Hospital Transfer Birth Plan
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  1. #1
    Posting Addict TiggersMommy's Avatar
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    Default Hospital Transfer Birth Plan

    We'll be going over my birth center birth plan with my MW tomorrow. I figured I'd bring my transfer birth plan along to get her advice. I've been putting off writing this thing as most of the topics aggravate me. I wish i could just write: Let me have my baby and don't then touch her. Alas, hospitals need a tad more explicit instructions. I have two versions, one for a non-emergency transfer (say I go over 41 weeks, argh) and one for an emergency transfer. I figure most of my requests will go right out the window in the event of a real emergency so I just summed up the most important things having to do with baby's care. I left off stuff that I'll do regardless of what they tell me (eat/walk around/get in the tub). Oh, and I left it as though we didn't know the sex JIK the U/S was wrong. I'd rather hear the surprising news that there's a penis coming my husband (or my own eyes).

    Any input from you lovely ladies on wording or things I may have forgotten would be greatly appreciated!!! Thanks!!!!

    Here's what I have so far:

    First stage:

    • Do not offer pain relief, if I need it I will ask for it at which point I prefer IV narcotics over an epidural.
    • If IV access is required, I request that a Heparin Lock be placed and left unattached.
    • I would prefer that fetal monitoring be done intermittently with a Doppler or fetoscope by my midwife.
    • I would like to try breaking my water, nipple stimulation, walking, and relaxation before any discussion of a medicated induction.

    Second stage:

    • Do not engage in directed pushing unless it is to allow for perineal stretching once the baby has crowned.
    • I will give birth in a position I find most comfortable or that my midwife deems appropriate.
    • Please avoid use of vacuum or forceps.
    • I do not consent to an episiotomy, I would rather tear.
    • If possible, my husband would like to “catch” the baby.
    • Avoid suctioning of the baby’s airways.
    • Place the baby directly onto my skin following birth.
    • My husband or I would like to announce our baby’s sex.
    • Please allow the cord to stop pulsing before handling/clamping/cutting.
    • Please allow me or my husband to cut the cord.

    Third stage:

    • I do not consent to cord traction.
    • Please allow 1 hour after birth for delivery of the placenta before intervening.

    Newborn care:

    • Our baby is to be left with my husband or me at all times.
    • We do not consent to routine nursery time.
    • We do not consent to the administration of the following and will sign any forms necessary:
    o Hepatitis B vaccination
    o Erythromycin eye ointment
    o Vitamin K shot
    o Any other vaccines
    • If our child is male, we do not consent to a circumcision
    • We will give baby his/her first bath.
    • Do not offer bottles or pacifiers.
    • We would like to delay our baby’s checkup for a minimum of 2 hours following birth.

    In the event of a C-section:

    • My husband is to be in the room.
    • I would prefer a spinal over general anesthesia.
    • If possible, the baby is to be immediately handed to me or my husband.
    • Please allow my husband or I to announce our baby’s sex.
    • Please allow the cord to stop pulsing before cutting.
    • I would like to attempt to initiate breast feeding ASAP.
    • If separation of the baby from mom is necessary, my husband is to accompany baby at all times.


    SHORT AND SWEET EMERGENCY LIST:

    • We do not consent to the administration of the following and will sign any forms necessary:
    o Hepatitis B vaccination
    o Erythromycin eye ointment
    o Vitamin K shot
    o Any other vaccines
    • If our child is male we do not consent to a circumcision
    • We will give baby his/her first bath.
    • Do not offer bottles or pacifiers.
    • Baby is to be accompanied by me or my husband at all times.
    Erin
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    Posting Addict Spacers's Avatar
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    Just an FYI, if you have a c-section, they might not want to delay cutting the cord because the longer you're open, the higher your risk of bleeding & infection. There's also not usually a convenient place to safely & securely hold baby while waiting for the cord to stop pulsing. And finally, c-section babies tend to have more fluid in their lungs because they haven't been squeezed through the birth canal, so they are more likely to need suctioning even with the oxygen supply coming through the cord. That's not to say it can't or shouldn't happen; in Germany, a study of premature babies delivered by cesarean section found that delaying the cord clamping by just 45 seconds greatly reduced the need for blood transfusions in the first six weeks of life. I've heard of a couple doctors IRL who were willing to do a "lotus birth," in which the entire placenta is removed along with the baby, but most doctors won't do delayed clamping with a c-section. Definitely talk with your doctor about this!
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    Posting Addict cactuswren's Avatar
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    I have heard that there is no good reason not to delay cord clamping with a c-section if everything is normal...they just don't like to bother. Definitely worth a quick discussion.

    I think this looks great, Erin. You might add other natural induction techniques in stage one (I'm telling you, blue cohosh absolutely did it for me, both in getting labor going and in getting from 6 to 10 when it had dragged for sooo long.) but that's my only suggestion!

