Thursday, 24 October 2013

Our Birth Preferences

In her informative and heartfelt book, Birthing Normally After A Caesarean or Two, Helene Vadeboncoeur concisely paraphrases Michel Odent regarding how women who have been labeled "high-risk" need to be treated with even more patience, gentleness, kindness and encouragement during labour than an experienced birther or perhaps even a first-time mother.  She says that “in contrast to the usual view, women who are the most likely to experience difficulties and the ones who are considered the highest risk are the ones who are most in need of the favourable conditions for labour, i.e. discrete support with minimal disturbance, dim lighting and comfortable surroundings.”  This flies in the face of common practice in hospitals, in which VBAC moms, when they are *allowed* to labour at all, are subjected to a barrage of obstetrical technology in an effort to save their babies from imminent danger and almost certain death or permanent injury.  This was certainly my experience when I was in labour with my son.  The way in which the hospital staff spoke to me and condescended to me, the flashing lights and incessant beeping of the CTG made me feel anxious, nervous that perhaps something was or would be wrong with me or my baby, and I felt I had failed before I had really even started.

As someone recently remarked to me, "Know better, do better."  In that spirit, and after a substantial amount of re-search and soul searching, I have composed the following birth plan for whenever Baby Number Three decides the time is right to join our family and manifests him/herself within me.  It is still a work in progress.  (Note the gap at the top of page 2 ... I still need to do more research to find out when is the best time to confirm that position of the placenta is ***ideal*** ... any recommendations on this point are most welcome!)  However, the basics are all there.  I decided to write preferences for VBAC on one page and preferences for an emergency caesarean on a separate page, as it helps me psychologically not to have the two things intermingled on the same page.  I am certain I won't need page 2 anyway!  I also wrote a short cover letter of sorts.  My plan is to cut that page in half and just staple the half-sheet on top of the two separate birth plans.  A few bits were "borrowed" from some of the lovely mothers on a Facebook VBAC group with whom I have been conversing ... You know who you are, and thank you!!!  I hope that my words will be equally beneficial for you.

Our Names                                                                             EDD:


We would like to thank you for all your support and expertise and for enabling us to provide the safest and most positive birth experience we can for our baby.  We have created this birth plan in order to give us the best chance of successfully achieving our VBAC.  We appreciate the need to be flexible and understand that some circumstances will mean our preferences cannot be accommodated, but we hope that you will facilitate our needs to the maximum extent possible.

Above all, our aim is to allow the normal physiological process of giving birth to take place unimpeded with a minimum of disruption and interference as long as it is safe to do so.  To that end, we ask to be informed of ANY and ALL procedures in advance and to be allowed the chance to give informed consent. 


 During the Pregnancy

· I have no wish to discuss elective caesarean until I reach 40+14.

· Only one ultrasound to be performed at __ weeks’ to confirm position of the placenta.
During Labour

• My husband and doula to be present with me at all times.
• To labour without arbitrary time limits in any position that feels comfortable for me.
• I do not consent to any vaginal exams except upon admission to the hospital and if I decide to request one.  PLEASE DO NOT tell me the findings of any V.E. unless I specifically ask for such results or if immediate medical decisions need to be made. 
· I do not consent to CTG and am happy to sign an AMA to that effect.  I am happy to follow WHO recommendations regarding intermittent monitoring: once/hour during latent phase, once/half hour during active phase and once/5 minutes during pushing.
• I do not consent to episiotomy.
 I do not consent to ARM or any form of induction or augmentation, incl. 3rd stage.
· Lights should be dimmed and the room quiet with interruptions, questions and conversation kept to a minimum.
· Use of the shower and/or bath and a birthing ball.
· Light eating and drinking if desired.
· Please do not offer pain relief medication.  If we need it, we will ask for it.
· Assistance with use of a mirror so that I can see my baby being born!
· Please do not reveal baby’s gender to me…I can’t wait to see for myself!
· If birth position allows, please let my husband or I touch/catch our baby first.
After the birth
· Immediate skin-to-skin.  Please do not bathe or clean the baby or remove the vernix.
• My husband would like to cut baby’s cord AFTER it has finished pulsating.
· Natural third stage without use of synthetic oxytocin.
• Vitamin K drops. No injection.
· If our baby must go to the nursery for evaluation or medical treatment, my husband will accompany our baby at all times.
Caesarean Birth
If a caesarean birth becomes medically necessary, we would like this to be as positive and “normal” an experience as possible for our baby and us. 
· I would like to have a midwife and my doula present for the birth.
• I would like my husband to be present with me at all times, especially for the spinal.
• I would like to leave baby’s cord pulsating for as long as possible before cutting.
• I would like immediate skin-skin once baby is delivered while surgical team finish.  Please do not clean the baby or remove the vernix.  My husband can assist if necessary.  Blankets to keep body temperature up and shield baby’s eyes from the bright lights of the theatre.
• I do not wish to be separated from my baby or my husband under any circumstances.

In event of General Anaesthetic
• I would like my husband to be present at all times and to have skin-skin with Baby while I recover.  They should not be separated under any circumstances.
Do not give our baby supplements (including formula, glucose or plain water).
If I am unavailable to breastfeed my baby, I would like the following steps taken to feed my baby in accordance with WHO guidelines (milk by cup/syringe/dropper):
1. Expressed mother’s milk. 2. Expressed donor milk. 3. Formula as a last and final resort.


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