how to approach my OBs with birth plan
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    Default how to approach my OBs with birth plan

    i guess i could go a couple different ways with this-

    just hand it to them and hope for the best because i'd say there is better than a 50% chance i wont even need 90% of the list- i intend to labor at home and show up in time for them to catch. its a 5 minute drive, in bad weather, with bad traffic, if we hit all the red lights.

    go over each item (its ONE page, i wanted to keep it simple)

    bring up horror stories that make me concerned


    I dont really want to have to get defensive because i've mainly been seeing the same OB but i have no guarentee that he will be delivering,(5 ob's rotate, you get whoever is on call unless you are special enough to find one OB you like best and become their personal patient, and they are willing to be called in for you) in fact, even though i like him now, his schedule is too easy to get into for me to think there isnt something that he does that other patients don't like, and i dont want to discover it while in labor like i did with the OB, who delivered DD or in the last month. When i brought up some concerns about DD's birth that i didnt like he really calmed my fears about that, but i'm still afraid that in the deliver room the attitude will be very different. I am going to make a POINT to see each OB in the practice between now and 35 weeks, no matter how much i have to lean on the receptionists to get them to make it work. there is one OB i never saw with DD and she's the one that i've heard nothing but angelic voices praising. she discharged me from the hospital with DD though.... thats the only time i saw her.

    and i do want to make sure i ask each one of them a few things and get to know them more than just a "urine is good, BP is good, heartrate is great, measuring fine.... did you have any questions?" and i say um...... well..... no because i intend to avoid you guys as much as possible before during and after this baby is born....

    should i have a few fluffy questions on hand so i dont have to argue over points of the birth plan with them( like no eating/drinking and my plan is to eat and drink whatever i want, or no IV and they say "but what if..." blah blah blah) i could ask things like "i was only in labor for 5 hrs with my daughter, do you really think this one will be even faster?" or ask questions i'd like answers to but i don't think they have them like "my DD was posterior, what can i do to avoid that, exercises, posture... anything?"
    ~Jenni~
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    Super Poster emommyof2's Avatar
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    To be completely honest, and I've said this before, I'm not a fan of birth plans. First and foremost for the reaction you get from the OB when you try and make them read/follow it. Most OB's get a very negative attitude with you when you approach them with a birth plan. They are completely convinced that all mothers are actually certifiably insane, know nothing, and expect everything to be roses and chocolate. Now... you and I both know that we are well read, educated, aware women who are just looking out for our own wishes during labor and delivery!

    If your going to go through the trouble of writing out a birth plan, here are some suggestions to make the idea more palatable for the OB:
    * When you approach your OB, say stuff like "Now I'm very aware that birth never follows a plan but we've written out some guidelines of what we would really like given different situations. We know that things always happen unexpectedly but just ask that you take both our wishes into consideration and take the time to discuss any major issues with us well in advance of preforming any procedures we have listed here as unwanted."
    * Don't call it a birth plan, seriously... bad reactions almost every time. Call it your birthing wishlist, as in like Christmas you know you might not get it all but it would be awful swell if you did!
    * Make sure the Doctor knows that you are rational, flexible, and understand that yes there are times that interventions are needed. And as an educated, rational, flexible parent you only expect the Doctor to talk things out with you and give you specific reasons why he/she would divert from your very obvious wishes. (IE: come up with a real reason not... your taking too long and my tee off is in an hour)

    Basically, gauge the reaction when you talk about the plan, if there is eye-rolling, pitch change, or flat out "Oh so you want a C-section then" You need to take this time now to be assertive with the OB. Better now than when your IN labor and trying to get your wishes across. Don't let him/her shove you off, or blow off the issue, DISCUSSION is key! Make them go over the plan right there in the office with you, and if they aren't the doc that makes the delivery have hubby do the same thing when they arrive at the hospital! Just remember OB's have the God complex, they believe that we are not smart enough to understand the very over our heads things that are going on in our own bodies... rarely you'll get one that isn't as stupid but hey... plan for the worst right? When in doubt, doctors in the states run their practice like a business, your the customer and guess what hun, your always right!
    Adam and Eirinn
    Ashleigh Jun 3 2000, Mackenzie Sept 21 2001, Jayde Jul 9 2006, and Liam Jun 9 2011

