Preferences for Labor and Birth

Preferences for Labor and Birth


Due Date: 03.05.11 - 24.05.11
Patient of / *** Hospital

2011

To whom it may concern.

We're looking forward to sharing our birth experience with you. We have created this birth plan in order to outline some of our preferences for birth. We would appreciate you reviewing this plan, and would be happy to do so with you. We understand that there may be situations in which our choices may not be possible, but we hope that you will help us to move toward our goals as much as possible and to make this labour and birth a great experience. We do not want to replace the medical personnel, but instead want to be informed of any procedures in advance, and to give informed consent. Please feel free to ask if you have any questions or comments. Thank you!

Please Note
-I would like to wear contact lenses or glasses at all times when conscious.

Labour
-I expect that doctors and hospital staff will discuss all procedures with me before they are performed.
-I would like to be free to walk, change positions and use the bathroom as needed or desired.
-I prefer to eat and drink throughout labour, as desired.
-I will remain hydrated by drinking moderate amounts of fluids (water, juice, ice chips).
-So I can stay as mobile as possible, I would prefer to have a heparin lock administered instead of an IV.
-Please do not administer an IV or heparin lock unless there is a clear medical indication that such is necessary.
-I would like a quiet, soothing environment during labour, with dim lights and absolute minimal interruptions.
-No vaginal exams unless requested.
-I wish to labour freely in the birthing tub or shower.
-Please allow me to vocalise as desired during labour and birth without comment or criticism.
-Please do not permit observers such as interns, students or unnecessary staff into the room without my permission.
-To preserve my privacy and dignity, I would prefer that everyone knock before entering.
- Please use a stethoscope or other non-electronic Heartbeat Monitoring device instead of a Doppler or Strap On Heart Monitor.
- I would prefer to be left alone with my support as much as possible without interruption.

Labor Induction/Augmentation
-I would like to avoid induction unless it is medically necessary.
-As long as Our Baby and I are healthy, I do not want to discuss induction prior to 42 weeks.
-If my pregnancy progresses past 40 weeks, I would prefer to base the decision to induce on the results of the baby's biophysical profiles, not on my own personal discomfort or anyone else's impatience.
-I would like to try alternative means of labour augmentation, like walking or nipple stimulation, before pitocin or artificial rupture of membranes is attempted.
-If induction is necessary, I would like to attempt it with prostaglandin gel or another means before syntocinon is administered.
-If induction is attempted, but fails, I would like to come back at another time rather than pursue further intervention (assuming my membranes are intact and that waiting presents no danger to Our Baby or myself).
-Please do not rupture my membranes artificially unless medically indicated.

Anaesthesia/Pain Medication/GBS Medication
-Please do not offer anaesthesia/analgesia unless I ask for it.
-If I ask for pain relief, please feel free to offer non medical choices for coping and/or remind me how close I am to the birth.
-I would like to avoid all narcotics, if possible.
-I would like to avoid an IV during labour, and would like my baby monitored before any medication is given.

Caesarean Section Delivery
-I feel very strongly that I would like to avoid a cesarean delivery.
-If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making.
-I would like My Partner - Shaun to be present during the surgery.
-Please explain the surgery to me as it happens.
-I would prefer spinal anaesthesia for the procedure.
-I would like to have a respectful atmosphere without chatter during any part of the surgical procedure.
-If possible, please do not strap my arms to the table during the procedure.
-If conditions permit, I would like to be the first to hold Our Baby after the delivery.
-If I am incapable of holding Our Baby, I would like My Partner – Shaun to be the first to hold Our Baby after the delivery.
-Please place Our Baby close to my face at some point, so I may kiss Our Baby if I an unable to hold Our Baby myself.
-If possible, I would like to breastfeed Our Baby immediately after the birth.
-Please lower the screen just before delivery so I may see the birth of the baby.
-I would like our plans outlined here for after the birth to be followed as closely as possible.

Delivery
-Even if I am fully dilated, and assuming Our Baby is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase.
-I prefer to push or not push according to my instincts and would prefer not to have guidance or coaching in this effort until the head is emerging.
-I do not want to use stirrups while pushing.
-I would like the freedom to push and deliver in any position I like.
-I would appreciate help from My Partner Shaun, by supporting my legs as I push, if I so desire at the time.
-I would like to have a mirror available and adjusted so I can see the baby's head crowning.
-I would like the opportunity to touch my baby's head as it crowns.
-I would like a soothing environment during the actual birth, with dim lights and quiet voices.
-I would prefer no-one other than myself, to touch the baby while it is emerging, other than checking for the cord once the head is birthed.
-I would like to catch the baby if my positioning allows me to.
-I would like to have the birth recorded with photographs &/or video tape.

