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HTML/plain-text Birthplan - lower on this page

Birthplan PDF File

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Mini-Dictionary of a few terms

To my birth attendants:

As a mother, I understand and accept the fact that I am ultimately responsible for my own health and the health of my baby. I have made every effort to gain the knowledge and information that I need to make informed decisions. After a careful consideration of this knowledge as well as my own values and priorities, I have established some guidelines to help you care for me in a way which is not only the safest for me and my baby, but also honors my needs and beliefs about birth.

I have complete faith in my body's ability to give birth normally. I believe my body was designed to give birth, and that it can do so with very little assistance. I have prepared myself for what the birth experience will be like by taking classes and talking with mothers who have had a positive birth experience to find out what they did that was helpful. I do not expect to have a short labor or to have no discomfort. But I do expect to be allowed to labor in the way that is most helpful to me, even if that way is in conflict with routine procedures. With help from my labor support person, I will require very little of your time and attention.

I have chosen a labor support person to be my birth advocate, and I authorize this person to see that my preferences as stated in this birth plan are carried out as closely as possible. This person will also provide physical and emotional support throughout the whole process of labor and delivery. If at any time a physician feels that medical conditions warrant an intervention into the birth process, I am willing to discuss the proposed intervention as well as the possible alternatives.

After discussing the situation, I will expect my final decision to be respected and honored, even if it is in opposition to the opinions of others.

The following guidelines are designed to help my birth attendants know what kind of birth experience I desire for myself and my baby. No deviations should be made from this plan without my consent:

1. It is my desire to receive no assistance of any kind with my birth unless I specifically ask for that assistance. I am at the hospital only so that emergency help is available if necessary. I will require no routine care of any kind.

2. I will not be separated from my support persons for any reason unless I request it.

3. Absolutely no procedure will be performed on my baby without my authorization and I will be present for any procedure that is performed.

4. The umbilical cord will not be cut until it has stopped pulsating, usually 3 to 4 minutes or longer.

5. Vitamin K shot will not be given under any circumstances.

6. No Vaccine will be given under any circumstance.

7. Since I have been tested for Gonorrhea, and my husband and I are in a monogamous relationship, I prefer that no eye drops or ointment be used in my baby's eyes.

8. If the baby is a boy, there will be no circumcision.

9. No PKU test will be administered in the hospital because the baby must nurse for at least two days before this is done. It will be my responsibility to see that the test is performed by a pediatrician at a later time.

10. No drugs of any kind will be administered during the labor and delivery process. I request that no offers for anesthesia be made to me by any doctor, nurse, or other hospital staff person. In the event that a cesarean section becomes necessary, I will decide at that time what kind of anesthesia will be used.

11. Pelvic exams will be performed only at my request.

12. I will have no perineal shave-prep.

13. No episiotomy will be performed on me under any circumstances. Perineal massage with oil, hot compresses, and perineal support will be used instead to prepare the perineal tissues to stretch. In the event that tearing of these tissues seems likely, I would prefer to allow the tissues to tear rather than be cut.

14. In order to allow the perineal tissues time to fan out so that no tearing takes place, and in order to reduce the risk of damage to the muscles of the pelvic floor, I will allow the baby to descend through the birth canal slowly and without sustained pushing efforts from me. Only exhale pushing will be used, and only when I feel the urge to do so. As long as fetal heart tones are good, delivery will not be rushed, but allowed to occur slowly and naturally.

15. The delivery will take place in a quiet, respectful atmosphere with dimmed lights, soft music, and quiet, calm speaking if speaking is necessary.

16. My amniotic membranes will be allowed to rupture spontaneously

17. Because of my belief that ultrasound is an unproven and possible unsafe technology, no electronic monitors or dopplers will be used. Monitoring of fetal heart tones will be done through fetoscope only.

18. I will be upright and active throughout my labor, walking as much or as little as I feel necessary, and assuming whatever position is most comfortable for me and helps assist the progress of labor.

19. It is my choice to give birth in the squatting position because of the obvious advantages it offers. If squat bars are not available, I will have two labor support persons with me to physically support me in this position while I give birth. I will require very little help from doctors or nurses to give birth because the squatting position encourages proper rotation, as well as quick and painless expulsion of the baby.

20. During labor and delivery I will be using vocalization as one of my tools for coping with labor. I find that it helps me to cope with the intensity of contractions while remaining totally relaxed. Hospital staff need to be aware that these vocalizations are constructive and that I am not making them because I am in pain, am distress, or need assistance.

21. As soon as the infant is delivered it is to be placed on my chest and observed for APGAR there. The infant will be allowed to nurse as desired so as to hasten the detachment and delivery of the placenta.

22. If the body temperature of the baby is of concern, the baby will be placed skin-to-skin with me and a warmed blanket will be spread over us both. At no time will the baby be separated from me and placed in a warmer.