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    Mega Poster LMCH's Avatar
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    typing one handed w/ kid on my lap...bear w/me...

    i brought it up w/ one of the ob's that was one of my faves. i asked when we could begin discussing/review my plan. well that was after i brought it up at an appt w/ one i didnt know well and she is the one who said we can go over preferences during labor as it comes up...and then went on to tell me "first babies are awful" when i mentioned not wanting an epidural

    with the other nice guy, he went over it w/ me and told me i would likely need to compromise and get a heplock if i was nit wanting an iv...which i didnt argue on at the time since they were ok w/ everything else.

    if there is an ob there you like/trust more, mention/ask about birth plan when you see him/her...and then feel out the situation based on their response . i wouldnt go in on the defensive at first...if they have issue w/ any of your prefernces, then you could quote stats, back up your decisions, etc

    eta like pp said, definitely mention you will keep an open mind in labor as every labor is different...i took that approach last time.
    ~*~Lauren~*~







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    Posting Addict jooniper's Avatar
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    I'm with emommy- I'd avoid using the term "birth plan" and have it be more of a "these are my concerns and some things I want to avoid".
    -Jenn -
    my family blog--my pics--
    Married to Kenny Aug '06


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    birth preferances, that is what i'll call it

    I know every child/labor is different, but i'm pretty sure that there are some things i can expect to go a certain way. For example, i was dilated to a 4 at 37 weeks and DD was born 1 day after 38 weeks. i'd be damn surprised if i went into labor at 39 weeks and was only a fingertip- that would be ver different than my body had responded before. DD was big, 8lb 8 oz, i'd die of shock if i had a 6lb baby at full term. i was in labor for less than 5 hrs after they broke my water.... several nurses i've talked to already assume i'd only have about half that. i'd assume only a little shorter myself, because i let them break my water when i wasnt in active labor because *i didnt know any better at the time* silly me. i also love my bathtub and i'd be surprised if i didnt enjoy it while in labor. i love my rice bag and kept begging for them to warm it up again with DD.... but them people kept getting distracted and forgetting to get it i wanted to go without pain meds with DD and i did, so unless this kid is pure evil, i think i can handle that again.

    i also knowi dont want the bed broken down and jacked up for hours, i felt like i was going to fall off and coudn't get out of it under my own steam even when i tried, so i want it in writing so they don't do that!

    Also, i know that my plan makes certain assumptions concerning common variations (complications) such as not GBS+, and no meconium, no excessive blood loss post partum, and a few DUH things like not breech, because that would void my whole plan. those would cause variations in my plan and i know it. but i'm making a plan *preferences* because with DD i didnt, and things happened that i didnt like, and they didnt need to happen, they happened because i was not in the right frame of mind to make my preferences known.
    -i could have continued to hold and try to nurse her while getting stitches from my tear, or just held her at least.
    - i got IV antibiotics even though i wasnt GBS+, OB made a mistake, i'd like that in my birth plan so its written somewhere else in case someone makes a mistake again
    - got stuck in the bed, never got to try the tub, because i didnt have a plan, they didnt kow i wanted to try the tub, and i had no idea how much time it would take pushing etc...


    i know things are already going to go differently because i'm more informed this time and i wont show up at the hospital too early (pretty sure i wont....) and i can eat at home and do whatever i want at the same stage i was walking the halls at the hospital with DD.
    ~Jenni~
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    Super Poster emommyof2's Avatar
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    Quote Originally Posted by gypsy86 View Post
    birth preferances, that is what i'll call it

    I know every child/labor is different, but i'm pretty sure that there are some things i can expect to go a certain way. For example, i was dilated to a 4 at 37 weeks and DD was born 1 day after 38 weeks. i'd be damn surprised if i went into labor at 39 weeks and was only a fingertip- that would be ver different than my body had responded before. DD was big, 8lb 8 oz, i'd die of shock if i had a 6lb baby at full term. i was in labor for less than 5 hrs after they broke my water.... several nurses i've talked to already assume i'd only have about half that. i'd assume only a little shorter myself, because i let them break my water when i wasnt in active labor because *i didnt know any better at the time* silly me. i also love my bathtub and i'd be surprised if i didnt enjoy it while in labor. i love my rice bag and kept begging for them to warm it up again with DD.... but them people kept getting distracted and forgetting to get it i wanted to go without pain meds with DD and i did, so unless this kid is pure evil, i think i can handle that again.

    i also knowi dont want the bed broken down and jacked up for hours, i felt like i was going to fall off and coudn't get out of it under my own steam even when i tried, so i want it in writing so they don't do that!

