Marjorie Greenfield—

I have written a lot on birth plans–the pros and the cons of putting one together, how to write one that will be helpful for you, and what factors to think about when you write one. So I was particularly interested to see the personal birthplan from one of our labor and delivery nurses posted (with her permission) on the bulletin board at work. I got Jenn’s permission to share it here because it is an example of a birthplan written by someone who really knows the ins and outs of the birth process AND who had exactly the labor she wished for–arriving at the hospital 7 centimeters dilated and proceeding with a totally natural unmedicated joyous birth.

NOTE: Please don’t be offended when you read this –you have to understand that she wrote it while she was home in early labor as a letter to her friends who would be caring for her. I tried to clarify some of her insider’s terms with [brackets]

Jenn’s Birth Plan

Continuous IV or IV heplock:  For the love of God, just put one in.  I will not whine about it.  Draw all the blood you need or want. Fetal Monitoring:  Make sure the baby [heart rate] is reactive.  If I wish to ambulate, go ahead and use portable monitors.  I will stay close to my room (or wheelchair alcove) so I don’t go out of range and you have to hunt me down like a lost puppy.  If you’re good with only intermittent monitoring, so am I.  Any whopping decels, put in internals [fetal heart rate monitor]-just let me know ahead of time.  If you plan on putting in one internal monitor, just put them both [heart rate and contraction pressure] in.  This will be easier on us all. AROM [assisted rupture of membranes]:  If I need it, do it.  Please have lots and lots of bed pads.  I will change them as I need to because I know it can get nasty quickly.  I would love a stack of big peri pads and mesh underwear to change often if I wish to ambulate.  I don’t want that junk dribbling down my legs. Augmentation [making labor stronger]:  I’m up for it if I don’t make ANY change over 2 hours.  I would prefer AROM first if I haven’t already ruptured.  If that doesn’t work, nipple stimulation would be great.  Just give them a tug every once in a while.  Just kidding.  No man-handling of the boobs.  Pitocin is just fine.  Give my body a good fighting chance first, though. Exams:  Check me as often as you think is necessary.  Or less often if that’s better.  Whatever you want to do. Foley vs. Straight cath [to empty bladder]:  If I have an epidural and need to be cathed, please just put a foley [indwelling catheter] in.  It saves me a little bit of dignity, and it’s easier on you.  Obviously, if I’m being cathed right before delivery, straight cath is just fine. Pain relief:  Trying to go NCB [natural childbirth], but I realize that I’m a wimp.  I would like to ambulate, get in the shower, and sit on the birthing ball.  Please sterilize the ball first.  No way would I ever request getting in the tub.  If I ask for nubain, give me nubain and phenergan.  I want it all AND the maximum dosage.  Just give it slowly so you don’t burn a hole in my vein.  That would not be appreciated.  If I eventually ask for an epidural (or straight off the elevator) try to convince me that I don’t need it.  If I give you the evil eye, just call anesthesia.  I don’t care who places it, just make sure they do it quickly. Students:  I’ll get back to you on this one. Residents:  If I like you, feel free to join the party.  Depending how much pain I’m in, I will be very blunt if I don’t want you in the room.  If I haven’t met you before (or have had only limited contact with you), introduce yourself and try to win me over. CNMs [nurse-midwives]:  You guys are the best with people going NCB (sorry everyone else, this is just my point of view), if you have time, I would love your assistance and guidance.  If you don’t have time, do not feel obligated to stay with me.  I know you can get very busy in a hurry.  By the way, any CNM will do, you’re all great in my book. Attendings:  Please just tell me your opinions and thoughts in front of me.  If you think I need something, let me know instead of keeping me in the dark.  I’m a big girl, I can handle it. Vaginal Delivery vs. C/Section:  Vag delivery is the goal.  Unassisted would be great.  If I have an epidural and am not feeling the urge to push, let me labor down until I feel something.  