THE COMPLETE BIRTH PLAN

THE COMPLETE BIRTH PLAN

I'm so glad you've found this, whether this is your first pregnancy or your fourth. I went into my first labour with the theory that I didn't want to read a single article about labour. I had heard how painful childbirth would be, and didn't want to scare myself any more than the stories I had already heard. I had to go through it either way and the professionals would be there looking after me so I figured why put fear into me when I could just allow the professionals to guide me at the time. Oh how I wish I could take that decision back. In hindsight I am shocked and appalled at how little the midwives knew. They put me on my back with legs in stirrups as convenient place for the midwives to view, while they sat in chairs at the end of the bed. I later learned that this is the second worst position for gravity to help with the delivery of the baby – second to being upside down! Not only does this position mean the uterus has to move upwards to contract, it also means the baby has to travel in an upwards position along the tail end of mothers' spine to make their grand entrance into the world. As a result, my son was not coming out quick enough and there was no medical urgency to need to speed things up, there was a need to hurry the process up and move me along for other patients to use the rooms. I said I did not want an episiotomy but the reply was 'oh well' and she proceeded to perform one. The scissors were blunt and while one lady left the room to find new ones, that didn't stop the doctor continuing to try and tear me apart with the blunt ones. Eight years later, I still have pain from this. So out comes my son and he is placed on my chest for a few minutes. He was moving his head from side to side and squirming his way around on my chest. Again, not having done any research myself, I had no idea that this is the natural response of a baby to self attach for his first breast feed, known as the 'breast crawl'. The first hour after birth is the golden hour for initiating breast feeding, when oxytocin levels are high in mum and baby receives maximum colostrum for a great immune boosting start to the outside world. Baby's who are allowed to self attach results in better attachment and reduces the likelihood of mum's having issues with painful nipples in the days to come. But with me (and the hospital staff!) not knowing this, instead baby was taken from me and placed in a crib beside my bed. After a short sleep, he start stirring. I buzzed for help with breast feeding but was told that he doesn't need to be breast fed. I need rest after giving birth and baby would be taken from me for the night so I could get some rest. It made sense at the time that I should get my last sleep now while I could before I went home and cared for my new son day and night. But in hindsight, I wish I could go back in time and educate her. The ignorance of the hospital went on.

So my goal in sharing my research with you in the complete birth below, is not to scare you with horror stories as I feared would happen by prepping myself for my first labour, but to provide the knowledge so you can have the power to pre-determine what is right for you in various circumstances to tailor a birth plan to your desires and have a positive experience as you prepare to meet your beatiful bub. Other birth plans simply state things such as 'Decide what positions you might like to deliver your baby'. But how do you know what position to choose? So below each point in the following birth plan is the reasoning on why you might like to adopt the point into your own plan. You will then have more knowledge from this practical and to the point, birth plan, than all the midwives and doctors put together at my first birth.

This birth plan is divided into three sections

• A plan to give to the hospital

• A plan to give to your birth partner

• A plan for yourself for the early days post birth

Delete any that are not part of your birth wishes, or alter any to suit your needs or desires

BIRTH PLAN – HOSPITAL

I want to be involved in any decisions that are going to affect me or my baby. Please discuss with me before touching my body or my baby. I nominate my support partner to make these decisions on my behalf if I no longer feel able to do so myself.

Birth can become so routine for doctors and midwives that they routinely are likely to routinely do their tasks without thinking that they are making you feel like an object rather than a human as you give birth. Reminding them to check in with you before hand and involving you in decisions about your body and your baby is important, during such an intimate moment in a woman's life.

I would not like to have clocks in my view and to not be given time frames or measurements with my labor progression. I would prefer not to know how long I've been at it, how long I'm likely to be at it or how dilated I am.

Knowing that you've dilated 3 centimetres in one hour can get your mind start doing maths of how much longer your going to be going through labour and questioning whether you'll cope. As one lady put it, the doctor told her he would return in half an hour to check on her progress – counting down that half hour on the clock while she went through each contraction was the longest half hour of her entire labor.

I do not want intravenous fluids unless medically necessary.

