I have a "Birth Wish List" drafted that I am bringing to my MW appointment on Friday. The group I delivered my son with had a standard form they had you fill out, so I haven't done it this way before. I am looking for suggestions, if maybe I missed something obvious.
Thank you in advance for looking.
Our goal is a healthy baby and healthy mom following a calm and gentle birth. These are our expectations for our birth. Changes will be made as needed to ensure the health of mom and baby.
During Labor
• I would like a heplock placed unless IV medications are necessary • I would like intermittent fetal monitoring instead of continuous monitoring as long as it is appropriate • I would like internal checks only when absolutely necessary. • I would like the room kept dim/as little noise as possible while laboring. • I do not want my strip membranes or waters artificially broken. • DH and I will discuss all changes or interventions alone before consenting to anything. • Please DO NOT offer pain medication; if I want, I will ask • If I ask for pain medication during a contraction, please discuss it with me when I am not having one
During Delivery
• I will push uncoached as I feel the need to do so. • Allow me to change positions during the pushing stage if I feel the need to do so; and assist me with achieving these positions as necessary. • Do not perform an episiotomy. • Please deliver the baby onto my chest. • Delay cutting the cord until it stops pulsing. • DH will be cutting the cord. • Allow the placenta to deliver without pulling. WE DO NOT KNOW THE SEX OF THE BABY, PLEASE DO NOT TELL US, WE WANT TO LOOK FOR OURSELVES!!!
Newborn Care
• Delay all newborn care (bath, eye drops, vitamin K, etc) until after we’ve had time to bond/baby has nursed; at least one hour. We will let you know when we are ready for them. • Bath baby with wash we have provided. I am VERY allergic to J&J and will not be able to hold/be around baby if it is used. • Perform all newborn care in the room with us. If the baby MUST be removed, DH will go with the baby. • If the baby is a boy, DO NOT circumcise. • I intend to exclusively breastfeed. o If formula is necessary, I will use a supplemental nursing system; no bottles • Do not give a pacifier
I think it's a bit too long and...rigid? I don't like calling it "expectations for our birth." Goals/hopes/preferences, maybe? As is, it sounds a little demanding and inflexible. Like, "do not perform an episiotomy" and "allow the placenta to deliver without pulling" sounds like you don't trust your doctor's judgment and experience. I didn't want an episiotomy either, but after 3.5 hours of pushing without one I was 110% supportive when my OB brought it up because at that point, it was completely appropriate, KWIM?
Find out what's standard at your hospital (like, at mine, they will ask you if you are BF/FF and put it up on a board in your room, so it would be redundant) and omit that.
Here's mine from last time, and I'll be using it again:
I would prefer to have a flexible birth environment above all else and want to know my options before any decisions are made.
I would like to go without pain medication for as long as I can tolerate, but I am open to pain relief and will ask for it if needed. In the event that I request pain relief, I would prefer an epidural to analgesics.
I would prefer to tear naturally over an episiotomy.
After the birth, we would like the cord clamping and cutting delayed until it stops pulsing. We would prefer to delay any non-emergent procedures such as a bath until after breastfeeding has been established.
In the event the baby and I must be separated, my husband is to stay with the baby at all times.
We are undecided on circumcision and would like to speak with our pediatrician before it is done.
Um, you need to be able to prepare to not be able to control some of these things. Hell, all of these things. Some of these seem completely unreasonable. I'm sorry, but I feel like something this rigid is only going to set you up for disappointment. There are going to be hospital protocols in place that trump your wishes, like with the vitamin K for instance.
Post by bluelikejazz on Oct 1, 2014 14:08:43 GMT -5
I also have no experience, but when we did our hospital tour, they said to have 2-3 bullet points that were most important for each "stage" (labor, delivery, childcare), as that may be all the nurses have time to read in the moment. So from that perspective, I would cut it down. Pick your most important (or like Brie said, things that may not be standard at your hospital) items, and list those (or at the very least, list them in order of importance to you). But make sure your DH knows all your preferences and can speak with the nurses about them as they arise.
As an expectant momma, I desire many of the same things you do. However, as a former L&D RN, I would strongly encourage you to reconsider some of the wording in your birth plan. (side note - all caps in a birth plan reads the same as an Internet post - yelling. Please don't include caps for emphasis - it just makes the staff feel as though you already believe us to be incompetent.). I think adding "unless medically necessary in an emergent situation" to many of your bullet points would go a long way to show that you have thought through all possible situations. I don't see possible C/S or instrumented delivery (foreceps, vacuum) addressed - it would be prudent to consider your preferences ahead of time should the need arise. Let me know if I can help or provide any further direction.
I'd narrow this down a bit to a few specific points, like "I will push uncoached" can be communicated during delivery pretty easily rather than written down here. Additionally, I'd lighten up your language a bit. I understand that these are important to you, but I'd be concerned you would inadvertently piss someone off with some of this language. They are there to help you, and are likely to do what you'd like without being this forceful. My 2c.
Have you been on a hospital tour? Ours answered some of these questions during the tour, for example, assuming all is well with me and the baby, they do all of the newborn care in the room, are pro breast feeding and immediate skin to skin, and I don't think any hospital will do an elective procedure such as circumcision without your consent.
