Writing a Birth Plan

This week, in my mostly crippled state, I’ve set out to accomplish sitting-down goals.  Writing our birth plan is one.  I had a few resources from our birth class which were really helpful.  If you’re writing your birth plan, I would suggest finding some sort of template to use as your starting point, such as this one, and then personalizing your plan from there.

I considered reading the book “Creating your birth plan: The Definitive Guide to a Safe and Empowering Birth” by Marsden Wagner M.D, M.S. , but decided to just write it based on what I already know is important to me and my husband.  I’ve done enough research in the past few years and felt like more reading about possible interventions and things would be a little much at this point.  Plus, I had a difficult enough time fitting it all on two pages.  🙂

I tried to include the things that were most important to us for each stage of labor and delivery and also addressed situations such as cesarean section and NICU admission.  Those are my “just in case” sections so that if we find ourselves with a real emergency we can at least have peace of mind that the choices we can still make are written down.  I feel like the whole birth plan is an odd mix of things that apply to a home birth and things that don’t.  We’ll have to explain to our doula and midwife when we show it to them that we understand that most of our wishes are standard practice for a home birth but that we felt we needed to have some written record of what we want in case we should find ourselves in a different environment.

So, without further ado, here it is (names removed for privacy):

Birth Plan for the Family of (Me and My Husband)

Dear Birth Team- we are so thankful that we are able to take advantage of your care and expertise as we welcome our baby into the world.  We’ve put together a short summary of our wishes regarding labor and birth.  Thank you for helping us to have a safe and positive birth experience. 🙂

Basic Information

  • Birth Team
    • Midwife- (name and #)
    • Assistant Midwife- (name)
    • Doula- (name and #)
    • Family Support- (my mother’s name), (my sister’s name)
    • Desired back-up Doctor and Hospital– (name of Dr and hospital)
    • Maternal History– This is my first baby.  After years of personal research and study, I’ve chosen to give birth at home after a healthy pregnancy because I know that I will feel most comfortable in this environment and will be more likely to have a low-intervention labor and delivery. I realize that sometimes complications arise during birth that would necessitate being in a medical environment, but would prefer to remain at home if at all possible.

 

Starting Labor

  • We wish to allow labor to begin spontaneously before 42 weeks.  After 42 weeks, we would consider the use of natural home induction.  We do not wish to do a medical induction unless advised by (midwife).
  • If (my) water breaks before labor begins, we wish to allow labor to begin spontaneously unless (midwife) advises otherwise.

 

Environment

  • I highly value my privacy and would like to have only the members of the team listed above present while I labor. I prefer dim lighting, candles, soft music, and subtle pleasant smells.  During early labor I would like friendly conversation to distract me from contractions, but during active labor when concentration becomes more difficult, I would like to hear softer voices and more limited conversation.  I may or may not want music at this point, and I may not be able to tolerate a lot of physical touch stimuli or close physical presence, but I will appreciate knowing that attentive support is close by.  I may want to spend some periods of time alone with (my husband).
  • I wish to be able to freely eat, drink, and move about during labor.

 

Early Labor

  • If labor begins in the evening, I will attempt to sleep or rest.  If labor begins in the morning, I will go about my daily activities and may want to begin a predetermined “labor project”.
  • We would prefer to use natural stimulation for a slow labor: walking, nipple stimulation, etc. 

 

Pain Management

  • We do not plan to use an epidural or IV narcotics.  The only circumstances under which we would consider an epidural would be:
  1. Caesarean section (after all other options were exhausted)
  2. Extreme exhaustion rendering (me) unable to continue to labor and have a vaginal birth without the rest afforded by an epidural (this would need to be under the strong advice of Stacia and all other options would need to have been exhausted).
  • We would like to use natural pain management techniques such as: breathing, relaxation, changing positions, bath or shower, cold wash cloths, massage, counter-pressure, and visualization.  I would like to have access to a birth ball, a birthing tub, and a shower.  If the things I am instinctively doing seem to be working for me, I would like to be given space and verbal and/or physical encouragement to continue using them.  If I seem to be unable to find relief on my own, I am open to suggestions from my support team. 
  • I will very much appreciate and respond well to verbal encouragement and affirmation during labor, and do not want “negatives” such as the mention of drugs, passage of time, or hospital transfer to be a part of the conversation.  I believe in my ability to birth naturally, and knowing that my birth team believes in me as well will be extremely helpful. 

