Birth Plan for Monica
Due Date: 4/22/09
Patient of / Hillcrest
We are looking forward to sharing our birth experience with you. We have created this birth plan in order to outline some of our preferences for birth. We would appreciate you reviewing this plan, and would be happy to do so with you. We understand that there may be situations in which our choices may not be possible, but we hope that you will help us to move toward our goals as much as possible and to make this labor and birth a great experience. We do not want to replace the medical personnel, but instead want to be informed of any procedures in advance, and to be allowed the chance to give informed consent. Please feel free to ask if you have any questions or comments. Thank you!
- My bloodtype is Rh- (Rhesus Negative)
- I would like to wear contact lenses or glasses at all times when conscious.
- I expect that doctors and hospital staff will discuss all procedures with me before they are performed.
- I would like to be free to walk, change positions and use the bathroom as needed or desired.
- So I can stay as mobile as possible, I would prefer to have a heparin lock adminstered instead of an IV.
- Please do not administer an IV or heparin lock unless there is a clear medical indication that such is necessary.
- Please limit the number of vaginal exams.
- Please do not permit observers such as interns, students or unnecessary staff into the room without my permission.
- I would like to avoid induction unless it is medically necessary.
- If my pregnancy progresses past 40 weeks, I would prefer to base the decision to induce on the results of my baby's biophysical profiles, not on my own personal discomfort or impatience.
- I would like to try alternative means of labor augmentation, like walking or nipple stimulation, before pitocin or artificial rupture of membranes is attempted.
- Please do not rupture my membranes artificially unless medically indicated.
- Please do not offer anesthesia/analgesia unless I ask for it.
- I prefer an epidural to narcotic pain medication.
Cesarean Section Delivery
- I feel very strongly that I would like to avoid a cesarean delivery
- If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making.
- I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery.
- If conditions permit, baby should be given to Gary Nowac (my husband) immediately after the birth.
- To help my perineum stretch, please help guide my pushing efforts by letting me know when to push and when to stop.
- I would rather have an episiotomy than risk a tear.
- Please administer local anesthesia when repairing any episiotomy or tear(s).
- Please allow the umbilical cord to stop pulsating before it is cut.
- I have made arrangements for donation of the umbilical cord blood.
- Please remove my IV/Heparin lock/catheter as soon as possible after delivery.
- I would like to hold my baby through delivery of the placenta and any repair procedures.
- If possible, please evaluate baby on my abdomen.
- I would prefer not to be catheterized until I've had some private time to attempt urination on my own.
- If available, I would prefer a private room.
- I would like to have my baby room-in with me at all times.
- I plan to breastfeed and want to nurse immediately following the birth.
- Please do not give my baby supplements (including formula, glucose, or plain water) without my consent, unless there is an urgent medical necessity.
- Please do not give my baby a pacifier.
- I would like to meet with the staff lactation consultant.