Pregnancy, Childbirth, and the Newborn: The Complete Guide, 4th Ed.

CHAPTER 8 Planning for Birth and Post Partum

Giving birth can be deeply satisfying when you participate fully in the event and your care is tailored to match your wishes. To help distinguish yourself as an individual with unique needs, it’s important to communicate your priorities and preferences for your care. This chapter describes the process of discovering your options, examining your priorities, and discussing your preferences with your caregiver and others providing your care. With this preparation, you’ll learn how to create a written plan that effectively communicates your wishes to make your labor, birth, and postpartum period rewarding experiences.

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In this chapter, you’ll learn about:

• Birth plans and how to use one to help you explore, clarify, and communicate your preferences for labor and birth

• Simple steps for preparing and presenting your birth plan

• Ways to plan for the postpartum period

The Importance of Planning for Birth and Post Partum

The main purpose of planning for your baby’s birth and the postpartum period is to establish a line of communication between you and those providing your care, ensuring that they know your priorities and preferences for treatment. If everyone understands and respects your wishes, you’re more likely to be satisfied with the care you receive than if your wishes are unrecognized.1

If you have only one or two caregivers providing all your care, such as midwives who belong to a small home birth practice or a freestanding (unaffiliated with a hospital) birth center, getting to know one another will occur naturally and easily. The ability to communicate clearly and honestly with one another will strengthen as a personal relationship develops.

If your caregiver belongs to a group practice—and most maternity caregivers in the United States and Canada do—it may be harder to build personal relationships, but establishing good communication is possible. Caregivers who belong to a group practice rotate who’s on duty during specific shifts. The caregiver on call attends to all patients from that group practice throughout his or her shift, including those who usually see other caregivers in the group. Nurses and hospital staff assist the on-call caregiver, but you probably won’t meet them before arriving at the hospital. This system of rotating shifts ensures that all your care providers have had time off for adequate rest. As long as communication among all staff is good, the system is efficient.

During a shift change in a hospital, the nurse whose shift has ended communicates a patient’s clinical status directly with the nurse coming on duty. Nurses also communicate directly with the patient’s caregiver whenever necessary.

More important than direct spoken communication is the medical chart. If you’re planning a hospital birth, your caregiver electronically records information on your physical and psychological well-bring in your chart at each prenatal visit, and frequently during your hospital stay. This chart becomes a permanent record that’s available to you and others caring for you whenever you need medical care in the future.

Some of your priorities and preferences for birth and the postpartum period might not be recorded clearly in your chart, even though you discussed them with your caregiver. This miscommunication can be a problem because your nurses likely won’t know much about you before you arrive at the hospital in labor. A birth plan can provide a way to communicate your wishes efficiently and effectively.

Your Birth Plan

birth plan (also called a “birth preference list,” “wish list,” or “goal sheet”) is a one- to two-page letter you write to everyone attending to your care during labor and birth. In it, you describe your concerns and fears for labor and birth, as well as your wishes for the treatment of you, your partner, and your baby. Although a birth plan lets you express your priorities and preferences, it’s not a contract that dictates the actions of all your care providers, nor is it a guarantee that problems won’t arise that will require a change in your plan. Instead, a birth plan lets everyone know which safe options are most important to you, which in turn increases your chances of receiving personalized care.2The goal of the birth plan is to enhance your satisfaction with the birth experience.

In Their Own Words

When my cervix was 9 centimeters dilated, I felt that I couldn’t handle the pain anymore and asked for an epidural. Our midwife told me that I could certainly have one, but suggested that a bath might help relieve the pain just as much. This was exactly the sort of help I’d requested in my birth plan, so I knew she was respecting my wishes. I got into the bath and stayed until I was fully dilated.

—Hillary

FREQUENTLY ASKED QUESTIONS ABOUT BIRTH PLANS

The following are answers to common questions many expectant couples have about birth plans.

How does a birth plan help us?

Preparing a birth plan helps you reflect on how you’ll best cope with the unpredictability, stress, and pain of labor and birth. As you learn about the different care options and treatments, think about your needs and preferences to help you decide what kind of care is important to you. Discussing your birth plan with your caregiver is an excellent way to enhance communication, clarify your expectations, and build trust and understanding.