    Also, i know that my plan makes certain assumptions concerning common variations (complications) such as not GBS+, and no meconium, no excessive blood loss post partum, and a few DUH things like not breech, because that would void my whole plan. those would cause variations in my plan and i know it. but i'm making a plan *preferences* because with DD i didnt, and things happened that i didnt like, and they didnt need to happen, they happened because i was not in the right frame of mind to make my preferences known.
    -i could have continued to hold and try to nurse her while getting stitches from my tear, or just held her at least.
    - i got IV antibiotics even though i wasnt GBS+, OB made a mistake, i'd like that in my birth plan so its written somewhere else in case someone makes a mistake again
    - got stuck in the bed, never got to try the tub, because i didnt have a plan, they didnt kow i wanted to try the tub, and i had no idea how much time it would take pushing etc...


    i know things are already going to go differently because i'm more informed this time and i wont show up at the hospital too early (pretty sure i wont....) and i can eat at home and do whatever i want at the same stage i was walking the halls at the hospital with DD.

    See I totally support that, your making a plan based on what you want to happen knowing full well what could go on etc. One thing you said however did sort of peek my interest, and most mommies that like me have had multiple children at this point, just like every pregnancy every labor and delivery is different. Sometimes not by much, sometimes by a HUGE amount.

    For example, my first was born at 40weeks +3days, Second at 42 weeks, third at 36 weeks... I've had everything from a huge tubby baby to my last that was only 1oz over the minimum weight limit (5lbs 5oz lands you in NICU here, 5lbs 6oz and your clear... stupid rule if you ask me) I've labored for 6 1/2 hours, fifteen minutes and for 18 hours, I've had no pain and tons of pain, not to mention complications that arise for no flipping reason!

    So yeah, only advice is if your planning on #2 being pretty much what you had for #1... well... I hope you get what you want but I wouldn't plan on it. And birth preferences is a great idea, I used 'birth ideas' once that got a laugh out of my OB. This time around I'm sticking to the basics, but I got a fabulous midwife this time around so no more fighting with OB's! ... though she did make me swear to get the heplock cause I have notoriously crappy veins for IV and she didn't want to fight with them if things DID go wrong... I think I'm ok with that.
    Adam and Eirinn
    Ashleigh Jun 3 2000, Mackenzie Sept 21 2001, Jayde Jul 9 2006, and Liam Jun 9 2011

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    let me copy and paste and see if there is anything i should include or take out...

    originally copied and modified from the inthe resources sticky

    Birth Preferences for Jenni

    Hi! We are looking forward to celebrating the birth of our second child with the staff at NMRH. This “plan” is an outline of a best-case scenario. We understand that events and circumstances change and may make some of these wishes difficult to follow, so please allow as many of these as possible when they are possible. We are open and flexible to any medical intervention that may become necessary in the case of a medical emergency. If at any point Jennifer becomes incapacitated, Bill is to make all of the decisions concerning Jennifer and Baby.

    Personal note: Please call me Jenni or whatever endearments you like. I respond to sweetie, pumpkin and many others. I probably won't respond well to Ms. H and might not pay attention if you say Jennifer.

    1st stage:
    - A nurse experienced in/or pro NCB would be appreciated.
    - No routine cervical checks-only as requested
    - I request the right to eat or drink if I am able, or so desire
    - I request the right to move about freely
    - hep-lock only- no IV unless complications arise
    - No visitors during labor, please ask first if there is someone who would like to see us
    - Intermittent monitoring please
    - I request a quiet and dimly lit room

    2nd Stage:
    -Please do not modify the bed until needed, I don't like feeling like I will fall off it, regardless of how much it helps others with their job.
    - No directed pushing please, unless it is to prevent tearing. I will push when I feel the urge. Please do not count.
    - I request the right to push in the position I am most comfortable in.
    - I do not consent to an episiotomy

    Baby:
    - Immediate skin to skin contact
    - Delay cord clamping for at least 5 min please
    - Delay weighing/measuring and antibiotic eye drops/ointment, i'd like to cuddle and nurse first. Please give us half an hour.
    - Breastfeeding only, no formula, sugar water, or pacifiers to be given
    - First bath I would like to assist, if I feel up to it

    In the event of complications:
    -PPH- I prefer aggressive uterine massage to pitocin or misoprostal, but if my care provider thinks either are necessary, she/he may ask for my consent. DO NOT ADMINISTER ROUTINE PITOCIN.

