Birth plans

Birthplans are an essential part of your birth experience and part of being responsible caring parents. From the first moment you sit down to write one for yourself you will realise how much you need to consider about the process of birth. A birthplan is a guide through each moment of labour and after the birth. A birthplan can make your birth experience more personalised - recognising your needs and desires. A birthplan can also protect you from any procedures that you are opposed to and do not want.

Please use this list of numerous options in birth for your birth plan. Of course any other things that are important to you should be included, they may be missing from here. Take your time going through all of the one's listed here. Feel free to contact CARES SA Inc if you have any questions or suggestions.

Well before you baby is due, at least a month, distribute copies of your birthplan to the midwife, obstetrician and birthplace and discuss it with them in detail. This is the time to ensure that there are no problems with policies, protocols and prejudices. If you find opposition to something in your birthplan, which as informed consumers is unlikely to be unreasonable, you may need to reconsider if your carer has your best interests at heart and respects your autonomy and decision making role. Any small differences or problems now, may become major issues during labour. It may also be helpful to ask your carer if they have ever had to deviate from a persons birthplan, and why. Some carers will acknowledge a birthplan, then ignore it during the birth and proceed in their usual way. Other carers will think 'fantastic' these people are informed and care about their baby's health and their own, and respect you all the more for that. Some people question the relevance and appropriateness of birthplans, CARES SA Inc believe that a person who investigates and learns about their birthing options and how they want it to be is a responsible and caring parent from the beginning.

Birthplans are often an idealised version of the birth we want. We need to be aware that sometimes birth does not turn out the way we plan for various reasons. We can make some arrangements in our birthplan for contingencies that we normally would not wish to consider. I have included some of them here, and they may be confronting to some people, but I never thought I would need a caesarean! Please note that these are all suggestions and not a prescription for how birth should be. They do not constitute medical advice and therefore CARES SA INC can not be held responsible or accountable for your decisions. Always consult with your health professional and remember to get a 2nd or 3rd opinion - it is your right. The responsibility for birth is ultimately yours.

Opening Statement

Discuss or describe what you wish for in this birth.

• My authorised spokesperson during labour is ______________________________. (eg partner, support person, doula, midwife)

The Birthing Environment

• I would like the room to be dark/light/dimmed lights.
• I want my choice of music to play in background.
• I want the room to be quiet/restful.
• I want photos taken of myself/partner/baby/carers/midwife/obstetrician
• I want photos taken
  • during labour
  • during crowning
  • at the moment of birth
  • straight after birth
  • first breastfeed
  • please do not take photos of my pubic area
• I want mats on the floor
• I want birth ball for labouring on.
• I want to use the bath for labour
• I want to use the shower for labour
• I want to use a birth stool
• I want my aromatherapy oils burnts that I have brought
• I want complete privacy, closed doors and curtains.

Labour

• __________________ is allowed access to me at all times as my support and birth partner.
• __________________ is allowed access to me at all times as my doula, supporting my partners and my desire to birth this baby gently and vaginally.
• As I am a VBAC labour I do not want to be treated any differently from any other labouring woman.
• I want to have continuity of midwifery care and meet my midwives before I go into labour.
• Please do not treat me like a potential rupture of scar.
• Freedom of movement at all times.
• Freedom to use the show and bath at all stages of labour.
• Please note when my last labour stalled, I will need extra psychological help/support to get past that stage in this labour.
• Family/friends to be admitted if I desire.
• Drinking and eating as requested by me.
• Spontaneous commencement of labour.
• No induction - oxytocin/syntocinin/prostaglandins (misoprostol).
• Absolutely no prostoglandin gel, I have a previous caesarean scar.
• No induction or artificial augumentation to labour as I have had a caesarean section previously.
• If I am overdue, then I will not consent to induction unless my baby is compromised.
• If I am overdue, then I will have regular CTG to ensure baby is OK.
• If I am overdue, then I will have tests to ensure my placenta is working sufficiently.
• Vaginal examinations only as agreed or for specific medical indication in whatever position I wish.
• Fetal stethoscope/pinnard/sonicaid doppler for intermittent fetal monitoring - no CTG or fetal scalp monitoring.
• Spontaneous rupture of membranes - no amniotomy
• No pubic shave
• No enema
• No vaginal examinations
• No time limits on the 'stages'of labour to fit hospital guidelines as I do not wish to escalate my labour and would like to progress naturally for however long it takes
• I trust the natural process of life, I trust my body and my baby

