Birth plan

Regardless of what type of birth you are planning, a birth plan is highly recommended. The birth plan is a written record of your desires for your upcoming birth. I have learned that good doctors appreciate a written birth plan. It allows them to have a clear understanding of you as a patient and your specific requests. It will ultimately lead to better birthing experience for both parties.

A written birth plan should be reviewed with your physician (or midwife) prior to your last trimester. The birth plan will open further communication between your doctor and yourself. The doctor may offer suggestions, denials, and/or seek special permis sions to accommodate you. Always, request that the birth plan be placed in your medical records.

You should also bring several copies of your birth plan when you go to the hospital/birthing center. I usually give the admitting nurse another copy of my birth plan, post a birth plan in my birthing room, and have copies on hand to give to new nurses.

Be certain to review your birth plan with your husband – it is a representation of you both. The better your husband understands your requests, the better he can advocate for you at your most venerable time.

There are many online resources for creating a birth plan. It can all be a bit overwhelming. I have posted my most recent birth plan. This is a birth plan that I used with my first VBAC and one that I plan to use this time around if I opt for a hospital delivery. I had great success with this birth plan. I briefly reviewed my birth plan with my doctor (Asst. Chief of Staff) that delivered Papi. She sent me straight to the midwife once she took a quick look at my desires, stating, “You don’t want me. You want a midwife! I’ll be there if there is in fact a medical need.” Her humble admission and willingness to pass me off for care allowed me to secure the midwife team. My requests were heard and special permission was sought. All of which were put into my electronic medical files so that all staff members caring for me would have complete access to my requests and approval. It was my hospital-homebirth!

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Here is a copy of my birth plan as a PDF. All personal identifications have been removed.

BIRTH PLAN

Name & Medical Number

Due Date:____________
OB:______________________
Birth Facility:__________________________

Mother: ________________ Father:__________________ Siblings:___________________________

We appreciate your kind care and respectfully request the following for our labor and birth.

Intervention only as medically necessary (noting routine) and with our consent (not general)
Freedom to move about, our choice of positions for all stages of labor
Encouragement of natural relaxation techniques
Relaxing, unhurried environment
(option of having) whole family together during entire birth process

We recognize that true emergencies do sometimes arise, and we will be relying upon your skill in the event of such a circumstance. We hope to have full communication in that case, with you informing us of all our options. If there are items in our birth plan that cannot be accommodated please let us know immediately so that we may anticipate the change.

No arbitrary time limit, routine induction of labor, or stripping of membranes

Attendants and Amenities:

Husband to be allowed to stay with me at all times
My other children to come and go as desired
To bring music
To dim lights
To wear my own clothes during labor and delivery
To take pictures and/or video during labor and delivery

Labor (Stage 1):

Once I’m admitted, I’d like:
No routine vaginal exams
To have intermittent rather than continuous electronic fetal monitoring
No routine IV – to stay hydrated by drinking clear fluids (saline lock if IV is needed)
To eat if I wish
Unrestricted movement and positions throughout labor
No arbitrary time limits or routine augmentation
Membranes left intact to rupture spontaneously, esp. prior to engagement of head
Pain relief by relaxation, birthing pool, shower, walking, and other movement and position changes
Opportunity of signing: Against Medical Advice” waivers if certain options are declined

Please do not offer me pain medication. I’ll request it if I need it.

Birth (Labor Stage II):

I’d like:

Choice of comfortable and effective positions

Birthing pool, squatting, hands and knees, whatever feels right at the time

To birth at my own pace with no arbitrary time limits
Encouragement to birth slowly and gently following pushing urges, allowing tissues time to stretch and pelvic outlet to open properly
Possible compresses and perineal support to allow tissues to stretch
A mirror available to view birth
To touch my baby’s head as it crowns
The room to be as quiet as possible
To risk a tear rather than have an episiotomy
My husband to help catch our baby

Birth (Stage III)

After birth, I’d like:

To allow baby to clear own mucus naturally rather than routine suctioning
Baby to be placed on my abdomen immediately upon birth; warming by skin-to-skin contact and blankets placed over baby – putting off any procedures that are not urgent
To allow cord to stop pulsating completely before any clamping, cutting or administrations of medications to mother
My husband to cut the umbilical cord
Local anesthesia should there be any tearing in need of repair
Time for breastfeeding and natural separation of placenta
No manual exploration of uterus after birth
Breastfeeding as desired by myself and baby – on demand
Not to get routine oxytocin (Pitocin) after I deliver the baby

Postpartum:

After delivery, I’d like:

All observation/examinations/procedures for baby to be done in my presence
Rooming-in with baby
My husband to stay with the baby at all times if I cannot be there
My children (3 girls and 2 boys) brought to see me and meet the new baby as soon as possible after birth
Bathing done at parent’s request, by parents, or not at all if parents desire
I DO NOT want my baby to receive ANY routine injections/vaccinations without being consulted first (this includes Vitamin K). We will commence immunization with our doctor after the birth
Vitamin K given only with informed consent of parents. (Oral dosage in my presence)
NO eye medication/treatment
Pediatric exams in mother’s room
PKU test given only with informed consent of parents (after a length of breastfeeding)
NO circumcision
100% breastfeeding on demand; no bottles, water, pacifiers, etc.

