Writing a birth plan: Getting started

Before getting pregnant, I knew that I would want to write a birth plan when the time came.  The task has been a little overwhelming, but I am finding the research extremely helpful in feeling informed and in control.  I have been reading the book, “Creating your birth plan: The Definitive Guide to a Safe and Empowering Birth” by Marsden Wagner M.D, M.S.  This book goes through every possibility in labor and delivery, from c sections to herbal pain relievers to episiotomies and beyond.  It touches on the risks and benefits of each decision and what questions you can ask in order to make an informed decision.  So far, I have been primarily using this book to help me with my decisions.  I am, by no means, done with my birth plan, but reading this book and putting down all my desires on paper is helping me to have a confident approach in birthing this baby.  I would highly recommend it.

Keep in mind while writing your birth plan that it is like a road map.  It is a guide of where you want to end up (with a healthy baby and mom), but the plan is not set in stone.  What relieves me about writing out my birth plan is the fact that I can consider the other routes that may be possible and decide ahead of time what’s important to me.

My birth plan is set on having as natural a birth as possible with as little intervention as necessary.  I realize not all of you will feel the same way about your birth, which is totally cool!  This is only to give you an example of what a birth plan can look like and give you some ideas about what you may or may not want.  Keep in mind, also, that I am not finished completely yet, but the bigger decisions are made.  The things I add will be smaller preferences more than anything else.  

This is my birth plan so far.  I hope it helps!

 

C Section: 

In the rare case that I may be recommended to have a c-section, all other options must be exhausted first.  I want a second opinion if this is recommended to me.  The following are what I am willing to concur to a c section for: 

  • Too fast or too slow fetal heart rate.  This will require more than one opinion.
  • Complete placenta previa.  
  • Abrupted placenta.
  • Transverse lie.  If baby cannot be turned.
  • Prolapsed cord.
  • Hyperstimulated uterus. 
  • Uterine Rupture.
  • Preeclampsia.  This will require more than one opinion.

 On the other hand, these reasons for recommending a c section will be questioned profusely before I will agree:

  • The baby is “overdue.”  Unless the baby is in distress, this is not a good enough reason for a c section.
  • The baby is too big.  This will require a second opinion and confirmation of the size of the baby.
  • The baby in breech position. Unless the baby is in distress, this is not a good enough reason for a c section.
  • Fibroids.
  • Diabetes.
  • Watching the clock (“Failure to progress”).  
  • Preventing damage to the pelvic floor.

 Epidural

My desire is not to have an epidural.  I will consider an epidural in these cases:

  • Cesarean section.
  • Extreme exhaustion. If I am not able to adequately rest, I will consider an epidural for a few hours of relief in order to rest.

 Uterine Stimulation

I do not want any inductions of labour.  I will consider induction only in these cases:

  • The baby is significantly overdue. AFTER 42 weeks.  Before this, only if the baby is in trouble.
  • Placental malfunction.  (the baby isn’t moving around as much as it should be or has stopped growing).
  • The baby is too small for its gestational age.
  • Preeclampsia.  This will require a second opinion and more than just an elevated blood pressure.
  • Water breaks. With no sign of infection, wait 48 hours before considering induction.
  • The baby is showing signs of oxygen deprivation. This will require a second opinion on the reading of the fetal monitor papers.

 The following reasons will NOT be considered for induction:

  • The baby is “too big.”
  • Gestational diabetes.
  • Too much (or too little) amniotic fluid in the bag of waters.
  • “Failure to progress.”

If induction must occur based on the above criteria, I want Pitocin, Cervidil, or Prepidil.  I do not UNDER ANY CIRCUMSTANCES want Cytotec (misoprostol or prostaglandin).

Antibiotics 

Antibiotics can be given only if betahemolytic streptococcus is detected and puts my baby at risk.  Antibiotics can also be given if I have a low-grade fever that is found in a blood test as well as temperature.  Any cases other than this will not require antibiotics, thus I do not want them.

Electronic Fetal Monitoring

I do not want EFM unless trouble develops (Induction, too fast or too slow fetal heartbeat, Baby in breech).  EFM is not to be a routine part of my labour and delivery.

 IV

No IVs unless:

  • Dehydration occurs
  • Inability to tolerate food (and need it for strength and nourishment)
  • In the event of an epidural

 Lithotomy

Being on my back is not to happen under any circumstances!!!  This is unnecessary and doesn’t help me as a labouring mum.

 Instrumental birth

 Vacuum extraction is only to happen if there is fetal distress late into the birth or if the baby is oxygen deprived.

 Forceps are not to be used UNLESS the vacuum extraction did not accomplish the goal under the criteria mentioned above.

Episiotomy

An episiotomy is NOT to be performed unless forceps are being used (which they shouldn’t be).

I want my placenta.  It should not be thrown away or given into the hospitals care.

 

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6 thoughts on “Writing a birth plan: Getting started

  1. I love this- so empowered! Can I ask why you have asked not to have that specific drug if induced? Is the drug controversial? (I might steal your birth plan to make a basis for my own. I think though that I’ve got to face the reality that I’ll probably be having a C-section 😦 as long as everyone’s safe it’ll be ok, right?).

    • I’m so glad it’s helped you! And you are welcome to use it as a basic structure for your own. That’s why I wanted to post it–can be such an overwhelming job! I chose not to have cytotec because it is a drug that can cause uterine rupturing and is very dangerous.
      Why will you be having a c section? It doesn’t seem like you want one. Is your pregnancy high risk? Just curious. I don’t have a problem with c sections, I just personally want that to be the last resort for me. And they are absolutely ok and can prevent traumas from happening in certain circumstances, so I know that you and bub can be healthy and well even if a c section ends up being the way he/she comes into the world. 🙂

      • Mr Dr knows I want a natural birth if possible, but I am carrying twins. Depending on how they lie, I might be able to have a natural birth – however there is only 1/4 possibilities which would result in that outcome – if one or both twins are lying breech or transverse, it won’t be an option. 😦

  2. Yeah, I’ll probably use this as a starting point for mine as well because right now it feels overwhelming! At home, not so much, but in the event of having to end up in the hospital- very!

    • Yes, it’s good to have it just in case. I don’t think I’ll need to use mine, but at least if anything does happen, the doctors and nurses will know what I condone and what I don’t. And yes, yes, feel free to use it as a starting point! I’m still working on it, but this is my skeleton, I guess you could say. It’s definitely a daunting task.

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