Our Priorities:

·         Keep lights and voices low and unobtrusive.  Kindly keep conversations soft or outside of the room.

·         Limit vaginal exams for medical necessity or upon E’s request.

·         Suggestions for enhancing progress, such as positioning or guiding the support team, are appreciated. 

·         Discuss interventions, tests, and procedures using the informed consent model.  If time and circumstance allow, we prefer trying less interventive methods before moving on to more invasive medical techniques.  Please involve E (husband), L (sister) and Kim (doula) in these discussions.

·         It is important to us that E is able to see the baby being born and to be as close as possible to her.  He would like to consider the option of catching and certainly cut the cord.  Should there be a need for the baby to change hospitals for any reason E will go with the baby while L stays with E.

·         E asks that she be told right away after the birth very clearly how the baby is doing.

Support People & Family in Attendance:

E- husband

Kim- doula/friend

L- E’s sister

D- friend

Possible attendees:

J- E’s mom

R- friend

Pain Management Preferences:

It is E’s wish to try and labor in as natural a way as possible.  The goal is to avoid medical interventions, such as narcotics or an epidural.  E and E would appreciate as much support as possible to make this happen.  E looks forward to using the birthing tub (with E).  E’s PPS is a -5.

Cesarean Birth:

E, L & Kim should all be present.

E or Kim will narrate events as they occur.  E would like the option of the drapes lowered to watch the birth. Skin-to-skin contact with the baby and breastfeeding during recovery are a priority.

During surgery, we’d like to understand more about why the surgery might have been necessary, i.e, malposition, short cord, etc…Please let us know what you find, when you find it.

Postpartum:

• E intends to breastfeed (during recovery) and would appreciate support and guidance in facilitating the process.

• Please don’t wake mother or baby for routine vitals and check-ups unless immediately medically necessary. 

• E would like to take an active role in baby’s first bath and other childcare rituals.

• Pediatrician: On-call doctor from Ballard Pediatrics at (206) 783-9300.

Birthplan for AF

Support People: 

·        FF, husband

·        Kim James, doula (except 8/15 through 8/17)

·        KS, sister (8/15 through 8/21 only)

Environment:

To contribute to my relaxation efforts, I’d like to have the lights dim and ask people speak in soft tones, if possible.  We’ll use the “No Visitor” sign and turn the ringer off the phone.

Controlling Pain:

I’m planning to use relaxation, breathing techniques, whirlpool and movement to cope with pain.  At the threshold of my pain tolerance or exhaustion, I may ask for medication (narcotics and/or anesthesia).  I’m willing to trade a little pain for the freedom to move around, so I hope not to ask for an epidural right away.

My PMPS number is:  +3

Most Important Issues:

·        If possible, I’d like to bear down and breathe spontaneously, avoid having people ask me to push to their count and breathe on command. 

·        I’d like to maintain some level of modesty, if possible.

·        We’d like to have the doctor or nurse cut the cord.

Concerns and Fears:

We declined the amnio during pregnancy to reduce the possibility of miscarriage.  Now I have anxiety over the health and condition of the baby.  I’d like to request that the caregiver examine the baby immediately after delivery, before bringing him to me with the reassurance that he is perfectly healthy.

Medical Interventions During Labor:

If induction or augmentation becomes necessary, I’d like to discuss alternatives before pitocin is used.

Cord Blood:

We’ll be donating the cord blood to Puget Sound Blood Center.

Cesarean Birth:

·        I’d like both Frank and Kim (or Kitren) to be allowed into the operating room if a Cesarean becomes necessary. 

·        If available, I’d like to use a drape with window, and have the anesthesiologist or obstetrician explain the procedure.

·        If the baby needs to go to the NICU or nursery, I’d like Frank to accompany the baby while Kim (or Kitren) stays with me.

Pediatrician:

Dr. John G. Schreuder, MD

Mercer Island Pediatric Associates

206-275-2122

He has privileges at Swedish.

Infant Feeding:

I prefer to breastfeed the baby early in recovery, frequently and on demand, and to avoid pacifier and supplements, if possible.

Rooming In:

We prefer to have the baby with us around the clock.

