Creating my Birth Plan

I have been working on my birth plan for several weeks, with Tim, and with much prayer and consideration. Planning started mid August and I have been taking notes as ideas and preferences arose. Finally, on September 18, I drafted a plan on Microsoft Word. Prior to doing this, I said a prayer for God to guide me in making the best decisions for both me and the baby.

Welky Birth Plan (VBAC)

Leslie and Timothy Welky; Baby due 10-26-12; Vanderbilt Medical Center; Vanderbilt Midwives; Doula Gaylea McDougal

• Please pair me with a nurse familiar with natural childbirth.
• I will be using prayer and meditation as well as praise music during labor and would appreciate the lights to be kept low and voices quiet. Please ask me how comfortable I am vs. how much pain I have.
•  Please only check me vaginally if completely necessary, with my permission. Do not inform me of progress. Instead, inform the birth doula present.

Following delivery, unless required for health reasons, I do not wish to be separated from my baby.

 

Unless contraindicated, I would like the following to be followed:

 

Pre-labor exams (at regular appts) 

 

· Please do not check my cervix except in the case of a needed induction to ascertain whether an induction would likely be successful.

· Do not strip membranes.

 

Labor

· Support people present: Tim Welky, Gaylea McDougal, possibly Heather Holter, possibly a photographer.

· Allow still and video pictures to be taken

· I understand that I must have continuous monitoring. I ask that this not inhibit my movement and that it not be a major indicator to the nurses of a need for cesarean. If a concern arises from the monitoring I ask that it be given time to determine if there is actually a problem before reacting by suggesting a cesarean.

· I understand that I must have a hep-lock in place. I do not wish to receive any fluids or medications unless absolutely necessary and unless consented to by me.

· No induction or intervention to help labor (except natural methods such as nipple stimulation) unless cervical scar tissue poses a problem. If cervical scar tissue does pose a problem, I request that a midwife will massage the cervical opening to help provide a vaginal delivery. The second option should be pitocin. Cesarean should only be suggested as a last resort (I had my cervix mechanically dilated on my first delivery).

· I request that no offers of drugs of any kind will be made during the labor and delivery process. I wish to have the option open for nitrous oxide, should I request it. I request that no offers for anesthesia be made to me by any doctor, nurse, or other hospital staff person. In the event that a cesarean section becomes necessary, I will decide at that time what kind of anesthesia will be used.

· I wish to use whatever comfort measures are allowed for me as well as whatever positions I decide in the moment. I do not wish to have the monitoring inhibit my movements.

· I wish to be able to have any liquids I prefer during labor.

· I wish to use the toilet as needed and not to have a catheter.

 

Birth

· I plan to labor down and spontaneously bear down with advice from my doula regarding pushing

· I wish to use squatting, semi sitting or side lying positions (any that I prefer) during pushing as opposed to back lying.

· I request that if possible, perineal massage with oil, hot compresses, and perineal support be used by the midwife to prepare the perineal tissues to stretch.

· Please offer a mirror for me to see the baby crowning.

· Allow dad to announce the gender of the baby (doula if dad not available)

· Please delay cord cutting until it has to finish pulsating, and allow the father to cut.

· I prefer to naturally deliver my placenta. After delivery of the placenta, do not send it to the lab. I intend to have my placenta placed in a cooler in the room and picked up Heather Crandall for placenta encapsulation.

 

Immediately after Birth

· Immediately after the delivery, place the baby on my stomach. Do all newborn assessments necessary on me. Allow the baby to stay with me at least one hour (per AAPA guidelines) and breastfeed immediately.

· Do not warm the baby with the warmer unless baby is not warming adequately with me.

· No liquids are to be given – I will nurse only. Also, do not give pacifiers or any other artificial nipples.

· Provide suction of baby by hand suction only. Intervene further only if other interventions are unsuccessful.

· Delay bath 6 hours or more – leave vernix on and ask before bathing the baby.

· If baby needs any other intervention or care, dad (and mom if I desire) is to accompany baby at all times.

 

Newborn Interventions

· Absolutely no procedure will be performed on my baby without my explicit authorization for each specific procedure. One or both parents will be present for any procedure that is performed.

· Delay hep B vaccination (none in hospital)

· No Erythromycin

· Delay vitamin K until I decide after the birth. Do not administer without explicit consent.

· Do not perform a routine glucose test. Ask before performing and give the option to decline altogether.
· If the baby is a boy, delay circumcision (if we decide on circumcision, one or both parents will be present for the procedure).

· PKU test only with parents present or by the pediatrician following the release of the baby from the hospital (on day 5 when more accurate)

· Hearing test OK with one or both parents present.

 

Cesarean Birth Plan

In the event a cesarean is unavoidable, I would like the following to be followed:

 · Allow dad and doula to accompany me during pre-op.

· Place the catheter in post anesthesia.

· Do not restrict my arms unless I cannot control them.

· Do not give me a sedative after the procedure.

· Use the double suturing technique when closing my incision.

· Use a spinal block – no general anesthesia.

· Allow my husband and doula to stay in the OR for the entire procedure.

· Allow my husband to take pictures.

· Allow my husband to watch the delivery of the baby by mirror or dropping the sheet.

· Allow my husband to announce the gender of the baby (doula if dad not available).

· Place baby on my bare chest immediately after delivery if possible. If not possible, allow dad to hold bare baby.

· After delivery of the placenta, do not send it to the lab. I intend to have my placenta placed in a cooler in the room and picked up Heather Crandall for placenta encapsulation. My placenta is to stay with me or my doula at all times.

· Our baby is to stay with us at all times. We do not consent to him or her being taken to the nursery for routine exams or consultations regarding non-life-threatening issues. We will only allow him or her to go to the nursery if in immediate danger, his or her issues have been explained to us and our permission has been given.

· If baby has to leave for an emergency, dad will accompany and I would like our doula to be with me during their absence.

· Perform all newborn interventions on my chest or while dad is holding baby.

· Let us wipe baby down and give baby’s first bath. Keep vernix on.

· Do not discuss topics that do not relate to mine or our baby’s care while operating.

· Please speak directly to me and not about me while in the OR.

· No pacifier, bottle, other nipple, formula, human milk fortifier or other supplement is to be given if a NICU stay is necessary. IV nutrition only if needed.

 

Immediately After Birth

· Follow directives as above

Newborn Interventions

· Follow Newborn Interventions as above