Perhaps the most important reason to have a birth plan is to provide a way to introduce yourself and your partner to unfamiliar caregivers, nurses, and hospital staff, and to effectively and efficiently communicate your issues, fears, or concerns to them. By providing a birth plan to read, you free yourself from the need to explain your wishes and expectations each time a new person takes over your care—a clear advantage if you’re coping with contractions during a shift change and can’t focus on conversation!

How does a birth plan help my caregiver?

A birth plan helps your caregiver understand your goals and preferences for labor and birth, and alerts him or her to any misunderstandings or unrealistic expectations you may have. By carefully addressing your priorities and preferences and suggesting alternatives where necessary for safety or practical reasons, your caregiver helps you create a birth plan that reflects the flexibility needed if problems arise in labor or birth.

How does a birth plan help the nursing staff?

Because most of the nurses won’t have met you before your arrival at the hospital, a birth plan helps them become acquainted with you and individualize your care. It gives them important information about your concerns and preferences, which you expressed before going into labor, when you were calm, comfortable, and able to think clearly. If the nurses know what’s important to you, they’re better able to meet your needs and help you fulfill your wishes. Studies show that women often feel disappointment, anger, or depression if their desires and expectations about birth aren’t met.3

How do caregivers feel about birth plans?

Reactions to birth plans vary. Some caregivers encourage birth plans and will work with women on them, if asked. Others might not be familiar with birth plans. Still others believe that birth plans are unnecessary. These caregivers argue that they wouldn’t administer treatment without the woman’s consent; therefore, there’s no reason for the woman to express her wishes about treatment beforehand. However, these caregivers might not realize how helpful it is for a woman to know in advance whether her desires for care are realistic and acceptable, or how stressful it can be for her to explain her wishes while coping with contractions.

Common Q & A

Q: What can I do if an intervention is suggested during labor, but it’s not in my birth plan?

A: If those providing your care recommend treatment that seems to go against your preferences, you or your partner may ask why it’s needed. The reason may be that the treatment is the safest way to handle a medical issue that has arisen. Or it’s possible that your nurses and unfamiliar caregivers are unaware of your preferences and are following standard protocol. Once they understand your desires and you understand their reasoning for the treatment, you should be able to discuss the matter with them and reach a compromise.

You may need to explain why you’re preparing a birth plan. Try to emphasize that you want it to enhance communication and trust among you, your partner, and everyone attending to your care. Let your caregiver know that your plan contains personal information you’d like the staff to be aware of, as well as ways they can best support you.

If your caregiver asks you to prepare a birth plan, he or she believes that it’s an essential part of your care. Your caregiver considers your input and collaboration important for building cooperation and trust. Having a strong relationship with your caregiver increases your satisfaction with the birth experience and can provide reassurance if problems arise during labor or birth that lead to necessary changes in your birth plan.

If your caregiver is clearly opposed to a birth plan, you’ll gain the valuable knowledge that he or she doesn’t want to know what’s important to you. You can respond by doing one of the following: Give up your birth plan and do what your caregiver requires, try to negotiate with him or her, or try to find another caregiver. (See page 20.) At the very least, learning about your caregiver’s opposition to birth plans will clarify your relationship with him or her, and you won’t be confused or surprised in labor when your caregiver provides care that goes against your wishes.

How do nurses feel about birth plans?

Some nurses believe that birth plans are guides for providing individualized care. If there’s not a birth plan in your chart, these nurses will ask you for one.

Other nurses, however, dislike and resist birth plans. Perhaps in the past they were presented with birth plans that seemed unfriendly, bossy, or unrealistic; as a result, they now believe that birth plans do more harm than good. Perhaps they worry that a birth plan is the woman’s attempt to control the staff or keep them from doing procedures that are essential for safety.

To minimize opposition, follow the advice on page 153 when preparing your birth plan. Be clear that you’re not trying to tell the nurses the best way to do their jobs. Instead, you’re simply trying to introduce yourself and your preferences so the nurses can take them into account when caring for you.