Circumcision:

We’d like to have the baby circumcised at the hospital using local anesthesia and Frank present during the procedure to comfort the baby.

Educational Needs:

·        I’d like to attend the breastfeeding class that Swedish provides.

·        I’d like the lactation consultant to observe the baby’s latch and give me any advice before I leave the hospital.

·        I’d like to learn how to wrap a tight swaddle.

Unexpected Events:

·        If it becomes necessary for the baby to be placed in the NICU, please explain our options for visitation and feeding.  We’ll want to be active participants in his care.

·        If the worst happens, please provide a parish nurse.

We appreciate all of the skilled and caring medical professionals that will help bring our baby to us safely!!

Birth Plan

Names:                  ZO and DP

Support People:      MO, mother and Kim James, doula

We understand that this will be an induced birth and that necessitates more interventions and management.  However, we ask that whenever possible, you consult with us before performing any procedures, explain risks and benefits of each intervention, and explain whatever alternatives may be available.  We ask for your help in keeping our birth as normal as possible and involving us as partners in this very important event.  Our goal is a healthy baby and mother, and secondly, a vaginal birth.

Special Concerns

I am somewhat fearful of the pain of childbirth.  I’ve done a lot of reading, attended CBE classes and retained a doula in preparation for labor.  To help control my fear, I ask that you always point out the positives:  good vital signs, good EFM readings, good protein readings.  Also, let me know when I’m handling the contractions well and when progress is being made.

¨    Quiet, peaceful environment.  Please keep voices soft and conversations low.

¨    Adjust volume on monitors, infusion pumps and other equipment to non-intrusive levels.

¨    We’ll play our own music.

First Stage

We understand controlling Z’s blood pressure is paramount.  However, if all vital signs are stable, we’d like to spend early and active labor in a variety of upright and active positions, mainly for Z’s comfort and to keep labor progressing normally.  Please suggest any positions you think would be helpful for us to try.

¨    We plan to alternate activity (walking, standing, leaning) with rest (rocking chair, birth ball).

¨    Labor in the tub once early/active labor is established.

¨    We’d like to eat and drink to thirst and hunger during early labor.

Pain Relief

Z is looking forward to her epidural once active labor is firmly established.  Her goal is to labor without pain medications until 5 cms dilation.  We understand an epidural may be suggested before 5 cms for theraputic reasons.  However, your suggestions for helping us reach our goal will be greatly appreciated.  We do not plan on using IV narcotics.

¨    Epidural at or around 5 cms. dilation.

¨    No IV narcotics.

¨    Prefer to remain in upright and active positions on the bed once the epidural is in place.

Medical Interventions

¨    Prefer no internal monitoring

¨    Strongly prefer no amniotomy.  If this is suggested, please explain why.

¨    Limit vaginal exams upon my request, or until necessary to track labor progress.

Pushing and Birth

We’d like to try a variety of positions to facilitate rotation and descent.  Please suggest any positions you think would help.  We’d also like to avoid an episiotomy and any instrumental delivery.

¨    I want to “labor down” and avoid pushing before I feel the urge.

¨    Avoid pushing on my back with legs in stirrups.  Avoid directed pushing.

¨    Please provide warm compresses and perineal massage.

¨    Please delivery baby skin-to-skin on my abdomen.

Newborn Procedures

We understand that our baby will likely be born before term and that may necessitate closer observation and more invasive newborn procedures.  We understand that newborn resuscitation is the priority if necessary. However, we’d prefer Z hold our baby, skin-to-skin for the first hour.  Please delay all newborn procedures until after the first reactive period.

Infant Feeding

We plan to exclusively breastfeed.  No glucose, formula, or artificial nipples, if at all possible.  If baby is born to young to suck or latch well, please suggest alternatives to formula/bottle feeding.

Cesarean Section

¨    I’d like at least two support people to attend.

¨    I’d like to hold baby and establish breastfeeding as soon as possible.

Sick Baby/NICU

We understand that babies born before term may need more close observation and monitoring.  We ask that:

¨    D go with the baby to the NICU and be allowed to feed and hold the baby.

¨    Explain events and procedures as they happen.