Evidence has shown that this can lead to an artificial drop in baby's weight post birth, as well as excess breast fluid and tenderness, both of which can negatively impact breast feeding. Instead, choose to stay well hydrated as detailed in support partner's role below.

https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/routine-iv-fluids-in-labor-what-to-know

I do not want medical intervention to speed things up unless there is a good clinical reason to do so.

I do not want to be offered drugs other than gas unless I ask for it

I would like dim lights

Oxytocin is a night hormone. Bright lights can stall or slow labour.

I would like to labour in whatever position I find comfortable at the time. So long as I do not feel differently during birth, I would prefer to not be lying on my back, particularly while in the pushing stage.

 SECOND STAGE OF LABOR (PUSHING STAGE)

I would like to negotiate about this hospitals imposed time restraints on the stages of labor unless there is a good clinical reason to stick to them.

I would like to push the baby out according to my body's cues.

This stage can be where the doctors and nurses routinely gather become involved in touching and instructing. Some birthing mothers may want this but others may find this goes against the body's natural urges that the doctors and midwives present cannot know and this is no time when you are able to pause labour and have a logical conversation with them at the time as your body naturally tells you what to do. 

As the baby's head appears, we would like our baby to take his/her first breaths unassisted (no suctioning unless medically necessary).

Routine suctioning has been found to affect a baby’s breastfeeding cues and ability to breastfeed easily. 

CAESAREAN

I want my support person present and I want him to hold the baby immediatelyafterwards, if I am unable to do so.

AFTER BIRTH

Please do not wipe baby after birth

The vermix which covers the baby's skin is smeared onto the mothers chest as baby does what is know as the 'baby crawl' to mum's breast for the first feed, or as is held by mother and placed in a position mother would like to hold baby, if that is what she prefers. This vermix on mum acts like a beacon and helps baby cue in to breast feeding for the first few feeds and gets breast feeding off to a better start.

Please place/my support partner will place our baby on my chest immediately after birth, with a warm blanket covering his/her body for warmth if indicated to be necessary.

Many hospitals now allow this in theatre while you are being sutured, if you are having a cesarean birth. Skin to skin contact with mum straight after birth helps your baby to stabilise his/her temperature, breathing, heart rate and blood sugar levels. Early skin to skin contact encourages successful breastfeeding, and your baby’s hand and mouth contact with your belly and your breasts stimulates maternal oxytocin to enhance uterine contractions, milk letdown and mother baby bonding.

We would like our baby to take his/her first breaths unassisted (no suctioning unless medically necessary)

This is also listed in second stage above, but is also listed here if this is routinely performed after birth when the doctor's midwives may read this section instead.

I do not want Pitocin (oxytocin) to speed up the delivery of the placenta

Pitocin, binds to or increases the number of ADH receptors and temporarily causes more water retention. There seems to be a connection between this edema and delayed milk production.

Page 121

I would like to birth the placenta naturally.  I would not like tension applied to pull the placenta come out.

I would not like tension applied to help the placenta come out.

Once baby is born and the placenta is delivered, progesterone levels drop rapidly and the milk comes in. Placenta remains in the uterus is more likely to happen in deliveries where tension was applied to help the placenta come out. Page 127-128

I would like to delay cord clamping until it has stopped pulsating, to increase my baby's own fetal haemoglobin, blood volume and iron stores

I would like to delay cord clamping until it has stopped pulsating and changed colour for my baby to receive stem cells, red blood cells and white blood cells (including cancer-fighting T-cells) to help fight disease and infection. Studies show this results in much higher iron stores in primary school age children. A two-minute delay in cord clamping increased the child’s iron reserve by 27-47 mg of iron, which is equivalent to 1-2 months of an infant’s iron requirements. This could help to prevent iron deficiency from developing before 6 months of age.

http://www.bellybelly.com.au/birth/cord-clamping-delaying-cord-clamping/

My support partner would like to take home the placenta

This is listed as an option for you to consider.

I would like our baby to remain with me on my chest to encourage him/her to self attach for his/her first breastfeed (with assistance from me as I feel is appropriate).