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Preparing Your Birth Plan

Preparing your birth plan is a task that requires plenty of time; ideally, you should begin working on yours a few months before your due date. To create the most meaningful and helpful birth plan, follow these four steps.

1. Decide what general approach to maternity care you prefer.

2. Learn about specific options available to you if labor progress and birth are normal and if unexpected problems occur. Select the options you prefer.

3. Make a rough draft of your plan and discuss it with your caregiver.

4. Prepare a brief final birth plan that summarizes your priorities and preferences.

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STEP 1: YOUR PREFERRED APPROACH TO MATERNITY CARE

To figure out your preferred approach to maternity care, ask yourself this question: “Of the following two options, which more closely reflects my thoughts about my body, my pregnancy, the kind of care I’m comfortable with, and how I want to participate in my baby’s birth?”

Option A: The self-reliant approach

I want to actively participate in my labor by using non-medical measures for comfort and labor progress and by taking part in decisions about procedures and other care options. My partner and I are learning about labor and birth, practicing comfort techniques, and attending childbirth preparation classes. We’re considering having a doula or another helper with us during labor and birth. I of course will accept medical help if it’s truly needed.

Option B: The caregiver-reliant approach

I want those providing my care to decide how to manage my labor and relieve my pain. I’m more comfortable with appropriate technology and medical resources than with my own knowledge and non-medical pain-relief techniques. I’ll do whatever is asked of me, but I’d like to be kept informed about what’s happening to me and my baby and why. I’m not spending much time outside of childbirth classes preparing for labor and birth.

Your preferences may align with one of these approaches, but if they lie somewhere between the two, explain how you’d like to participate and what role you want your caregiver to play. Choose your caregiver based on these preferences (see Chapter 2), or if you already have a caregiver, evaluate the care you’re receiving. How does your caregiver respond to your questions? Are you comfortable with his or her answers? Does his or her care match your preferred approach?

It’s possible that you chose your caregiver without knowing much about your options. As you learn more about your choices, you may feel happy with your caregiver or you may become uncomfortable with his or her care. If you’re uncomfortable, you can take one of the following actions:

1. Continue to accept your current care and give up some of your preferences.

2. Express your discomfort and try to work out acceptable compromises with your caregiver.

3. Change to another caregiver whose care better matches your preferences.

Two Views on Birth Plans

With this pregnancy, I want to create a simple birth plan that includes only what I feel is most important, and doesn’t bother with what I consider “small stuff.”

—Allison

After my first birth, I didn’t get to hold my baby right away, and I regretted that. So for this birth, our birth plan is very basic, but there’s a whole paragraph about newborn procedures and how I’d like that first hour to go, assuming all is well with me and my baby.

—Maria

STEP 2: LEARN ABOUT YOUR OPTIONS AND IDENTIFY YOUR PREFERENCES

By reading this book, you can learn about most options and procedures for labor and birth, including key questions to ask about possible risks and alternatives. (See page 10.) Additional resources include other books and web sites, maternity caregivers, friends who have given birth, childbirth preparation classes, and hospital tours. Pay attention to whether the resources you use are evidence based (that is, rely on well-designed research, not on opinions or customs). See page Appendix C for a listing of recommended resources. Your childbirth educator or doula should be familiar with the routine practices of maternity care in your area, and he or she also may be a helpful resource as you prepare and write your birth plan.

As you learn about options, you’ll notice those that are natural or low-tech are more compatible with the self-reliant approach, while options that rely on technology and medicine are more compatible with the caregiver-reliant approach. You may discover that you feel strongly about some options; these are good issues to discuss with your caregiver.

To help you choose your preferences, visit our web site, http://www.PCNGuide.com, to download a birth plan work sheet.

STEP 3: PREPARE A ROUGH DRAFT AND DISCUSS IT WITH YOUR CAREGIVER

Use the following list of topics to prepare a rough draft of your birth plan. (See page 153 for more detailed descriptions of these topics.)

List of Birth Plan Topics

• Practical information

• Introducing yourselves

• Issues, fears, or concerns

• Care preferences for:

* Managing labor pain

* Normal labor and birth

* Unexpected events, including complications and a cesarean birth

* Postpartum care

* Care of a healthy newborn

* Complications with the newborn

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You may need to schedule a longer-than-usual prenatal appointment so you’ll have time to discuss your draft with your caregiver and learn whether your plan needs to be revised for clarity, consistency, or safety. This discussion is essential to have because your caregiver may request modifications to better fit with his or her preferred practices, perceptions of safety, and hospital customs. In most cases, you’ll probably be able to reach a compromise that satisfies you both.

STEP 4: PREPARE THE FINAL DRAFT

Revise your rough draft into a final draft. Incorporate any suggestions or modifications from your discussions with your caregiver and others. Use bullet points, and don’t exceed two pages. A brief yet complete birth plan will be easy for your caregiver and nurses to read and understand. It’ll also clearly highlight your priorities and preferences.

Don’t include lists of procedures that are acceptable and unacceptable to you. If circumstances change during your labor and birth, some “unacceptable” procedures may become necessary and “acceptable.” When expressing a preference about a particular procedure, include phrases such as “unless medically necessary” to indicate that you realize that deviations from your birth plan may become necessary.

After completing your birth plan, read it from a nurse’s perspective. Is your plan friendly, respectful, and flexible (that is, does it indicate your awareness that labor isn’t always normal or predictable)? Does the tone promote mutual trust and collaboration? If not, revise the language to help ensure that all your care providers will respond positively to your birth plan.

When you’re satisfied with your final draft, make copies for yourself, your partner, your caregiver, the nurses, and your doula. Bring extra copies with you when you arrive at the hospital in labor.

COMPONENTS OF YOUR BIRTH PLAN

Your birth plan should cover the following topics. Limit your discussion of each topic to one short paragraph or a bulleted list that summarizes just the essential points.

Issues, Fears, and Concerns about Childbirth

Here are examples of issues, fears, and concerns that couples have included in their birth plans:

We have a history of infertility and miscarriage, so we tend to worry a lot about our baby’s well-being and may need frequent reassurances.

I’m terrified of needles and will need someone who’s understanding, supportive, and very skilled with inserting needles.

I have trouble trusting strangers. Please introduce yourself and talk with me for a while before you begin my care.

I’m anxious about labor pain, and worry about losing control.

I’m uncomfortable with the idea of being seen without my clothes on; please help preserve my modesty.

Practical Information

Give your names, due date, and the names of your caregiver, doula, other support people, and your baby’s caregiver. You also may include a statement about the limitations of your birth plan, such as, “We realize our birth plan isn’t a contract or a guarantee of an uncomplicated labor. Our highest priority is the health of our baby and me. Thank you for your help.”

Introducing Yourselves

Tell those providing your care a little about yourselves, to help them see the importance of the preferences in your birth plan. For example: “We’ve been together for six years, and this pregnancy finally happened after three years of trying to conceive. We’re hoping for a natural, non-medicated birth, and would value your support.”

Preferences for Managing Labor Pain

Here are examples of preferences for managing labor pain that couples have included in their birth plans:

I’d prefer to give birth without pain medications. My partner and doula will support me using techniques we learned in childbirth preparation class.

I’d like to have an epidural as early as possible.

As long as my labor is progressing normally and I’m coping, I want to avoid pain medications. However, if my labor is prolonged, if complications arise, or if the pain is too great, I may request an epidural.

I feel strongly about avoiding pain medications. Please don’t offer them to me; I’ll ask for them if needed.

Issues, Fears, or Concerns

If you don’t have any particular issues, fears, or concerns, you might not need to address this topic. But if you do, here’s an opportunity to disclose them. See page 153 for examples.

Your feelings may be influenced by a previous negative experience, such as a miscarriage or a traumatic birth, unpleasant encounters with caregivers or hospitals, or childhood trauma. By disclosing your feelings and the reasons for them, you’ll more likely receive treatment that takes your unique needs into account.

Preferences for Managing Labor Pain

After reading Chapters 10 and 11 to learn about self-help and medical measures for pain relief, describe your preferences for managing labor pain as clearly as possible. This may be a challenge because you don’t know how much pain you’ll have in labor or how long your labor will last. Use the Pain Medications Preference Scale on page 187 to help you describe your needs for pain relief.

Preferences for Normal Labor and Birth

Caregivers always recommend some monitoring of the mother and baby in labor, such as checking the baby’s heart rate and the mother’s temperature, blood pressure, and contractions. When labor and birth proceed normally, few other interventions are necessary to ensure the well-being of the mother and baby.

Some interventions might be routine in hospitals; however, they might not be necessary, especially if there’s not an indication of a problem. Examples of such interventions include intravenous (IV) fluids, continuous electronic fetal monitoring, artificial rupture of the membranes, and suctioning the baby’s nose and mouth. Other routine interventions exist for the convenience of the staff or caregiver, including the supine (on your back) position for birth and the separation of baby from mother right after the birth for newborn testing and observation. Still other interventions are required by state or provincial governments, such as administering antibiotics to the baby’s eyes and conducting newborn screening for various conditions.

Find out which routine interventions you’re likely to encounter (along with the reasoning behind them). When preparing this section of your birth plan, mention only the preferences that matter to you. You don’t have to express an opinion on every intervention, especially those that usually aren’t done in your area. For example, you may say, “I prefer to avoid interventions and procedures, including routines such as IV fluids and continuous electronic fetal monitoring, and I want to discuss any that are being considered, along with possible alternatives.”

In Their Own Words

I’d educated myself on what I wanted for labor and birth and knew that the Bradley Method was for me. I had a doctor who was supportive and, after reading my birth plan at the hospital, I was assigned a great nurse who had used the Bradley method herself. My birth plan was followed nearly exactly. I wasn’t offered any pain medications, and the nurses were all great.

—Betsy

Preferences for Unexpected Events, Including a Cesarean Birth

If a problem arises during labor, birth, or the postpartum period, you may need undesired medications or interventions in order to ensure your well-being or your baby’s. Under most circumstances, you’ll have time to ask key questions (see page 10) such as, “Do we have time to discuss this intervention before you need me to make a decision?” In rare emergencies, however, the need for immediate action may preclude low-tech measures or even explanation and discussion.

When creating your birth plan, consider separating it into a Plan A and a Plan B. Plan A covers your preferences when labor and birth go smoothly. Plan B addresses how you’ll want possible complications to be handled. For example, by including modifications to your birth plan that cover a cesarean birth, you can retain some priorities and preferences in your original birth plan in the event you’ll require a cesarean birth (see page 328). Although an unexpected cesarean birth can be disappointing, you’ll feel better about the experience if you’ve thought about this possibility, understood your options, and expressed your preferences. By being flexible with your birth plan, you’ll increase your chances of having a healthy baby and a satisfying birth.

Preferences for Your Healthy Newborn’s Care

If you and your baby are healthy and doing well immediately after the birth, he’ll need little more than skin-to-skin contact with you (with a blanket covering you both) and access to your breasts; later on, he’ll also need a warm environment, diapers, and clothing.

Your caregiver will probably want to do routine observations, tests, and procedures on your newborn to discover serious congenital disorders or to prevent potentially serious illnesses. When considering the options listed on pages 370–371, balance concerns for your baby’s comfort and well-being with the potential benefits and risks of each procedure. Some one-time common routines and procedures are now unnecessary or even harmful. For example, feeding sugar water or formula to healthy breastfed babies was once routine, but now pediatricians and lactation consultants consider the practice unnecessary or harmful.

Preferences for Unexpected Problems with Your Newborn

You may worry about prematurity, illness, birth defects, birth trauma, or even stillbirth. To help manage your concerns, consider in advance how you’ll want these misfortunes handled. This way, if a problem does arise, your forethought will prevent having to make such decisions when you’re upset and unable to think clearly. Your birth plan can reflect your consideration of these rare possibilities, which increases the likelihood that you’ll receive treatment tailored to your preferences. (See page 303.)

Sample Birth Plans

The following are two examples of birth plans. While both plans cover many of the same topics, each is written in a style that reflects the personality of the writer.

