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2006-05-03 - 10.40pm��previous entry��next entry
My Birth Plan!!
BIRTH PLAN
Neil and Alice (surname) � due date: 7th June 2006
To: Community Midwife Team
We have chosen to give birth to our baby at home because it feels like the most natural, comfortable, and familiar place to be for the occasion, and because we are confident in the ability of my body and the care of the community midwives to provide a safe and satisfying birth experience.
We realise that every birth experience is different, and that expectations cannot be set in stone.
In our desire to have the happiest and most memorable birth possible, we have listed our preferences below. These decisions have been made after much research, consultation and thought, and also my previous birth experience. Therefore, your help in attaining these goals is very much appreciated.
You can rest assured that in the unlikely event of complications, our full co-operation will be rendered after an informed discussion with the attending midwife has taken place, and adequate time for private consideration has been given us.
Previous experience of labour and birth
Our first baby was born on the 9th of November 2004. Labour began on the 8th with regular painful contractions and a large, heavily blood-stained show from the morning. I started out with a planned homebirth, which went very well until the baby turned to posterior and the pain of contractions became completely different and quite unbearable. I used a TENS machine up until this point of labour, and coped well with the contractions. I rocked on my birth ball and used relaxation and controlled breathing, and progressed without any difficulty.
My first internal examination was at around 4.30pm, where I was found to be 1.5cm dilated, fully effaced, but my cervix was only soft on one side so far. My waters could be felt bulging through the cervix. I developed a trickling leak over the course of the late afternoon/early evening but I�m not sure when my waters actually broke. I was examined again at 10.30pm and found to be 8cm dilated, so I took off my TENS machine and got into the birth pool. Immediately after the internal examination, the baby turned to posterior. I stayed in the birth pool for nearly 3 hours without progressing, and coping less and less well with the pain of the contractions in my back.
At around 1am, I agreed to a hospital transfer as I was getting too tired and finding the pain too difficult. Once at the hospital, I was examined again and found to be still at 8cm with a big lip of cervix. I used some entonox whilst waiting for an epidural, which I didn�t find at all effective. I had an epidural placed and found it really helpful, but made no progress for several hours and the baby remained posterior. My contractions became less consistent and regular and I was given a syntocinon drip to speed things up again. I developed a temperature overnight and this was brought down with paracetamol. I was given IV antibiotics and some IV fluids. My epidural was topped up a couple of times overnight.
At 8.15am I was examined again and found to be fully dilated, with the baby having turned to a lateral position. I had no urge to push so we waited until 9.50am to allow my contractions to bring the baby down a bit, and then as I still had no urge to push, I began pushing 3 times to each contraction as best I could. Arthur was born with no intervention at 11.28am. My placenta took its time to come out, even with the syntocinon drip turned back on, but it eventually came out without intervention and completely intact. I had a second degree tear (repaired and healed without any problems) and an estimated blood loss of 400mls.
Despite having had to transfer to hospital during my previous planned homebirth, I am very confident about having another homebirth. I plan to use the TENS machine and birth ball during labour as before, but not to have a birth pool this time, as it took up too much room and I didn�t find it particularly helpful last time. With the baby in an optimal position for birth, I don�t anticipate the need for hospital-based pain relief, as I coped very well up until the change in Arthur�s position. I am still open to the possibility of transfer depending on the circumstances, but would like the opportunity to deliver my baby at home, and feel happy and confident with my decision.
People at the birth
Neil (my husband) and Jane (my mother) will be present throughout labour and delivery. Our little boy, Arthur, who will be aged almost 19 months at my due date, will be at home for the duration, and Neil and Jane will be on hand to take care of his needs if he is awake. Hopefully it will work so that I will still be able to have one of them with me at all times for support while Arthur�s needs are also being met! As far as I am able, I will interact with Arthur as normally as possible. I would like him to have as much normal access to me as possible, and am happy for him to be present during any stage of labour or the birth itself, depending on how things are progressing and how I am coping at the time.
Items for comfort during labour
I am keen to use positions during labour that will help my progress, and also to remain as mobile as possible. I will be using pillows and a birth ball to facilitate these positions. If a hospital transfer is required, I would like the option to take my own birth ball with me if possible. I may wish to use the bath or shower for additional comfort or pain relief.
Nutritional needs
Snacking and drinking throughout labour as desired. I would appreciate encouragement to maintain fluids by sipping water or other gentle drinks, or by eating ice chips, especially if labour is prolonged.
Birth environment
* I would prefer dim lighting with lamps, rather than bright overhead lighting, to help me stay relaxed.
* I would like the option to play music as desired, and possibly to watch TV or a video earlier in labour as a distraction.
* I would like to be given privacy if I desire it at any stage (with the exception of a complication occurring).
* It is important to me that I am able to have solitude and quietness when I desire it, to help me relax and focus in on my body.
* I would like the freedom to move and vocalise my needs as necessary, or in whichever way helps me.
* I would prefer not to be hurried or pressurised at any point during labour and delivery, or given anxiety-producing time constraints, as long as Matthew (the baby) is tolerating labour well.
Medication
* No analgesia unless I ask for it please. I am keen to try to experience all of labour and childbirth without IV, IM or epidural pain relief.
