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 and sweet. Use the tips below to customize your list of preferences then follow the sample plans when writing your own birth plan.
- 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 preference sheet, 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 are in 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. They may truly believe routine interventions such as an epidural, episiotomy, I.V., catheter, 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 are pdf files so you may copy/past text to create your own version.
Please have a draft copy of a birth plan ready to review with your doula during your prenatal meeting. After your meeting, revise your birth plan using Google Docs, and send it as an attachment to your doula so she can suggest edits, if needed, and you will be able to accept/decline any changes.
If your medical care provider or birthing facility provided you with a "checklist" type of birth plan, please use it to help you write your formal birth plan/preference sheet, which should resemble a below sample. These are tried and true example plans but feel free to copy statements from several below to compile your own work.
Episiotomies, Tears and Pushing
To limit tearing during the second stage of labor:
- Support your skin! Avoid processed foods, focus on nutrition, and eat a well-rounded diet.
- Plan on a waterbirth or water immersion for a long period of time right before delivery. We encourage you to explore what underwater birth can offer you and to seek out medical facilities and care providers offering inflatable tubs or birth pools for labor and delivery. For further reading on waterbirth, checkout NPR's Shots article from March 2014.
- Apply warm compresses when crowning; there is sufficient evidence to support the use of warm compresses to prevent perineal tears. Read the Cochrane review of eight randomized trials (involving 11,651 women) conducted in hospital settings in six countries.
- Get off your back! Squat, kneel, stand or lay on your side while pushing.
- Breathe the baby down and focus on completely relaxing your pelvic floor. Bear down gently when you feel the urge to push with contractions. Use mind-body relaxation techniques such as guided meditation (hypnosis).
- 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.
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 - Vaccine-derived immunity for Hepatitis B (HBV) is short-lived and needs to be given again later in life to provide protection. Talk to your pediatrician about potential risks of this vaccine. Some parents choose to have their pediatrician give the shot at their baby's first visit rather than at the hospital.
- Vitamin K1 injection virtually eliminates the chance of life-threatening Vitamin K deficiency bleeding. The only known adverse effects of the shot are pain, bleeding, and bruising at the site of the injection. Out of many millions of injections, there has only been one report of an allergic reaction in recent history. A regimen of three doses of oral Vitamin K1 at birth, 1 week, and 1 month reduces the risk of bleeding. Although this 3-dose oral Vitamin K1 regimen is better than nothing, it is not 100% effective. Read more on Vitamin K.
- 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. Read this Evidence Based Birth pdf.
- 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.
In this video, you will learn:
- Frequently marketed claims about placenta encapsulation
- How many experimental trials have ever been done with placenta encapsulation
- Results from the newest randomized, placebo-controlled trial on placenta encapsulation
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.
"As far as caring for the placenta, the short answer is that I ask them to put it into two freezer bags (double-bagged) or some hospitals will put it in a food-grade plastic container. It needs to be put on ice within 4 hours of the birth, preferably 2 hours. I ask them to bring a cooler with them to store it in." - Melanie Belk Nasmyth of Natural Afterbirth.
See attached file for complete instructions for placenta safety.
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 Obstetricians and Gynecologists (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.