Birth Plans

I was reading about having a "flexible" birth plan.  Supposedly the doctor and you sign it or something?  I never had one with my other two daughters, so I don't know what this is about.  Is there something I should be writing down and giving to my OB?  What information should it include if I should?  

[AndiJ78]

www.babycenter.com has one, but I found with the births of all three of my boys that we went over everything during my OB vists and upon registering with the hospital. nothing written down from me so much as a series of questions asked by my ob and the hospital. my only big things were early placement of the epidural but no meds running through it (sort of a just in case type thing) and no forceps.

My only fear was that I would get so caught up in the rigidity of the plan that I would not allow myself to be open to changes that will inevitably arise.

[ajemmom]

I never had one, but I have read about them.  You write down exactly how you would like your birthing process to go, such as, if you want medication, if you do or do not want medicine to speed the process along, etc.  I know that some can go as far as to say who they do/do not want in the room, they want the lights dim, etc.  I guess that may work for someone who has to have everything planned out, but in my experience, you should know what you want, but just go with the flow when it comes to labor.  Each labor is so different,  you just have to relax and let nature take it's course!  I don't think that OB's expect you to give them a birthing plan, but if you do make one, I'm sure they would look at it and try to respect your wishes.  Best of luck!

[rita02]

i say just be realistic and flexible. so many things can change during labor and each one is defferent from the last. know what  you want but again be realistic and flexible...Good Luck  and God Bless!

[Pearl99]

The basic hospital birth is what you will most probaby get if you don't set up ahead of time with your docs something else (in a plan or in a conversation). The most likely scenario is a heavily "managed" process (which most people think of as "normal"), like they break your waters when they want to, they assume you will take as much medication as you can get your hands on (and offer it early and often), they will perform pre-emptive episiotomies, will monitor you constantly, have you flat on your back for labor and delivery, give hep B, vit K, anti-chlamydia eyedrops to newborn, maybe have an iv in, a catheter etc. If you don't progress according to hospital schedule you will be given pitocin injections and /or in nationally an average of 1/3 of all births a C-section (should any of the above provoke 'stalled labor' or 'fetal distress'.  If you are past a due date they might encourage chemical induction.

The birth plans state things like not wanting to be constantly checked vaginally or wear a monitor laying down, not wanting episiotomy, not wanting pitocin iv either for dilating "faster" or after delivery, wishing to not be "offered" pain meds (unless you ask), wanting dim lights/few intrusions, to walk around as long as possible, to use squatting positions etc. They are for the most part for those who desire natural childbirth. Usually these moms have already found doctors who believe that birth is not a medical procedure and have been through a Bradley or Lamaze type class that encourages empowerment and relaxation techniques of the delivering mother. In the old days you had to put down stuff like to not shave pubic hair and to not give enemas--they were considered standard. Oh, and that you want to breastfeed right after birth, that's not always assumed.  I don't think it's a contract as much as an awareness of having OPTIONs for how you would prefer the birth to be. Obviously any mother will be open to changes in the plan depending on how things go and no doctor would put the 'plan' above the baby's health.  

[Crritter]

My Dr. was the same as the others, she talked to me about it beforehand and knew before I went in what I wanted.  I did not care whether or not I got an episiotomy, she knew I didn;t want one if not necessary, but trust my Dr. and her judgement.  They kept me comfortable and she even talked to the nurses about it so they kept an eye on me and offered the epidural as soon as they could, since I have a history of reacting to the pitocin, which I did as they were placing the epidural.  I would talk to your Dr. and see if they do birthh plans, or if htey just write your wishes down in your chart as mine did.

[ImmortalOne]

(This is what I've come up with for the birth plan for this baby, just wanting feed back and any considerations I should make otherwise.  I had horrible back labor with both of my daughters and the 2nd daughter almost ended up with a C-section.)

We have created the following birth plan do help you understand our preferences for my upcoming labor and delivery of our daughter.  With two previous difficult deliveries, I fully understand that certain circumstances may arise and these are only guidelines that may be followed.  Something that is very important to us is that if the baby becomes in any distress at all, a C-section is performed without hesitation.  If you have any questions or suggestions, please let me know.

I would like the following able to be present for the labor and birth of my baby:
? Jayson Mahala (baby's father)
? Katherine D.L.