Misc.

My brown scapular (cloth necklace) is to remain on for the duration of my stay in the hospital
A Priest may be requested to visit in the case of an emergency for either my baby or myself

Priest’s Name & Number

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***UPDATE***

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This is day 10 of my pregnancy reflections. I realize that the idea of the 31 Days series was to have 31 posts on one topic within the month of October. Let’s just say that I’m functioning on my own terms these days. I won’t have 31 posts in October but perhaps I can manage 21 more posts before my baby is due – that’s 4 more months for 21 posts.

You can find the other posts of my 31 Days here.

Lena & Gary – May 2010

BABY ENZO

This is a bit personal and I usually don’t share such a thing but I’m learning to become an open book – ALL FOR!

Below is my birth story for Enzo, AKA Dragonfly. He was my eighth pregnancy and fifth (living) baby. He was also my first labor after my very necessary c-section for Papi. I opted to have Enzo in the hospital because despite my greatest efforts, I could not afford the additional costs of a midwife and homebirth. I doubt I would have opted for the hospital birth if I didn’t have the excellent care of the assistant chief of staff at a hospital with an exceptional model of care for pregnant mamas.

I came into this birth knowing exactly what I wanted and needed to have a successful labor. It was spelled out for the entire medical staff in my very lengthy and detailed birth plan. The Good Lord gave me the graces to be at complete peace prior to going into full labor.

This is the story of my 24+ hour labor and delivery that I refer to as my home birth in the hospital.

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Thursday, May 13

It was a long labor that started after a “calm” that scared me on Thursday, May 13. I was out trying to run errands in my last effort to be active. Enzo decided to give me a reprieve before my long labor to come. His movement for the day was slowed to the point that I became nervous and decided to go into L & D to be checked. Needless to say, he was fine.

Friday, May 14

Slow irregular contractions started to take wave on Friday evening. This is typical for me. I knew it was the start of labor for me but still remained poised because I anticipated my normal, long labor to follow. The contractions picked up and were consistent throughout the evening but did not persist. I was able to find good quality rest time. Gary stood home to help with the kids.

Saturday, May 15

Saturday rolled around and my contractions started to become more regular but were still mild. Once again, I remained poised. I stood upstairs worked through each contraction and rested when able. I had wonderful coaches and company from kids who managed to sneak by Gary throughout the day to get to me. Papi helped me out with my birthing ball exercises, Sweetie messaged me when needed, Sparkles and Rose did whatever was asked. I had a great team! Still, I knew I had a ways to go but did leave hope that my water would break soon.

My contractions intensified Saturday evening and I tried different pain management techniques with Gary within my home so as to prepare prior to the hospital visit. I didn’t want to be stuck without some absolute options of ways to soothe me (this labor) while having no other true support team once I got to the hospital. We finalized the optimal positions/exercises for me using the birth ball. Gary mastered his massage technique and I experimented with the shower and tub. It was concluded that the birthing pool would be a must for me again this time around.

Sunday, May 16

I knew I was not anywhere near the point of delivery but had progressed in labor. My contractions were strong enough and close enough to get me to consider making the trip to the hospital. I would have loved to stay home longer but wasn’t sure how I would do in a 1 hr car ride with more intense contractions.

5 am

Gary and I decided it would be best to go to the hospital while we were at this point in labor. We were both calm and would be able to set up at the hospital without being rushed.

Gary drove me to the hospital after Papa arrived for the kids at 6:00 am. I sat in the back of the van on my exercise ball and ate my breakfast between contractions. I continued my hydration regime that I started on Saturday. I wanted to be sure that I did not become dehydrated.

7am

I was assessed and given a room. All the amenities were set up since I was dilated to six and it was baby number five for me. The nurses and midwife thought that I would be having a baby soon. I reassured them that I have long labors and continued to labor on my own with Gary.

The entire medical staff at the hospital was more than accommodating to my wishes spelled out in my rather lengthy birth plan. I was encouraged to turn in my detailed birth plan by a midwife that I met about a week prior. She reassured me that it would be read and scanned into the system and followed as closely as possible. She also sought approval from another Head of the Department. This approval was placed in my record. I’m sure all of these facts helped me to get the care I desired.

