Birth Plan
I am passionate about every mother and family have the childbirth they desire. I also am passionate about knowing your options. I hope this information helps you to achieve the most wonderful experience.
Below is my huge birth plan file. I added hyperlinks for additional information webpages. Feel free to edit and use this for your own childbirth. I had a homebirth with my second child. But I created a hospital birth plan just in case of emergency. The detailed birth plans were for my birth team and for my peace-of-mind.
There are two one-page birth plans at the end of this document that would have gone to the hospital staff in the event of an emergency hospital transport: one for vaginal birth and one for cesarean birth.
Keep in mind there are birthing centers as an alternative to both hospital and home births. Check your area for natural birth support groups, doulas, breastfeeding support groups (La Leche League, etc.), and babywearing support groups.
Read books in support of your plans:
Spiritual Midwifery by Ina May Gaskin
The Thinking Woman's Guide to a Better Birth by Henci Goer
Hands of Love : Seven Steps to the Miracle of Birth by Dr. Carol J. Phillips
The Womanly Art of Breastfeeding by Diane Wiessinger, Diana West, Teresa Pitman
Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England & Rob Horowitz
Diaper Free: The Gentle Wisdom of Natural Infant Hygiene by Ingrid Bauer
Childbirth book-list from The Natural Child Project website.
Also, plan for a babymoon. You could even create a sign for your door to notify guests any special requests you have.
Don't push yourself to engage in work or responsibilities before you are ready. Plan for a "baby moon" - the month following birth - as a retreat into your process of birth, of becoming a new family and of transition. Arrange before the birth for domestic support during this month - meals made, housework and laundry done. Friends and family can make up a roster - a real birth gift.
- Robin Grille
In these birth plans, covered as many options I knew about at the time. Let me know if you have anything for me to add.
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Wishing an empowering and joyful birth,
Amy
Life Coaching with Amy
www.CoachingWithAmy.Life
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Detailed Hospital Birth Plan
for <parents' names>
This detailed hospital birth plan is for our birth team to assist us in communicating all these details to the medical staff.
We greatly appreciate you taking the time to review our preferences for the birth of our child. We understand that birth is a natural process and flexibility is sometimes required. We have prepared this so that you may get a general sense of our goals and attitudes surrounding birth. Of course, these preferences are written from the assumption that the baby and mother are physically healthy; if a situation arises that compromises the safety of either, we trust you to guide us in achieving a safe outcome. Thank you in advance. <name of parents>
ENVIRONMENT
1. I would like to wear my own clothes during labor and birth.
2. I would like to give birth in a birthing room.
3. I would like the following people to be present at my labor and birth:
Partner: <name>
Doula:< name>
Homebirth Midwife: <name>
Our daughter: <Older child's name>
Daughter’s doula and aunt: <name>
4. I would like to play music.
5. I would like the lights dimmed and the room to be quiet.
6. I do not want residents or students to be present during the birth.
7. I would like the medical staff visits to be kept at a minimum if possible as I am uncomfortable in a hospital setting and with being treated as a patient.
8. We would like to photograph (still photography, not videotape) in the delivery room.
9. I would like the following amenities: CD player and birth ball
PREP
10. I prefer to not have a routine enema.
FIRST-STAGE LABOR
11. I prefer to not be separated from my doula, Homebirth Midwife and/or partner at any point during labor or birth.
12. If I go past my estimated due date, I prefer to not induce labor as long as the baby and I are healthy.
13. I prefer not to undergo internal/vaginal/cervix exams during labor unless they are essential for my or the baby's health.
14. I would like the option to return home if I am less than 5 centimeters dilated.
15. I prefer intermittent hand-held monitoring to continuous. When monitoring is required, please assist me in remaining upright and mobile. I request waterproof telemetry if continuous monitoring is needed.
16. As long as the baby and I are healthy, I would like to be free of time limits and not have my labor augmented.
17. I prefer not to have artificial rupture, stimulation or stripping of membranes.
18. If my water breaks at the onset of labor, I prefer to wait at least 12 hours before discussing inducing labor (if my and my baby's condition permits).
19. If the discussion of inducing or augmenting labor arises, I would like to discuss natural ways of inducing instead of drugs:
Acupuncture
Breast stimulation/thumb sucking
Caster oil cocktail (2 oz of castor oil mixed will in 2 oz orange juice)
Enema
Herbs (blue and black cohosh, etc.)
Sexual intercourse
Walking
20. I would like to be free to walk and move around as I choose during labor.
21. I would like to eat and drink during labor.
22. I would like to stay hydrated by drinking clear fluids and using ice chips.
23. I prefer to not have an IV; if one is medically necessary, I would like a saline lock.
24. I would only like pain medication if I request it. I do not want pain medication offered to me.
25. I would like to handle pain in the following ways:
Acupressure
Bath/shower
Hot/cold therapy
Massage
Relaxation
Sterile water injections
SECOND-STAGE LABOR
26. As long as the baby and I are healthy, I would like to be free of time limits on pushing.
27. I would like to push instinctively (self-directed pushing): when my body tells me when and how to push.
28. I would like to try the following positions for birth:
Hands and knees
Side-lying
Sitting squat (sitting in the bed set at a 45-degree angle with several pillows for support)
Squatting
Standing upright
Whatever feels right at the time
Remind me to push in an upright position in order to prevent upward tearing (towards urethra).
29. I would like to have the following birthing equipment made available to me:
Birthing bed
Birthing stool or chair
Squatting bar
Mirror
30. I would like to bring the following birthing equipment with me:
Birth ball
31. I would rather risk a tear than have an episiotomy.
32. Unless I'm having a medical emergency, I prefer not to have an episiotomy offered to me.
33. If an episiotomy is required due to an emergency, I would like it to be a pressure episiotomy which is done while I am pushing, when there is good crowning, and my legs are pulled back to my armpits.
34. I would like perineum ointment applied to ease burning sensation during pushing.
35. To help eliminate tearing, I would like to have warm compresses, perineum support and massage and direction for pushing during crowning.
36. I would like to view the birth using a mirror.
37. I would like to touch my baby's head as it crowns.
POST-BIRTH
38. I would like to catch the baby with the help of my partner and daughter.
39. I would like to wait until the umbilical cord stops pulsating before it's clamped and cut.
40. My partner would like to cut the umbilical cord.
41. Please advise me when the placenta has separated. I would like to deliver the placenta spontaneously and during nursing (no tugging on the cord please).
42. I prefer not to have routine Pitocin after the birth.
43. If my uterus isn’t contracting or I am hemorrhaging, I would like to put a small portion of the placenta in my mouth.
44. I would like to stay in a private room with my partner and both of our children staying with us.
45. I would like my hospital stay to be as short as possible.
BABY CARE
46. Please do not wash the amniotic fluid or vernix off of the baby’s body or hands.
47. I would like to hold my baby immediately after birth with direct skin-to-skin contact. Please cover us with warm blankets.
48. I would like to postpone newborn procedures until I have had a chance to bond with and nurse my baby.
49. I would like all newborn procedures to take place in my presence, and done while I'm holding/nursing the baby.
50. If I can’t be with my baby for newborn procedures, my partner would like to stay with and hold the baby at all times with skin-on-skin contact.
51. I would like the baby to have skin-on-skin contact with my partner to assist with warming and breathing.
52. If baby has jaundice, my partner should sit in the sun with baby rather than using phototherapy.
53. I do not want the baby to have eye ointment applied.
54. I would like the baby to be given oral vitamin K which we brought with us instead of a vitamin K shot; I have purchased my own vitamin K. Please see waiver form.
55. I do not want the baby to be given immunizations / vaccinations, including Hepatitis B.
56. If my baby is a boy, I do not want him circumcised.
57. We don’t want to bathe our baby while at the hospital. If, for some reason, we must, my partner and I want to give the baby his/her bath ourselves, on our own time.
58. I will breastfeed my baby.
59. I would like to feed my baby on demand, around the clock.
60. I prefer that no pacifiers (pacifiers, formula, sugar water) be offered to my baby at any point; I would rather pump if necessary.
61. I would like 24-hour rooming-in with my baby.
62. We choose to opt-out of the PKU test for our baby. -or- I request that the <state> Department of Health destroy the baby’s PKU test sample and results. We have the opt-out form with us.
TO <Partner>, <Homebirth Midwife>, and <Doula>:
<Doula and Homebirth Midwife>: I trust your experience and intuition. I would like you to take charge so I only have to focus on listening to my body. Please, one of you, stay with me the entire time during labor/birth, and afterwards as long as you are able/want to. Please tell <Partner> when to speak up to the medical staff in accordance with my birth plan (I don't want to have to worry about doing this, and you are more familiar with what goes on in the hospital.). Help remind <Partner> of instructions, below. If I have to have a cesarean, please remind <Partner> to refer to the "Cesarean Section" portion of the birth plan (especially if you can't be in the OR with us).
<Partner>: Make sure that, if I'm not with the baby, you are with the baby every minute. Hold the baby the entire time (except for weighing the baby)—preferably skin-on-skin. No eye ointment for the baby. I don’t want the baby bathed at the hospital; if the medical staff insists on bathing the baby, I want you to do it yourself. Do not allow circumcision or any shots. We brought our own vitamin K. Do not let the staff give the baby any pacifiers (pacifiers, formula, sugar water); bring baby to me to nurse (I will pump milk if necessary). Use skin-on-skin contact for heating and breathing help. If baby has jaundice, sit in the sun with baby rather than using phototherapy. Make sure that <Doula> or <Homebirth Midwife> is with me if you can’t be. Consult with me, <Doula> or <Homebirth Midwife> first if the staff wants to do something contrary to our birth plan.
Please do the following:
1. Tape birth plan to the door.
2. Hand out birth plan to medical staff.
3. Request a squatting bar right away.
4. Do what you can to help create a “home-like” environment in the hospital.
5. Play CDs.
6. Dim the lights.
7. Keep the medical staff at a distance.
8. If the medical staff is doing something that is against my birth plan, stop them immediately, ask them what they are doing and tell them we need 5 minutes to discuss it. See the list below called "Questions to Help Us Get Information".
9. Take pictures of labor, birth, and afterwards.
10. Apply perineum compresses.
11. Ask that perineum ointment be applied to ease burning sensation during pushing.
12. If, for any reason, I can't be with the baby the entire time, make sure <Partner> is with and holding the baby—preferably skin-on-skin contact.
13. Put "breast-fed baby" sign on baby's bassinet.
14. Do not invite any visitors to the hospital without discussing it with me first. (I might want us to be alone the entire hospital stay.)
15. Please be aware of and sensitive to my fears, most of which I've listed below.
Fears I have regarding labor in a hospital
Being in a hospital makes me nervous.
Medical staff makes me put my guard up and tense up (their protocols come before anything)
Being treated like a patient, having my power taken away
Being treated like just another patient, not as an individual with my own unique needs, etc.
Being on a time limit during labor
I’m afraid I’ll have to have a cesarean.
Having to trust other people to help me, “protect” me, and defend me if necessary (and fearing that they won’t do it)
Being interrupted by the medical staff entering the room to check on me (taking me out of my “groove”)
Being questioned or doubted about anything on my birth plan or other decisions I make (having to defend myself)
Medical staff doing something that I don’t want done
Baby not born into a peaceful, dark, quiet environment
Invasive procedures done to baby
Baby not able to nurse immediately or be with me due to emergencies--lack of bonding time
Medical staff taking the baby away, and <Partner> not being with and holding the baby
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QUESTIONS TO HELP US GET INFORMATION
For every Test and Procedure suggested, ask the following questions:
1. What will we find out from this test/procedure?
2. How accurate is it?
3. What are the risks?
4. Do the risks outweigh the benefits?
5. What will you or we do differently based on the results?
6. If nothing, is there another reason to do it?
For every Treatment, Drug and Intervention suggested, ask the following questions:
1. How will this be helpful?
2. Why must this be done now? What might happen if we wait an hour? A week? Or do nothing?
3. What are the advantages/disadvantages?
4. This may be the treatment you usually recommend, but what other approaches can you tell us about?
5. If several treatment choices are possible: Is there a logical sequence in which to try the different options?
BRAND acronym:
Benefits, Risks, Alternatives, Nothing, Decision
BRAIN acronym:
What are the Benefits?
What are the Risks?
What are your Alternatives?
What does your Instinct tell you?
What if you do Nothing?
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PAIN-COPING TECHNIQUES (From the book Birthing from Within by Pam England)
§ Be curious about the pain
§ Notice what's already working and do more of that
§ Practice Breath Awareness
§ Build a Partnership with Your Baby
§ Non-Focused Awareness (mindful awareness without judging)
§ Quaker Listening
§ Edges of Sensation
§ Edges of Comfort (Where exactly does the sensation begin and end? How does it move/change with each breath out?)
§ Center of Sensation (emptiness/stillness in the eye of the hurricane)
§ Spiraling (out of the center of sensation, moving the spiral with each exhalation)
§ Touch Awareness (downward stroke on my outward breath)
§ Massage
§ Primordial Vocalization or Co-chanting
Recommended essential oils for labor: lavender, rose geranium and ylang ylang
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DRIVING DIRECTIONS & CONTACT INFO
Driving directions to our home:
<directions>PHONE NUMBERS
<Birth team's home, work cell and pager numbers—including parents, midwife, doulas, in-laws', birth tub supplier, photographer, other emergency contacts>My Clinic:
<family doctor, address and phone>
HOSPITAL
<hospital name, address and phone>
<driving directions to hospital>
Midwife on call: <phone>
Labor & Delivery: <phone>
Names of Hospital Midwives I've met at this hospital:
CHILDREN’S HOSPITAL (Rooming-in with Baby)
<address and phone>
<phone>– Emergency Room
<phone> –Children’s Clinic
<phone> – Breastfeeding Resource
<driving directions to children’s hospital>NEAREST, LAST-RESORT HOSPITAL
<hospital name, address, phone, website>
<driving directions to hospital>
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HOMEBIRTH Birth Plan for
< parents' names>
Birth team:
<Partner>
<Midwife>, Homebirth Midwife
<Doula>
<Older child>, our daughter
<Older child's doula>, our daughter's doula
<Birth photographer> photography and video
Birth tub:
If it’s not already here, call <birth tub supplier> (Home #, Cell #) to deliver it. Fill it right away.
Checking in with you: When I call you, if I tell you directly to not come over, then you don’t need to come over. But if I leave it up to you, that means I don’t want to bother you but I need you to come over.
Photography/Videography:
I want video and still photography during labor, birth and afterwards. I especially want photos of birth team in action, of <Older child> participating, and the baby being born. I am planning on calling <Birth photographer> when labor starts; but her schedule might not permit her to come. Please, everyone, fill in to take photos and video.
Laboring:
During my first labor, I spent a lot of time laboring alone. When labor started getting intense where I had a hard time relaxing myself, I needed external help. This might be the way this labor is too. I need to be reminded to rest, and to have a bedroom set up so I’m not disturbed (door closed, massage CDs playing, earplugs in, eye mask on).
Pushing:
Remind me to push in an upright position in order to prevent upward tearing (towards urethra).
My Fears:
Baby not in the correct position
Having to go to the hospital for any reason
Tearing
Visitors coming too soon for too long, and wanting to hold the baby when I’m not ready
My house being messy/dirty when everyone comes over
<Older child>:
About <Older child> and the birth: I want <Older child> to participate in the labor and birth process as much as she naturally desires (without influence). She can be in the birth tub with me with her swimsuit on (or naked if she asks). Don’t use distraction methods unless she is visibly upset or is interfering with my comfort measures and doula/midwife support. If she is asleep, wake her prior to the baby being born. She would like to catch the baby. <Older child> likes to be read to, to do puzzles, draw, color, paint, eat snacks, talk and listen, play UNO and memory/matching game, make forts, dance and sing, play with stuffed animals and her other toys, and to be outside. I’m hoping she isn’t watching TV/videos the entire time, but am okay with TV/videos if “necessary.” I don’t think she will want to leave the house/yard/immediate area during labor; if she does go somewhere, please keep her relatively close to home; and have your cell phone on. Don’t make her try to go to sleep by herself.
<Older child>’s doula: We will notify <Daughter's doula> once labor has started; if it’s in the middle of the night and <Older child>’s sleeping, it’s okay for <Daughter's doula> to come at her leisure.
<Partner>:
<Partner>’s main responsibilities are helping birth staff find or use anything they need around the house, and being available for <Older child>. Also, please get the birth tub here and filled (bring in the two “wet noodles” to use in the tub). Make sure everyone knows how to operate the cameras, and keep them in central location. I could need you in supporting me in an upright position during pushing.
In the case of transport:
<Partner> should make sure either <Daughter's doula> is at home or hospital with <Older child>. Otherwise, call her to meet us at the hospital. If< Daughter's doula> isn’t available, call <Mother-in-law> to meet <Older child> at the hospital. Ultimately, we want <Older child> at the hospital with us to stay.
<Midwife and Doula>: Please bring my birth plan to the hospital, and distribute accordingly. Make sure <Partner> has a copy with him. One of you please stay with me the entire time.
<Older child>: <Daughter's doula> will either stay at the house with <Older child> or bring <Older child> to the hospital. Ultimately, we want <Older child> at the hospital with us to stay. If <Daughter's doula> isn’t with <Older child> at home or the hospital, <Partner> will take <Older child> to the hospital. We will have either <Daughter's doula> or <Mother-in-law> (<Partner>’s mom) come to the hospital to be with <Older child> at the hospital until she can join <Partner>, baby and me. <Doula> or <Homebirth Midwife> can stay with <Older child> until <Daughter's doula> or <Mother-in-law> arrives. I don’t want <Partner>’s dad driving <Older child> anywhere due to his health issues; and I’m not comfortable with <Mother-in-law> driving either. If <Older child>’s cousin, is able to help out somehow that is fine because <Older child> is very comfortable with him (but he doesn’t have his own transportation).
At the hospital, <Partner> is responsible solely for the baby, and being with him/her the entire time until I can be with the baby. Please follow the birth plan.
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Vitamin K Informed Consent and Waiver
Vitamin K injections are routinely given to newborns when they are born in the hospital, to prevent vitamin K deficiency bleeding (VKDB). VKDB presents in three different ways:
• Early VKDB, occurring on the first day of life, is rare and confined to infants born to mothers who have received medications that interfere with vitamin K metabolism. These include the anticonvulsants phenytoin, barbiturates or carbamazepam, the antitubercular drugs rifampicin or isoniazid and the vitamin K antagonists warfarin and phenprocoumarin. The reported incidence in infants of mothers who have received such medications without vitamin K supplementation is between 6 and 12 per cent
• Classical VKDB occurs from one to seven days after birth and is more common in infants who are unwell at birth or who have delayed onset of feeding. Bleeding is usually from the umbilicus, gastrointestinal tract, skin punctures, surgical sites and uncommonly in the brain. Severe intracranial hemorrhage may occur suddenly and result in death or severe CNS dysfunction. The incidence reported in the literature is variable, with rates of 0.25 to 1.5 per cent in early reports of both sick and well infants to 0 to 0.44 per cent in recent reviews predominantly of well infants. There is considerable uncertainty about the true rates of classical VKDB since full diagnostic criteria outlined above were seldom met.
• Late VKDB occurs from eight days to six months after birth, with most presenting at one to three months. It is almost completely confined to fully breast-fed infants. Several recent reports emphasize a late form of hemorrhagic disease occurring at 4-6 weeks of age, often manifest as intracranial bleeding, and occurring exclusively in breast-fed infants who did not receive vitamin K as newborns or have fat malabsorption. Other sites of bleeding include skin, gastrointestinal tract, umbilicus or surgical sites. About 30 per cent have minor bruising or other signs of coagulopathy (warning bleeds), preceding the serious hemorrhage. Infants at risk may have signs of predisposing cholestatic liver disease such as prolonged jaundice, pale stools, and hepatosplenomegaly. The rate of VKDB in infants who did not receive vitamin K at birth has been reported as between five and 20 per 100,000 births. The mortality is about 30 per cent (Loughnan and McDougall 1993).