Pain Management - Natural / Non-Invasive Pain Management

• Because I have been careful to not take anything that may harm my baby for the last 9 months I want to ensure that this continues in labour. I know that drugs cross the placenta rapidly and I wish to protect my child from this. You can support my desire to do this in many ways.
• Because this is a VBAC we have a doula/midwife supporting our birth, her/his presence is essential ingredient to a successful vaginal birth. Please respect his/her role and make them feel welcome. Please do not feel threatened by them as they are by now intimately acquainted with us and you will benefit from their knowledge of us.
• Use hot shower
• Use bath
• Use Bach's Flower rescue remedy for emotionally challenging times.
• Use my homeopathic remedies - (as a guide these are some available, however, see your homeopath who will prescribe the correct ones for you)
  • motherwort for first stage pain
  • ginger for energy
  • scullcap to ease tension
  • St John's Wort relieves crampy
  • Ginseng for exhaustion and energy
  • Black Cohosh
  • Blue Cohosh
  • Beth Root strengthens uterine contractions
• Labour on all fours, especially if baby is in occiptal-posterior position
• Labour standing.
• Encourage me to vocalise my labour and not feel inhibited by this, as it can be surprising and confronting to hear myself like yelling or moaning.
• Encourage me to walk and do pelvic rocking
• Encourage me to get into different positions.
• I have learnt self-hypnosis and will be using this method of pain relief.
• I want to use TENS machine (Transcutaneous electrical nerve stimulation) for pain relief. (This is a method that you need to organise before labour and try before labour so you are prepared for the tingling sensations)
• Use massage with/without oils - (as a guide these are some available, remember if you are having a water birth that you need to ensure the oils dont get into the babies eyes)
  • Rose - the female oil, anti-depressant qualities
  • Clary Sage - great pain relieving properties use on a flannel as a compress. Can make everyone in the room feel light headed and euphoric.
  • Neroli - reduces fear, anxiety helping to concentrate on breathing.
  • Jasmin - has analgesic and anti-spasmodic actions. Good in massage oil.
  • Lavender - the queen of essential oils, antiseptic properties. Very gentle and can relax muscles and sooth pain.
  • Geranium - good for circulation and the fragrance is uplifting (care if asthmatic)
  • Ylang-ylang - a wonderful calming oil, anti-depressant qualities.
• Hot packs applied to painful areas (hot water bottles covered in sheepskin covers have amazing heat retentive capabilities, and wash up great)
• Please give me lots of reassurance and encouragement. I need to hear that everything is going fine and that I am doing well.
• Please remind me that my baby is on its way and I will meet it soon.
• Please stay close to me, I do not want to be alone.
• Please respect my wish if I ask to be left alone.
• I would like to be supported and encouraged to labour without pain relief as this is best for my baby and me.
• If I ask for an epidural I am really asking for support as I am in pain and scared.
• Please repeat these affirmations to me during labour (for example)
  • I am relaxed calm and open
  • My breathing is slow, deep and rhythmic
  • Each breath out relaxes me deeply and fully
  • My baby is safe and healthy
  • My body is preparing to birth
  • My body is wise and knows exactly how to birth
  • I relax fully, letting my body do its work
  • My baby is in the perfect position for birth
  • Each contractions ends and I relax fully
  • I am strong and celebrate this birth experience
  • I can birth my baby gently
  • Each contraction brings my baby closer to my arms
  • I see my cervix open with each contraction, bringing my baby to me.
  • I love my baby

Chemical Pain Management

• If I do require some pain relief I am willing to try gas (nitrous oxide), as I understand it can help me to focus on my breathing and get through each contraction.
• I do/do not want pethidine.
• If I ask for an epidural I want to have one administered only after I have reached 4cms at least.
• If I am having an epidural I want it to be a low dose epidural so that I can walk and keep upright.

