Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Top Ten DOs for Writing Your Birth Plan: Tips from an L&D Nurse, PART 2 July 23, 2009

If you haven’t already, please check out PART 1 of this post:  Writing Your Birth Plan: Tips from an L&D Nurse.  Also, at the end of this post check out a birth plan written and sent to me by one of my blog’s readers who is due any day now!

  

#1    DO keep your birth plan short, simple, and easy to understand (1-2 pages max).

 

“Keep [your birth plan] short.  If you need to spell out a long list of points, you may not be with the right caregiver. If most of the things you want aren’t things your caregiver is used to doing (in which case you don’t need to put them in a birth plan!), you are unlikely to get them. For maximum effectiveness, keep your birth plan to a single page.”

Writing a Birth Plan by findadoula.com

 

#2    DO keep the language of your birth plan assertive and clear.

 

“Remember to keep your language assertive – polite but clearly stating what you want. Use phrases like “I am planning” and “I would like” rather than “if it is ok” or “I would prefer.

 

Be specific.  Avoid words and phrases such as “not unless necessary” or “keep to a minimum.” What one person thinks is “necessary” is not what another does. What one person defines as the minimum is not what the next person does. Instead, use numbers or specific situations, for example: “I am happy to have 20 minutes of electronic monitoring and if all is well then intermittent monitoring every hour for five minutes after that”  or  “I am happy to have a vaginal examination on arrival in hospital and after that every four hours or on my request.”

Writing a Birth Plan by findadoula.com

 

 

“Be sure to be assertive, but not aggressive when discussing your options. Do not allow your caregiver to brush off your decisions or suggest that this is unimportant. At the same time, don’t assume your caregiver [or nurses] will be hostile or uninterested in hearing what you have to say.”

How to write a Birth Plan by birthingnaturally.net

 

#3    DO use your birth plan as an impetus for doing your own personal research about your preferences for childbirth. 

 

One great place to start is at MothersAdvocate.com who, in partnership with Lamaze International and Lamaze’s Six Steps to A Healthy Birth, have created a website that offers FREE, evidenced-based, educational video clips and print materials to educate and inform childbearing families on how to have a safe and healthy birth for both you and your baby.  These extremely well reserached and produced materials are a MUST READ for all expecting moms!!!

 

The introduction handout for these video clips and print-outs entitled Introduction: Birth–As Safe and Healthy As It Can Be reads:

 

“While no one can promise you what kind of birth experience you will have, common sense tells us and research confirms that there are two tried-and-true ways to make birth as safe and healthy as possible:

 

• First, make choices that support and assist your natural ability to give birth.

 

• Second, avoid practices that work against your body’s natural ability, unless there is a good medical reason for them.

 

Lamaze International, the leading childbirth education and advocacy organization, has used recommendations from the World Health Organization to develop the Six Lamaze Healthy Birth Practices that support and assist a woman’s ability to give birth. Years of research have proven that each of these practices increases safety for mothers and babies.

 

The Six Lamaze Healthy Birth Practices are:

 1. Let labor begin on its own.

 

2. Walk, move around, and change positions throughout labor.

 

3. Bring a loved one, friend, or doula for continuous support.

 

4. Avoid interventions that are not medically necessary.

 

5. Avoid giving birth on your back, and follow your body’s urges to push.

 

6. Keep your baby with you—it’s best for you, your baby, and breastfeeding.”

 

The topics of the print materials include: 

Choosing a Care Provider,

Changing Your Care Provider,

If You Have Been Induced,

Maintaining Freedom of Movement,

Positions for Labor,

Finding a Doula,

Creating a Support Team,

Tips for Labor Support People

and even a Birth Planning Worksheet!!

 

 

“We cannot know the day or week labor will begin, how long it will last, exactly how it will feel, how we will react, or the health and sizes of our babies.  What we can do, however, is educate ourselves about the vast array of possibilities and learn which are more likely to occur. We can decide what is ideal and what we will strive for, what are the means to creating the most conducive environment for such a birth, and which people can best help us to attain those birth arrangements. Finally, we can prepare our own bodies and hearts for the process.”

Eyes-Open Childbirth: Writing a Meaningful Plan for a Gentle Birth

by Amy Scott

 

#4    DO include your fears, concerns, and helpful things for the nurse to know.

