I honestly don't think it's that great, it still very much has a DRAFT feeling to me, but oh well. Here you go! The last section is mostly related to hospital birth in case we have to transfer. I'm pretty happy with it but I might like to add that we'd like to keep the baby with us, or send my DH with it.
Informed Consent Questions
1. Is this an emergency, or do we have time to talk?
2. What would be the benefits of doing this?
3. What would be the risks?
4. If we do this, what other procedures or treatments might we end up needing as a result?
5. What else could we try first or instead?
6. What would happen if we waited an hour or two (a day or two, a week or two, etc.) before doing it?
7. What would happen if we didn't do it at all?
Birth Plan for: Amy -- (Husband: Matthew --)
Due Date: December 22
Midwife: Janet Macaulay
- My support people will be my husband Matt and my sister Emily.
- We would prefer not to have any visitors present during the birth.
- I would like to minimise internal examinations unless requested or if deemed necessary. I do not want my water broken.
- I would like to be free to move around and use whatever positions I find comfortable, including use of my birth ball and birth pool.
- If the baby appears to be poorly positioned or labour is not progressing, I would appreciate it if you could suggest changes of position or movement.
- I would like to enter the pool when I want to but would like to be told if the midwife believes it is too early in my labour and labour may be stalled.
- I would like to have a water birth and would appreciate your support in encouraging me to give birth underwater.
- I hope to have a completely natural homebirth using no drugs for pain relief, and would appreciate your encouragement to use other methods, such as movement, massage, relaxation, or my birth pool.
- My preference is to give birth in my birth pool OR wherever feels right at the time
- If I feel the urge to push I would like to be examined to confirm whether or not I am fully dilated OR if I request an internal at any other time
- Please keep the room as quiet and calm as possible during the second stage. I do not want someone yelling ‘PUSH!’ at me and would prefer to be told to ‘breathe’ the baby out. I would like to push when I feel the urge and not on demand unless the baby is in distress.
- I do not want to give birth on my back. Please encourage me to use positions that will allow maximum mobility in my pelvis.
- I intend to 'catch' my own baby, and would like to be reminded to do so.
- I would like to avoid perineal damage if possible and would appreciate your guidance in giving birth gently to accomplish this.
· I would like the cord to be allowed to finish pulsing before being cut. Please offer my husband or myself the opportunity to cut the cord.
· I plan to have a natural third stage and to allow the placenta to show up in its own time. Please do not administer any drugs unless you feel there is a real need. I would appreciate your advice in helping me deliver the placenta naturally.
· If I give birth in the pool I would like to get out of the water for the third stage if I wish to.
· I would like to be shown the placenta.Care of the baby:
· I would like to waive the administration of eye antibiotics.
· I consent to giving the baby the Vitamin K shot.
· I would like to breastfeed my baby as soon as possible after the birth
· I would like to keep the baby unclothed and close to my skin immediately after the birth to maximise skin-to-skin contact.Repair of the Perineum, if necessary
· I would like to discuss my options. If any tear is minor and you think it will heal on its own, without stitches, please let me know.
In case of transfer to hospital:
· If transfer by ambulance becomes necessary, please do not strap me in on my back - I would prefer to be on my side, to make contractions easier to deal with
· I would like to keep an open mind about my pain relief options and would prefer not to be offered pain relief unless I request it
· I do not agree to student doctors being present during my treatment
· I am very keen to avoid a caesarean section if it is at all possible, I particularly would like to avoid a caesarean for slow progress. If labour is simply taking a long time but my baby is not in immediate danger, please would you encourage me to keep going and perhaps to try changes of position or movements that might help. Please do not offer a caesarean unless my baby is in danger.
· If a caesarean section becomes necessary, I would prefer to remain awake with epidural or spinal block anaesthesia. I would like my husband Matt to stay with me at all times, and would like to breastfeed the baby as soon after birth as possible.
If there are problems after the birth:
· If I suffer a severe postpartum haemorrhage, please do not perform a hysterectomy unless it is the only available course of action. This is my first child and I still hope to have more.
· Please do not give my baby supplements of glucose water or formula milk without my permission. I would expressly like to avoid having any formula supplements unless it is unavoidable, and certainly not in the first two days in any event.
· Under no circumstances is my baby to be bottle-fed as this could lead to nipple confusion and hinder breastfeeding. If supplements are necessary, please give them by spoon or other method, not by bottle.
· If I have trouble breastfeeding, I would greatly appreciate the help of a midwife who is fully supportive of breastfeeding, and would also like to be given contact details for local breastfeeding counsellors.
· I would like to go home as soon after the birth as I am able to move, unless I, or my baby, have health problems that require hospital treatment.