Birth Plan for Pat Rosen

• My primary caregiver is Dr. Sally Doe, and my due date is July 5.

• My support people will be my husband, Ken; a doula; and perhaps a friend.


Who We Are

• Ken and I are both originally from the South, so we feel it’s a little exotic to have a kid born on the West Coast! This is our first baby, and we don’t know if it’s a boy or girl. We figured, why spoil one of life’s big surprises?


Issues, Fears, Concerns

• As a child, I had minor surgery involving my urethra, and I remember it as painful and quite frightening. So I have lingering anxiety around vaginal exams and interventions (for example, needing a catheter). Not very convenient when giving birth, I know, and I’ve tried to get around the anxiety, but it does crop up.


Preferences for the First Stage of Labor

• Controlling pain: I’d like to use natural coping techniques (breathing, focused relaxation, comfort positions) to a point, but expect I’ll want pain meds in active labor. Please let me know when it’s okay to have an epidural.

• Medical interventions: I’d like to avoid interventions; delay them until I get the epidural or if a problem comes up.


Preferences for the Second Stage of Labor

• Positioning: I hope the epidural will be light enough that I can try different positions in the bed to help the birth.

• Pushing efforts: I’d like to labor down, barring any complications, and have help knowing when and how long to push.

• Medical or surgical interventions: I’d like to avoid an episiotomy, and will work very hard to avoid a forceps delivery or a vacuum extraction.


Preferences for Unexpected Labor Events

• Complicated labor or problems with my baby: We’d like to make informed decisions, so please keep us informed if you have concerns about our baby’s well-being or mine.

• Cesarean surgery: I’d like to have at least two of my people with me.


Preferences for My Postpartum Care

• I plan to breastfeed and would like a visit from a lactation consultant. I have inverted nipples and anticipate needing a little extra help.


Newborn Care Plan

• Immediately after the birth: Bonding time is very important to us. We’d like to have our baby placed naked on my chest as soon as possible after the birth, unless there’s a medical reason not to do so.

• Newborn procedures: Please delay newborn procedures until after the first hour.

• Feeding: We plan to breastfeed exclusively and on cue. We’d like advice from the lactation consultant, as this is all new to us!

• Vaccinations: Please don’t give our baby a hepatitis shot. We’ll have the pediatricians give vaccinations when recommended.

• If our baby is sick: We absolutely want our baby to have help if needed, and ask that you include us in the decision-making process so we can do all we can for our baby. We wish to stay with our baby so we can hold and feed him or her as much as possible.

• Visitors: We’d like our baby’s grandparents brought in to see us and meet him or her as soon as possible after the birth; other friends can come as well, provided we have the energy to visit with them.

• Our educational needs: Because this is our first baby, we need all the advice and help we can get about baby care and feeding!

• Discharge: We hope to stay in the hospital for as long as our insurance policy allows.

Birth Plan for Jane Smith

Due date: April 12


Support people: Joe, my husband; Mary Jones, doula (or her backup, Carla Davis)


Our baby’s caregiver: Dr. Jim Adams, Seattle Pediatric Services


Introducing Ourselves: We’ve selected the midwives at Metro Hospital because we’re interested in a safe and natural birth process. We’ve struggled for years with infertility issues and are very excited to, at long last, welcome our first child to our family through the help of in vitro fertilization.


Issues, Fears, Concerns: I’m a private person and am sensitive about my modesty. I’ll be more comfortable if you knock before coming into my room, and if only essential people come in. I want to be kept covered, including while in the tub.


Preferences for Managing Pain: On the Pain Medications Preference Scale, we’re at -7, which means we prefer a natural birth to avoid side effects of medications to me, my labor, or my baby. I’ll be disappointed if I elect to use pain medication. Please don’t suggest it to me. If I get discouraged, please suggest comfort measures and encourage me. My code word is pumpernickel. If I say that word (and only if I say it), you should stop encouraging me to go without pain medication, and help me get an epidural or other effective pain medication.


Preferences for Normal Labor and Birth:

First stage of labor

• Prefer to avoid routine interventions and wish to discuss any being considered, such as IV fluids, continuous electronic fetal monitoring, and so on.