I would rather not push for hours upon hours, but I do understand that we can’t wait forever either.  If I push for a long time, I’ll let you know if I’m up for vacuum, forceps (if the head’s low enough), or c/section.  I would prefer forceps first, but I understand some people are not comfortable using them.  Vacuum would be the second choice, and I have brought a Dyson from home to assist (they never lose suction).  Obviously, c/section is bottom of the barrel.  Of course, if baby is breech, in distress, if I fail to progress or descend, I understand c/section is the only way to go.  Be gentle, make sure I’m nice and numb, and be careful not to nick anything important.  That’s all I ask.  No staples.  I think they are the lazy way out of a c/section. Episiotomy:  Don’t really want one.  If you think my butt’s going to split open if I don’t have one, by all means, cut away.  If there’s enough time before hand and I’m still going NCB, do me a favor and numb the area first. Enemas and shaving of the pubic region:  I understand that we don’t do these, but every birth plan still includes them, so I didn’t want to deviate from everyone else.  No enema.  If I poop, I poop.  I’m sorry.  I know it’s disgusting.  I’ll try my best not to do it.  If I do, just try to wipe it away without gagging in front of me, and keep some spray handy so I don’t stink up the entire floor.  That would be so embarrassing.  Shaving.  I think I’ve done a fairly good job staying trimmed up.  Don’t tell me if I’ve missed a spot or that I have the most bumps you’ve ever seen.  It’s hard to see what’s going on down there, so be happy that I tried at all.  If you’ve ever given birth, you know what I’m talking about. Once the baby is out:  Hold the crotch area up so that Chris (my husband) can announce the sex.  Don’t laugh if he fumbles or get’s it wrong.  If the kid looks good and doesn’t have any mec [meconium], I would like it up on my chest for exactly 12 minutes.  I’m just kidding.  I just want it long enough to see what it actually looks like.  I do not expect the baby nurse to do the entire assessment while the kid is latched onto the boob.  I would like my husband to cut the cord.  You do not have to wait until the cord stops pulsating.  I couldn’t care less about this.  If the kid looks crappy, feel free to cut away and send it over to the warmer.  Once there, if Chris is able to at least trim the cord, we’d be cool with that.   Cord blood donation:  I would like to do public donation if I deliver when the cord blood donation people are in house.  They don’t even have to ask, just take it. Video Recording:  Not an issue, we’re not even bringing the camcorder. Vitamin K and erythromycin:  Give it. Breastfeeding:  I’m going to give it a go.  This is the only thing that I REALLY want to accomplish.  Please give me any words of wisdom and encouragement that you have.   Circumcision:  If the baby is a boy, whack away.  Just make it tidy.  I don’t want a son with a botched penis.  I would never forgive myself. Visitors:  The only person I want in the room (besides all of those caring for me) is my husband.  If family comes up to the floor, you have my blessing to send them away.  They have been informed of this, and they are well aware that I may be in labor for a long time.  When they need an update, Chris will give them an update.  If I change my mind and want additional people in the room, Chris will let them know.  You should not feel obligated to keep track of them.  Let me know if they get annoying so that I can yell at them after I deliver.   Eating:  If I want to sneak a little bit of food, I will.  I just won’t tell you about it.  Don’t hate me.  If anything else comes up that is not touched upon here, just ask.  We just want a healthy baby and healthy, happy mom.  I can’t wait for everyone to meet this munchkin.  You’ve been looking forward to this as much as we have.  I love you all and make sure everyone gets the chance to send around this birth plan.  It may be the only one that makes sense to us.

Marjorie Greenfield, M.D., is a practicing, board-certified obstetrician-gynecologist, a fellow of the American College of Obstetrics and Gynecology, and associate professor of reproductive biology at Case Western Reserve University School of Medicine. Dr. Greenfield has written hundreds of articles for the Web and currently blogs about pregnancy for Yahoo.com.

Further Reading: