A Gentle Start Childbirth
Services
Every
baby deserves a gentle start to life. . .
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Birth plan Guidelines Birth plans are great for helping you set your goals for the birth of your child. They are also wonderful for helping your practitioner understand your preferences regarding your care. It is important that you edit your birth plan for brevity. You should go over your final birth plan with your care provider before you go into labor. Some couples find that by having their care provider sign their birth plan, it helps the nursing staff take care of their needs when they arrive in labor. This worksheet contains both the general and specific. As you work through it, highlight the things that are of utmost importance to you. They will be the ones that go on the final birth plan. Title Section: Birth plan of Mr. and Mrs. Gestation Name: Partner: Doula: Due date: Practitioner: Place of Birth: Birth philosophy: This birth plan is intended to express the preference and desires we have for the birth of our baby. It is not intended to be a script. We fully realize that situations may arise such that our plan cannot and should not be followed. However, we hope that barring any extenuating circumstances, you will be able to keep us informed and aware of our options. Thank you. FIRST STAGE OF LABOR
Environment Dim Lights Peace and Quiet Music Wear my own Clothes No students, residents, etc. Minimal vaginal exams (Vaginal exams can actually cause problems such as infection and premature rupture of membranes) Other:
Mobility: Maintain mobility (walking, rocking, up to the bathroom, etc) Freedom to move in bed (up to the bathroom) Mobility not important (catheter, used with epidural)
Hydration: No restrictions Clear fluids Ice chips Heparin/Saline Lock (Most hospitals require this as access to vein should emergency occur. Can also be used in place of IV for antibiotic administration for MPV or GBS) IV (you will have to have this if you chose any medications)
Monitoring: Intermittent Monitoring (ACOG standards) Fetoscope Doppler EFM Continuous monitoring EFM Internal Fetal Monitor
Pain Relief Offers Only if I ask Offer if I seem uncomfortable Offer as soon as possible
Pain relief options: Non-Medical: Relaxation Positioning Water Heat or Cold Therapy Massage Acupressure
IV Medication: Stadol Nubain Demerol Other
Epidural Ultra low dose Classical Epidural Other Induction/Augmentation Usually induction and augmentation will not be discussed in a birth plan. If you have chosen or require an induction then the decision will usually be made before you arrive at your birth place. However, it is important to know that you do have options. Induction: Natural Methods (Nipples stimulation/walking, sex, etc) Herbal inductions (cohoshes, etc) Prostaglandin Gel Pitocin Amniotomy (braking waters) Cytotec
Augmentation: Walking Nipple stimulation Pitocin Amniotomy Other
SECOND STAGE Choice of positions Prolonged length Spontaneous bearing down (listening to your body) Directed pushing Stirrups Squat/Birth Bar Foot pedals
Perineal Care: Prefer no episiotomy (massage, compresses, etc) Prefer to tear Episiotomy Pressure Episiotomy (without anesthesia) Local Anesthesia for repair
BABY CARE Cord Cutting: Immediate Delayed Partner to cut cord
Eye Care: None Delayed Immediate
Feeding Baby: Breastfeeding ONLY Bottle feeding only Combination NO PACIFIERS OR GLUCOSE WATER
Separation: None Delayed Partial rooming in (baby in nursery at night) Nursery
Circumcision None Parents Present With Anesthesia
COMPLICATIONS AND CESAREANS Cesarean Surgery Spinal/Epidural Anesthesia General anesthesia Partner Present Doula present Video/pictures Screen lowered to view birth Description of surgery Touch baby Partner cuts cord Breastfeed in recovery room Other
Sick Baby Unlimited visitation for parents Handling baby Transport with baby if necessary Other THE KEY POINTS. . . You are responsible for the decisions regarding your birth… I know pain medication is available and I will ask if I need it. I would like a nurse who is supportive of my goals. I expect informed consent at all times.
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Send mail to
AGentleStart@Comcast.net
for information!
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