• Desire freedom of movement.

• Prefer intermittent monitoring of my baby.

• Plan to use breathing, shower, bath, and other comfort measures.

• Want to drink clear juices, Popsicles, and eat light snacks.

Second stage of labor

• Use upright positions or positions suggested by my midwife.

• No episiotomy-please take steps to avoid tearing (warm compresses, controlled pushing, and support of my perineum).

• Let my baby’s cord stop pulsating before being cut. (Joe to cut the cord.)

• After my baby’s birth, immediate skin-to-skin contact and breastfeeding

Third stage of labor and the first hours after the birth

• Delay all routine procedures until an hour after the birth or the first feeding.

• Decline hepatitis B shot; decline circumcision.

• Keep my baby in my room at all times unless otherwise requested or required.

• Breastfeeding only, no supplements unless needed


Preferences for Unexpected Labor Events:

Prolonged labor and induction

• If induction is necessary, I’ll try self-help measures and acupuncture first.

• If pain is too intense, I desire input from staff for relaxation, pushing techniques, and other ideas to help me avoid taking medication.

• I strongly prefer to avoid (but understand the possible necessity for) the following interventions: Epidural or narcotics for exhaustion or specific medical procedure such as vacuum extraction or cesarean surgery. Please explain the reasons for any suggested procedure.

Cesarean surgery

• Prefer regional anesthesia

• Please explain everything during surgery.

• Joe and Mary (doula) to be present.

• Prefer to have the screen lowered at the time of the birth.

• Prefer for immediate contact between my baby and Joe.

• If my baby must go to nursery, Joe goes with her; Mary stays with me.

Preferences for the Postpartum Period in the Hospital

If giving birth in a hospital, your postpartum stay will likely last one to three days. Because the length of your stay is limited, carefully plan how you’ll use the time. For example, will you want friends and relatives to visit, or will you prefer to rest and focus on your baby? Will you want help with breastfeeding or formula feeding, diapering, dressing, or bathing your baby? Before leaving the hospital, find out your options for follow-up help with feeding and baby care. See below for more information on creating a postpartum plan.

A FINAL WORD ABOUT BIRTH PLANS

You’ll need time for research and thought as you prepare your birth plan. Decisions you make in advance, when you’re calm and able to concentrate, will help guide everyone when you need to devote all your energy to coping with labor and birth. When you’ve finished writing your birth plan, you’ll have a fairly complete idea of what you can expect for your care during labor, birth, and the immediate postpartum period. By communicating your priorities and preferences for care both under normal circumstances and if complications arise, you can receive treatment that’s modified with your wishes in mind.

Your Postpartum Plan

A postpartum plan is quite different from a birth plan in that it’s designed for you, your friends, and your family to ensure that the needs of you and your baby are met in the days or weeks after the birth. You don’t need to create a formal document, as you did with your birth plan, but be sure to discuss your wishes with your partner and any friends or relatives who will be helping you after the birth.

These first weeks almost surely will be more challenging and stressful than you expected (but also more wondrous). You’ll appreciate the help from family, friends, support groups, and professionals such as lactation consultants and doulas. Your postpartum plan will ensure that everyone knows and understands your needs during this time.

DECISIONS TO MAKE FOR YOUR POSTPARTUM PERIOD

To help ease the transition into parenthood, identify your postpartum needs in advance and plan for how they’ll be met. Here are some questions to get you thinking:

• Whom will you want to see after the birth? How will you restrict visitors if you’re tired and frazzled and are trying to figure out breastfeeding?

• What resources are available to help you in the first weeks after the birth, such as classes, support groups, books, and DVDs? Visit our web site, http://www.PCNGuide.com, to download a form that helps you keep track of the resources you’ve found.

• Will your baby be breastfed or formula-fed? (See Chapter 18.) What help will you need with feeding?

• What help will you need with transportation, housework, meal preparation, shopping, and child care for older children?

• Who will help you? Your partner, relatives, friends, a postpartum doula, or a mother’s helper? (See page 26.)

• If you’re feeling overwhelmed or depressed, whom can you call? Make a list of family, friends, and counselors who can help if necessary. (See Chapter 16.)