Research shows that, if left undisturbed, a healthy newborn baby will take
up to 1–2 hours to orientate toward the breast, attach and start to breastfeed. Babies affected by medications used during labour may need a little longer. Allowing your baby to self attach (with assistance from you as you feel is appropriate) ensures that your baby learns to hold his/her tongue and mouth in the correct position to effectively milk your breast.
 

Please perform all essential paediatric observations while our baby is on my chest
It is possible for most procedures for newborn babies to be carried out with the baby on the mother’s chest. Such contact provides your baby with optimal physiologic stability, warmth and opportunities to breastfeed. Removal of the baby to weigh, measure and so on has been shown to seriously disturb the first breastfeed. There is no reason for these procedures to be performed immediately after birth.

 

I have decided for my child not have the vitamin K or Hepatitis B injection

Hospitals routinely offer these injections to baby. This is listed her as something for you to be aware of in advance, so you can research and make your decision on in advance.

We would like our baby to be weighed by myself or my birth partner after his/her first breastfeed, lying on his/her tummy on a warm cloth.
Research has shown that if a baby is taken from his/her mother for weighing and dressing, s/he may not show any interest in feeding and may not know how to suck. Lying on his/her back is very different to being a in the fetal position. A baby placed on his/her back is therefore likely to become very frightened, resulting in the release of stress hormones. Baby’s temperature is also likely to drop.

 

I wish my breasts to be treated gently and only touched with my permission.

IF MY BABY OR I REQUIRE SPECIAL CARE AFTER BIRTH

If I am unable to hold our baby skin-to-skin after birth, I would like my partner to hold our baby.

If our baby cannot breastfeed within 6 hours of birth, we would like to keep him skin to skin to stimulate his feeding reflexes. Please assist me to express my colostrum every 2 hours to stimulate my milk supply and for feeding to our baby when s/he is ready.

BIRTH PLAN – SUPPORT PARTNER

 

Bring:

• Expressed colostrum

You may choose to express in the last few weeks of pregnancy in case breast feedig immediately post birth is not possible due to your labor circumstances.

• Hospital birth plan to give to hospital staff

• Water bottles for during and post labor

• Lactation balls

You may wish to make in late pregnancy and store to help get breast feeding off to a great start

 

DURING LABOR

I want to upright and gently keep active in the early stages of labor (if I'm awake)

This helps gravity move baby down into the pelvis

https://www.pregnancybirthbaby.org.au/giving-birth-first-stage-of-labour

 

I want to try to get some rest (if labor starts during the night)

This may be tricky with excitement, fear and the anticipation of labor beginning, but if you can, it will help you reserve your energy for the more active labor to come.

 Nominate who will look after any current children and contact telephone numbers
 

I would like to stay home for as long as possible

As a general rule, once you've had regular, intense waves (each lasting about 60 seconds) every five minutes for an hour, it's time to call your midwife or doctor and head to the hospital or birth centre. Some caregivers prefer a call sooner, so clarify this ahead of time.

http://www.babycenter.com/stages-of-labor?page=2

Go through early labor techniques with me

These may include, breathing, hypnotherapy or attaching a TENS machine.

 

1. Remind me to release tension

If you are sceptical of this, try it while you labor. During one contraction, do whatever you want, tensing your muscles. Then, during the next contraction actively relax your muscles. You will feel a difference.

 

2. Guided imagery

Also called day dreaming with a purpose, guided imagery involves picturing yourself in a comfortable, relaxing setting. This imaginary place can be your favourite park, the beach or fantasy land. The point it to let your mind wander to that relaxing place as you feel labor pain. Some helpful tips for using guided imagery include:

• Focusing on the details of this comfortable setting (the air, the smell, the sound, etc.)

• Letting your body relax as your mind takes you to your imaginary place

• Playing some soft music or other sounds that can help you feel like you're really there

(Internet)

3. Massage and breathing

In a study, when massage was used as well as breathing techniques during labor, there was a measurable decrease in pain, a shorter labor and hospital stay. Find the base of mum-to-be's spine, between her buttocks, and massage firmly in a circular motions, using the heel of the hand, on either side of the spine. The more intense the pain (i.e. during contractions), the firmer the counter pressure should be.

