Wednesday, October 29, 2008

My Birth Plan

In General:
Ideally, if all goes smoothly, I hope that the midwife who attends me in labor will remain in the background, taking observations to check on the baby's and my safety, but otherwise not getting involved in my labor, unless I request otherwise. If I do find that I would like her to become more involved, I would like her to support and encourage me, using her experience to guide me through labor and offer suggestions.
The Labor:
I would like to remain active and use whatever position I find comfortable. Please encourage me to stay off my back! I may wish to move throughout the house and to use the bath or shower from time to time.
I would like to avoid internal examinations if possible, unless there is a particular reason why you think one is necessary. I am open to natural methods to soften the cervix, such as nipple stimulation, clitoral stimulation, sex, or another method suggested. Please do not offer to break my waters, and please be very careful to avoid doing so during any internal examinations. If the baby appears to be poorly positioned or labor is not progressing well for some reason, I would appreciate it if you could suggest changes of position or movements which might help. I would like to have music playing during the labor, I will have a play list and music readily available.
I am a firm believer that all my strength and source of hope is found in my Lord Jesus Christ and that I can do all things through Him, who strengthens me. Prayer will be a big part of my labor, as well as praise.
Birth Companions:
The following people may come to my home during the labor or birth:
My husband/partner, Peter.
My daughter, Hailey.
My mother-in-law, Pat, who will be helping to look after Hailey.
My doula/best friend/massage therapist, Rebecca.
Birth Pool:
I have a birth pool and will use it if it helps me.
It is important that the pool temperature is comfortable for me so, unless it is outside normal safety limits, I will choose the temperature myself. I understand that I would probably want a cooler temperature during the first stage of labor, and warmer - nearer blood temperature perhaps - for the second stage. I would like to have a water birth if possible and would appreciate your support in encouraging me to give birth underwater.

Pain Relief:
I hope to manage using no drugs for pain relief, and would appreciate your encouragement to use other methods. For example, I might use movement, massage, relaxation, birthing stool, or the birth pool.

The Birth:
I do not wish to have an internal examination to confirm whether or not I am 'ready' to push. I shall only push when I physically cannot do otherwise! If there is any reason to suspect that I might have a premature pushing urge then I would like to discuss this on the day. Please keep the room as quiet as possible during the second stage. I would like to minimize distractions at this time. If you need to discuss matters with the second midwife, please could you do so very quietly and preferably out of earshot!
I would like to give birth in the birthing pool or wherever seems right at the time. I intend to 'catch' my own baby, and would prefer the midwife not to touch at all unless there is a problem. I would like the midwife to observe and to be on hand in case of emergency, but otherwise I want to be left to give birth entirely under my own guidance. I would like to avoid perineal damage if possible and would appreciate your guidance in giving birth gently to accomplish this. I would like olive oil to be applied if I do end up giving birth outside the birthing pool. However, I would rather tear naturally than have an episiotomy. I would rather not be told how to push, or guided in the second stage, unless there is a particular reason to suppose that I need assistance, or unless I ask for assistance.
I would like to see or feel the head as it crowns, and my birth partner will have a hand mirror available for this.
I would like to have relaxing music playing when my baby is born.
I would like the lights dimmed when my baby is born, and for the minimum amount of noise to be made. I hope that it will be a gentle entry into the world.
Please do not suction mucus from the baby's nose and mouth 'just in case' - only suction if necessary.
Please do not announce the baby's sex as I would like to find out for myself, or have my husband discover the sex.
Third Stage:
I would like the cord clamped and cut when it stops pulsating. I wish no drugs to be used unless specifically indicated. It is important to me that you do not clamp the cord until it has stopped pulsating, unless you need to take emergency steps which preclude this. **Please do not pull on the cord or use fundal pressure unless there is a specific indication to do so, as I have read that this is contra-indicated in drug-free third stages**. Please offer my daughter the opportunity to cut the cord if possible. If she chooses not to, or is unable to, I would like to cut the cord. We do wish to keep the placenta, and would prefer it be laid flat in a Ziploc in the freezer to be taken care of at a later date.

Care of the Baby:
I would like to breastfeed my baby as soon as possible after the birth
I would like to keep the baby unclothed and close to my skin immediately after birth, to maximize skin-to-skin contact. Please do not administer prophylactic Vitamin K after the birth. If the birth is traumatic for the baby or there is some other risk factor for HDN, I will be happy to discuss this with the midwife and allow vitamin K if we both decide it is appropriate.

Repair of the Perineum:
I would prefer to avoid having stitches if possible, so if you think any tear will heal of its own accord, without stitches, please let me know.
In Case of Transfer to Hospital:
If transfer by ambulance becomes necessary, please do not strap me in on my back - I would prefer to be on my side, to make contractions easier to deal with. Please do not offer Pethidine/Demerol, or any other medications as I am concerned about its possible effect on my state of mind in labor, and on my baby's health. I am very keen to avoid a caesarean section if it is at all possible, as I do not want to enter future labors with a scarred uterus. I particularly would like to avoid a caesarean just for slow progress. If labour is simply taking a long time but my baby is not in immediate danger, please would you encourage me to keep going and perhaps to try changes of position or movements which might help. Please do not offer a caesarean unless my baby is in danger. If a caesarean section becomes necessary, I would prefer to remain awake with epidural or spinal block anesthesia. I would like my partner to stay with me at all times, and would like to breastfeed the baby as soon after birth as possible.
If there are problems after the Birth:
If I suffer a severe post-partum hemorrhage, please do not perform a hysterectomy unless it is the only available course of action. Although I already have 1 child, I still hope to have more. Please do not admit my baby to Special Care simply for observation, but only if there is a specific reason for concern.
Baby Feeding:
Please do not give my baby supplements of glucose water or formula milk without my permission. I would expressly like to avoid having any formula supplements unless it is unavoidable, and certainly not in the first two days in any event.
Under no circumstances is my baby to be bottle-fed as this could lead to nipple confusion and hinder breastfeeding.
Going Home:
I would like to go home as soon after the birth as I am able to move, unless I or the baby have health problems which require hospital treatment.

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