 

If appropriate, a birth plan can also include a few sentences regarding things you just want the nurse to know about and are important enough to make sure that every shift is aware of.  For example, I once had a patient who wrote the following in her birth plan:

 

“My husband is a type I diabetic and at times suffers from episodes of hypoglycemia where he does not have any warning signs or symptoms.  So if my husband starts to act inappropriate or seems ‘out of it’ or ‘drunk’ please offer him some juice!!  I am afraid that if I am in the throws of labor that I will not notice and this is something that I am very concerned about!”

 

Although this information wasn’t necessarily birth related, as a nurse taking care of this family I found this information EXTREMELY helpful to have in the birth plan!!  By putting it in her birth plan, this mother felt more at ease knowing that she did not have to waste any time worrying about forgetting to tell each new nurse that took care of her.  Having this in her birth plan also served as a reminder for me to pass along this important information when I was giving report to the next shift. 

 

#5    DO review your birth plan with your birth attendant and ask him/her to sign off that he/she read and understands it.

 

“Add a line at the bottom of your birth plan for your doctor or midwife, and other caregivers, to sign your plan under the statement ‘I have read this plan and understand it.’  When caregivers sign your plan, they are only acknowledging to you—on the record- that they have read and understood it.  They do not have to sign and say: ‘I agree.’  No matter what you tell them, they are always responsible for offering you their best judgment and skills as different circumstances arise, and then together you and your caregivers can agree on your care.  This benefits you.  Your birth plan will help you take responsibility for your decisions and ask to be fully informed.”

Creating Your Birth Plan, page 219

By Marsden Wagner & Stephanie Gunning

 

#6    DO make your birth plan personal (don’t just copy paste) and DO make sure that you understand and can elaborate on everything in the birth plan if asked.

 

In my humble opinion (regarding birth plans), there is nothing more frustrating for a nurse (and nothing more detrimental to a nurse’s overall attitude and view of birth plans) than to have a patient just copy and paste a general, “all-purpose” birth plan off the internet, check the boxes that “sound good”, and pass it in to a nurse with her name typed in at the top.  Why?  Because when a nurse (like myself) sits down to review the birth plan with the mother and her labor companions in order to start a dialogue about how the nursing staff can assist in adhering to the birth plan, it will most certainly become obvious to the nurse that the patient has done little to no research on any of her choices making it almost impossible to help the patient follow her birth plan when the birth attendant comes in and wants to do things differently.

 

Let me give you a few examples:

 

Example 1:  One time I had a patient who had the following statement on her birth plan:  “Regarding an episiotomy, I am hoping to protect the perineum. I am practicing ahead of time by squatting, doing Kegel exercises, and perineal massage.”  Now don’t get me wrong, this statement is great and it is one that I personally believe in and try to promote.  So while reviewing the patient’s birth plan with her and her husband I enthusiastically said the following, “Oh, I see here you have been doing perineal massage and Kegel exercises and wish to avoid an episiotomy.  That is great!  How many weeks have you been doing perineal massage for?”  The patient looked blankly at me and said, “What?  Oh I don’t even know what that is!  My sister just told me that I shouldn’t get an episiotomy so I checked that box.” 

 

Ladies, it is really hard for a nurse to advocate for you if you don’t even understand what you are asking for!

 

Example 2:  Almost all the birth plans I have seen make some statement about pain relief and pain medications.  Again, I think that this is a great thing, especially if the mother was inspired to research all of her pain relief options (both pharmacological and non-pharmacological) and make an informed pain relief plan during the writing of her birth plan.  One time I had a patient who had the following statement in her birth plan, “Regarding pain management, I have studied and understand the types of pain medications available. I will ask for them if I need them.”  Again, I was very enthusiastic when I read this and said to the mother, “I see here that you have done some research on pain management.  Wonderful!  Have you taken any childbirth preparation classes or read any books?”  The mother responded, “What do you mean?”  I replied, “Well you know, like any classes or books by Lamaze, Bradley, Birthing From Within, Hypnobabies, etc.”  The mother responded, “No.”  I then said, “Oh, did you do any research on the internet or talk to anyone?”  To which she replied, “No, not really.  I mean, it’s my first time so I don’t know what to expect.  My best friend just said she hated her epidural so I don’t really want one of those.  Unless , of course, I really need it.  We’re just going to wing it.” 

 

Ummmm, huh?!?!  Now again, don’t get me wrong.  I feel that I am very supportive of mothers that are preparing for a natural, or physiological, childbirth and I often write about the risks and benefits of common obstetrical interventions, including pain medication and epidurals.  But ladies, your nurse can’t be the only one who is advocating for your natural childbirth.  YOU have to be on board too and YOU have to understand your reasons for not wanting pain medication or epidural.  Because if you don’t even know why you don’t want an epidural then the next person who walks into that room who feels differently, be it a nurse or your birth attendant, guess what’s going to happen?!  You’re probably going to agree to anything said nurse/birth attendant tells you you should get, because you don’t know any alternatives.

 

I am not trying to say that taking a certain childbirth preparation class or reading certain books is required for a positive and empowering birth experience.  But some type of research and preparation on the part of the mother and her labor companions/partner is EXTREMEMLY IMPORTANT!!   

 

Now here’s one more example to give you the full perspective.

 

Example 3:  One time I was taking care of a patient who had the following statement in her birth plan: “My husband and I have been preparing for and planning a natural childbirth.  I am very interested in using the Jacuzzi tub for pain relief in labor and have been reading about other drug-free ways to cope with pain.  I am not interested in pain medication or an epidural as I had both with my last baby and had a poor experience with both.   I respectfully request that they not be offered to me.  I have done research and feel that the risks outweigh the benefits.”  When I asked her about it we embarked on a really informative discussion about her last delivery, in which she had persistent numbness in her right leg for 2 months after the epidural as well as a debilitating spinal headache that took required two blood patches and made it difficult for her to nurse or care for her baby during her hospital stay.  She also told me that she did not like the way the IV narcotics made her feel, as she was “seeing things” and generally “very out of it.”  After our conversation I felt confident in advocating for her with her doctor (who often insisted his patients get epidurals) because I knew that if I said anything to the doctor that she would, in a sense, back me up and likewise I would back her up!! 

 

It is so hard when a patient has something in her birth plan like “I don’t want an epidural”, and hence I argue with the doctor about how the patient does not want an epidural, but then when he goes into the room to ask the patient himself, the patient says “Oh well, whatever you think is best doctor!”  It really just makes the nurse look like she is trying to “push her own agenda” when in reality the nurse was just trying to follow the patient’s birth plan!! 

 

One more thing…I don’t want anyone to feel like I am implying that a woman has to “prove” anything to me when I ask questions about her birth plan.  That is NOT the case.  I just know from personal experience how important it is for a woman to understand and agree with everything she herself puts in her birth plan!  Remember, mothers, labor companions, and nurses work best when they are all on the same page and work as a team to facilitate a positive and empowering birth experience!!

 

#7    DO look at examples of great birth plans online to get some ideas.

 

The following is a list of some good places to start. Remember, while these websites provide a wealth of ideas, they should not be simply copied and pasted!  The best and most effective birth plans are personal, NOT just a list of things with check marks next to them!!

 

a)      BirthingNaturally.net

b)      Sample Birth Plans from BirthingNaturally.net

c)      ChoicesinChildbirth.com

d)      American Pregnancy Association

e)      BabyCenter.com

f)      MothersAdvocate.com

 

#8    DO run through scenarios in your mind about how labor could unfold and actually talk these scenarios out with your labor companions and doula (or perhaps even your childbirth educator or birth attendant too!) 

 

Think about all the different ways labor could unfold and how you might react if labor was faster or slower than expected; harder or easier than expected. What would you need for comfort, support and information in each of these variations?  Thinking about “worst case scenario” doesn’t mean it’s going to happen.  But if it does, or if any variation does, it will make you more at ease to know that your team has already talked about it and knows your wishes. 

 

“If you knew that something would go wrong or would pose a difficult challenge during a portion of the labor and birth, what would your ideal strategy and scenario for handling that problem be?  How would you want your midwife or doctor to speak with you?  How would you like your spouse or another support system to help?  What alternatives would you like to try, and in what order?  Again, in your mind’s eye permit yourself to have the best.  What would help you relax and be able to continue labor under difficult conditions?”

Creating Your Birth Plan, page 219

By Marsden Wagner & Stephanie Gunning

 

 

#9        DO try to treat researching and birth plan writing as a fun and exciting experience, not a chore! 

 

Enjoy this time!  Don’t be afraid to be creative and fanaticize!  There are so many amazing thing that you can discover and learn about while doing research for your upcoming birth.  It is never too early to start so don’t put it off till the last minute!

 

And finally…

 

#10    DO remember to bring your birth plan to the hospital!! 

 

It won’t do much help to the nursing staff if you forget it at home on your coffee table!  I encounter this very often at work and I always feel so badly because I know that there is usually a lot of work put into writing a birth plan.  It might be best to make sure that you place a copy of your birth plan in the bag you have packed to take with you to the hospital.  I have even had a few mothers put an extra copy in their car’s glove box so that they wouldn’t forget it!

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

SAMPLE BIRTH PLAN

 

This birth plan was sent to me by a reader of NursingBirth who goes by the name “ContortingMom”.  Contortingmom’s guess date is 7/17/09 and she is still “cooking” with her first baby :)  I really like her birth plan for a variety of reasons.  #1 She was inspired to add some stuff to her birth plan after reading a couple posts of mine (which I think is pretty cool :) and #2 I think it is a perfect example of a personalized birth plan!!  No check boxes here!  Thanks again to ContortingMom for allowing me to post her birth preferences for other moms to read and learn from!!

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~

Birth Preferences:

I understand that labor and birth are unpredictable and ultimately want the health and safety of both the baby and I to take precedence. In all non-emergency situations, all proposed procedures are to be discussed (benefits and risks) so I can direct the decision making with informed consent.    

Your help with these preferences is very much appreciated.

 

Labor:

• I intend to have as natural a labor as possible – including freedom of movement, intermittent monitoring, a saline lock instead of an on-going IV, and clear liquids as tolerated.

• Due to my GBS+ status, I request only very limited vaginal exams and do not want an amniotomy.

• Please accept my request that pain medication not be offered to me. For many reasons – personal and medical, I’m striving for an unmedicated labor and delivery. If I eventually want drugs or an epidural, I’ll be the first to ask for it and understand that options change as labor progresses.

• If augmentation is necessary, I would like to try non-pharmacological methods before resorting to meds. However, if my OB and I agree that pitocin is required, I request that the it be administered following the low dose protocol and increased in intervals no closer than every 30 minutes, allowing my body an appropriate amount of time to adjust and react to each dose increase.

 

Birth:

• Please do not direct my pushing with counting or yelling. I will ask for help if needed.

• I strongly prefer a tear to an episiotomy and do not want a local anesthetic administered to the perineum.

• I plan to be as active during pushing & delivery as possible, including choosing productive positions. They will be probably anything except supine, lithotomy or “sitting squats” that put pressure on my tailbone. It’s been broken several times & currently inflamed. I also have restrictive pain from spinal injury & surgery, so please allow a position suited to my medical needs. I’ll make sure the OB has comfortable access.

• I would like to have the baby brought to my chest immediately for skin-to-skin contact & initial procedures – and to try nursing to see if it works to contract my uterus, delaying pitocin until we know.

 

If Cesarean Is Required:

• Please use double-layer sutures when repairing my uterus. If I have a second child, I hope to attempt a VBAC and understand this is a requirement for many doctors.

• As health permits, I would like to skin-to-skin contact with the baby, to stay together during repair and recovery, and to breastfeed during the initial recovery period.

• If my husband has to leave the operating room with the baby, I would like my doula to take his place.

 

Baby Care:

• We would like to spend as much time as possible with our baby after birth before being taken off for procedures and will be breastfeeding, so please refrain from giving bottles/pacifiers.

 

We Appreciate Your Support. Thank You!

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40 Responses to “Top Ten DOs for Writing Your Birth Plan: Tips from an L&D Nurse, PART 2”

  1. kgjames Says:

    oh very good birth plan – I have a few things to add into mine. And yay, I had been hoping to see part 2 before I went into labor! :)

    Because I will be doing a VBAC (with twins, nonetheless!), I believe that augmentation of any type would be inappropriate due to increased rupture risk. Is that true? Also, can you explain to me the 30 minute adjustment interval for pitocin increases? Is that the optimal interval?

    TIA,
    Kimberly
    http://labortrials.wordpress.com

  2. Jenny Says:

    I’ve actually heard not to make them more than a paragraph or two because often times if they get too long nurses and docs get annoyed with them.

  3. Dou-la-la Says:

    Another incredible resource. Thank you.

    I gotta say, I especially agree with #6. The women in the examples given, frankly, kind of give a bad reputation to the ones who DO pour a lot of thought and time and effort and research into their birth plans. Know what I mean? A more jaded care provider might assume that they’re ALL copying and pasting and checking off boxes without doing any reading, much less soul-searching.

    Are we going to get a part 3, Top Ten DON’Ts? ;o)

  4. Noble Savage Says:

    Thank for you such an informative, well-laid-out post. I’m going to pass this along to any newly-pregnant friends.

