# Would anyone care to share their birth plan with me?



## N8'sMom (Jun 25, 2007)

I need a sample birth plan to go off of.
My main things are:
No eye gunk
No hep B shot
No circ
No vitamin k shot
Baby rooms in with me

I would just like to see something that I can sample from. Feel
free to pm me if it's TMI to post on here.

Also did anyone put on their plan any type of threat for legal
action if the doctors did any of the things that they asked
to not be done? Perhaps something like...
"We will take legal action if our baby receives these
procedures after we have opted not to have these done"

Thanks in advance!


----------



## jessjgh1 (Nov 4, 2004)

http://www.mothering.com/discussions...d.php?t=698896

That was mine I posted in my ddc. I'd be happy to email you the word version since the formatting gets messed up. I'm sure I made some minor changes, but that was the gist and I got tips from reading many birth plans here and on the due date club.

I also discussed my birth plan with my midwife and doula and KNEW that the hospital I birthed at would be *VERY used* to everything on it, except a little bit with Vitamin K refusal. They were respectful and understanding of everything.... and did not pressure at all to do vit. k, even though they were not really used to that one being refused. The on call pedi, is another story, but the nurses and my midwife were awesome.

Good luck!

Jessica

----------------
Here it is, but the formatting will be quite messy, which is why I posted the link since some of the formating was retained in my op:

Jessica lastname
EDD: 7/15/2007
Daniel (husband)
Joshua (son)

Midwife: Name Business Name Phone
Doula: Name Business Name Phone
Backup Doula Name Business Name Phone
Name Hospital (Maternity) Phone
Pediatrician: Name Business Name Phone

BIRTH PLAN

FOR THE MOTHER Page 1 of 2

MINIMAL VAGINAL EXAMS
NO IV, FREEDOM TO DRINK AND EAT LIGHTLY
INTERMITTANT FETAL MONITORING
NO ARTIFICIAL RUPTURE OF THE MEMBRANES:
In the unlikely event that this might be beneficial, please explain the options and obtain consent.
NO PAIN MEDICATION
Childbirth is a natural process. Do not offer pain medication.
NO EPISIOTOMY
In the unlikely event that an episiotomy should be considered, please obtain consent.
NATURAL URGE/ PUSHING STAGE:
No forceful directed pushing. I will wait for an urge to push and listen to my body for cues to begin and stop. If our midwife believes I need to stop pushing (ie: mal-positioned cord, tearing, etc) I ask to be calmly informed. If there are reasons for strongly directed pushing or if I am not feeling an urge to push, I wish to be informed about options.
ALLOW FOR NATURAL EXPULSION OF PLACENTA
Allow for natural expulsion of the placenta, no drugs or pulling to speed the process.
NO RHOGAM
Mother and father are both A- blood typing. Records are on file from our first birth.
CORD BLOOD DONATION
A maternal blood sample as required can be taken during labor or after birth at mother's and midwifes discretion. After the cord has stopped pulsing, a cord blood donation can be obtained by our midwife, at her discretion. Collection kit from Cryobanks International. 800 869-8608
FOR THE BABY

DELAYED CORD CLAMPING
Wait till the cord has stopped pulsing before clamping. Mother may wish to be assisted into a position (i.e. side lying) to accommodate closeness if cord is pulsing for a while after birth.
ANNOUNCING OF GENDER
If our son Joshua is able to attend the birth and is willing, we wish our midwife and doula to help facilitate Joshua to announce the baby's gender to my husband and I.
IMMEDIATE OPPORTUNITY FOR PARENTAL BONDING AND BREASTFEEDING
We expect to hold the baby immediately after birth unless consent is obtained for a reason of medical concern. Breastfeeding as initiated by baby or as soon as possible after the birth.
NO EYE OINTMENT FOR BABY
NO RHOGAM
Mother and father are both A- blood typing Records are on file from our first birth
NO CIRCUMCISION
If baby is a boy he will not be circumcised. He also does NOT need to be retracted for any exam.
NO BATH FOR THE BABY
Vernix is a valuable substance. It provides protection, lubrication and antibacterial properties for baby both in utero and after delivery. We will decide when to bathe baby later at our discretion.
NO VACCINATIONS (continued next page)