• What equipment, supplies, and preparations will you need for your baby? (See page 160 for a list of useful baby items.)

• Will you use cloth or disposable diapers or both? Will you use a diaper service? (See page 374.)

• Will you work outside your home after the birth? If so, when will you start? Will you work part-time or full-time? Who will provide child care when you and your partner are at work? Can you and your partner share some or all child-care duties? (See page 28.)

• Will you continue to breastfeed while working? Is there a private, comfortable place at work where you can pump your breast milk? (See page 431.)

• How will your financial situation change after the birth? Plan and follow a budget, if necessary, to avoid excessive spending and ensure that you can meet expenses.

Develop your postpartum plan from the answers to these questions and from information you’ve gathered from friends and relatives with experience parenting a newborn.

YOUR POSTPARTUM RESOURCE LIST

After the birth, you’ll thank yourself many times over if you take the time now to gather the contact information of people who can help with postpartum care. Visit our web site to download a template that you can complete. Make several copies of this list for yourself and your partner. Post one on your refrigerator door, stash another in your purse, set a copy by your landline phone, and program the list into your cell phone. For help preparing your list, consult your caregiver, a postpartum doula, lactation consultant, or your childbirth or parent educator. You can also search the Internet for resources that may help.

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EQUIPMENT AND CLOTHING FOR YOUR NEWBORN

If you’ve ever browsed through a baby boutique or big-box store, you may be overwhelmed by the amount of stuff that’s advertised as necessary for proper baby care. However, the number of essentials you’ll need is modest. Use the following guide to help you acquire the necessary newborn equipment and clothing before your baby’s birth. Visit our web site, http://www.PCNGuide.com, to download a checklist of this guide.

Bed

• A safe sleep space in your bed or your room

• Bassinet, co-sleeper, crib, or hammock bed

• 2-4 sets of bed linens for the crib or bassinet

• 3-6 lightweight blankets

• 1-2 blanket sleepers for warmth

• Special swaddling blanket (optional)

• 2-4 waterproof pads for your baby’s sleep space, your lap, and diaper-changing areas

Diapers

• Ask the retailer or diaper service how many diapers to purchase or order for the diaper system you’ve chosen. (See page 374.)

• 6-8 waterproof wraps or pants for use with cloth diapers

• Changing table (optional)

• 3-6 washcloths, or diaper wipes, to clean your baby when diapering

• Diaper pail (if using cloth diapers)

• Diaper rash ointment (Ask your caregiver what to use.)

Bath

• 2-4 hooded towels or soft towels

• 6-8 baby washcloths

• Mild soap and shampoo

• Baby bathtub (optional)

• Cotton swabs for the umbilical cord

Baby clothing (Some babies are born too big for newborn-size clothing.)

• 1-2 sweaters or jackets (depending on the season)

• 4-8 undershirts or “onesies”

• 3-6 gowns or stretch suits with feet

• 2 blanket sleepers (depending on the season)

• 1-3 pairs of booties or socks

• Hats: 1 knit hat for a newborn and 1 appropriate for the season (sun hat for summer, warm hat for winter)

Travel

• Car seat

• Diaper bag

Baby equipment (These are optional, but come in handy.)

• Thermometer that’s safe and accurate for babies (see page 388)

• Dresser

• Baby carrier or sling

• Carriage or stroller

• Birth ball (inflatable exercise ball)

• Blunt-tipped nail scissors or baby nail clippers

• Massage oil

• Mobile

• Baby swing

Key Points to Remember

• Preparing a birth plan will help you and your partner learn about your caregiver, birthplace, and safe care options for normal and complicated labor and birth. Begin preparing your birth plan a few months before your due date.

• By providing a birth plan, you better ensure that everyone can understand your priorities and preferences for care.

• A complete birth plan includes practical information about you; issues, fears, or concerns you may have; and your preferences for managing labor pain, normal labor and birth, unexpected events, postpartum care, and newborn care.

• Think about what assistance and support you’ll need during the early weeks and months after the birth. Seek helpful resources for the postpartum period, and use them to prepare your postpartum plan.