11-7-2008 - Hypnobirth Birth Plan

My mood while writing this blog: empowered

A few notes:

This is our birthplan, as yet unreviewed by our Doula, Tammy Soderling (awesome, props, much love!). Please post comments/suggestions on style. Especially if any of them need to be worded more sweetly. I'm feeling kind of indignant towards med staff right now and don't really wish that to SHINE through...

A WORD ON STYLE

Jen will be using Hypnobirthing to facilitate a calm, natural vaginal birth. Jen will be in a state of meditation and should be minimally disturbed. Please avoid harsh lighting and we would appreciate quiet, calm voices as well as closing doors whenever entering or leaving the room.

We wish to have a nurse experienced with natural birth and who will help us avoid medical interventions by discussing alternative options. We wish our resident and attending to be patient people, interested in natural birth and “alternative” crowning/birth positions.

We wish to have all procedures, no matter how routine, discussed with us. We hope to be major players in the birth and appreciate any education offered to us through this adventure. Answering our questions will help us feel safe and secure in your hands.

ADMiSSiON

We request:

To decline routine iv prep. If an iv is required at any point, please allow us to place a cover over the area. Jen has a reallllly hard time with needles.

To return home if less than 4 cm dilated.

Having the following people present at all times: Shawn Meudt and Tammy Soderling.

To decline discussion on pain tolerance and pain levels.

To have no telephone calls put through to our delivery room.

THiNNiNG AND OPENiNG

We request:

The patience and understanding of medical caregivers to refrain from any practice/procedure, even if considered routine, that could stand in the way of our having the most natural, unmedicated birth possible.

To be apprised and consulted before the introduction of any procedure.

To decline discussion of pain and pain medication.

To forego all vaginal exams.

Intermittent monitoring of the baby’s heart rate by Doppler or manual use of EFM.

Internal monitoring of the baby only after discussion of fetal stress indications.

To be allowed to snack and drink as we see fit.

To follow mom’s physiological cues regarding movement and position.

To allow labor to take its natural course, avoiding references such as “moving things along.”

To use natural oxytocin in the event of a stalled or slow labor, and allowed the privacy to do so.

DURiNG BiRTHiNG (EMERGENCE OF BABY)

We request:

To have the position of the baby checked to make sure he is properly engaged for delivery. We would like suggestions on repositioning the baby should he be engaged in a sub-optimal way, including Rebozo application to dis-engage his head.

To allow natural instincts to facilitate the descent of the baby, as much as possible, with mother-directed breathing-down until crowning takes place.

To use Hypnobirthing breathing techniques, without staff prompts. Please refrain from helpful suggestions as Jen has practiced long and hard how to “push” the baby out.

I do not anticipate “chin-to-chest” pushing or “curling around the baby.” I plan on exhaling during pushing, not holding my breath, and do not wish to be advised to do these routine things. Shawn and Tammy will be guiding Jen in pushing in the way that she has practiced.

To assume a birthing position of choice with the kind patience of the physician as Jen will not likely be her back nor in stirrups.

That lights be dimmed when crowning begins and throughout delivery. We kindly ask that our miracle be respected by using quiet voices and avoiding sharp noises or loud coaching.

To tear naturally over receiving an episiotomy. Please apply warm compresses and oil to the perineum to help avoid tearing.

Please do not assist the baby in crowning by moving maternal tissues out of the way.

For the baby to emerge completely naturally from the vagina. Please refrain from guiding the head or easing/helping the body out. We hope to allow contractions and pushing to deliver the baby in entirety.

That our baby not have routine suctioning during or after emergence from mom, even if meconium is present in amniotic fluid (per ACOG 9/07).

As the baby begins to emerge, please notify and allow Jen to receive the baby. If Jen is not responsive to this, please hand the baby directly to Shawn after birth.

POST-DELiVERY

We request:

The cord not be clamped until it has finished pulsating. We recognize that babies can take a minute to transition to breathing and hope to avoid resuscitation by keeping the cord intact.
When the cord has finished pulsating, Shawn would like to cut the cord.

The baby not be cleaned before handing him to Jen or Shawn. Please provide us with a warm, dry blanket to place over him when he has been placed on Jen.

Any fetal resuscitations take place at bedside, while baby is resting on mom’s chest. For this reason, we would like to have a small oxygen tank available in our room. Please also perform APGAR tests while baby is with mom. We have read the studies on Kangaroo Kare (skin-to-skin) and find this to be the optimal way to soothe baby after birth and during these procedures.

That routine pitocin not be given to aide in the delivery of the placenta. We would like to have uterine massage applied immediately after baby’s emergence and for help getting baby latched on and breastfeeding to assist in the delivery of the placenta. We would like to wait up to 30 minutes for the natural delivery of the placenta, barring complications.

We would like to delay standard measurements, cleaning, eye drops and Vitamin K administration for 1-2 hours while mom and babe establish breastfeeding and the family falls in love with each other.

STANDARD PROCEDURES & HOSPiTAL STAY

We request:

Please do not offer pain medications to Jen post-delivery. She will request them if needed.

Please discuss all standard procedures with us. We would like to start off as highly informed parents and hope your knowledge-base can get us off on the right foot.

All medical procedures, such as vitamin K shot and eye salve, to be administered while one of the parents is holding the baby.

That one of us be present with the baby at all times.

Help establishing good breastfeeding practices. We understand that lactation consultants are very busy people and would be happy to have nurses with personal experience breastfeeding to help us out. We do request to see a lactation consultant at least daily during our stay.

Please, nothing introduced orally to our baby, save mom’s breast!

Please give us pointers to sponge-bathe him using water alone. We ask that no soap be used for the first 24 hours.

We would like assistance with all standard care practices: bathing, diapering, soothing, etc.

IN CASE OF CESAREAN-SECTiON

Please note that Jen will do everything possible to avoid this procedure. If resigned to partake, Jen will be broken-hearted and need as much verbal support from the operating staff as possible. She would appreciate a “play by play” throughout.

Please respect our miracle and avoid small-talk and loud voices during the procedure.

Please have the sterile drape lowered or mirrors set up so that I may view the entire delivery.

After delivery, please hand the baby, minimally cleaned, directly to Shawn. Resuscitations should happen while Shawn is holding him, as well as APGAR scoring.

We would like to wait to have measurements taken until the baby has bonded with mom and breastfed in recovery.

Please allow Shawn to present the baby to Jen, allowing for mom/baby contact during this time.

Please provide a place for Shawn to have skin-to-skin contact with the baby while Jen is indisposed, in recovery or a separate room. Please provide them with dim light and warm blankets.

Shawn is to remain with the baby at all times.

Please allow Tammy to enter the room while closing is taking place.

Please allow Shawn to lay the baby, naked, on Jen’s exposed chest, even if she is only semi-conscious, in recovery.

Please allow Tammy to remain with the family at all times.

Please provide me with a lactation consultant as soon as I am fully conscious. I anticipate some difficulties breastfeeding considering the wound and time span between birth and first feeding.