--------------------------------------------END PAGE------------------

repeat contact info

BIRTH PLAN

PAGE 2 of 2

NO VACCINATIONS
Do not give our baby any vaccinations. This includes, but is not limited to, the hepatitis and vitamin K shots. We may use an oral Vit. K instead of the shot in consultation with our pediatrician
EVALUATIONS/TESTS/ PKU/NEWBORN SCREEN/HEARING TEST
We ask that evaluation or testing of our child take place in the room with the parents present at all times, if possible. We also ask that any testing or evaluations be postponed until after the baby has nursed for the first time. Father will accompany baby to the nursery for blood pressure and hearing tests.
ROOMING IN / NO SEPERATION
Unless required for health reasons, we do not wish our child to be separated from us at all and ask that our child 'room in' with the parents at all times;
If our child must be taken from the room to receive emergency medical treatment, Dan (the father) will accompany our child at all times.
NO BOTTLES, SUGAR WATER, FORMULA OR PACIFIER FOR BABY


----------



## jessjgh1 (Nov 4, 2004)

Quote:

We may use an oral Vit. K instead of the shot in consultation with our pediatrician
Oh, I forgot to mention that when I wrote this I was still researching this and didn't have a pedi lined up (had a few I was thinking of using, but didn't have a definite plan yet). I wasn't exactly sure what I wanted to do about vit k yet either

I found out that none of the pedi's in the area would do oral k and decided against vit k (unless there was trauma or other advisable concern) , but left it in because I thought it might keep them off my back a little.

Jessica


----------



## N8'sMom (Jun 25, 2007)

Thank you!!!


----------



## teachinmaof3 (Sep 15, 2003)

I like Childbirth.org's birth plan generator as a starting point.


----------



## thefreckledmama (Jun 1, 2007)

I kept mine short and to the point. I copied and pasted it from the actual form I printed out.

*Please obtain informed consent prior to any procedures or medications administered to
Jamie or Baby.
*
Labor and Birth

Please do not offer pain medications. I will ask for them if desired.
I would like intermittent monitoring with a Doppler and/or fetoscope so I may be free to move around in order to manage pain and expedite labor.
I would like minimal vaginal exams.
I would like no direction while pushing; I will follow my body's natural urges.
Please delay clamping and cutting the umbilical cord until the placenta has detached from the uterine wall.
I would like to deliver the placenta naturally-without the aid of Pitocin or cord traction.

Regarding Baby

No separation. If it becomes necessary for the baby to leave my room, my husband or I will accompany her.
No pacifiers or bottles. (Including sugar water)
No prophylactic eye ointment.
No Vitamin K injection.
No Hepatitis B vaccination.

Other

In the event a cesarean section becomes necessary:
I would like my husband to be with me at all times.
My husband will accompany the baby at all times after her birth.
I would like my uterus closed in two layers-opposed to the single layer method.

__________________________________________________ ____

There are other things that I might have put in my birth plan, like I'm going to wear my own clothing, and I want to eat and drink at will,....but I'm just going to do them. My birth plan is mainly what I want down in writing that people are seeing ahead of time, it's not like a nurse can accidentally change me into a hospital gown w/o my consent, KWIM?

The only point that my OB wasn't 100% on the same page as me was the Vit. K, and she just said why she would do it if I were her, and to think about it.


----------



## N8'sMom (Jun 25, 2007)

Kalopsia......

What is the two layer closing of the uterus you mentioned??
I haven't heard of this and am interested.

Thanks!


----------



## 3xx1xyFamily (Nov 25, 2007)

This was mine from DD#1, planned natural childbirth, before OB turned unsupportive and FOUND a reason to preform a c-sec.

We have chosen to write a birth 'plan' as means of expressing our wishes. We do understand that unforeseen circumstances arise in birth from time to time. If our birth 'plan' fails to explain how we wish those situations to be handled we ask that we are given a clear explanation of the situation, as well as our choices and be allowed to accept or refuse any procedures. Our 'plan' is written from our own research and beliefs with the best interest of the mother, our daughter and our family in mind. We are attempting a natural birth using HypnoBirthing techniques.

