Thursday, October 20, 2011

homebirth preparation: birth plan or preferences

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 As I've done reading on preparing for birth, one thing I keep coming across is conflicting information on birth plans. I read one book that says to forget birth plans, just know your information, and be assertive. I have others that say be very specific about every detail, and then even more that say something in between.

When I started working on my birth "plan" during my pregnancy with Elizabeth, I decided to take a bare bones approach. I knew that if I were to transfer to a hospital, that we would be going because we were seeking things that I couldn't have access to at home, and that many of those things would likely be the exact opposite of any detailed, ideal birth plan I might have created. I knew that I could state my preferences for many things, but hospital policy and the needs of the situation might warrant some of those preferences being set aside.

I knew I didn't want to irritate doctors and nurses by having absurd requests.
I knew that anything too wordy, or more than a page was likely to be overlooked.
I knew I should have several copies of this on hand.

So how did I decide what to include in my plan to keep it short and to the point?

I included the information that my husband might not know, or be able to remember very well. I knew that I could work my way through whatever might happen to me, but that I needed to be an advocate for my child.

This resulted in the first half of my preferences sheet being my medical information and history, and the second half being a brief list of my care preferences during and after birth.

Here's roughly what it looks like (I've left off some specifics because, hey, the internet doesn't need to know Everything about me...) In each additional pregnancy, I've revised it a bit.  This time, I added a section about cesarean birth. I've included my commentary on this in italics.

Birth Preferences Sounds better to me than a plan, since I know I can't guarantee how birth will go. Plan implies unwillingness to adapt.  I'm willing to adapt if the situation calls for it.
Medical Information
Carrie Full Name
Date Of Birth: (one would hope a husband would know this, but...)
Social Security Number: (you really think I'd give that one out?)
Blood Type: A+ (over achiever all the way!)
I have two children, born vaginally. This is my third pregnancy.
Estimated Due Date: Mid-November (if you know me, you know I'm not set on a particular date.  But I'll include it specifically for the medical staff we might encounter)

Health insurance information (insert here ;))
Primary Care or OB information (again no need to share all my details...)
I am not currently taking any over-the-counter or prescription medications.
I have no known allergies to medications.
I am taking the following vitamins, herbs, or supplements:
Prenatal Vitamin
Calcium supplement
Vitamin C
Occassional B Complex supplement
Red Raspberry Leaf tea
Nettles Leaf tea 
Date 1st birth - I received pitocin augmentation for prolonged/stalled labor. I did not take any pain medications, had no episiotomy, and the baby was born without the assistance of forceps or vacuum. There was one small laceration that did not require stitches.

Date 2nd birth - prodromal labor (3 days), followed by precipitous birth. Few light contractions all day, around 10:30 pm they started in again as short, non-progressing contractions then picked up rapidly in intensity during the last half hour. Baby born 2.5 hours after first contraction.
No history of post-partum hemorrhage. 
I had one surgery under general anesthesia at age 13 for a reason I will not disclose on the internet. No biggie, but y'all don't need to know. No known negative reactions. 
Preferences for Care of Carrie
In the event that I require a c-section, I request that:
- double layer suturing be used instead of single
- no sedatives to help me relax or sleep after surgery, unless I request
- at least one arm remain free
- the baby be allowed to rest on my chest, skin-to-skin during surgical repair, unless the baby requires emergency attention. 
After learning more about cesarean birth, I knew that these were things I needed to specify, as there can be great variability in practice. These were the most important thing to help ensure later chances at a VBAC and at encouraging bonding and a quick start to breast feeding.
Preferences for the Care of Baby
We prefer cord clamping to be delayed until about 2 minutes or later. (This grand rounds was what confirmed me as a advocate for delayed clamping)
We decline any prophylactic eye drops, and eye drops of any kind.
We decline Vitamin K shots or supplementation of any kind.
We decline newborn vaccinations.
We decline prophylactic antibiotics for the baby for GBS. If baby shows signs of infection we will discuss the best course of action.
If the baby is a boy, we decline circumcision.  
I know that there can be a lot of controversy about some of these topics, but my reading suggests that there is no clear and present need for baby to experience these procedures during the first few days after birth. 
We would prefer that any newborn checks, tests or exam be delayed until Carrie has an opportunity to hold the baby, and that they be performed while baby is in contact with Carrie or Jude.
We prefer baby's first bath be delayed until Carrie or Jude can bathe the baby.
We prefer the baby be breastfed only; no bottles or pacifiers, please.
We prefer for the baby to remain in the presence of Carrie or Jude at all times, or if neither is available, in the presence of one of our support people.
We prefer for the baby to room-in with Carrie. 
Most of this section is to ensure that a good breastfeeding relationship gets off to a good start, and to do our best to ensure that baby doesn't experience the things we have declined.  Unfortunately, I know families that have had procedures done to their children without parental consent, and this needs to be guarded against.
I have managed to keep this all on one page, and in a normal sized type.  If I have other things to add in the future, I'll have to figure out what to edit.  Probably the short birth histories would be first to go.

Keep in mind that my birth preferences are designed especially around the need to transfer, and if you are birthing in a hospital or birth center, what you may need to specify will be different, based on your particular circumstances.


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