* I would like to use a TENS machine to manage the pain. I have my own TENS machine, which I would like to be able to take with me to hospital, should the need for transfer arise. I would also appreciate the freedom to request massage or to move and vocalise as necessary to ease pain during contractions.
* I would prefer not to use gas and air.
* Please encourage me to keep going without the pain relief options I have requested to avoid, as I am sure I will need the extra encouragement at the time!
INTERVENTIONS
Homebirth
* I would prefer very infrequent vaginal examinations, only as requested by me, or where absolutely necessary. I would like these to be done as gently as possible to avoid rupturing the membranes.
* I do not want my membranes ruptured artificially.
* I would prefer Matthew�s heart rate to be monitored intermittently by Doppler or with a Pinard stethoscope.
* It is very important to me that nothing be done or suggested that would inhibit freedom of movement or my ability to improvise movements and positions.
Hospital transfer
* If hospital transfer is required or desired, I would prefer minimal staff around me, and my husband and mother present at all times.
* Please do not artificially rupture my membranes.
* I would like the freedom to continue to mobilise as much as possible, and would therefore prefer minimal EFM which would confine me to bed.
* I do not want my baby to be monitored internally.
* Please do not use IV methods to speed up or augment my labour. I would prefer natural alternatives if possible.
* If vaginal examinations are necessary, I would prefer them to be conducted infrequently, and only after my consent is given. Please carry these out as gently as possible, to avoid rupturing the membranes.
Delivery preferences
* I would like to be able to position myself as desired, with complete freedom to improvise as the need or urge arises.
* I would prefer to avoid delivering my baby whilst lying on my back, and would like the freedom to change positions as needed during delivery.
* I am willing to comply if a certain position is required to delivery Matthew safely � eg. shoulder dystocia.
* I would like the freedom to deliver squatting, semi-squatting (supported by birth partner) or on all fours, as desired.
* I would like the freedom to touch the baby during delivery, and to view his birth with a well-positioned mirror if requested.
* I strongly desire �mother-directed� instinctive pushing, rather than coach-directed.
* I would like to take the crowning stage slowly, and as controlled as possible to avoid tearing. Please could perineal support be provided with a hot compress, and massage if requested, to help avoid tearing.
* Please do not give me an episiotomy unless it is deemed absolutely necessary, and please allow me to participate fully in the decision if it is.
* I would like the umbilical cord to be left intact until it is no longer pulsating. Neil may like to cut the cord, so we would prefer this to be an option.
* I would prefer natural delivery of the placenta. Please do not administer syntocinon, apply cord traction or uterine massage.
Hospital delivery � additional notes
If assistance in delivery is necessary, I would prefer the use of a ventouse cap to a forceps delivery if possible. Please use a local anaesthetic if stitches are necessary.
Preferences for first contact with Matthew
* I would like Matthew to be delivered onto my abdomen and into my arms for immediate skin-to-skin contact.
* I may require some help to clean him off if he is very bloody or messy, but I would prefer this to be done while he is still having skin-to-skin contact with me.
* I would like dim lighting (lamp light only) to protect his eyes please.
* I would like the freedom to initiate breastfeeding immediately � it is very important to me that breastfeeding be initiated within the first hour after birth. Please only try to help me to breastfeed if I ask for help. I would like to breastfeed Matthew before his cord is cut to facilitate the 3rd stage of labour.
* Please provide us some space as soon as possible after the birth, so that we can have some private time for family bonding. To facilitate this, we would appreciate it if any procedures such as newborn exams or jabs could be delayed until we have had some private family time.
* Please examine, clean or bath Matthew in my presence.
Extra notes
* Neil and I practise Attached Parenting with our toddler. It is very important to us that Arthur be fully unrestricted in his access to me during labour and immediately after Matthew�s birth, with the obvious exception of complications.
* I am still breastfeeding Arthur on demand. I am well researched on all aspects of breastfeeding a toddler and a newborn, and how important it is for the newborn to get plenty of colostrum. However it is important to me that Arthur is allowed the opportunity to breastfeed at any stage during labour � provided I can tolerate it � and especially immediately after the birth. I am confident about breastfeeding both Arthur and Matthew at the same time, though I may need a little help with positioning Matthew to allow Arthur some room on one side of me to join in! I would very much like to breastfeed my two boys together if Arthur would like to, as soon as possible after the delivery.
Extra notes for hospital
* Please allow Matthew to stay with me at all times, unless he needs to be in the SCBU.
* Please do not feed our baby formula milk under any circumstances. It is very important to me that he is exclusively breastfed.
* Please do not supplement his feeds with water or give him a dummy (pacifier).
* We feel very strongly about our decision NOT to have our son circumcised.
* Please do not use disposable nappies on our baby. We will provide our own cloth nappies and deal with the soiled ones ourselves.
We are willing to be flexible about deviating from our birth plan if it is medically necessary, but we wish to be informed of the risks, benefits, and necessity of intervention or transfer to hospital, and to participate in those decisions.
We thank you in advance for your support and kind attention to our choices. We look forward to a wonderful birth!
Neil and Alice
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