 

Approach to Additional Interventions

  • We would like to avoid interventions such as artificial breaking of waters, continuous monitoring, IV fluids, vacuum or forceps extraction, episiotomy, pain medication, medical labor augmentation, & cesarean section.  If interventions are recommended, we would like to discuss the consequences of choosing or not choosing the intervention.

 

Pushing Stage

  • I would like to push spontaneously and use positions that encourage my body to open.  I do not wish to push in the lithotomy position.  I would like the option for a water birth.
  • I am open to perineal support and/or lubricating oils and warm compresses to lessen the possibility of tearing.  I would like give my perineum time to naturally stretch around my baby. 
  • We would like for (my husband) to catch our baby for (me) or (my husband) to discover the sex of the baby.

 

Third Stage

  • We would like to allow the cord to cease pulsation and/or the placenta to be delivered before cutting the cord ([husband]would like to have the honor of cutting the cord). 
  • We would like to allow natural expulsion of the placenta.  Please do not dispose of our placenta as we wish to save it for encapsulation! 
  • I prefer local anesthesia for the suturing of any tears.

 

After the Baby’s Birth

  • We wish for our baby to be immediately placed on (my) chest for a minimum one hour of uninterrupted skin-to-skin contact, and all assessment and care during that time period to be delayed or done without removing the baby.  We would like for (me) and Baby to take an herbal bath.
  • We prefer natural expulsion of amniotic fluid and suctioning of mouth, nose, and deeper airways to be done only if medically necessary. 
  • I would like to be allowed to immediately begin breastfeeding if Baby is interested and do not consent to the use of formula.

 

Newborn Care Procedures

  • If our baby is a boy, we DO NOT wish to have him circumcised!
  • We do not give permission for antibiotics, vaccines, or a vitamin K injection to be administered to our baby.
  • We wish to use either an oral dose of vitamin K or to forego vitamin K.
  • We wish to decline antibiotic eye treatment for Chlamydia and Gonorrhea (I do not have these infections).
  • We would like to do the PKU test.

 

Rhogam

  • (My) blood type is O- and (my husband’s) is O+
  • We would like to test Baby’s blood type and, if Baby is O+, do a Kleihauer-Betke test.
  • If the Kleihauer-Betke indicates blood mixing, (I) will have the Rhogam injection.  If no blood mixing is indicated, (I) will decline Rhogam.

 

For a Cesarean Birth

  • We wish to reserve cesarean birth as a last possible option and want (my husband) to be present during the operation.
  • We would like minimal drugs (epidural only).
  • Following a cesarean birth, we wish for our baby to be warmed by skin-to-skin contact with (me) or (my husband).  We want (my) arms to be free so she may touch Baby as soon as possible.  (My husband) should stay with Baby while (I) am unable and should be allowed to warm Baby using skin-to-skin contact.
  • We wish for Baby to be allowed to breastfeed in the recovery room and do not give our consent for formula, sugar water, or pacifiers to be given.

 

NICU Admission

  • We want NICU admission to be a last possible option.
  • If (me) and Baby must be separated, we want (my husband) to stay with Baby and to provide skin-to-skin contact.
  • I would like to breastfeed or provide pumped breastmilk.

I tried to use neutral language (i.e. “we don’t wish to” instead of “you’d better not”), imagining how the plan would be viewed by any health professional, especially one who doesn’t know us or is not as familiar with a natural birth.  It’s difficult to be very clear about your wishes but respectful of the medical staff at the same time, and it makes me doubly relieved that we will probably never need to show this to anyone but our home birth midwife and doula.  Whew. 🙂

I realize that everyone’s plan will be different based on individual preferences, viewpoints, and birth setting, but hopefully our plan can give you some idea of the things you can include in yours.  I also realize that it’s impossible to include every scenario or list every preference on a birth plan (without making it into a book), but I hope that ours at least conveys the most important things to us and will give anyone a feeling for the kind of birth we’d like to have.

 

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