Thursday, March 11, 2010

How to UP/UC: Birth Plans

At around the middle of your pregnancy, those weekly emails you signed up for eventually start saying, "Your baby is the size of a fruitcake now! Time to write up a birth plan!"

What does a birth plan look like if you are planning a UC? Do you need one?

For Margaret's birth, I didn't have an "official" written birth plan, but we did have an understanding of how things would go. If it makes you feel better to write things down, do it. If you're too lazy (me!) then don't.

Initial Plan
"Ok, McKay. I'm in labor: what do you do?"
"Whatever you tell me to do." Exactly.

We also had some transfer plans in place.

Transfer Plan I- in labor
A birth plan for a transfer is obviously going to differ from a birth plan that starts in a hospital. For one: you are going for the intent of getting medical care that you can't get at home. This means things like "I don't want my waters broken," "I want to be able to eat/move freely," are a bit superfluous. It's likely you'd be transferring for a cesarean because you can try almost any other sort of invention at home. Things you will have to consider include postpartum baby care like many other birth plans. Do you want the baby bathed immediately? If the baby is doing well and the transfer was for maternal distress and not fetal distress, do you want to practice kangaroo care? Delayed cord clamping? What are your decisions about the Hep B vaccine? Eye drops? Vitamin K shot? PKU? Also, you'll need to make decisions about feeding-related issues such as supplementation, artificial nipples, etc.

Transfer Plan II- postpartum
Transferring postpartum is slightly different in that both parties might not need to be to be admitted to the hospital. If you are transferring for the baby, the mom doesn't need to be admitted, and similarly, if you are transferring for the mother, the baby doesn't need to be admitted. Limiting the number of people admitted to the hospital will probably decrease the amount of time you spend there. Again, if the baby is being admitted, baby-related plans need to be discussed as above.

It might seem like a lot to remember, so if you need to write things down, do. Emergencies aren't usually a time when you are thinking 100% clearly. It's also important to realize that as a mom, you might be transferring because you've lost consciousness and you aren't going to be awake to ensure your desires are carried out. Having a written plan can help your partner remember all the details.

Our current birth plan
The "Initial Plan" that I discussed above was our birth plan last time. This time I've added more to "Do whatever I ask for." For example, while I did eat and drink during Margaret's labor, I don't think I did it enough, so we've discussed and agreed on "If I haven't had a bite to eat or anything to drink in 3 hours, gently remind me to do so." I say "gently" because I was a bit annoyed at suggestions while I was in labor last time.

Our transfer birth plans are as non-interventional as possible, taking into account that transferring means we are getting some interventions. Special considerations include kangaroo care. We have discussed that if we transfer in labor and the baby is doing well (say, Apgar of 7+), then McKay is supposed to say, "Since the baby is doing well, we're now going to put the baby on mom's chest," and then take the baby and do it. Everything else: bathing, weighing, etc., can wait. Even if I'm unconscious, baby could be given a chance to self latch through breast crawl (see below) which, on average, takes about 45 minutes.



Cool, no?

5 comments:

  1. LOVE the video. I think the breast crawl is one of the coolest things ever! And good thinking on the transfer plans. I hadn't even thought about doing something like that before. I guess it freaks me out a little, like if I have a transfer plan, I'm more likely to end up needing it or something. But, I do think it is a good idea.

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  2. What an awesome video! Thanks for sharing it!
    Birth plans are really important. We had Stephen in the hospital, so we had to be super duper specific about things, but we were pleased that they followed it---especially in letting us keep Stephen with us for an hour after birth before performing the usual newborn stuff (other than weighing, measuring, swaddling, APGAR---they did those in the same room as us, at least).

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  3. Thank you for sharing that video! So many women don't have believe that their babies have the ability to do this, but they CAN!!! Very moving...

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  4. I love self-latching. Even if you don't use the breast crawl, I think that letting the baby 'drive' so to speak can avoid so many problems!

    Back to the topic at hand, my first child was born unexpectedly at 34 weeks. While we had been planning a hospital birth, we had NOT been planning a high-risk preterm labour, and I had not written a birth plan. And I don't think it made any difference. Once you're dealing with issues like this you are sort of just along for the ride. And it's more or less OK, because if you actually NEED that care, it's much easier to accept it. I think the greater concern, as you point out, is unnecessary medicalization of an otherwise normal birth.

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  5. I hope I can try to experience the breast crawl someday! Even though my son was born at home, his cord was short (according to my midwives) and since we were delaying cutting the cord, there wasn't enough cord length to get him to the breast with me laying down. So I had to sit up; we put him to the breast several times to try and help the placenta to get moving along.

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