6. How To Create Your Birth Preference Sheet
Please wait until you have completed your childbirth education classes before drafting your birth preference sheet (also called a birth plan).
Your birth plan must be read by your care providers in order for it to be effective so keep it short but sweet. Use the tips below to customize your list of preferences and use the sample plans as a guide to write your own.
- Keep it brief
List only what’s most important to you. You can refuse any intervention when it is offered - just ask for the Against Medical Advice Waiver.
- Make it easy to read
Avoid small fonts. Use bullet points and leave some white space. Print on colored paper to distinguish it from the white papers in your file.
- Say it with food
Nurses work long hours and appreciate snacks. Your birth preferences, with an attached photo, will be read by every nurse at the station when presented with a small basket or gift bag of reasonably healthy snacks, such as cookies, fruit, crackers and cheese, nuts, etc. Chocolate can be included but there should be some nourishing food along with it. Bring an additional basket for the postpartum nurses, too!
- Make it relevant
If your hospital doesn’t give enemas, don’t tell them you don’t want one. The nurses don’t need to know that you want to labor at home for as long as possible.
- Solicit help
Most doctors and nurses go into the health profession because they want to help. However, because they are in the medical profession, many of them have never seen a natural (unmedicated) birth, and they truly believe that the epidural, episiotomy, I.V., heplock, catheter, internal fetal monitor, etc. are all helpful. Asking for their help in avoiding such interventions gives them a different perspective.
- Keep it positive
Try to avoid the words and phrases that include no or don’t.
- Keep it simple
"We want to work with a nurse who believes in natural childbirth" and "I will actively participate in all decisions to provide informed consent" are the types of simple statements that will get you what you want.
The samples below can be opened using Google Docs, Word or TextEdit
After your prenatal meeting, please share the revised version of your birth plan with your doula. Using Google Docs, you can send your plan as an attachment so your doula can suggest edits, if needed, and you will be able to accept/decline any changes.
- Birth Plan One - waterbirth or "natural" vaginal birth - Atlanta Medical Center/N. Fulton/Dekalb Medical Center
- Birth Plan Two - unmedicated "natural" vaginal birth - Northside/Piedmont
- Birth Plan Three - relinquishing mother / adoptive parents
- Birth Plan Four - can be used for medicated birth at any hospital
- Birth Plan Five - waterbirth or "natural" vaginal birth - Atlanta Medical Center/N. Fulton/Dekalb Medical Center
Episiotomies, Tears and Pushing
During childbirth, apply warm compresses when crowning or have a waterbirth, use positioning rather than lying on your back, and bear down gently with the urge to do so rather than be directed how to push.
If an epidural is used, you likely will not feel an urge to push with contractions and must be directed how to push and how long to do it for. This is called purple-pushing and increases your risk of tearing and/or for the need of an episiotomy.
Read about natural tearing when pushing verse a midline or medio-lateral episiotomy. The degrees of lacerations are explained and photos are posted.
The best way to avoid a tear or the need for an episiotomy is to make sure your skin is healthy so eat a well-rounded healthy diet.
INT, Saline or Heparin (Hep) Lock
An INT port is a saline or heparin lock that provides vein access (a portal) that is used for low-risk mothers in labor in the hospital. It allows immediate access to a vein in the event of a complication and can be placed during the initial blood draw upon arrival at the facility. This allows you to be free from the IV lines and pole, affording you increased mobility during labor.
There are many benefits to having a saline lock - just in case it is needed for medications to treat pain, nausea, heartburn, hemorrhage, etc. but there are also risks to consider!
Routine Newborn Procedures
- PKU or "heel stick" test - Phenylketonuria (PKU) is a genetic disorder, which your newborn will be tested for in the first few days of life. This test involves sticking the foot of the child for blood. It is only accurate when your baby has been receiving a diet containing phenylalanine, in both human milk and artificial formulas, for a period of 24 hours.
- Hepatitis B Vaccine - Why give an infant protection against a sexually transmitted disease? Vaccine-derived immunity for Hepatitis B (HBV) is short-lived and needs to be given again later in life to provide protection against this lifestyle disease. Talk to your pediatrician about the risks of this vaccine and whether there have been safety studies. Ask to read the literature or do further research for yourself on an alternative vaccine schedule.
- Vitamin K injection - The injected amount of Vitamin K is 20,000 times the newborn level at birth. The dose given is based upon normal adult values. Learn the history of this routine procedure that follows birth and weigh the risks and advantages.
- Erythromycin eye ointment - This is an antibiotic given routinely to babies immediately following birth that protects them against contracting ophthalmia neonatorum (ON), a type of pink eye that causes blindness in 3% of infants. If the baby's mother does not have chlamydia or gonorrhea, then the newborn cannot catch ON. If a baby is born by c-section and the bag of waters didn't break before surgery, then it is extremely unlikely that the baby would catch ON.
- Circumcision - Once considered a routine procedure, many people now consider leaving their baby boy intact. As with any medical procedure, routine or not, risk is involved. Over 100 newborns die each year in the USA, mostly from loss of blood and infection after circumcision. (Van Howe 1997 & 2004, Bollinger 2010).
To date, not many studies have been done about placenta encapsulation but we have many clients that swear by its effectiveness for both milk production and treating postpartum depression. If you're undecided, you can preserve your placenta in your freezer for up to one year postpartum and see if you later need it.
We recommend the services of Natural Afterbirth in Atlanta. Learn about their process and How To Keep Your Family Safe: Placenta Processing And Sanitation. If you plan to hire a placenta specialist NOT associated with Natural Afterbirth, you must choose where your placenta will be processed. Read a comparison of the benefits and drawbacks to each option.
Research states that a baby can receive full benefit from delayed clamping when placed on mom's lower abdomen immediately following birth. For more info and a video link to Dr. Nicholas Fogelson's Grand Rounds presentation on this subject, review this post on our blog.
Milking the cord must take place before the cord has been cut or clamped. This is beneficial for babies who are struggling to breathe in the minutes following birth by allowing the placenta to deliver oxygenated blood via the cord. Watch the below video by Penny Simkin about delayed cord clamping so you can see the amount of blood that is transferred before cutting the cord.
Information on Cord Blood Banking
The American College of Obstetrics and Gynecology (ACOG) offers sound advice on cord blood:
- Patients should know the chances are remote that stem cells from their baby's banked blood will be used to treat their child or another family member.
- Patients should be aware it is unknown how long cord blood can be successfully stored.
- Physicians who recruit patients for for-profit banks should disclose any financial interest or potential conflicts of interest.
- Children who develop genetic diseases or inborn metabolism disorders cannot be treated with their own cord blood -- no one can be treated with their cord blood as it would carry the same genetic mutation.