Not all parents are comfortable with having their newborns injected with vitamin K. This document tells you the reasons vitamin K is routinely given to all newborns born in hospital. The disorders above are almost completely preventable if the vitamin K injection is given at birth.
Your midwife can provide a form of oral vitamin K. K-Quinone-is an oil soluble source of vitamin K-1 (phytonadione), the non-toxic natural form of vitamin K present in plants. K-Quinoe is extracted from alfalfa, nettles and green tea. Each drop provides 2 mg of vitamin K-1 activity. This particular product has not been studied by the medical community and may provide some degree of protection against VKDB, although it will probably not be effective against vitamin K deficiency caused by a baby’s inability to metabolize fats. The vitamin K is given at birth, at one to two weeks of age, and at six weeks of age.
The mother can purchase this vitamin K when she orders her birth kit and take it herself if she wants to increase vitamin K levels in her breastmilk. Mothers given oral supplements of 0.5 - 3.omg vitamin K per day produce substantially increased breast milk vitamin K levels.
If you do not want your baby to receive vitamin K please sign and date below. If you want your baby to receive injectable vitamin K you must arrange with a doctor to have the vitamin K injection present at the birth, or to have your baby seen by the doctor in the baby’s first week of life, and given the injection at the physicians office.
If you want to use oral vitamin K, please tell your midwife.
- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
We have decided to use oral vitamin K for our baby which we purchased ourselves. We agree to be sure that all three doses are administered at the appropriate intervals of birth, one to two weeks, and at six weeks.
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Parents signatures Date
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Natural-Birth Preferences
We greatly appreciate you taking the time to review our preferences for the birth of our child. We understand that birth is a natural process and flexibility is sometimes required. We have prepared this so that you may get a general sense of our goals and attitudes surrounding birth. Of course, these preferences are written from the assumption that the baby and mother are physically healthy; if a situation arises that compromises the safety of either, we trust you to guide us in achieving a safe outcome. Thank you in advance. <parents' names>
Labor
Atmosphere: Please respect the calm, quiet atmosphere in which we choose to labor and welcome our child. Please take into consideration that I am very uneasy being in a hospital and under medical care.
Comfort: We are relying on natural, proven methods to cope with the sensations of labor. We have educated ourselves on available pharmaceutical options, and ask that you do not offer them – we will ask for them if we feel the need. I will eat lightly and drink to avoid the need for IV fluids to aid my endurance.
Early labor: I realize that labor may start and stop before it becomes active. I am prepared to use natural methods to keep myself rested and patient as my body and baby prepare themselves.
Progress: I realize labor does not always follow a normal progression, and prefer to follow my body’s cues rather than augment labor artificially. If my baby’s condition warrants augmentation, I’d like to try natural methods such as walking and nipple stimulation before drugs.
Monitoring: I prefer intermittent hand-held monitoring to continuous. When monitoring is required, please assist me in remaining upright and mobile. I request waterproof telemetry if continuous monitoring is needed.
2nd Stage
Pushing: We understand that the urge to push does not necessarily begin at 10 centimeters. dilation, and trust my body to tell me when and how to push. I will be using the advantage of gravity and vocalization to aid my pushing efforts. Please assist me in whatever position feels most comfortable. I prefer a quiet, calm environment to “cheerleading”. Please provide a mirror and encourage me to touch the baby so that I may visualize my efforts.
Episiotomy: Please use warm compresses, perineum support and massage, and direct my pushing during crowning to avoid the need for an episiotomy and reduce the risk of tearing. I would like perineum ointment to ease burning sensation during pushing. I do not consent to an episiotomy.
Postpartum
Placenta: Please advise me when the placenta has separated so that I may spontaneously deliver it. I prefer no tugging on the cord be done. I would like to rely on breastfeeding and uterine massage to aid the involution of the uterus rather than Pitocin.
