The Birth Plan

Well...I've finished my birth plan, with the help of some very patient friends and this handy dandy website.  Please don't think this means I expect everything to go according to plan; I am well aware that complications may arise and/or hospital procedure may conflict with our wishes.  At the end of the day, all that matters to us is our babe's health and safety.  

 

I reviewed the BP with my doctor this past Friday, and she was surprisingly receptive.  Don't get me wrong, she made a few jabs at me and my BP; but for the most part she was in agreement and (seemed) to fully understand our wishes.  She approved and initialed the plan and stapled it to our file.  The few items that were unacceptable were due to hospital policy at Scottsdale Healthcare on Shea; I've highlighted those items throughout the plan.

The website's format includes an opening note to the doctor and staff, followed by a list of our preferences for various procedures and labor care.  Now, I realize my opening note might seem a tad contradicting...allow me to explain...  I would *like* to have a drug-free and intervention-free delivery, and that is what I'm going to try to do; BUT if at some point the pain becomes unbearable, I'm allowing myself to get an epidural (after reaching a certain dilation goal that I've set for myself).  Or if the baby is in distress, obviously, I want her to be safe and I have absolutely no problem with intervention.  AND if at any point, some form of intervention can be used in place of cesarean delivery, I want the intervention.  I want to do anything I can to avoid a c-section.  So, without further adieu, (my longest post to date and) Our Wishes for Childbirth:

I would like to try to have a drug-free and intervention-free delivery. I realize complications may arise, and I do not expect everything to go according to plan. I would like to avoid a cesarian delivery at all costs; I would like to exhaust all methods of intervention prior to committing to a c-section delivery.

Sincerely,
Taylor Shelton

Labor

• I would like to be free to walk around during labor.
• I wish to be able to move around and change position at will throughout labor.
• I would like to be able to have fluids by mouth throughout the first stage of labor. Hospital will only allow ice chips, and absolutely no food.
• I would like the lights in the room to be kept low during my labor.
• I would prefer to keep the number of vaginal exams to a minimum.
• I do not want an IV unless I become dehydrated.  If I test positive for Strep B, I will have to have an IV from the get-go.

Monitoring

• I do not wish to have continuous fetal monitoring unless it is required by the condition of My baby.
• I do not want an internal monitor unless My baby has shown some sign of distress.

Labor Augmentation/Induction

• If labor is not progressing, I would like to have the amniotic membrane ruptured before other methods are used to augment labor.
• I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before Pitocin is administered.  Dr. O prefers that we not use nipple stimulation by breast pump because it can cause too many contractions.
• Other Labor Augmentation/Induction Preference: I would prefer to use natural methods prior to artificial methods.

Anesthesia/Pain Medication

• I realize that many pain medications exist. I'll ask for them if I need them.
• Other Anesthesia/Pain Medication Preference: In the event that the pain becomes unbearable for me, I would like to have an epidural; please, absolutely no narcotic pain relief.  Dr. O said that if I decide that I need pain medication early in labor, it is better to use narcotic pain relief than an epidural because an epi can slow labor progress.

Cesarean

• Unless absolutely necessary, I would like to avoid a Cesarean.
• If my primary care provider determines that a Cesarean delivery is indicated, I would like to obtain a second opinion from another physician if time allows.  There may not be time for this in the case of an emergency c-section; from the time the decision is made to the time the baby is delivered is ten minutes or less.
• If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.
• I would like My husband, Casey present at all times if My baby requires a Cesarean delivery.  Hospital policy prevents Casey from being present while I am being prepped for surgery, but he will be brought into the operating room just before the surgery begins.
• I wish to have an epidural for anesthesia. 
• So I can view the birth, I would like the screen lowered just before delivery of My baby.
• If My baby is not in distress, My baby should be given to My husband, Casey immediately after birth.  Hospital policy states that all c-section babies are immediately put in the artificial warmer; Casey would be allowed to accompany the baby and touch her through the warmer.

Episiotomy

• I would prefer not to have an episiotomy unless absolutely required for My baby's safety.
• I am hoping to protect the perineum. I am practicing ahead of time by squatting, doing Kegel exercises and perineal massage.
• I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch.
• If possible, I would like to use perineal massage to help avoid the need for an episiotomy.
• Other Episiotomy Preference: I prefer to take my chances with a tear than an episiotomy; unless an episiotomy can prevent a c-section delivery. 

Delivery

• I would like to be allowed to choose the position in which I give birth, including squatting.
• I would like My husband, Casey and/or nurses to support me and my legs as necessary during the pushing stage.
• I would like to try to deliver in a hands-and-knees position.
• I would like to try to deliver in a squatting position, using My husband, Casey or a squatting bar for support.  This will only be permitted if Casey and I can support my weight, the nurses and doc will not provide assistance.
• Even if I am fully dilated, and assuming My baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
• I would appreciate having the room lights turned low for the actual delivery.
• I would appreciate having the room as quiet as possible when My baby is born.
• I would like to have My baby placed on my stomach/chest immediately after delivery.
• Other Delivery Preference: Please keep all mirrors out of the room; I do not wish to watch the birth.
• Other Delivery Preference: I do not want my husband or other family members at the foot of the bed.

Immediately After Delivery

• I would like to have My husband, Casey cut the cord.
• I would prefer that the umbilical cord stop pulsating before it is cut.
• I would like to hold My baby while I deliver the placenta and any tissue repairs are made.
• I would like to have My baby evaluated and bathed in my presence.
• I plan to keep My baby near me following birth and would appreciate if the evaluation of My baby can be done with My baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
• If My baby must be taken from me to receive medical treatment, My husband, Casey or some other person I designate will accompany My baby at all times.
• I would prefer to hold My baby rather than have (him/her) placed under heat lamps.
• I do not want a routine injection of Pitocin after the delivery to aid in expelling the placenta.  Dr. O said this is ultimately my choice, but if I start to hemorrhage, the doctor will have to be "elbow deep" in my vagina to stop the hemorrhage without any form of anesthesia.
• After the birth, I would prefer to be given a few moments of privacy to urinate on my own before being catheterized.
• Other Immediately After Delivery Preference: Please do not show us the placenta.
• Other Immediately After Delivery Preference: Please let the cord stop pulsating before cutting it; this is very important to us.

Postpartum

• I would like a private room, if available.
• Unless required for health reasons, I do not wish to be separated from my baby.
• I would like to have My baby "room in" and be with me at all times.

Breastfeeding

• I plan to breastfeed My baby and would like to begin nursing very shortly after birth.
• Unless medically necessary, I do not wish to have any bottles given to My baby (including glucose water or plain water).
• I do not want My baby to be given a pacifier.
• I would like more information about breastfeeding.
• I would like to meet with a lactation consultant.

Photo/Video

• I would like to take still photographs during labor and the birth.
• Other Photo/Video Preference: I would like a few photos to be taken during the labor; and I would like both photos and video taken immediately after birth. 

Other

• My support person(s) is/are (support people) and I would like them to be present during labor and/or delivery.
• Other Other Preference: My support person is my husband, Casey Shelton, and I would like him present during labor and delivery.