2003-09-02 - 1:33 p.m. - Cycle day:

We've had a good response to our birth plan, so I thought it might be helpful to others if we posted it. Here it is ...

To: (Hospital Name)
Parents: (Mother) and (Father) (Lastname)
Approximate Delivery Date: Sept. 1, 2003
Obstetrician/Pediatrician: Dr. (OB)
Labor Assistant: (Doula’s Name)

Thank you so much for caring for us during the delivery of our first child! We have reviewed the many options available to us at this time, and the following details are those that we feel will best provide the birth and perinatal experience we’re hoping to have. We so appreciate your training and talents and know your work will be invaluable to us. We fully expect our baby’s birth to be normal and free of most medical intervention, but in the event that complications do occur, we will confer with our obstetrician, whose medical judgment we respect and trust.

Labor:

Environment

• We would like the birthing environment to be as calm and relaxing as possible. To this end, we do NOT give permission for students, hospital house staff, or other non-essential personnel to be in the room during labor and birth. Please knock before entering the room.
• We are employing a professional labor assistant (doula). Her job is to coach, support and provide constant care to the parents during labor. If at any time (Mother) is unable to voice her opinion during labor, (Father) and (Doula) will speak on her behalf.
• We would prefer to have the room lights dimmed during labor and delivery if requested.
• We would like (Father) and (Doula) to remain with (Mother) throughout labor and birth regardless of circumstances, especially if a problem should arise.

  Interventions

• We are aware of our pain relief options. Please do not offer pain medication.
• Please do not administer any medication without (Mother)’s prior consent. This request excludes none and specifically includes oxytocins, analgesics, barbiturates, prostaglandins and tranquilizers.
• Please do not artificially rupture the amniotic sac.
• Please keep internal exams to a minimum, especially after the membranes rupture.
• We prefer no routine IV. Intravenous fluids will only be used with good medical reason as determined by the parents and the physician in consultation.
• Please do not conduct continuous electronic fetal monitoring, either internal or external, without good medical reason. Frequent listening to the fetal heart is expected. If the nurse is proficient with intermittent auscultation, that would be our preference. If constant monitoring or intermittent electronic fetal monitoring is deemed medically necessary, (Mother) would prefer to be monitored in such a way that movement is not limited.
• Please allow (Mother) to walk during labor and be assisted by staff in assuming whatever position is most comfortable during labor and birth. She prefers not to be arbitrarily confined to bed during labor and to avoid the lithotomy position during the pushing phase.
• There will be no episiotomy without good medical reason. The doula or nursing staff may apply warm, wet cloths or oil to support the perineum prior to delivery.
• Please allow pushing to occur naturally at the appropriate time, barring any medical need for a more rapid delivery. (Mother) would prefer to breathe at her own pace and not be commanded to push for a specific duration (e.g., a ten count).
• If c-section is necessary, please close the uterus using a double-suture technique.

Post-partum:

• Please place the baby on (Mother)'s abdomen after being delivered, ideally with skin-to-skin contact.
• It is our desire that the baby be nursed within minutes of birth to assist in bonding with the baby and completing the final stage of labor.
• Please do not have the cord clamped or cut until it stops pulsating, unless it must be cut to complete the birth of the baby. Please allow enough cord to remain to accommodate the umbilical placement of an IV, should such an intervention be required.
• We would like to waive the use of ethryomycin or other antibiotic eye ointment.
• Please allow the third stage of labor (delivery of the placenta) not to be rushed but to proceed at its own pace. The use of oxytocin drugs and manual removal of the placenta are to be reserved for true medical emergencies.
• We would prefer that all care of the baby take place at (Mother)’s bedside. Barring medical complications, the baby is not to be taken to the nursery.
• The baby is NOT to be given a pacifier or bottles of water or sugar water. Please assist us in providing breastmilk to the baby if a medical emergency prevents normal breastfeeding.
• The parents must be consulted and give permission before any vaccinations or injections are performed. We would prefer that an oral dose of Vitamin K be administered.
• If the child is a boy, he will NOT be circumcised.

This plan has been reviewed and approved by the parents, delivering physician and labor assistant:

(Mother) (Lastname) (Father) (Lastname)

Dr. (OB) (Doula)

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