  5. RT Says:

    When my partener and I were preparing for the birth of our first child we took the time to carefully write up a birth plan based on our research and desire for a natural child birth. We went over it with our doctor and she agreed with our plan and suggested a few helpful changes to the plan. When we arrived at the hospital we were suprised to learn about some hospital policies inclulding the intervals and lengths of monitoring and frequency of vaginal exams. While our doctor had told us about some hospital policies, others she had omited and some she had completely wrong. We had taken the hospital tour but recieved no information from the hospital on these policies. I spent the first six hours at the hospital arguing on and off again with the on call doctor about what was necessary. She brought out waiver forms she said we had to sign, but we refused. Amazingly at the morning shift change everything else changed. The new doctor and nurse respected our desires without waving paper work in our faces. In fact it seemed like all the “hospital policies” that we had fought against simply disapeared. In the end we had an amazing natural birth experience and I am grateful to the doctor and nurse who respected us enough to let it happen.

    I have been thinking a lot of how we will revise our birth plan for our next child. How can a person find out about the hospital policies prior to the birth? In your experience do many on call doctors have their own preferences which they pass off as “hospital policies”? Can your doctor’s requirements on monitoring, etc trump the on call doctor’s requirements? Or are you just stuck with who you get when you show up?

  6. contortingmom Says:

    Hi All, Have a question for my birth plan that was in this post. I’m 41 weeks now, I plan to go the distance as long as I can. I REALLY want to avoid induction. But, I thought if I just accepted that it might happen and prepare for it, maybe that will kick my body into gear. So, I’m tweaking the plan to create an induction version just in case.

    My idea is to move the pitocin part up top and alter another bullet like this:

    • Since I am being induced, I request that pitocin it be administered following the low dose protocol and increased in intervals no closer than every 30 minutes, allowing my body an appropriate amount of time to adjust and react to each dose increase. As soon as a good contraction pattern emerges, I would like the IV disconnected to see if my body kicks in.

    • At that point, I intend to have as natural a labor as possible – including freedom of movement, intermittent monitoring, a saline lock instead of an on-going IV, and clear liquids as tolerated.

    Do you think this would work practically? Any ideas?

    And to Jenny: This plan is one page printed out and seems to be going over well with the medical professionals I show it to. I am also including preferences for a csection and baby care that are often separate pages or not considered at all. Keeping it short and to the point is important, but not to the point where you don’t include important info IMO.

    And RT: Even if things are “hospital policy” or what the doctor wants – they are still medical procedures that you can decline. They are not law and they’re not going to kick you to the curb. Having said that, I am worried about the same thing right now. After doing everything I could to get the best HCP considering my circumstances, she is away until Monday and the most scalpel happy jerk of a doc is on call all weekend. :( I certainly don’t want to have to be on guard and cause conflict during my child’s birth – but I will do what I have to do. At least my dh is on board and I have a great doula too.

    I would also LOVE to figure out how to find out hospital policies ahead of time. I have tried to no avail so far except for the questions I asked during the hospital tour. Why can’t they just give you a USEFUL hand out? All we received was a glossy book that really had no actionable info.

    • NursingBirth Says:

      contortingmom, I see where you are going but don’t give up hope just yet!!! I think that it is healthy to think about “what ifs” in order to plan accordingly but I just also want you to know that you still have a week left so not all hope is lost for going into labor on your own :) Also just wanted to let you know that “induction” and “intermittent monitoring” is pretty much a contradiction. I haven’t heard of one hospital that will allow you t be on pitocin and NOT do continuous monitoring. Perhaps other hospitals will let you do cervical ripening without continuous monitoring (i.e. misoprostol, cervidil, prepidil) but then again, these methods of cervical ripening come with the risk of uterine hyperstimulation (tachysystole) and so that is why continuous monitoring is used. At my hospital it is hospital policy and an automatic physician order for continuous monitoring or any kind of pharmacological (medication) induction/augmentation.
      As far as saline lock, I often saline lock my patients if they are having their cervix ripened as long as they are drinking well. So if you go into the hospital for, say, overnight cervidil it is completely legitimate and safe to ask to be saline locked….they can always hook up an IV in case of emergency. However you HAVE to have a running IV to run pitocin because pitocin that is how pitocin is administered…through an IV drip!

  7. contortingmom Says:

    Also – it’s my first baby:) (not second like it says in the post) – so everything I know is just from doing lots of research. I hope it all actually works out in the real world.