23. All newborn care will be done in the same room with me and preferably with the baby in my arms. At no time will my baby be separated from me.

24. When one gives birth in the squatting position, suctioning of the baby is rarely necessary due to the natural drainage of fluids. If suction does prove to be necessary, deep suctioning of the infant will be done only if suction with a bulb syringe proves to be inadequate.

25. I request that a warm Leboyer bath be provided within one hour after birth to allow the baby to make a smooth and comfortable transition into the world. No soaps or disinfecting agents will be used to wash the baby, and vernix on his skin will be massaged into the skin rather than removed through washing.

26. My baby will be given no substance by mouth other than my breast milk or colostrum. At no time will sterile water, glucose water, or formula of any kind be given. The baby will be allowed to nurse on demand, and no rubber nipples or pacifiers will be given. If the baby's blood sugar level is of concern, more frequent nursing will be encouraged, since maternal colostrum provides a healthier and more stable blood sugar level than processed glucose.

27. I will eat light, non-constipating foods during early labor and clear liquids during active labor, if desired.

________________________Signature

________________________Date
Mini - Dictionary of terms used in Birthplan
amniotic membranes
The amniotic membrane surrounds the fetus in the womb.

The amniotic membrane, which surrounds the fetus in the womb, is a unique source of 'biological dressing' that has been used in wound healing for decades.

APGAR
"The Apgar score was devised in 1952 by Dr. Virginia Apgar as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after childbirth.[1][2] Apgar was an anesthesiologist who developed the score in order to ascertain the effects of obstetric anesthesia on babies."
for more, see: http://en.wikipedia.org/wiki/Apgar_score

cesarean section
A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen.

colostrum
"Colostrum (also known as beestings or first milk or "immune milk") is a form of milk produced by the mammary glands of mammals in late pregnancy." ... "Newborns have very small digestive systems, and colostrum delivers its nutrients in a very concentrated low-volume form. It has a mild laxative effect, encouraging the passing of the baby's first stool, which is called meconium."
Read more here: http://en.wikipedia.org/wiki/Colostrum

dopplers
Fetal Dopplers are instruments for monitoring babies' heartbeat. Dopplers should be distinguished from simple "listeners" which amplify any sound that is picked up which can include a baby's heartbeat. Dopplers work on the Doppler shift principle and thus require a generated ultrasound to be directed at the baby. Some people feel this procedure and ultrasound imagining procedures should be avoided for the best health of the baby.

How Fetal Dopplers Work
Fetal doppler technology is based on the Doppler shift principle. This theory was first discovered by Christian Doppler an Austrian physicist in 1842. Doppler discovered that sound waves from a moving source would be compressed or expanded, or that the frequency would change.

Dopplers work on the principle of listening to reflections of small, high frequency sound waves (ultrasound). These ultrasound waves are generated by microscopic vibrations of pizeoelectric crystals. When the waves are reflected from moving objects, such as a foetal heart the frequency changes slightly. It is this change that is analysed by the electronics of the doppler and converted into a sound that you can hear or a digital display of the heart rate.
Source of quote: nawiz.com/acatalog/Fetal_Doppler_Information.html


episiotomy
An episiotomy is a surgical incision through the perineum made to enlarge the vagina and assist childbirth.

fetoscope
Fetal Stethoscope that can be used to detect the baby's heartbeat.

Gonorrhea
Gonorrhea, a sexually transmitted disease can also be spread from mother to child during birth.

Leboyer bath
"A LeBoyer Bath refers to one of the important elements of Frederick LeBoyer's famous, revolutionary, and non-violent birthing method, which he first published in the early 70's." Read more at: http://www.gr8birth.com/leboyer_bath.html

perineal
Definition of Perineal. Perineal: Of or relating to the perineum.

"In human anatomy, the perineum is generally defined as the surface region in both males and females between the pubic symphysis and the coccyx. The perineum is the region of the body inferior to the pelvic diaphragm and between the legs. It is a diamond-shaped area on the inferior surface of the trunk which includes the anus and, in females, the vagina."
The quote above is from here: http://en.wikipedia.org/wiki/Perineum

PKU test
The PKU test screens for Phenylketonuria by obtaining a blood sample via heel stick from the newborn..

A phenylketonuria (PKU) test is done to check whether a newborn baby has the enzyme needed to use phenylalanine in his or her body. Phenylalanine is an amino acid that is needed for normal growth and development.

vernix
Vernix, also known as Vernix caseosa, is the waxy or cheese-like white substance found coating the skin of newborn humans. Wikipedia


ultrasound
"Ultrasound, sonograms, and dopplers use high frequency sound waves to produce an image of the baby on a viewing screen or amplify the baby's heartbeat so it can be heard more easily." Read more at: The Dangers of Prenatal Ultrasound http://www.unhinderedliving.com/pultra.html