I am glad you are going with a midwife since usually they follow a more natural experience.
That said coming from someone who didn't make a plan this time it I am so much happier with the outcome vrs last time when I had so many things I thought I wanted that didn't happen.
Thanks. Almost all of these actually address things that I thought had been addressed prior to my first birth, but not put in writing, and then were ignored (not for any medical reason). I will admit that I had a pretty horrific first birth from the perspective of having the medical professionals ignore my wishes when it was completely unnecessary from a wellness stand point. I am bringing this to my midwife for my appointment Friday, and she will help me eliminate anything that it standard for their practice/the hospital.
I have done a hospital tour, but honestly don't remember what they told me. I toured 2 hospitals and I know the information is crossed in my head.
For whoever said hospital procedure trumps my wishes, absolutely not. They can not do anything to me or my newborn without my consent. Please don't let medical professionals feel like you don't have a choice, you ALWAYS have a choice.
Post by sparkythelawyer on Oct 1, 2014 16:40:55 GMT -5
Since you want this much specificity and control over an experience well known for its total and complete lack of control, have you thought about hiring a Doula to help you out?
I'm sorry you had a bad birth experience last time. I'm sure that is coloring your opinion now, and I completely understand why it would. But as an RN, consider this - you will not be the only person laboring when you go to the hospital. It is possible the RN will have multiple other moms at the same time. I think such a long list will hinder the nurses ability to care for you in the best way possible because it will be hard to focus on all of the things that are in your birth plan, plus the birth plans of all of their other patients currently laboring. I agree that you should make a shorter, succinct list of bullet points (I really like the red/yellow/green one above) so that it is easier for those caring for you to know exactly what your wishes are.
I'm glad you're going with a midwife this time, but I also suggest a doula. They will be able to know your birth plan inside and out and communicate your wishes when you are struggling to do so.
bbmomma I guess I am alone on this - I'd leave it as it is.
You're a STM, I'm guessing you have discussed this at length with your DH, he'll advocate for you and baby, and why not go in guns blazing with very specific things you want this time around. If they were ignored the first time, and not for medical reasons, then it sounds like you need to be very specific about what you want.
And damn, I am so thankful I don't have to ask for most of these things. Most of your list is routine where I have delived in the UK and Canada.
Too long and the tone is off-putting. Then again, my perspective may be a bit skewed since I don't have too much of a choice with most of the things you have outlined. Some of the stuff seems just really small to have to worry about while you are in the heat of the moment, and like others have pointed out, may set you up for disappointment.
Like what oceanspray brought up - what happens if you are in an emergent situation and none of this can be followed? Will you be ok with that?
I feel like a terrible mother because I don't plan on having a birth plan. If I need one, it will be one sentence:
Get us out of here alive and well, with as little pain as possible.
This is exactly where I'm at. Perhaps after my first birthing experience I'll have more opinions, but for this one I'm taking it as it comes and trusting the doctors to get us both through this alive.
Post by sillygoosegirl on Oct 1, 2014 19:34:24 GMT -5
Everything on it looks reasonable to me. In fact, everything on it is just standard practice where I will be giving birth.
I would definitely recommend going over it with your midwife and removing anything that is already standard procedure where you will be birthing, to hopefully improve the odds that the remainder will be read, understood, and respected.
Also, hopefully items such as "no circumcision" (which applies to like half of newborn boys these days) can be notated in a standard place in your chart where all the medical staff are used to seeing it.
The best advice I received from my OB was to go in with no expectations. I had my "wish list" per se, but things frequently change and I didn't want to be disappointed in the experience. I am glad she told me this beforehand.
There's nothing unreasonable with any of your plan. Most of it is standard practice where I'm delivering. The tone is incredibly off-putting. I'm sorry you had a bad experience with your first birth, but you're doing a disservice to everyone involved in this birth by going in expecting more of the same.
I agree that you might best be served by hiring a doula or trusting your husband to advocate for you based on current circumstances, along with the birth plan.
I'm also side eyeing the fact that you can't be bothered to remember what the protocols are at the place you're going to deliver, but you expect them to conform to a list of demands. These things are understandably important to you. It's your responsibility to educate yourself on the standards of care and go from there.
I'm sorry you had such a negative experience before. I agree with a lot of the other PP's that the overall tone of the plan seems quite harsh. Definitely clarify which hospital you toured does what and remove anything considered a standard for whichever you choose. I know that my hospital practices skin to skin for 1 hr so I would leave that out if I had a birth plan since its redundant.
I don't have a midwife so this may sound like a weird question....but aren't they your advocate during labor as well? Or is that just a doula? I ask because I would think in that case the midwife would serve as your voice along with your DH. Giving her the plan makes more sense than giving it to the nurses But again....I really don't know how that works with a midwife and I won't have a birth plan other than "get her out of me the safest for each of us".
The one thing that stands out the most is where you mention that you and your DH want to discuss any potential change alone. I totally understand decision making in private. But....things can change very, very quickly and you may not have time for a lot of discussion. 1 minute can mean life or death for either of you and having everyone file out, have you talk and come back in could find you in harms way if the absolute worst happens (which of course no one wants). Consider the need for quick decision making on those big game changers.