  8. Kimberly Says:

    This is an interesting quote. To me the fact that parents have to write a plan up indicates that something is very wrong with the L&D system of today. Where is the respect for their wishes? Where is the continuity of care? How can we expect women to have a good experience when they have to constantly fight for their rights?

    This information is very useful, it’s just a shame that it’s necessary.

  9. contortingmom Says:

    What I am wondering was if you still needed constant monitoring even if the pitocin drop was OFF/no longer needed b/c the body was contracting on its own. I’m mostly effaced and all, so if I were to be induced, I imagine we’ll go straight to pitocin. Again, this is just a “what if” – like getting your car washed so it will rain:) I haven’t given up hope yet.

  10. Expecting #2 Says:

    I don’t know if you have any other information from this woman, but I am curious about the woman who had prolonged numbness for two months after her epidural. I also had this problem, thought the severe numbness lasted about 4 months, and I have some permanent damage. How common is this? I have never come across any one else with this complication. I guess I am just surprised that someone else had a similar experience to mine, and I’d like to know more.
    Thanks!

  11. Johanna Silva Says:

    Awesome posts, as usual! Thank you so much for taking the time to do this! I have learned so much about the things that went wrong with my first birth and about what I will do differently if we have another baby.

  12. enjoybirth Says:

    Great points, ESPECIALLY about not just checking things off on a list and printing it out, without thinking about all that is on there. I view creating your Birth Preferences as a way to research your choices and make educated decisions about what would be ideal for you!

    I love that you actually review each point with your patients,
    I have yet to see a nurse do that. Good for you!

  13. Joy Says:

    Thanks for posting all of this! I already wrote and talked over my birth plan with my doctor. But after reading how specific you suggest us to be I think I may “do it over” and talk it over with him again so that I am heard. And I’ll be sure to bring up the delayed cord clamping thing I talked to you about (sorry I never replied back. I’m actually really sick, even right now, but had to do something other than lay in bed).

    And I appreciate you talking about the fear aspect. I’m very fearful of a few things. For one, that my husband won’t be a strong voice for me when I can’t be one for myself. So I thought about asking his mom to be present (she was present our last delivery and was amazing).

    I really like that contortingmom put “No yelling or counting while pushing!” It was SO DISTRACTING when having my other two kids, not to mention it kept making me giggle. The nurses sound absolutely ridiculous when they do that that I couldn’t help but keep laughing. So I guess laughing while pushing is better than screaming your head off, but still. I’m a quiet person and like things quiet.

  14. Joy Says:

    Okay so I just updated mine but I feel like it’s too long! 1 1/2 pages and I wanted to use a large enough font that it was easy-to-read. It’d be fun to ask all your pregnant “participants” to link up their birth plans to share and make suggestions, provide more insight, etc.

  15. Erin Says:

    Everybody might be doing this anyway in their birth plans (I’m sure most people were better prepared going into birth than I) but I want to encourage all mamas wanting a natural birth to think about and research ALL interventions anyway, in case you need them. I wanted a natural birth and c hose to deliver in a birth center – epidurals were off the table, so I didn’t read much about them. Then lo and behold, I was one of the tiny percent of people who have to transferred to L&D for epidural and pit and I simply didn’t know anything about these interventions, their possible side effects, etc. It didn’t occur to me to ask them to lower or turn off the epidural for the pushing stage, to wait until I could feel my bottom for more effective pushing. I wonder if I had done that if I could have pushed more strongly & avoided a vacuum.

  16. Heather Says:

    GREAT birth plan! I’m a CBE and I will be sharing all those great tips with my classes. Thank you!!!

  17. Paige Says:

    http://shine.yahoo.com/channel/parenting/mom-refuses-c-section-baby-taken-away-492112/;_ylt=Alb01vImTb_CMbVAuPRmJ_ZabqU5

    Please view this link and post a blog on it. It is not spam. It is from yahoo. A woman who refused a c-section had her baby taken away. How can we avoid such a thing?

  18. contortingmom Says:

    Hello from Contorting Mom,
    Looks like my plan to mentally prepare for induction did the trick. I went into labor a few hours after my last post. I went from “hmm is this labor?” at 6pm – to holy crap, contractions 2 mins apart arriving at the hospital at 11pm. Funny thing is, I forgot the Birth Preferences! But thankfully my doula brought a copy. Everything went very well, if not a little crazy and hectic.

