Birth Plan for Hospital Transfer

Someone requested a sample birth plan for hospital transfer.

Here is my transfer plan for my son’s birth in 2010. It is probably longer than ideal, but is an example of what one could look like. (FYI, my son was born in the hospital – he was premature – but they never saw this plan because he was born so quickly they hadn’t even checked me in before he arrived…  But, they provided FABULOUS care for my full stay.)

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Birth Plan, in case of Hospital Transfer

Hello,

My name is X, my husband is Y. Our daughter A was born by cesarean 17 years ago, and I was born VBAC 13 years ago, both at Overlake Hospital. I am a doula, childbirth educator, and lactation consultant. With this birth, we had planned a home birth with no pain medication and few interventions. However, the fact that we are now at the hospital indicates that I need additional monitoring and/or medical procedures, and we are grateful for your assistance in providing this needed care to usher our third child into the world.

This birth plan expresses some of my preferences, so they can be taken into account and balanced with medical necessity. Of the preferences expressed here, the ones I feel most strongly about are related to how our baby is cared for in the first hour of life.

Preferences:

  • Coping Techniques: As much as possible, we would like to continue to cope with the labor as we would have at home: with minimal interruptions, freedom to move around and continue whatever coping rituals we have developed. If there are decisions that need to be made, please talk with Y about them first. It will be helpful to me to stay in my “birth zone” – an instinctive, emotional space; but if I am asked a lot of questions, I will slip into my academic brain, which tends to block my pain coping skills and labor progress.
  • Routine Interventions
    • Monitoring: I understand that continuous fetal monitoring is standard with VBAC. I would prefer external to internal monitoring.
    • Food and water: At minimum, I would like to consume clear liquids in labor, as is per guidelines from the American Society of Anesthesiologists.
    • IV: I have often been told that my veins are small and tend to roll, so are difficult to insert an IV into. If an IV becomes necessary, I would ask that you pick a staff member who is particularly skilled at insertion.
  • Augmentation
    • Pitocin: fine. No prostaglandins or misoprostol, due to increased risk of rupture.
    • Amniotomy: would prefer to delay till baby is well positioned (OA)
    • Epidural: If pain-related tension is delaying progress, it may be a reasonable tool
  • Pain Medication
    • IV narcotics: are not effective for me; I feel mentally out of control, and don’t gain sufficient pain relief
    • Epidural: If I request it, I would like to start with a low level dose of medication to enable as much mobility as possible; if PCEA is available, this would be ideal
  • Second Stage management
    • I would like to be able to use positions other than semi-sitting (side lying, or hands and knees), especially if my baby is suspected to be large. If I have epidural anesthesia, I may need support getting into and maintaining a position.
    • If possible, I would like to use spontaneous pushing, following my own urge to push and own instincts rather than directed pushing. If I do not have an urge to push, I would prefer to labor down (passive descent), unless time is of the essence
  • Cesarean. I understand that an emergent situation, such as a uterine rupture, could lead to the need for cesarean under general anesthesia. However, if a cesarean is needed but not emergency, here are my preferences for the procedure:
    • Y will accompany me in the O.R. (And my midwife, if possible.)
    • If possible, I would appreciate that baby be delivered slowly through the incision, allowing for a more gradual adaptation, as described in Smith, Plaat, and Fisk, “The Natural Cesarean”, 2008 July; 115(8): 1037–1042 http://tinyurl.com/la83t2; however, this isn’t a high priority for me.
    • I would prefer that the screen be lowered during delivery so I can see the baby.
    • I would prefer internal repair and double-layer suturing.
    • Should I become shaky or nauseous, I would like to handle that with natural coping techniques. I do not want to be given any medication that will make me fall asleep, or cause any amnesia effects during that first hour with my baby.
    • I want skin-to-skin contact with baby as soon as possible, preferably with breastfeeding initiation in the O.R. during repair (with support from Y)
  • Care of the Baby in the First Hour (Highest priority for me)
    • Would like to delay cord clamping and cutting till cord has stopped pulsing
    • Whether baby is born vaginally, or by cesarean, I would like as much of its first hour as possible spent skin-to-skin on my chest. If, for whatever reason, baby cannot be skin-to-skin with me, then it should be skin-to-skin with Y.
    • As much as possible all newborn procedures should be conducted with baby in parents’ arms. Bath, weighing, and measuring can be delayed till after initial breastfeeding.
    • Breastfeeding to be initiated in the first hour after birth, ideally by allowing baby the time to self-attach.
    • Routine procedures
      • Eye ointment should be given as late as possible (one to two hours, as per state requirements) after vaginal birth; but as early as possible after cesarean
      • Vitamin K: we will be using oral vitamin K, so no injection is needed
      • Hepatitis B: We decline this vaccination
    • Care of the Baby Until Discharge
      • As long as baby is well, baby is to remain in-room with parents at all times, with family providing care, and minimal disruption
      • If baby needs special care, then a parent or family member will accompany the baby at all times, holding the baby skin-to-skin as much as possible
      • No formula or other supplements to be given without express written approval from a parent, and supplementation to be given by spoon, cup, or SNS, not bottle.

Thank you for your time and attention to my preferences, and thank you for the care you are providing to our family.

X and Y

 

 

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