    - Caesarean Section-
    o I would like my husband present.
    o I would like to announce the sex.


    *there are several things that i'mpretty sure the nurses would let me do behind the OBs backs... like eat jello.... and the DO NOT offer pain meds here unless you ask for them, and they are pretty BF friendly but not exactly godlike. most of this stuff i think i could have had with DD if i had known enough to request it.
    ~Jenni~
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    Super Poster JennsDesertCrew's Avatar
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    Quote Originally Posted by gypsy86 View Post
    let me copy and paste and see if there is anything i should include or take out...

    originally copied and modified from the in the resources sticky

    Birth Preferences for Jenni
    I think this is perfect! When I use to be active as a doula I encouraged short and simple. I also labled it "Jane Doe's Birth Wish List" If you hand in the baby center 10 page check list it's not going to be looked at. I'd stick it on cute bordered baby and have a space where you AND your doctor sign. A doctors signature usually gets attention.
    Stress is triage about wanting a nurse that enjoys natural deliveries. They are out there and the pro epidural ones really don't want to deal with you. If you don't feel comfortable with your nurse and feel your wishes are being ignored ask to speak to the charge nurse and request a new one. This is your birth don't worry about stepping on toes.
    With my last homebirth I was transferred prior to delivery. I spoke with my OB on the phone telling him all the things I wanted to do that I knew I'd have a problem with. Yes, yes I was told come to the hospital and you can do whatever you'd like. Best OB ever btw! My nurse fought me tooth and nail but I held my ground and finally asked for a new one. She tried to take my food away. I'm a hungry one in labor and no body messes with my food!
    Jenn
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    i've been thinking about whether i'm being reasonable with my requests and when i look over these, i feel realy reasonable.

    once upon a time i had this image in my head of myself in the future in labor and my goal was to make 3 nurses and one Dr cry.... now i know i can't manage that, but if i make them swear its just as nice LOL.

    I already know that if i get Lois, the evil night nurse from HELL, i will request a new one. i DO NOT like that old lady! she looks and acts like Mr Rogers and spent 40 minutes telling me i wasnt in labor because she couldnt get my contractions on the monitor, until she was adjusting the belt as i had one! what a B! if i can't get a new one, i'll just tell her to go away. i dont want her there.

    other than Lois, the other nurses i had were like 5 stars fabulous Jean during the day, then once it hit saturday i got Diane and Jennie, and i could keep any of them, loved 'em. From my experience, even if they wont let me have lunch, i'm sure they'll let me have jello and juice and graham crackers if i want them, so i hope i wont have to worry about arguing over the food,i'd like more than ice chips until i hit transition though.

    back on track here..... if i want my eggs over medium, the kitchen is going to make them, if i want to cuddle with my baby for half an hour before he or she gets a bath, thats a reasonable request barring complications. if i have PPH and i'm bleeding all over the place, i can see why they may need to do other things, but if i DONT have it, i just want to hold my baby and not get their "routine" pitocin unless i NEED it.

    i forgot to add to that, i'd like to use the tub for pain releif.... and please assist me in doing so.

    i've already compromised on things i'd like differently if i could, i know they'll want a hep-lock, but i dont want the IV because i think IV fluids are really overused in non-emergency situations, but i dont want them blowing veins like they did with my DD trying to get one in in a hurry because aparantly nobody thought i'd be quick (5hrs, first baby) without pitocin, which i got after she was born because.... um... well, i wasnt bleeding excessively, must be because they already had my name on the bag and didnt want to waste it.
    ~Jenni~
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    Posting Addict MrsMangoBabe's Avatar
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    it all looks really reasonable to me
    -Brittany
    Doula, Childbirth Educator, and Mom to three adorable troublemakers
    Two time joyful Hypnobabies natural birthing mom
    My blog: Birth Unplugged

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