Birth Options and Preferences
A Birth Plan is a written plan or checklist expressing a couple’s care preferences for their labor and birth experience. A Birth Plan usually assumes a normal and uncomplicated birth, but will also contain options should a non-conforming labor occur. It is the couple’s responsibility to devise their own customized Birth Plan. The customized Birth Plan is then presented to the couple’s primary caregiver for discussion, negotiation and agreement during routine prenatal appointments. It is impractical to wait to present one’s Birth Plan to the hospital staff for negotiation upon arrival at the hospital in labor.
Below are listed numerous options from which a customized Birth Plan may be devised. It is understood that only a few of the many presented possibilities will be important to any one person or couple.
Labor Coach
- Coach of my choice
- Coach may be (a) present, or (b) asked to leave during admission procedures such as the prep, enema, IV insertion, and/or vaginal exam.
- Coach may remain with me throughout labor-from admission to delivery and after.
Admission and Labor Procedures
- Routine enema (Fleet or bucket enema) upon admission to the hospital.
- Enema upon request of patient or if patient has not had diarrhea or BMs within 6 hours of the onset of labor.
- Enema administered by patient at home prior to admission to the hospital.
- No enema.
- Routine mini prep-hair shaven around the labia.
- Clipped-Hair around the labia clipped short but not shaven.
- Unshaven and unclipped.
- Routine IV (intravenous) upon admission to the hospital.
- IV insertion delayed until active labor.
- Use of IV fluids only if a clinically indicated need develops.
- Insertion of a heparin lock (may be converted to an IV as needed).
- No IV.
- Ice chips and lollipops to keep mouth moistened.
- Ingestion of clear liquids during labor such as water, apple juice, Gatorade, Gatorade ice chips, etc
- Nothing by mouth until after delivery.
- Routine amniotomy (artificial rupture of membranes).
- Allow for spontaneous rupture of membranes unless a medical need for amniotomy arises.
- Confined to labor bed throughout labor.
- Confined to labor bed except to get up to use bathroom.
- Use of bathroom throughout labor.
- Position changes for comfort as desired.
- Ambulation (walking) in labor allowed.
- Routine electronic fetal monitoring throughout labor.
- Routine external monitoring
- Routine internal monitoring
- Routine electronic fetal monitoring on an intermittent basis throughout labor allowing more freedom of movement, position changes, ambulation, use of bathroom, etc. Convert to continuous fetal monitoring if medically indicated.
- Frequent auscultation of the fetal heart rate if EFM not used.
- External telemetry fetal monitoring while woman is out of bed and ambulating.
- Amniotomy (artificial rupture of the membranes) as a method to augment labor.
- Routine use of oxytocics (medications) to stimulate a sluggish labor.
- Allowance of non-invasive means to stimulate a sluggish labor including position changes; ambulation; removal of stressful individuals (family member, visitor, staff member); privacy with coach; warm towel on chest with tactile nipple stimulation to increase own oxytocin release.
- Support by staff of couple’s use of labor coping strategies including relaxation techniques, focal point and/or visualization, breathing styles, coach support, massage, music, position changes, personal expressions of noise, and more.
- Staff interactions and procedures confined to time between contractions whenever possible. It is understood that some procedures may best be done during a contraction such as late labor pelvic exams, episiotomy, amniotomy, etc
- Artificial pain relief decisions made with laboring woman/couple, not just by the staff.
Delivery and Birth
- Primips allowed to push in labor room until bulging of the perineum, then moved into delivery room for the last few pushed and delivery of the baby.
- Primips and multips move to the delivery room as soon as completely dilated. All pushing done in the delivery room.
- If delivering in a conventional delivery room on a conventional delivery table, have stirrups adjusted for individual height, leg length and comfort. Also, have back of table elevated so as not to be pushing flat on back.
- Delivery in a birthing room, LDR/P (Labor-Delivery-Recovery/Postpartum Room), or labor room bed.
- Delivery position of most comfort, accessible to birth attendant, and of best advantage for delivery of the baby.
- Arms free during delivery, not strapped down.
- Pushing technique expected to include prolonged breath holding and bearing down effort for expulsion. Making sounds discouraged.
- Pushing technique to include a less intense, partial open-glottis technique. “Working noises” acceptable.
- Two to three hour limit for second stage labor (pushing) then forceps application, vacuum extraction, or Cesarean delivery expected.
- Allow a reasonable and safe amount of time for pushing without routine external fundal pressure (excluding true fetal distress requiring more active management and delivery of the infant.)
- Routine episiotomy.