The Birth

• Presence of my partner/birth support person/people at all times
• No time limits
• No coached pushing
• Physiological third stage, I want to wait until I understand how my body is working to birth my baby.
• I do/don't mind being naked
• Support perineum with heat and pressure.
• A 2nd degree tear is preferable to an episiotomy.
• Forceps only in an emergency and after consultation and discussion with me and my partner.
• Ventouse only in an emergency and after consultation and discussion with me and my partner.
• Ventouse is preferred to forceps.
• No episiotomy for Ventouse.
• I want to touch my baby's head as it crowns.
• Birth in an upright position, no stirrups of lithomy (on back) position.
• I want to deliver my own baby.
• I want to view my baby's entry into the world with the assistance of a mirror.
• I want my partner to deliver our baby.
• I want to find out the sex of my baby myself.
• As long as my baby is happy and healthy I want no time limits placed on third stage.
• On delivery I want baby to be placed onto my abdomen/chest.
• If baby is cold, then skin to skin contact with my abdomen and covered with a warmed blanket is good care.
• I would like to use my own blankets to wrap my baby / I would like a hospital blanket wrapped around me and my baby.
• Umbilical cord to be clamped after it has stopped pulsating.
• I want the option of a Lotus birth (leaving the placenta attached to the baby) and if there is no medical reason why it can't be done, I would like the placenta to remain connected to the umbilical cord and my baby until I feel I am ready to cut the cord or it falls off naturally.
• Please ask before starting this procedure as we may want to wait.
• Myself/partner is to cut the umbilical cord.
• Baby is not to leave my view, or if extra care is required then partner must go with baby.
• Leave parents and baby together alone as soon as possible after the birth.
• No exploration of uterus for dehisence (small separations in the previous caesarean scar), you could introduce/expose me to infection.
• I would prefer my tear to heal by itself without suturing.
• Baby to take first breaths unassisted, no suctioning.

After the Birth

• I want my other children to be present as soon as possible.
• I want to see my placenta
• I want to keep my placenta and take it home with me. It is an important part of me and my child.
• Delay routine checks for the first hour.
• I do not want baby to be washed.
• Immediate breastfeeding after birth.
• Natural delivery of placenta, no artifical hormones to speed up process.
• Carry out checks of baby whilst he/she is on my abdomen.
• Full rooming in.
• Baby is to be exclusively breastfed.
• I would like lots of support with breast feeding
• I will leave hospital when I feel it is time.
• I want my partner/children to stay in the hospital overnight.
• I do/do not want my baby to have vitamin K injection.
• I do/do not want my baby to have eyedrops, I will use my breastmilk.
• I do/do not want my baby to have Hepatitis B injection.
• I do/do not want my baby to be circumcised
• I give permission for these people to be able to see me when they want_______________________________
• Private room
• I do/don't mind dummy for baby
• No formula feeds for baby or supplemental feeds
• Demand feeding
• Baby to be examined by any health professionals only with parents authorisation and in our presence.
• If there is any concern about baby, we want to know without delay.
• If baby requires transfer to a higher level hospital then I wish to be transferred with baby.
• We wish to be kept informed of any developments with our baby.
• We need to be given full information about what is happening to our baby.