12 am

I continued to practice my birthing exercises with Gary throughout the morning in the hospital. I tried out the shower a couple of times. Sunday afternoon rolled around and I knew that our precious baby would not be coming anytime soon. Everything was going smoothly and slow. I was able to eat and drink through my labor as I wished. I did not pass any opportunities. Gary went out around 4pm to pick up a pizza and more Gatorade. I rested on my back in bed for the first time in several months. We ate dinner together and teased that this was turning out to be a great vacation.

My “vacation” did not last long. My contractions began to pick up again. I refocused and went back to work. Slow and steady was the tempo. My water did not break until 1 am on Monday morning. By that time I had already had three nurses change shift and two midwives. The midwife on duty diligently announced that I could start pushing. I reassured her that I did not work that way, typically I would have four-six more hours of labor. She did not seem too interested in my own assessment but left me to it.

Monday, May 17

1 am

Slow and steadied, I continued. The midwife was scheduled to change shift soon and she made another appearance before leaving. She reiterated that I could start pushing and if things did not progress that we could talk about other options. I was not at all interested in other options and planned to avoid any further discussions at all costs.

I began what would be my longest battle with pushing. Despite my better judgment, I went for it and started pushing with my contractions at 3 am – 5 am. Needless to say, there was no progress. I knew that I was not cooperating with my body and allowing my contractions to do their job, however slow that may have been.

It became intense and my back labor was like no other. I spent most of my time in the shower but longed for a break from the back pain. I even managed to place a phone call to a doula (who so kindly offered me her free phone service). I called to inquire if there was a magical way not to have such intense back labor. She reiterated all the techniques that we were already trying. I had become physically drained and emotionally defeated. Not to mention, Gary was out like a log. He was operating on two hours of sleep.

5 am

It was about 5 am and I sat on the bed with Gary at my side. We were both exhausted and it was well written on our faces. The new shift of nurses arrived. My nurse, Shawna, walked in and immediately began to put me at ease. She reassured me that I could take a break to gain a much needed rest. However, I was not completely sold. I was ready for baby Enzo to be out!

She allowed me to continue as I desired while staying by our side. She saw me through a series of contractions and witnessed my complete exhaustion first hand. She offered me another option, to be checked for dilation. She stated that if I were ready I could continue to push and if not, that I should get some rest. It turned out that I was at nine with some cervix left. Whether this was a result of pushing unnecessarily or just my body taking its sweet time, I do not know. Whatever the cause, I was due for a rest. No more pushing!

My contractions and hard back labor continued but I was able to withstand them and embrace the work that my body was doing. I was no longer being counterproductive. This was difficult for me because the previous midwife had me so defeated that I began second guessing my body. That’s where Shawna came in. She walked me through my meditations and breathing – reassuring me the entire way that my body was doing its job and baby Enzo would be here shortly.

12:30 pm

I did not want her to leave! She was such a tremendous help to both Gary and I. She left on break at about 12:30. At which point I decided that I was ready to have baby Enzo and so I decided to speed things up naturally for myself – a shower always helps me get contractions going. I made Shawna promise that she would come back it I called her.

Within 30 minutes in the shower I was ready to push. Once again, I began to double guess my body due to the previous long episode of pushing. Where was Shawna? I pulled the emergency cord in the shower and informed the nurse’s station that I needed Shawna. In ran the new midwife on duty.

She began to introduce herself to me and I interrupted her to inform her that I knew who she was but I wanted Shawna. The midwife was not too happy with this request. "What can I help you with," she persisted. I told her, "I’m no longer sure if I’m ready to push or just experiencing pressure.” She offered to check and I hesitantly agreed. She informed me that in fact I was completely dilated and ready to go. She then urged me to get out of the shower. At which point I told her that I would stay in the shower until Shawna got back on watch. The midwife left and within seconds, guess who showed up… Shawna. She was beckoned from her break.

I began to push just as she came in to assess me. I could hear the midwife urging me to make it to the bed. I informed her that baby Enzo’s head was already out and that I would not be making it anywhere. She managed to have Shawna and Gary help me walk to the bed while I postponed pushing.

1:11 pm

Baby Enzo was born shortly after another series of exchanges of the midwife’s desires vs. my own desires.

He gave a brief scare. The cord was wrapped tightly around his neck, his face was blue, and he was not breathing. He was immediately taken to the infant bed for treatment. Gary kept watch on him while I lay there praying for for the intercession of the Blessed Mother to accept God’s will.

“We have a heart beat……..he’s breathing……” Praise be to God! Enzo was just fine. He made his way to me and began to nurse.

Monday, May 24

Baby Enzo is a big boy with a sweet disposition. He reminds me of his daddy in many ways. His sisters can’t get enough of him and his brother constantly keeps guard of him. Thank you all for your prayers and well wishes. DEO GATIAS