this is mine sorry its so long wanted to make sure i had covered everything my MW laughed at how organised i am as i have had it done since 21 weeks
Due Date:- 13th April 2012
Birth Partners:- Lee (F.O.B), Gail (mother), Clare (doula)
Allergies:- Tegaderm Dressing
Labour and Place of Birth
I will be giving birth to my baby at home and intend to deliver in a birthing pool
I would like lights and noise kept to a minimum throughout the whole of my labour and delivery
I will be staying as mobile as possible and changing positions as i feel necessary
Vaginal examinations are to be kept to an absolute minimum so only performed when absolutely necessary and only after gaining my verbal consent
I will be eating and drinking freely as and when i feel the need to
I do not what continuous foetal monitoring
Any monitoring is to be done by way of a Doppler
I do not want internal foetal monitoring on babies head unless medically necessary and only after verbal consent by myself
Induction of Labour
I wish to be allowed to go into labour naturally and in my bodys own time
I do not want my amniotic membranes to be ruptured artificially unless absolutely necessary and only after my verbal consent
I do not want to be offered any pain relief drugs of any kind, I will ask for them as the need arises
I plan on using water/birthing pool as my main form of pain relief as well as other natural methods such as birthing ball, keeping mobile and massage
I would like entonox to be available should I ask for it
If i am not coping well i would like the option of pethidine/diamorphine before considering the need to transfer to a hospital. I am aware this would mean I would not be able to give birth in the water
I do not want an episiotomy and would prefer to tear naturally in preference to this
I would like local anaesthetic to be administered before repairing any damage to my perineum
I will be choosing whichever position feels best for me to deliver at the time and this may change as i feel it necessary
I intend to deliver my baby in the birthing pool
I wish to be able to feel my babies head when it crowns
I want Lee Kennedy to be as involved in the delivery as he is comfortable with
I want as little noise as possible during the active stage of labour and delivery
I do not want any assistance with delivery (forceps/ ventouse) unless critical for the safe delivery of my baby
I wish Lee Kennedy to catch/deliver the baby
I wish Lee Kennedy to place the baby straight onto my chest immediately after delivery
I do not want the babies cord to be clamped until it has stopped pulsating
Lee Kennedy is to cut the cord
I want a natural 3rd stage of labour without oxytocin or any other drugs to help deliver the placenta
I will be having a minimum of 60 minutes skin to skin with my baby immediately after delivery
Any procedures that need to be carried out on myself or baby can be done while i am having skin to skin contact
Weighing and measuring the baby will only be allowed after skin to skin time
I am happy for my baby to receive the vitamin K injection
No formula is to be given to my baby
No pacifiers are to be given to my baby
I will be breastfeeding my baby and the first feed will be done while having skin to skin following delivery
If it is medically necessary for my baby to be taken away from me Lee Kennedy must remain with baby at all times and his consent must be given before any procedures are performed on our baby
I am aware that circumstances may arise during labour and birth that mean this plan cannot be followed exactly for the safe delivery of my baby but full consent must be obtained before anything other than what is stated on this plan is done to myself or my baby. I am happy to be transferred to a hospital if this is medically necessary for the safety of my baby or me.
i have taken surnames and addresses off just because of posting it on here hope it helps xx
There are a lot of examples online if you search for "birth plan" in your choice of search engine.
I ended up finding one (and I can't remember at the moment where I found it) and then altering it to include information the hospital will ask that my doctor may or may not have on file when she comes (as she's mentioned that sometimes they come from home and have to wait on the office to send the file over).
The info I've included is:
* My name
* My birth partner's name and contact information
* Emergency Contact
* OB-GYN Name/Practice/Phone Number
* OB-GYN Address
* Pediatrician Name/Practice/Phone Number
* Pediatrician Address
* Blood Type - including when I had my Rhophylac (think RhoGAM/AntiD) shot and how it was delivered
* Group B Strep Test Results
* Drug Allergies - including the reactions for drugs that are commonly used in labor
* Preferred pain medication (as I've got a long list of drug allergies and have a few that are known to work for extreme pain)
* Baby's Name - including a note that his middle name does indeed have a space in it
* Pain Management - preferred ways of dealing with pain (drugs/music/bath/shower/etc.)
* The Birth - c section/vaginal birth; epidural choice; umbilical cord handling; OH's involvement
* After the Birth - skin-to-skin; visitors preference
* Cord Blood Banking - do you want it? If so, private or public? If private, what's the cord blood bank information?
* Breastfeeding - Are you doing it?