    I didn’t have the best nurse at first. She immediately assumed I came to the hospital too early and was just being dramatic. It didn’t help that my intake exam showed I was 3-4cm. I really did my best to be polite and normal, but she was not paying attention to when I was in the middle of contractions. I kept explaining to her that they were right on top of each other, and she said “well, short contractions are common in early labor” ?? HA. Anyway, she swapped out nurses herself (we didn’t have to ask) and the second one was great. When they were doing the change over, I asked to be checked for progress (about an hour had passed) and I was complete at 10cm! So, I think the first nurse realized I wasn’t just a jerk then:) I met the OB on call briefly in the middle of all this. That’s when my water broke. My doula said the whole thing was like a really long transition. Certainly felt like it! Anyway, my body did its primal thing and it was very helpful to be able to reassure myself with all I had learned during the hard times. It was a good thing I planned for no drugs, because I don’t think there was ever a chance to get them anyway. After about 30 minutes of pushing – the nurse asked just about at crowning time to “wait for the doctor” And I said “I’m going to do what I’m going to do.” My husband said this made the cool nurse smile. I had been on the squat bar and was in some sort of wacky side-lying squat during the crowing stage. I actually used the brief “waiting for the doc” time to do some perineum stretching. My daughter was born soon after perfect as can be. I didn’t tear, but had some bleeding issues after the birth. My husband stayed with her (they do all the procedures in the room) and after trying fundal massage for a while, they gave me a shot of pitocin b/c my saline lock fell out near the end. She had some breathing issues at first, but is ok now. It just made going drug free more worth it – as she was able to recover quickly. We were able to breastfeed about an hour after birth and she did great.

    We’re home not and everyone is doing well. Recovery has a lot easier than I anticipated. In the end, since the labor was so fast, I didn’t even need most things on the my preference sheet – but being informed REALLY saved the day. It made a very fast and potentially scary labor a success.

    • Aron Says:

      Congratulations! So great that being informed helped you to keep your perspective and find your voice when you needed it. I’m always amused when I’m with a client who is CLEARLY in transition and whatever medical provider is checking her can’t see past the dilation numbers to observe the woman’s true state. I’ve seen women go from 2-10 in under two hours, laboring in transition the entire time, because the active labor needed to get TO that 2 cm mark had already been accomplished at home. Dilation has very, very little to do with how far along one is in labor or how much longer one has to go. Just sayin’.

      Enjoy your babymoon!

  19. Sarah Says:

    Hello, NursingBirth! I have a question I hope you can answer or at least point me in the right direction: I am studying to become certified as a childbirth educator and have been interviewing the hospitals in my area to get a feel for their policies, as well as to gather some numbers (c-section rate, medication rate, episiotomy rate, etc.).

    A few of the hospitals have been a little huffy when I ask some of my questions–mostly the percentage ones. One woman I talked to at one hospital voiced her discomfort with my question with: “I don’t have access to that number, and even if I did, I don’t think I would give it to you.” (I should say that I am interviewing hospitals as a patient, not as a CBE, and I am very polite and respectful with these people. I believe it is the question, not me, that made her defensive.) I responded to her that it seemed like that kind of information should be available to the consumer.

    My question to you is this: do hospitals/individual providers have some sort of obligation to divulge this kind of information? Surely they are keeping track somewhere. Where/how can a consumer find out?

    One telling thing was that one of the hospitals bent over backwards to give me any info I asked for. But they had awesome numbers. I’m guessing the hosp. that wanted to withhold info. probably doesn’t have stellar numbers.

    Any input or guidance you can give would be wonderful. Thank you! I look forward to each of your posts!

  20. i just found this blog and i am SO happy! i am in nursing school (planning on getting my MSN in midwifery) my mom is a nurse and was a doula for years. i will definitely be checking back for more.

  21. melissa Says:

    great post! wonderful to have ‘do’ instead of ‘don’t’ because it is helpful and productive!! [though don't is definitely sometimes necessary!]

    Interesting to note the addition of non-birth items in the birth plan–I had noted in the birth plan of my 3rd child that my second child is adopted, to explain why a little brown boy would be running around the room of a bunch of white folks [ :D ], and asked politely that both my older children be spoken to respectfully if need be. I felt it might come in handy.

    Keep up the good work–I’m a fan!

  22. Simon Hardeman and Spike Breakwell Says:

    Push!
    The female may get the urge to get out and do this when the car runs out of petrol halfway to the hospital.

    Gestation
    They’re all closed.

    Pain
    Apparently you are one.

    Maternity
    After one of these you reach the hospital.

  23. Meg W, RN Says:

    Congrats contortingmom!!!