Newborn Care: In an effort to reduce the risk of jaundice or anemia, please do not clamp or cut the cord before it stops pulsating. Please do not wash the amniotic fluid or vernix off of the baby’s body or hands. I will warm my baby with immediate skin-to-skin contact – please cover us with warm blankets. We truly appreciate your patience in withholding all possible procedures so that we may greet our baby and spend his/her first alert hour alone together. I would like to hold/nurse our baby during procedures whenever possible. My partner and I would like to bathe our baby on our own time. We do not want the baby to be given any immunizations / vaccinations,, including Hepatitis B. We have brought our own oral vitamin K instead of a vitamin K shot (we have a waiver form). If our baby is a boy, we do not want him to be circumcised. We choose to opt-out of the PKU test altogether for our baby. -or- I request that the <state> Department of Health destroy the baby’s PKU test sample and results. We have the opt-out form with us.
Feeding: We have great faith in breastfeeding and recognize the importance of no artificial nipples or sugar water to its success. Thank you for supporting and guiding us through the initial days of this learning process. We welcome a visit from a Certified Lactation Consultant.
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Cesarean Section Preferences
We greatly appreciate you taking the time to review our preferences for the birth of our child. We understand that birth is a natural process and flexibility is sometimes required. We have prepared this so that you may get a general sense of our goals and attitudes surrounding birth. Of course, these preferences are written from the assumption that the baby and mother are physically healthy; if a situation arises that compromises the safety of either, we trust you to guide us in achieving a safe outcome. Thank you in advance. <parents' names>
PRE-SURGERY
1. I would like to be consulted with prior to the decision to have a cesarean section.
SURGERY ENVIRONMENT
2. I would like the following people to be present at the cesarean birth:
Partner: <Partner>
Doula:< name>
Homebirth Midwife: <name>
3. Please do not leave me without one of my support people (<Partner>, <Doula> or <Homebirth midwife>).
4. I do not want residents or students to be present during the surgery.
5. We would like to photograph (still photography, not videotape) the baby being born.
PREP
6. I would like to be conscious.
7. I would like the screen lowered so I can see the baby being born.
8. I would like to have my hands free to touch the baby.
SURGERY
9. I would like the doctor to explain what s/he is doing during the entire surgery.
10. I would like two layers of my uterus to be stitched rather than just one.
POST-BIRTH
11. My partner would like to cut the umbilical cord.
12. I would like to stay in a private room with my partner and both of our children staying with me.
13. I would like my hospital stay to be as short as possible.
BABY CARE
14. I would like to hold my baby immediately after birth with direct skin-to-skin contact. Please do not wash the amniotic fluid or vernix off of the baby’s body or hands. Please cover us with warm blankets.
15. If I can’t be with my baby for newborn procedures, my partner would like to stay with and hold the baby at all times with skin-on-skin contact.
16. I would like the baby to have skin-on-skin contact with my partner to assist with warming and breathing.
17. If baby has jaundice, my partner should sit in the sun with baby rather than using phototherapy.
18. I do not want the baby to have eye ointment applied.
19. I would like the baby to be given oral vitamin K which we brought with us instead of a vitamin K shot; I have purchased my own vitamin K. Please see waiver form.
20. I do not want the baby to be given immunizations / vaccinations, including Hepatitis B.
21. If my baby is a boy, I do not want him circumcised.
22. We don’t want to bathe our baby while at the hospital. If, for some reason, we must, my partner and I want to give the baby his/her bath ourselves, on our own time.
23. I would like baby to be in the recovery room with me.
24. I will breastfeed my baby.
25. I would like to feed my baby on demand, around the clock.
26. I prefer that no pacifiers (pacifiers, formula, sugar water) be offered to my baby at any point; I would rather pump if necessary.
27. I would like 24-hour rooming-in with my baby.
28. We choose to opt-out of the PKU test for our baby. -or- I request that the <state> Department of Health destroy the baby’s PKU test sample and results. We have the opt-out form with us.
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Wishing an empowering and joyful birth,
Amy
Life Coaching with Amy
www.CoachingWithAmy.Life
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Do you need coaching? Please contact me. I’d love to help you.