* Circumcisions - Are you going to have it done? (if relevant)
Midwife went through this with me at my last appointment, she just wrote things I said in my green notes. I'm like Megan though, I've not put much as it's my first and I simply cannot predict how I am going to be or what may happen. I have put, however, that I do fancy trying the birthing pool. I really, really don't like the idea of an epidural (just don't like the idea of a needle into my spine ) but have not absolutely said No as, for all I know, I could end up begging for one Plus would obviously have one if I needed a c-section x
Full name: Amanda Danielle A*****
Partners name: Daniel Anthony A*****
Due date: 6/15/2012
Doctors name: Robert L********
Hospital name: S**
Before labor begins:
My delivery is planned as a natural vaginal. I trust that my practitioner will seek out my opinion concerning all of the issues directly affecting my birth before deviating from my plan. If I go past my due date and the baby and I are fine, I prefer to go into labor naturally rather than be induced. If NST observation becomes necessary after my due date, I am flexible and support this procedure. I prefer to have no vaginal exams until I go into labor, and I prefer that when I go into labor that there be minimal internal vaginal exams or at my request only. If I am less than four centimeters dilated, I would like to discuss with my healthcare provider the option of going home.
If induction becomes necessary, I would like to try natural induction techniques first (with the guidance of my practitioner). That includes the following: Nipple stimulation, walking, Evening primrose oil. If medical induction becomes necessary I prefer to try stripping membranes. If my water breaks before I go into labor, I would like to talk to my practitioner about alternatives to treatments such as antibiotics.
Upon arrival at the hospital, I prefer to have my partner with me at all times. Also please, no residents or students attending my birth. I also would prefer to give birth in a room with a shower/bath. If birth equipment is available, I would like to use a birthing ball, and squatting bar. During my birth I would like Music played (I will provide), to wear my own clothes during labor and delivery, to have a TV available, to have my birth photographed/filmed, As few interruptions as possible, and to eat and drink as approved by my doctor. I am not interested in an enema, shaving my pubic area, a urinary catheter, and an IV.
Please only offer pain medications if I ask for them. I want to try to handle pain with these natural and alternative methods: Breathing techniques, massage, deep relaxation, and water/bath/shower. I want to be able to walk around and move as I wish while in labor. I would like to feel unrestricted in accessing any sounds of chanting, grunting, or moaning during labor. Please always keep my door closed while I am in labor.
I prefer the baby to be Intermittently monitored to allow for as much mobility as possible.
Second Stage labor:
As long as the baby and I are healthy, I prefer to have no time limits on pushing. During labor I would like to try whatever positions I feel is right at the time. I prefer to have no episiotomy and risk tearing (unless I'm having a medical emergency). To help prevent tearing I would like to apply hot compresses and breathe properly for slower crowning.
I want either my partner to catch the baby or I will catch the baby and pull it onto my abdomen as it is born. I want our baby to hear our voices first. It's important to me to push instinctively. I do not want to be told how or when to push, unless I request guidance. As long as my baby is healthy, after it is born I want my baby placed immediately skin-to-skin on my abdomen with a warm blanket over it. Please delay all essential routine procedures on my baby until after the bonding and breastfeeding period. I want to place my baby on pulse oximetry after 24 hours of life to rule out any obvious heart conditions present at that time, as recommended by the federal government, American Academy of Pediatrics and American Heart Association.
If a c-section is medically necessary my partner is to be present at all times during the c-section. I would like the baby to be shown to me immediately after it's born. As long as my baby is healthy, I would like my partner to be the baby's constant source of attention until I am free to bond with it. I would like to have contact with the baby as soon as it is possible in the delivery room. If my baby is healthy, I would like to hold my baby and nurse it immediately in recovery. I would like to sign any waivers necessary to permit me to be with my baby in recovery.
Third stage labor:
Please wait for the umbilical cord to stop pulsating before it is clamped, I want my partner to cut the umbilical cord If he decides he wants to. I would prefer for the placenta to be born spontaneously without the use of pitocin.
If the baby has any problems, I want my partner to be present with the baby at all times, if possible. I want to have routine newborn procedures delayed until bonding and breastfeeding have occurred. I would like all newborn routine procedures to be performed in my presence. I would like to delay the administration of vitamin K up to 1 hour after birth, after breastfeeding and bonding, unless medically necessary. I prefer any immunizations be postponed to a later time. We would like to give our baby his first bath using our own non-toxic baby products. Please do not circumcise my baby. We would like to wait, and delay the PKU testing until we are ready to leave the hospital. My baby is to be exclusively breastfed. Do not offer my baby formula, pacifiers, artificial nipples, or sugar water without my consent. If my baby's health is in jeopardy I want to be transported with my baby, My partner to go with the baby, to breastfeed or express my milk for my baby, to have as much bodily contact with my baby as possible, and to be offered a room at the hospital for the duration of my baby's stay. I would like my in-hospital routine to be full rooming in, no separation, no exceptions, unless my baby is sick.
My hospital stay:
I prefer that my hospital stay be as short as possible. I want to have my partner stay with me for the duration of my hospital stay. I want privacy during my stay and for my guests to limit the time they are visiting me.
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