[taysmommy]

birth plans are great, but unfortunatly (at least with my experience) the doctor doesnt get there until delivery, and the nurses do what they think is necesarry. and dont pay attention to what the doctor writes in your chart (again just my experience) my doctor explicitly stated that i should immidiatly get the epidural when i was admitted in active labor (guess he knows im a sissy) they didnt do this, guess they thought this was my first baby and i would have pleanty of time, two hours after i got to the hospital the anestesiologist got there, took 30 mins to administer the epidural, then 15 mins later dd was born, so i didnt get any pain relief what so ever, i was so mad at the time(while i was in pain of course) but i got over it when i realised i just had my baby in 3 hours, hope your plan is executed how you wish, im not doing one this time, i dont see the point since the hospital i go to is busy they dont look at them anyways

[peekawho]

The eating and drinking part.  In many, probably most hospitals, you won't be able to eat once in active labor, in case a C/Section is necessary.  

On the whole, I like to call them Birthing Wishes, rather than a Birth Plan.  Birth can't be planned out.  It's too variable.  If you get too caught up in "planning", invariably you will be disappointed.

[ImmortalOne]

This is baby #3 for me, and after some issues with my first two this is the reason I wrote it up.  Like the Demerol being administered too close and during the actual birth of my 1st daughter which made it so I couldn't hold her afterwards.  Or how long they waited to take my 2nd daughter when she was in distress and she was born blue and purple with an apgar test of 1.0 at birth.  I covered what I wasn't allowed to do with my 1st two children and had hoped to have happen with this baby.  

[tmv]

Hi there, are you a seasoned ob nurse or what? lol!  I have read a lot of your comments and have thought the exact thing....sometimes a little while later as I have been a sahm for 7 years! I worked 15 years ldr and occasionally nb nursery. It's nice to find a sister in medicine. I ran onto this site a few months ago when checking on the Cleveland clinic dr's for my dad's meniere's disease. I am sooooo adicted to it now!

As for the birth plans, if you trust your dr you are going to be fine. Find one that is more laid back or even a cnm if you don't want any extras. But, I can tell you that I totally agree with peekawho. The nursing staff is only doing the minimal amount to protect you and the baby. Even the episiotomy-sometimes you can get by without it, other times depending on many factors, you may have to have one to prevent a 4th degree tear to the rectum! I've seen a few birth plans and most of the staff truly rolls their eyes because it is what they do every day. They're not there to torture you, they are their to help you safely through a delivery. As far as the erythromycin opthalmic to the baby's eyes, it is the law in some states. Keep an open line of communication to your caregivers. Sometimes they will already anticipate your requests.

Best of luck to you, tmv

[peekawho]

Most of those things are done anyway, but there are a couple of comments.

The iv placement--your nurse will have to judge where the best veins are.  Of course we try to accomodate your wishes, but the veins are what they are.  I'd rather have one stick in my right hand than 4 or 5 in my left!  

The walking epidural--be sure your hospital offers this.  They were all the rage a few years ago, but most places have abandoned use of them, they simply didn't work well.  Most larger hospitals offer patient controlled epidurals...you push a button to give yourself more pain relief if you need it.  Works very well.

Cord blood donation--have you already set this up?  Most times, YOU have to arrange and pay for it.  Not always, but the majority of times you do.  

Just be flexible, that's my only advice.  You will not be stricken dumb upon your admission to L&D.  You will still be able to tell your nurse what you want.  
The best piece of advice I can give you is to not go in too early.  Wait at home until you can't take it any more.  You'll still be there early, if it's your first baby.  

The very best of wishes to you!  You deserve this to go well!  

[peekawho]

The Demerol being administered too close to the birth is often b/c there is no absolute way to know how close you are.  Sometimes being given Demerol relaxes you so much that you may go faster afterwards.  You might even be 3 cm dilated and then progress more rapidly than anyone expected!  

The fetal monitor is an imperfect tool.  We do the best we can with it, but it's not terribly accurate.  Its unfortunately the only thing we have.

Again, best of luck to you and I really wish it all works out well for you.  Can't believe time is flying!

[anxiousmomtobe?]

I agree with Peek you should think of it as a birth wish.

With my ds we had a carefully thought out birth plan.  After pusing for two hours and not being able to deliver I requested a consult with the specialist.  Up until that point everything had been discussed with us and the nurinsg staff had paid careful attention to the plan as did my family doctor.

Once the ob entered the room the plan became moot.

I will do a birth plan for this baby as well, but I do know it might go out the window as well.

[mature_enough]

They are so great to have! I'm glad you're considering a birth plan! Hopefully you will find one that meets all of your needs. (You can always write on one if it is a standard print out and talk about the plan w/ the birth center, hospital, dr, or midwife you plan to use before and after you go in for delivery.