- Necessity of episiotomy evaluated at time of crowning to baby’s head.
- To help prevent necessity of episiotomy-slower delivery, perineal massage, warm compresses to perineum, peniurethral support with delivery, coaching to pant-blow (“Hee-blow”) with delivery of baby’s head; maternal position to decrease perineal pressure.
- Spontaneous delivery (may require extra patience by the birth attendant).
- Forceps or vacuum extraction to facilitate birth of the baby. For which indications might they be used?
- Choice of anesthesia?
- Infant placed in warmer immediately for evaluation and care by nurse within sight of the mother.
- Infant placed on the mother’s abdomen or chest immediately for bonding. Nurse evaluated infant on mother’s chest unless infant’s condition necessitates evaluation under warmer.
- Coach may cut umbilical cord if prearranged with birth attendant.
- If baby is stable, infant is to be wrapped up and held by the mother and coach in delivery room for bonding.
- If the infant goes to a separate nursery, the coach may accompany the baby and nurse into the nursery.
- Infant to stay with parents with no separation.
- Is the use of a camera and/or tape recorder and/or a video camera allowed? If so, how much and when?
Delivery of Placenta
- Manual removal of placenta soon after birth of the baby.
- Time limit of third stage labor to 10-15 minutes followed by manual removal of placenta.
- Allowance of spontaneous delivery of placenta which can normally take from 5- 30 minutes after delivery of the infant.
- Routine administration of Pitocin for contraction of uterus after delivery of the placenta.
- Evaluation of uterine tone prior to administration of oxytocics.
Cesarean Birth
- Cesarean delivery decisions due to antepartum (pregnancy) or intrapartum (labor complication.
- Scheduled surgery.
- Surgery after labor begins spontaneously.
- Coach in waiting room.
- Coach allowed present during delivery as support person for mother.
- What type of anesthesia and rationale for choice: Epidural, spinal, general?
- What type of post-surgical and post-delivery pain relief: IM injections, morphine epidural, PCA (patient controlled administration) pump, oral tablets?
- Mother allowed to wear contact lenses or glasses during delivery?
- Baby held up for mother and coach to see. When baby is placed in the warmer for evaluation and care, the warmer is placed within sight of the mother.
- If the infant is stable, he/she is to be wrapped up and given to the mother and the coach to hold prior to going to the nursery.
- If the mother is too heavily medicated, the coach may see and touch the infant prior to the infant going to the nursery.
Recovery Room
- Coach allowed in the recovery room with the new mother.
- Coach not allowed in the recovery room.
- Infant allowed in the recovery room with the mother and coach.
- Infant not allowed in the recovery room.
- Family members and visitors allowed in the recovery room (may be restricted to a certain number of persons at one time).
- Family and visitors not allowed in the recovery room.
- Privacy, as much as possible.
Postpartum
- Baby remains with the mother and coach with no separation. Baby’s initial care and observations are done in the mother’s room.
- Baby sent to the Admit Nursery for 2-3 hours for care and observation until considered stable.
- Eye drops applied immediately to baby after birth.
- Eye drops delayed for bonding for up to 2 hours after birth.
- Eye drops are Iliotycin or Erythromycin get (silver nitrate is usually not used any more).
- Baby’s first feeding is glucose water in the nursery.
- Baby’s first feeding is colostrum from the new mother. Glucose water may be given if the baby does not nurse adequately at this point. It is also understood that many new babies are not enormously hungry immediately after birth.
- Complete rooming-in; modified rooming-in; partial rooming-in (specify which).
- Nursing or feeding on demand.
- Nursing or feeding on schedule.
- Unlimited coach visitation.
- Specified visiting hours for coach.
- Sibling and grandparent visitation with infant.
- No sibling and/or grandparent visitation with infant.
- If infant is in Special Care Nursery (Neonatal Intensive Care Unit), is there limited or unlimited visitation of the infant by the mother encouraged? by the coach? by the grandparents?
- Circumcision
- Reasons for procedure?
- Done where, when and by whom?
- By which procedure is it done?
- How to take care of the circumcised penis until it heals?
- Cost?
- No circumcision
- Rationale?
- Increased incidence of non-circumcised male infants?
- How to take care of an uncircumcised male child?
- Vaginal deliveries home in ____days if no complications.
- Cesarean deliveries home in _____days if no complications.
- Early discharge program with the mother and baby home in ____ hours after the birth if no complications.
- Pediatrician must discharge the baby from the hospital.
- Obstetrician must discharge the mother from the hospital.
- Visit by a home nurse included in the early discharge program?
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