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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User

    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.

     

    Henci Goer

    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

    Archived User

     

    So this is what I came up with.  I had my midwife sign it, as you suggested and really appreciate your advice. 

    BIRTH PLAN FOR THE KARL-GRUSWITZ FAMILY

     
    Attending the birth will be:
    Mary and baby, Abe (father), Jessica (doula), Noah and Beatrice (brother and sister), caregiver for Noah and Beatrice – Madeline Lofblad (friend), Stephanie Fink (Mary’s sister) or Meredith Hodgkiss (Mary’s cousin), and our Avalon midwife. This was all pre-approved by Donna Poplowski.
     
    **I would like you to know that my second child, Emerson Lily died at birth on 8/3/03. I recognize that I may be more emotionally needy than some other birthing mothers, and ask that the staff be gentle with me. I fully trust my body to birth my baby and in writing this birth plan, really just want to have a peaceful, safe, natural birth. Thank you for helping us to welcome our fourth child into the world!
     
    Assuming there are no medical issues, I respectfully ask for the following:
     
    *A completely natural birth
     
    *A room with a birthing tub
     
    *No offer of pain medication
     
    *Quiet, low-lighting, and calm energy in the birthing/post-partum room at all times
     
    *Only necessary hospital staff in the room when absolutely needed – I would like as few    interruptions to the natural flow of my labor as possible. Please do not have any ‘conversations’ in the room or speak about me…when talking is needed, please use calm, quiet voices.
     
    *I respectfully ask for explanations (and discussion time, if needed) for any intervention/procedure. Nothing is “routine” for me, and I want to be fully-involved/informed and making decisions about my labor and birth.
     
    *In the event of an emergent situation, I ask to be kept well-informed about the staff’s concerns and that my husband and I are involved in all decisions being made. Please know that you will have our full cooperation in the event of an emergency, and that Noah and Beatrice will be removed from the room.
     
    FOLLOWING THE BABY’S BIRTH I ASK FOR THE FOLLOWING:
    *Baby to be given to me immediately
    *Cord to be cut only when it stops pulsating/placenta is birthed
    *Placenta NOT be sent to pathology. We are taking the placenta home and will bring bags/small cooler to package it
    *Immediate breastfeeding of baby
    *Any and all exams/assessments of baby to be done while baby is with me – NO SEPARATION
    *No Vitamin K or eye antibiotics to be given to baby (nothing ‘routine’ without consulting me first, please)
    *No bath be given to baby
     
    If an emergent situation were to arise, Abe and I will remain with our baby at ALL times. Please do not feed her any formula or use a pacifier/artificial nipple of any kind. Also, please do not use disposable diapers (we will provide cloth diapers for use at the hospital). If unable to be with the baby immediately, I ask that I be connected with her as soon as possible and am able to touch, hold, breastfeed, and care for my baby to the extent compatible with her condition.
    Henci Goer

    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


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