Our Hospital Birth Plan

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June 4, 2013 by Sarah Christine Bolton

I’m sharing this for anyone planning a birth (home, hospital, birthing center).

I didn’t do this for Mae, and I think it profoundly affected the experience I had at the hospital.

Please feel free to use this if you need a template. Even if you are really confident in your decisions, it helps so much to think through these issues and determine in advance (before you are exhausted, in pain, emotional, etc.) what is OK and what is not OK.


Transfer Birth Plan – From Home to Hospital
Birth Preferences for Sarah ****** and Eric *******
EDD (estimated due date): November 14, 2012
Practitioners:  Amy ******************

Our primary goal is a healthy mother and healthy baby. We believe birth is a normal physiological event and an inherently safe process, and were therefore planning a home birth.
We realize labor doesn’t always progress as planned, and although we hoped to still be at home, we are happy and grateful to transfer our care at this point.
We desire a non-medicated labor and birth, limiting the use of medical interventions to that necessary for treatment of an abnormality or complication. To allow for a peaceful birth we request a birthing environment that is warm, dim lit, quiet and peaceful with the least interruptions possible. We also ask that doctors and nurses be respectful of the sanctity of birth, and be respectful of maintaining a peaceful, meditative environment during labor and delivery.
We understand that complications can arise unexpectedly, and are grateful for the expertise of our doctors, midwives and the nursing staff, and the technology available to assist us in that event. However, assuming no complication, we need your help to fulfill our desire for a natural birth.

In the absence of complications we ask that the following requests be honored:
We wish to be fully apprised and consulted of all risks and benefits before the introduction of any medical procedures or intervention.
We ask that all members of our birthing team remain with us at all times. Because we are a home birth transfer, this includes our midwife (Amy **********) and assistant (Brooke **********), whose primary task will be to assist us.
If labor induction or enhancement is required at any time, we would like the opportunity to try all the natural inducers first as long as the baby and mom are healthy.
We plan to stay hydrated by drinking clear fluids but we are aware that an IV may be required during labor for dehydration, medication instillation or other medical needs. We are willing to compromise on the need for an IV by utilizing a heparin-lock for access.
We wish to have no offer or suggestion of medication or self evaluation of pain level (scaled 1-10) unless requested by us. We will freely communicate with you if we need to describe a pain level. We also ask that at no point directive pushing techniques be introduced to allow for spontaneous maternal pushing.
We ask that the baby be monitored as per ACOG guidelines for intermittent monitoring rather than continual monitoring, as long as no abnormality or complication is detected to allow for freedom of movement and maternal comfort during labor.
As we know that water can be a useful comfort and relaxation tool, we would like to have liberal access to tub (if available) or shower during labor. Also we ask for the freedom to labor in whatever positions provide comfort and encourage progress.
I would prefer to have a minimum of pelvic exams during labor. As long as the baby and mother are safe during labor, I would prefer that my body be allowed to progress as it sees fit.
I would prefer not to have an episiotomy unless it is absolutely needed for the baby’s safety. My preference would be for perineal massage or warm soaks to be administered to keep the perineum intact.
Please delay cord-clamping and cutting the cord until it has stopped pulsating and the placenta is naturally delivered. Also, please preserve placenta, as we plan to take it home.
Unless there is excessive bleeding we would prefer not to have routine pitocin after delivery and plan to breastfeed and use uterine massage to promote involution.
Unless our baby is in crisis, we wish for him to be delivered directly onto the mother’s abdomen and remain there for bonding and immediate breastfeeding. We wish to delay any routine newborn procedures (bathing, eye drops, Vit K, routine exam, etc.) for at least 1-hour post-delivery, and preferably for 2 hours, and ask they be performed bedside.
Our baby will be breastfed on demand. We ask that, to help us establish successful breastfeeding, no rubber nipples, sugar water, pacifiers, formula, etc. be given.
Unless there is a serious medical condition requiring advanced care, we desire continual ‘rooming-in’ with our baby and no mandatory time in the nursery to promote breastfeeding and bonding. If exams, etc., must be done in the nursery, at least one parent will accompany the baby to the nursery and remain there during the exam/procedure.
We do not wish for the baby to be bathed in the hospital or by hospital staff. We prefer to wipe the baby down with warm towels or blankets immediately after birth to dry her and for us to bathe our baby for the first bath at home.
We would like the option of early discharge for mother and baby assuming there are no over-riding health concerns. We would like to avoid an overnight stay if possible, and would prefer to limit our hospital stay to 12 hours post-partum.
As we are planning on early discharge, we prefer routine immunizations and tests (primarily PKU and HepB) be completed at our pediatrician’s office per their advice and schedule rather than at the hospital.

We trust your judgment and know you will help us have the best birth experience possible, and thank you, nurses, midwives and doctors of this hospital, in advance for respecting our preferences for this natural and beautiful process. We are excited for this adventure and feel lucky to have your help, support and guidance.


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