Hello,

I'm expecting my fourth baby in a few weeks.  A brief history - my first was born via c-section following a Cytotec induction.  My second was born (VBAC) at home, and died at birth.  My third (VBAC) was also born at home.  I'm planning to have my fourth in a hospital and have some concerns about going into such a "medicalized" setting, although I have a homebirth midwife supporting me as my doula, and feel very confident that my midwives will do everything in their power to help me have a natural, safe, homebirth-like birth.  I have had "large" babies - 9,10, and almost 11 lbs and this new babe appears to be healthy, as well.  I've decided a hospital birth is best this time because my third baby needed some help breathing following a precipitous birth - and her apgars at 5 minutes were not as high as I would have liked.  I completely trust my body and my baby and the birth process, and while I have "history", want this new baby to have her own story - her own labor and birth, free from other's fears based on my history. 

I really want the hospital staff to respect our wishes for no interventions and a natural birth, and have them understand that I may be more emotional than some other mothers they work with, needing to be treated gently (as any mama should be), but I don't want to come off as being pushy or too directive.

I've been working on a birth plan for the hospital staff and would like any suggestions you would offer.

Thank you.

I think the best thing you can do is consult with your midwives. They will know the ropes in the hospital where you will be having your baby and will know how to minimize the chance of having problems with hospital staff. As you may already know, some medical staff do not welcome birth plans. They see them as adversarial on the woman's part, and certainly, and, to be fair, in some cases they are.  Here are some suggestions of mine, and if anyone else who reads this has recommendations, please chime in.

• Help nursing staff to see you as a person. Introduce yourself briefly at the beginning. Adapting what you wrote in your post would be perfect. Then you can explain why certain things are important to you such as why you may be emotional and need extra reassurance and encouragement. 
• Keep the birth plan short. You don't want the poor nurse to be paging through a manuscript. One way to do this is to find out the usual hospital policies and then don't bother to request anything they do anyway.
• Resolve conflicts between what you want and usual policies ahead of time. Get agreement from your own care providers first, of course. Then they can tell you who to talk to on hospital staff. You may need to talk to the obstetrician(s) who back up or supervise your midwives and possibly the nurse manager of Labor & Delivery. 
• Compromise where you can.  For example, hospital policy may mandate an IV, and you don't want one, but you can live with a heparin or saline lock. (They insert the IV catheter, but it is attached to a short bit of capped tubing instead of a long tube and an IV bag. You have mobility; they have a port should one be needed.)
• Ask your midwife to initial or sign the completed plan, and, if possible, ask the back-up ob to do the same. The intent here is to show that your care providers have seen it and approve of it. This should help when dealing with nurses or a care provider you haven't met ahead of time. 
• Ask that a copy be put into your records, but carry a copy with you as well. Have your doula or partner politely request that any new nurse review it.
• Give positive reinforcement to nursing staff, i.e. "Thank you so much for helping us with this. This is so important to me (or her, if your doula or partner is saying this), and it means a lot."

Let us know how it goes.

-- Henci

This is just gorgeous! I'm glad that I was able to be helpful to you in developing it. Please let us know how everything goes.

-- Henci