Page 130 & 131 of The Natural Way To Better Birth And Bonding

4. Attaching a TENS machine

 Regularly give me sips of water

If you do not take sips of water or juice between your waves, you stand a good chance of becoming dehydrated. When your body is dehydrated, your muscle output is decreased by 30%. That means that your uterus will contract just as hard, but it will do 30% less work. Dehydration also heightens feelings of exhaustion. People not allowed to drink freely, even when receiving IV fluids at 125ml/hr are at increased risk of a longer labour by 1.5 hours and a cesarean.

(Internet)
 

Remind me to go to the bathroom. Labor can stall if I have a full bladder.

(Cheers To Childbirth – Lucy PERRY – Page 149)

 Cover the clocks – literally (car, home and hospital)

I would prefer to not now how long I've been at it, how long I'm likely to be at it, or how dilated I am. If they need to check for medical reasons, I do not want to know.

 My partner and I will not wear perfume/aftershave or use strong-smelling deodorant or soap for the first few days after birth.

These products can eliminate or mask natural odour signals that a newborn baby uses to locate the breast.

Keep Talking To A Minimum

Labor uses the more primal part of the brain. Laboring women are more away of pain when they are using their more intellectual part of the brain that is required for conversation.

(Cheers To Childbirth – Lucy PERRY)

Keep me feeling completely safe, protected, supported and loved.

Adrenalin block endorphins and oxytocin. your job is to make sure your partner has as little adrenalin in her system as possible. This hormone is produced by all the negative feelings such as embarrassment, irritation, frustration, fear, panic and anger. Adrenalin is designed to stall labor or at least slow it down if there is an immediate danger to the mother. She needs to feel completely safe, protected, supported and loved. This is your job.

(Lucy PERRY – Cheers To Childbirth)

I want dim lights

Again, this can help with the release of oxytocin, as oxytocin is a night hormone. Also, mum is more likely aware of what is going on around her rather than being able to access the more primal part of her brain when the room is lit up.

Page 152 of The Natural Way To Better Birth And Bonding

Reassure

She may be afraid that this is it and she's not ready for it. You have to use calm reassurance and all your manly charm to convince her that she was built to birth, that you'll be with her every step of the way and that you com0pletely adore her. People can achieve great things when they feel loved.

(Cheers To Childbirth – Lucy PERRY – Page 133)

Water

Studies show that warm water causes the cervix to dilate twice as fast, so the first stage of labor is significantly shortened, but only once labor is properly established (If labor is not properly established, water can cause it to stop completely.)

The Natural Way To Better Birth And Bonding

Positions

- Keep Me Moving

If baby is posterior at the beginning of labour, remaining mobile as long as the woman can influences the baby's position during labour. Also, endorphins are the body's natural painkillers. Keep moving gently to keep endorphins flowing.

(Cheers To Childbirth – Lucy PERRY)

- No Lying on My Back

When you are on your back, the contracting uterus has to move "up" against gravity, which is much more work than simply moving forward. Also, you can constrict the blood flow to the heart, causing you to be light-headed. Staying off you back can help in preventing labor pain.
http://www.birthingnaturally.net/birth/pain/sources.html

- Other Positions

Walking in labor is a great way to help not only speed labor but make you more comfortable. It is also a great way to spend early labor. Some women will choose to walk through their neighborhoods, or even the mall on colder days. No matter where you choose to walk, even if it's simply the halls of the hospital, walking can help your pelvis move about more freely and help gravity assist your baby in moving down into your pelvis.

The side lying position is a gravity neutral position, meaning that there are no benefits of gravity in this position. This is a great position for slowing down your labor or birth.

Squatting is a great way to increase the diameter of your pelvic outlet. This position should not be used until your baby is engaged in your pelvis. Once engaged this is a great position to help encourage descent of your baby further into your pelvis. It is also a great position in which to give birth.