  24. Morgan Says:

    DO make sure you include your desires for what happens to the baby in the event you have a cesarean. No matter what birth you are planning, have this decided ahead of time, or you may find that your baby is taken to the nursery for the first hour of life rather than snuggling and nursing in your arms in the recovery room. Be proactive, make decisions for the “what ifs”.

  25. I just wanted to thank you for this blog. i am a doula in birmingham, alabama.. and I just get so excited seeing your passion for moms’ choice in birth! You are a great beacon of hope!

    I know you like a good “hospital natural birth story” so check out my last one (where the nurse got to catch!!):
    http://rachelgarcia77.blogspot.com/2009/08/birth-story-greta-and-bob-natural-labor_09.html

    thanks again for all you do!

  26. Joy Says:

    Do hope you’re doing okay! Probably swamped at work with all the new babies.

  27. Michelle Says:

    I have a suggestion for a blog post, if you are interested.

    I had pre eclampsia in a previous pregnancy, and ended up being immediately induced when I went to the hospital (we were planning a homebirth). They wanted a c-section but did let us come in the next day for inducing.

    I often read about how important it is to get enough protein. I’m curious about what you’ve seen with this trend. Are you finding that women who have healthier diets have lower rates of pre e? I realize you havent done a study, so I was just curious about your own personal experience on this.

    Also, I know what hospital protocol was/is for this. Was wondering about your thoughts.

    I know you are a nurse and not a doctor. LOL

  28. Krista Says:

    Nursingbirth, I miss your posts! Hope everything is ok. Post soon!

  29. Missing Says:

    You are missed!

  30. Jessica Says:

    Hope all is well in your corner of the world. I’m sure you’ve been busy, but just want to let you know you’re missed! :)

  31. breezyinsc Says:

    This is pretty unrelated but I am a Blogger Virgin, so bear with me. I am earning my certification as a Labor Doula through CAPPA (I read NursingBirth was doing her CLC through CAPPA too! Yay!) and I am a little unsure of how RNs perceive Doulas. I’ve heard a lot of chatter that a few pushy Doulas have made it more difficult for the majority of us who are, by nature, easy-going gentle spirits.

    My question is this: Are Doulas, by and large, welcomed to the support team or seen as potential hazards in L&D wards? I have been procrastinating over going down to the hospital my next client is delivering at and introducing myself because…well…I feel kinda silly, like a kindergartner trying to hang out with a biker gang. I know that I need to, because all of my future clients will be delivering here as well.

    It’s my own anxiety, I’m sure, but I just feel like I’m a lay-person intruding on a professional world. Is there a tactful way to break the ice? My training suggests I take a big plate full of baked goods and a handful of business cards to L&D and try to make nice with the RNs.

    How do you like to be introduced to Doulas? I fully respect that we are in YOUR territory, but is there a less stressful way to do this?

  32. Morgan Says:

    I love the idea of having a doula stay with the mom (during a c-section) if the husband has to leave the room.

    I blogged about the importance of writing a birth plan for a c-section and will link to this post you wrote. Great information. Thank you!

  33. autumn Says:

    I’m so glad to here people talk about actually using a doula. I’ve always been intrigued, but now I feel like I wouldn’t be “weird” if I had one whenever the magical day happens.

  34. Jennifer Says:

    I know this was posted months ago, but I now read it, and I have a suggestion that was super helpful in my birth plan. I was giving birth with a supportive OB in a less than supportive hospital. Rather than saying that I generally wanted the baby to be with me immediately after birth, I specifically asked that the Apgars be taken with the baby laying on me. This was perfect because my doctor was able to communicate clearly to the L&D team what was to happen. “Could you please do the Apgars with the baby laying on mom? Great, thank you!” Rather than leaving the staff trying to fit their procedures around my wishes, they had a clear idea of how everything was going to work.

    A lot of other things didn’t go according to plan, but that part did and that time with my son ended up being infinitely important to me.

  35. [...] everything you ever wanted to know about birth plans, click here. I’ve provided a link from a Labor & Delivery nurse who blogged about it in great [...]

  36. [...] It’s vital to include your wishes regarding cord blood in your birthing plan. For everything you ever wanted to know about birth plans, click here. [...]

  37. [...] Top Ten Do’s for Writing Your Birth Plan: Tips from an L&D Nurse, Part II Share this:TwitterFacebookLike this:LikeBe the first to like this. This entry was posted in Writing a Birth Plan on October 2, 2012 by julianne davidson. [...]


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