & she was very happy with it.

For those who recommended doing a back up plan for a c-section, what are things you would put in it?  Obviously a preference to be awake & not fully under, still immediately placing the baby on the chest, having my partner in the room - all of those are standard at my hospital.  I was just wondering if there was anything anyone would add.

The one thing I do want to note is that there is no reason you can't attempt to delay clamping as well as bank cord.  We've also done considerable research, spoken with our bank, & our doctor - we've made the choice that delayed clamping is more important to us, so our preference is on delayed clamping.  However, banks have certain cell amounts that they would need to consider a sample "viable" (for example, 100 million cells).  Average samples include 4x as much, so delaying clamping by 60 seconds should still provide a viable sample - & even if it doesn't, the only costs incurred (at least with our bank) is for delivery ~$150.  We also get to make the final decision on whether we want to bank the sample regardless of size (who knows what will be able to be done with even 1 million cells in the future) or facilitate it's donation.

ETA: Adding C-section question.

Here's a good link to an example of a c-section birth plan:

https://birthwithoutfearblog.com/2012/09/18/a-family-centered-cesarean-birth-plan/

The main thing for me was I wanted my uterus to be closed using a double layer stitch.  There is some evidence that suggests it might make a VBAC safer, though I've also read that might not be the case, something to discuss with your provider.  My MWs seemed to support the double layer stitch as a better option, but that was 2ish years ago, things change so quickly it's a good thing to read more about.  I think the other thing I would request is to have one arm free to touch my baby.  They generally will 'restrain' your arms in a c-section.  It's not as bad as it sounds just a way to remind you not to move your arms during the procedure.  But I would request they leave at least one arm free if possible.

By the way you are correct it is possible to do both banking and delayed clamping, though if banking is top priority it should not be attempted since there is a chance there will not be enough.  For DD we did delayed clamping and were also able to donate, so it is possible to do both. 

rubylovebug

@sschwege - Thanks so much!  I really need to look into c-sections more, I had no idea there was so much to think about & what great suggestions for inclusions!