    My birth plan appt was really pretty simple. I had Sandy, and she looked it over and basically said "...yep, this is all what we would do anyway." and we chatted a bit and that was it. I must say, she was the midwife who attended me from my arrival at 9:30pm-7am, and she followed my birth plan beautifully. I had basically just said I don't consent to anything without discussion and to leave me alone as much as possible, just be like a lifeguard and step in if needed, and she took me at my word. Can't guarantee that at the hospital, but at least you know the mw will be there to advocate for you--it should be pretty much the same as the BC if you go for a routine reason (41+).

    How exciting that you're at your birth plan appointment already! Soon it will be lodge time and I can get some quality stalking done
    -Leigh-
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    Posting Addict TiggersMommy's Avatar
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    Thanks ladies! I'd put the least amount of thought into the C-section portion. I'll talk with my MW about cord clamping and suctioning today but I don't know how much help she'll be seeing as she doesn't do them.

    My birth center plan is so much simpler. Their routine is pretty much everything I'd want anyway. I'm most concerned with the second stage portion in a hospital setting. It's so easy for something to be done very quickly without having a chance for discussion. I'm keeping my fingers crossed for a birth center birth so that I won't have to worry about any of that!

    Leigh- I love Adair's expressions in your new siggy pic!
    Erin
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    Posting Addict cactuswren's Avatar
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    Hey actually, TODAY should be lodge time, no?

    Thanks--our friend who is doing a Faces photo project took them this weekend. He really captured her! I love them.

    If you have the mw at the hospital, it should be almost exactly the same as at the BC. The only reason you wouldn't have a mw is if there is complication....at which point you're right, not much opportunity to discuss. What I would actually make the MOST sure of is that your DH feels fully informed and capable of advocating for you. If he will be there and feel knowledgable enough about your wishes to be able to confidently speak up and/or answer questions, that's better than any piece of paper.
    -Leigh-
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    What an awesome plan! I'm definitely doing a transfer plan this time as well. I didn't even think of it during the last pregnancy and for some reason transferring is weighing heavily on my mind, so I think being prepared will help take some of the stress away.
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    Posting Addict MrsMangoBabe's Avatar
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    in my experience birthing at a hosital, it isn't too difficult to get what you want during 1st stage, but 2nd and 3rd stage are more difficult...

    Your plan looks good. One thing on the emergency list, you might consider rewording the circumcision part. "I do not consent" is strong language, and as far as I know, these days circumcision is not routinely done to boys without parental permision. I wrote "we will not be circumcising our son" on my birth plan and the only person who even brought it up was one of the on-call pediatricians, and that was to say basically "you're not circumcising, are you?" and when we said no, she basically said "good choice." (that was the gist of it, not her exact words)
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    Posting Addict TyrantOfTheWeek's Avatar
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    Your baby is a girl, right? So the circumcision is moot anyway.
    The non-emergency stuff looks ok, but I would think if it were an emergency, your plan wouldn't even be looked at since getting the baby out is #1.

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  9. #9
    Posting Addict TiggersMommy's Avatar
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    The wording on the circumcision is a compromise between what my hubby wanted and what I wanted. I was fine with "we will not be circumcising if our child is male." Hubby wanted, "If you circumcise our son, I will circumcise your face." But yes, baby is supposedly a girl so it's not an issue. I added it JIK.

    My MW told us last night that in the event of a real emergency, we might as well not even have a birth plan as it won't be read by the hospital staff. She sort of chuckled when I asked if they'd consider delayed cord cutting or lotus birth with a C/S. Oh well, if it comes to that, a healthy baby is really all that matters. Even if I can influence any member of the staff with my birth plan I'll be satisfied.
    Erin
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    Posting Addict Spacers's Avatar
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    Quote Originally Posted by TyrantOfTheWeek View Post
    The non-emergency stuff looks ok, but I would think if it were an emergency, your plan wouldn't even be looked at since getting the baby out is #1.
    I have to disagree with this part. Short of being brought in an ambulance to the wrong hospital, the hospital staff should absolutely be familiar with your plan, even in the event of an emergency. They should review it as soon as you're admitted, or when your midwife calls to notify them that you're transferring. I wasn't even in labor when I was at the hospital before Tiven was born, I was only there for an NST, but they still looked at my birth plan because it was part of my records. And that's why I was so pissed off about them giving her the eye goop & Vitamin K shot, it was right there: We do not consent. Black & white on the birth plan that was reviewed by my nurse less than an hour before Tiven was born. Baby was out, she was breathing & screaming, there was no longer an emergency, and they should have checked our birth plan or consulted one of her parents before doing a single thing to her. When they were busy saving her life, I completely understand throwing the birth plan out the window, but when lives are no longer in danger, they need to do what the parents want.
    Last edited by Spacers; 09-08-2010 at 03:33 PM.
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