Perineal Care
-I prefer not to have an episiotomy unless it is medically indicated.
-To help my perineum stretch, please help guide my pushing efforts by letting me know when to push and when to stop.
-Please administer local anaesthesia when repairing any episiotomy or tear(s).
-Please suture tears only if necessary.

After birth
-Please do not take my baby away from me.
-Please place Our Baby on my bare stomach/chest immediately after delivery.
-I would like the option to cut the cord.
-Please allow the umbilical cord to stop pulsating before it is cut.
-I would like to breastfeed Our Baby as soon as the baby desires for as long as baby desires without interruption.
-I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of syntocinon.
-I would like my blood loss to be monitored after birth, while waiting for the placenta.
-I am willing to wait an hour or more for my placenta to be birthed, but in the event of significant blood loss, please administer syntocinon after consultation with me.
-Please show me the placenta after it is delivered, but please avoid My Partner - Shaun's vision.
-Please remove my IV/Heparin lock/catheter as soon as possible after delivery.
-Please allow me and Our Baby to partake in an Herbal Bath supplied by me for at least 30 minutes after birth and after any Perineal Care.
-Please ensure the said Bath is cleaned and disinfected before the Warm, Hip High, Herbal Bath is run.
-Please supply me with Haemorrhoid treatment & possibly pain medication/management after our bath. Please discuss my options that will work with Breastfeeding.

Newborn Care
-I would like to hold Our Baby skin-to-skin during the first hours to help regulate baby's body temperature.
-I would like to hold Our Baby through delivery of the placenta and any repair procedures.
-If possible, please evaluate Our Baby on my abdomen.
-I would like to Breastfeed Our Baby for as long as possible immediately after birth and would like immediate access to an Electric Breast Pump to help my milk come in quickly.
-If Our Baby must go to the nursery for evaluation or medical treatment, Myself or if I am totally unable too, My Partner - Shaun, or someone I designate, will accompany Our Baby at all times.
-Please do not take Blood Sugar Levels or any Heal Prick Tests without my initial consent and not before I have had numerous attempts at Breastfeeding.
-Please do not do anything or administer anything to Our Baby without my initial consent.
-I would prefer to bathe Our Baby myself, at my discretion.
-Please do not administer eye medication for Our Baby.
-If Our Baby shows signs of possible eye infection, we would prefer erythromycin eye treatment or other antibiotic eye drops instead of silver nitrate. Do not administer silver nitrate.
-I would prefer to have Vitamin K administered orally. If this is not available, do not administer Vitamin K.
-Please do not give Our Baby Formula.
-Please allow us the chance to *Sun* Our Baby to help avoid Jaundice.

Post-partum
-I would prefer not to be catheterised until I've had some private time to attempt urination on my own.
-If available, I would prefer a private room.
-I would like to have Our Baby room-in with me at all times.
-I would like my other children to have free visitation access.
-Assuming I feel up to it and Our Baby is healthy, I would like to be released from the hospital as soon as possible following the birth.
-I would like permission for access to my chart and Our Baby's chart and would appreciate my own copy on release.

Breastfeeding
-I plan to breastfeed and want to nurse immediately following the birth.
-Please do not give Our Baby any supplements (including formula, glucose, or plain water) without first informing me of the reason(s) and seeking my consent, unless there is an urgent medical necessity and My Partner - Shaun is firstly notified, if I am unable to consent.
-Please do not give Breastfeeding suggestions unless I ask.
-I would like to meet with the staff lactation consultant, if I feel I am having any issues.
-Please supply me with any prescribed Breastfeeding Medication immediately.
-If I have supplied it, please arrange for any breastfeeding herbal remedies to be administered immediately. i.e. Fenugreek Tea, Lactation Cookies, Fenugreek Tablets etc.
-Please provide access to an Electronic Breast Pump after Our Baby's initial Breastfeed.

Additional notes
-I would like to take still photographs during labour and the birth.
-I would like to make a video recording of labour and/or the birth.
-I would like my Son, Nathaniel, to be in the delivery room with me and My Partner - Shaun, with his own sitter, if he so desires to be. Otherwise I would like him to be able to stay at the hospital, in a waiting room, if he so desires, so he can meet his baby sibling immediately after birth, if he is awake.
-I am not having Our Baby circumcised.
-If the hour is late, I would like My Partner - Shaun, to have the option to stay with us after birth, to sleep before returning home, if he desires.
- If Nates' sitter is tired, I would also like the option for her to have a sleep/rest before returning home, if she so desires.