Pre-Admission

We request:
-To only consider inducement (i.e. stripping the membranes, pitocin, etc.) if onset of labor is unusually long or there is medical urgency and to use only natural means of inducement, moving to gels, pitocin drip or other medical procedures as a last resort.
-To remain at home as long as possible before going to the hospital

Hospital Admission

We request
-To decline routine IV prep upon admission. Heparin or Saline lock preferred.
-To have a private birth room with the door closed and drapes drawn for privacy. We ask that the lights be kept dim and that all staff entering the room remain calm and quiet.
-To bring a CD player with soft music playing in the background
-That our family and friends be allowed to visit through the early stages of our daughters birth

During Thinning and Opening Phase of Labor

We request
-Medical caregivers refrain from any practice or procedure that could unnecessarily stand in the way of our having the most natural childbirth possible
-That all staff honor our need for quiet and only essential medical staff be present
-Vaginal exams be kept to a minimum to avoid premature rupture of membranes
-Only intermittent monitoring of the baby's heart with fetoscope/Doppler or manual EFM
-No internal fetal monitoring in the absence of fetal distress
-To be free of blood pressure cuffs and monitoring devices between readings.
-To take fluids and light foods
-The freedom to move, walk and change positions throughout labor
-In the event of a stalled or slow labor that natural oxytocin stimulation (nipple or clitoral) be used and we be given the privacy to do so.
-To labor in the shower or tub and to have the use of a birthing ball and stool, if one is available

During Birthing

We request
-That ALL visitors and unnecessary staff be turned away until we have had bonding time with our daughter. We ask that only essential medical staff be present (i.e. no students, residents or other hospital staff)
-To allow natural birthing instincts to facilitate the descent of the baby, as much as possible, with mother-directed breathing down. Please, encouraging words in low calm voices free of "pushing" and counting prompts
-To choose a birthing position that will least likely result in tearing. Use of oil and hot compresses to avoid tearing
-Use of suctioning device rather than forceps if assistance is medically necessary and medical staff has allowed for complete birthing before suctioning baby
-Our daughter be immediately placed on mothers chest for skin to skin contact
-Use of still and video cameras to capture our daughters birth
-Father to assist in "catching" our daughter.
-Allow up to 30 minutes for natural placenta delivery, immediate breast feeding, uterine massage and nipple stimulation to assist in natural placenta delivery.
-No cord traction, pitocin or manual removal of the placenta unless there is an emergency

For Baby

We request
-Bright lights be temporarily removed until our daughter is moved to the mothers chest
-Delay "cleaning or rubbing" We will bathe our daughter when we return home.
-Delay cord clamping and cutting until pulsation has ceased; Father will cut the cord
-Allow our daughter to remain with us after birth and that all routine medical procedures and measurements be delayed for 1 hour to allow time for breastfeeding and bonding.
-That all medical procedures and measurements be done in our room
-Delay the use of Erythromycin or other salve for baby's eyes to allow optimal sight for bonding
-Oral Vitamin K to be used if available
-Father to stay with mother and baby throughout hospital stay
-Breastfeeding only. No bottles, formula, pacifiers or artificial nipples. Breastfeeding several times during the first few hours after birth.
-All vaccinations, and screenings (including PKU) to be done by our pediatrician at our scheduled appointment.

We would like to be discharged from the hospital to return home as soon as possible.

Thank you for participating in the birth of our daughter. Our goal is to make our birthing experience the best and most joyful it can possibly be.


----------



## mom2jasper (Dec 5, 2004)

they use some kind of antibiotic cream on the umbilical cord at my hospital. I am refusing this (in addition to vit K, eye stuff, etc.). Routine suctioning? This is not in my plan but I question the procedure, so will mention something about it.


----------



## BetsyS (Nov 8, 2004)

Mine was short:

Please don't count while I push.
If I need a c-section, please do a double layer closure.

Some things that I just did, no talking,no birth plan:
could have worn my own clothes (chose to put on a comfy hospital gown), ate/drank whatever I wanted (wasn't interested in much, though, honestly), listened to CDs we brought in, they didn't offer pain meds, discussed all medical decisions thoroughly before they were done (such as augmenting with Pitocin)

For the baby--no Hep B, vit K, erythromycin. He roomed-in and slept in the bed with me. Breastfeeding only, no pacifiers, no bottles. They asked before doing a blood sugar check on him per their routine. The pediatrician examined him in our room. No circ, and they didn't make me sign anything or give me any grief.

Postpartum--I ate take-out.







: I got myself up to the bathroom the first time (even post c-section). I went home at 36 hours (pretty short for post surgery). If I'd had a vaginal delivery, it would have been 12 hours probably.


----------