Caesarean Birth

• If this is an elective Caesarean, I want labour to start spontaneously before it is performed as it is healthy for my baby to experience labour.
• If this is an emergency Caesarean, I want to know why it is being recommended.
• Caesarean Section can only proceed with my consent.
• I need to know that all options have been exhausted before the decision to have a Caesarean is made.
• I will not accept a Caesarean section for time limit reasons, if my baby is still healthy.
• If it is an elective Caesarean I wish to organise to donate my own blood for the operation.
• I will not accept a Caesarean section for maternal tiredness, an epidural may be enough to give me a rest and try again.
• I do not want the catheter to be inserted before my epidural/spinal anaesthesia.
• I do not want to be left with no one I know before the operation - no pre-operative abandonment.
• I want someone to be there and comfort me if I am having contractions whilst the epidural/spinal anaesthesia is being inserted, apart from the anaesthesist.
• I want my midwife to continue being a midwife whilst I am having the Caesarean section, I do not want her to become a theatre nurse.
• I want my doula / support person to come into the theatre, recovery and take photos.
• I still want my environment to have my music playing and oils burning.
• Please shield our baby's eyes from the bright operating table lights when he/she is removed.
• I have a special welcoming blanket for our baby which is the first thing I want baby placed into, followed by its fathers arms.
• I want my partner to cut the baby's umbilical cord.
• Do not clamp my baby's umbilical cord immediately as it may cause my baby to go into shock.
• I want the placenta to be held above baby in order for it to get all its life giving oxygenated blood.
• I want to be kept informed about what is happening to me during the caesarean section, at all times. It is my body and I want to know what is happening to it.
• I want to find out the sex of the baby by myself, please do not announce it for me.
• I wish to have a transverse incision on my abdomen and uterus, as this is the best incision for future births.
• I have already had a caesarean operation, please use the existing transverse scar.
• I have already had a caesarean operation, please use the existing classical scar.
• I wish to remain awake for the caesarean and entry into the world of my baby.
• I choose to have a spinal/epidural anaesthesia.
• My partner must be with me at all times.
• If I need a general anaesthesia (this may be possible if you have a back injury, or sometimes with placenta praevia), then I want my partner to be given our baby as soon as it is born.
• If I need a general anaesthesia then I want my partner to be present/waiting just outside the operating theatre.
• Please drop the screen when baby is coming out of my abdomen.
• I want the theatre staff to be very quiet and respectful at the moment of birth, this is a life changing event for us!
• I appreciate that the theatre staff are doing a very important and vital job in caring for me physically, emotionally I would also like them to remember that this is a very sacred moment in my life.
• I am not a squeamish person, I would like the screen to be dropped for the whole operation.
• My partner is the be given the baby as soon as it is born to show me.
• My partner must go with baby for its health check straight after birth.
• My baby must be brought back to its parents, by its father as soon as it is checked as OK.
• I wish to have skin to skin contact with my baby, please leave one arm accessible/unrestricted.
• Please do not have the screen so high that I can not have my baby lying across my chest.
• I would like the birth to be videotaped/photographed. (student nurse or doctor can do this)
• I would like photos/video taken of the birth. If against hospital policy, please take and keep the camera so we may negotiate after the birth. These are precious memories we do not want lost.
• I want to breastfeed my baby as soon as possible.
• I want my baby's health checks to be conducted within my full unimpeded view.
• Please leave us alone once all necessary health checks have been completed.
• I want to see my placenta.
• I want to take my placenta home.
• I want to drink and eat as soon as I feel the need.
• I want the catheter to be removed as soon as possible.
• I want the IV to be removed as soon as possible.
• I want to know how my pain will be controlled after the operation.
• I would like suppository pain relief.
• I would like pain relief through my epidural.
• I want to know how I will feel after the operation emotionally.
• I want to be helped to breastfeed comfortably after the operation.
• I may be very fearful about my first bowel movement after the operation and need lots of support.
• I may be depressed about the birth and need to talk about it without any criticism for feeling the way I do.
• I love my baby, but that doesn't mean I loved the birth.
• I may be on a high after the birth, but I may need support later, please let me know about this.
• I need to be told what to look for when I look at my incision, how to look for signs for infection.
• If I had staples please warn me about their appearance.
• I want suture of my incision, not staples.
• I want to be given information about support groups for Caesarean mums (birth and recovery, breastfeeding).
• I want my bed to be kept low, so I can get in and out to care for baby without straining the incision.
• I need to have lots of rest and restrict my visitors.
• I want my obstetrician who performed the operation to come and see me and explain why it happened in detail and then invite me to come and repeat the conversation when I feel I need to.
• I would like photographs of the theatre staff for my baby's album, these are the first people who welcomed him/her into the world.

CARES SA members during the year 2009 compiled a brochure which may be of interest to you titled "Empowered Birth By Caesarean"