The squatting position helps protect your perineum making it less likely that you would tear or require the use of an episiotomy during your birth. It is joking called the midwives' forceps because of its ability to speed the pushing phase of labor.

http://pregnancy.about.com/od/laborbasics/ss/laborpositions.htm

At the hospital:

• Give birth plan

• Ensure birth plan is given to new person if change of nurse shift

• Place colostrum in fridge/freezer

 

AFTER BIRTH PLAN FOR THE EARLY DAYS– SELF

 I would like to room in with my baby at all times so that I can learn our baby’s feeding cues.
 

I do not wish to bathe our baby for at least the first 48 hours after birth.
Reasoning listed in first point of BIRTH PLAN-HOSPITAL-AFTER BIRTH (above)
 

I do not wish to wash my chest area for 24 hours after the birth.

Reasoning listed in first point of BIRTH PLAN-HOSPITAL-AFTER BIRTH (above)
 

We do not want our baby to receive anything other than breast milk unless medically necessary. If it is considered necessary, we would like to discuss this first with a paediatrician.
 

If there are concerns about our baby’s weight, I would like to try more frequent feeding and other strategies for addressing this, with complements only to be given as a last resort and by a breastfeeding supplementer.

I will breastfeed my baby according to his/her needs and will follow my baby’s feeding cues in terms of length and frequency of feeds.

Early, frequent breastfeeding is the single factor that has consistently been shown to underpin a good start to breastfeeding. Research shows that breastfeeding in response to early feeding cues (as opposed to timed or scheduled feedings or waiting for the baby to become distressed and crying) helps prevent engorgement,
decreases the incidence of sore nipples, helps to ensure milk supply matches baby’s appetite, decreases the incidence of jaundice, increases
the rate of baby weight gain and increases the duration of breastfeeding.
 

I will keep my baby skin-to-skin as much as possible for at least the first few weeks after birth.
Skin-to-skin contact is important for stimulating the hormones needed to make milk. It also assists with bonding and is lovely for both of you to cuddle your baby as much as possible!
One of the most enjoyable and beneficial things you can do as a mother is simply holding your baby "skin to skin"  With baby wearing only a diaper and your bra removed, snuggle him upright, nestled between your breasts.  Your breasts will actually heat up or cool down in response to your baby's body temperature, but if needed, a blanket can be placed around the two of you.  This kind of skin-to-skin contact has been shown to help increase milk volume.  An additional benefit is that baby is also more likely to nurse when he is "in the restaurant" and smelling your milk.

My partner and I will not wear perfume/aftershave or use strong-smelling deodorant or soap for the first few days after birth.
These products can eliminate or mask natural odour signals that a newborn baby uses to locate the breast.

We would prefer that relatives and friends do not cuddle our baby for at least the first 24 hours.
Handling of your baby by friends and relatives will leave their individual smells (food, perfume, aftershave, deodorant, cigarette smoke) on his or her clothes. This may confuse your baby and interfere with his/her recognition of you as his/her mum and his/her ability to breastfeed.

 We do not want our baby to have artificial nipples (dummies or bottles) at any time. If alternative feeding methods of expressed milk are needed, we would like our baby to be fed using a syringe, cup or spoon.
Research has shown that the use of dummies and other artificial nipples in the neonatal period is detrimental to exclusive and overall breastfeeding. Bottle-feeding requires very different tongue and jaw movements and has a very different milk flow to that of breastfeeding. When supplemental feedings are medically necessary, cup feeding has been shown to be safe for both term and pre-term babies and may help preserve breastfeeding duration for babies requiring multiple supplemental feedings
 

FIRST TWO DAYS
In the first two days, baby may nurse as often as every half hour, counting from the beginning of one feeding to the beginning of the next.  The actual feeding is usually for only short periods, with baby waking to feed at night more than during the day. Page 17
 

AFTER MILK COMES IN
After the milk comes in, most babies begin feeding every two to three hours, or eight to twelve times in twenty-four hours, on average.  Page 17
 
IF I NEED MORE INFORMATION OR SUPPORT
If I need information or support regarding breastfeeding, I will not hesitate to:
call the Breastfeeding Helpline on 1800 686 268 (Australia), available 24 hours a day, 7 days a week.