The Birth Plan...

So, I've created a birth plan. For those of you who don't know what this is, it's a document that women create prior to their birth specifying their preferences for their delivery and post-partum experience. Although I support women going through the process of creating a birth plan so they can think about their options before the big day I also strongly encourage my patients to avoid creating a rigid idea of exactly how they want their birth to happen as this often results in disappointment and frustration. I think all of us who have worked on labor and delivery have had the experience of having a woman come in with a very specific birth plan that she demands be followed exactly (usually this is someone who wants to have a completely natural experience). Ironically, it seems that this sets up the woman for exactly the opposite experience - usually a complicated delivery that ends in a c-section.

In a friendly conversation with my obstetrician a few weeks ago, he jokingly said, "Just don't write up a birth plan... you know that's the kiss of death." This got me to thinking that I should create a birth plan that would top all others. Here's what it says:

Christy Seed's Birth Plan

Due Date: 02/03/2009
Patient of Dr. Tynes

Partner: Stephen Ruda

Support Person: Arwen Mohr
Scheduled to deliver at Sutter Coast Hospital

To everyone who will be involved in the birth of our precious little one,

Stephen and I are extremely excited about the birth of our son and want to have the "perfect" experience. To help ensure this, we have created a birth plan with a few requests...

LABOR

• I would prefer to avoid an enema and/or shaving of pubic hair.

• I wish to be able to move around and change position at will throughout labor and will be bringing multiple props to enable me to achieve certain positions including but not limited to:

  1. a birthing stool

  2. a large black inner tube

  3. a small table

• I would like to be able to have pizza and ice cream (Ben and Jerry's Chunky Monkey) throughout the first stage of labor and popsicles during the second stage of labor.

• I will be bringing my own music to play during labor. I find heavy metal music to be quite relaxing and will play this throughout my stay.

• I would like the environment to be kept as quiet as possible and that if talking is necessary it be done only in whispers.

• I would like the lights in the room to be kept low during my labor and will bring my own lava lamps as these have been shown to facilitate relaxation (see New England Journal of Medicine, July 2006 issue for double blinded, placebo controlled study).

• I would prefer to keep the number of vaginal exams to a minimum and would like pain medication before each exam.

• I do not want an IV unless I become dehydrated or am close to death.

• I would like to wear contact lenses or glasses at all times, regardless of whether I am conscious.

• I will also be bringing a large blow up doll that Stephen has requested that I punch when necessary instead of punching him.

MONITORING

• I do not wish to have continuous fetal monitoring.

• If monitoring is necessary, please turn the sound down completely so as to not disrupt the heavy metal music.

• I do not want an internal monitor, if one is required I will need pain medications before it is placed.

• In addition, if an internal monitor is necessary, please apply a topical anesthetic to the baby's scalp 15 minutes prior to applying the electrode.

LABOR AUGMENTATION/INDUCTION

• I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring (see above).

• I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation, jumping up and down, handstands or somersaults, etc) before pitocin is administered.

ANESTHESIA/PAIN MEDICATION

• I realize that many pain medications exist, I'll scream for them if I need them.

• Before considering an epidural, and if the situation warrants, I would like to try an injection of narcotic pain relief (Stadol or, more preferably, a combination of VERSED and ATIVAN).

CESAREAN

• Unless absolutely necessary, I would like to avoid a Cesarean. If, however, pushing becomes too difficult, please listen to me when I ask for a Cesarean.

• If my primary care provider determines that a Cesarean delivery is indicated, I would like to obtain a second opinion from another physician. I understand that there are no other obstetricians in Del Norte county, therefore, consulting the ER physician or even the local veterinarian would suffice.

• If a Cesarean delivery is indicated, I would like to be fully informed and have the physician sign a contract ensuring that I will feel nothing during the operation.

• I wish to have an epidural for anesthesia – if however I feel any pain I wish to have the above stated combination of Ativan and Versed.

• So I can view the birth, I would like to have a hole cut in the screen so that I can wear my periscope glasses to view the entire operation and delivery of the baby.

• I would like Stephen to be dressed in sterile attire so enter the surgical field to cut the cord immediately after delivery.

• If the baby is not in distress, the baby should be given to Stephen immediately after birth. If the baby is in distress, please allow Stephen to perform mouth to mouth resuscitation rather than using the ambu-bag as the ambu-bag can stimulate pressure points on the infant's face (See Journal of Pediatrics, November 2002 issue for summary article).

EPISIOTOMY

• I would prefer not to have an episiotomy, really now, who would request to have an episiotomy?

• I am hoping to protect the perineum. I am practicing ahead of time by squatting, doing Kegel exercises, and perineal massage as well as wishful thinking that a 9 ½ pound baby won't cause any tears.

• I would like to use perineal massage to help avoid the need for an episiotomy.

• I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch.

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DELIVERY

• I would like to be allowed to choose the position in which I give birth, including on the toilet. I recognize that this may be uncomfortable for my doctor but I believe that it is the most physiologic position for birth.

• I would like a mirror available so I can see the baby's head when it crowns and see the pained expressions on my own face.

• I would like the chance to touch the baby's head when it crowns (I would prefer that no one else touches his head until I am able to do so as I want to be the first person to ever touch him).

• Even if I am fully dilated, I would like to try to wait until I feel the urge to push before beginning the pushing phase.

• I would appreciate having the room lights turned low for the actual delivery, Stephen and Arwen have several dozen candles that they will be lighting prior to the delivery. (Please note that the lava lamps are to be turned off during the actual delivery – see above)

• I would appreciate having the room as quiet as possible when the baby is born – no talking.

IMMEDIATELY AFTER DELIVERY

• I would like to have Stephen and Arwen cut the cord TOGETHER (they have rehearsed this at home).

• I would prefer that the umbilical cord stop pulsating before it is cut.

• I would like to hold the baby for at least two hours before he is weighed, examined, given medications, etc.

• I plan to keep the baby near me following birth and would appreciate if the evaluation of the baby can be done with the baby in my arms.

• If the baby must be taken from me to receive medical treatment, Stephen and eight other family members will accompany the baby at all times.

• I would prefer to hold the baby rather than have him placed under heat lamps.

• I do not want a routine injection of pitocin after the delivery to aid in expelling the placenta or decrease my chance of having a huge hemorrhage and dying.

• After the birth, I would prefer to be given a few moments of privacy to urinate on my own before being catheterized.

• I would like to donate the umbilical cord blood to whomever will take it.

• I would like to see the placenta after it is delivered and have it frozen immediately for preservation.

POSTPARTUM

• I would like a private room – preferably one with a good view.

• I would like to have the baby "room in" and be with me at all times and will be bringing my own bassinet for him.

• I would like to have a professional masseuse provide me with a full body massage two times daily while I am hospitalized.

• Please allow time for my professional beauty consultant to style my hair and perform my manicure and pedicure prior to any pictures being taken.

• I have arranged for a professional caterer to bring me my post-partum meals. The menu is as follows:

  1. Breakfast:

-Bagels, Lox and Cream Cheese

-Mimosas

-Fresh fruit salad

2. Lunch:

-Fresh arugala salad with roasted pine nuts, organic pears and gorgonzola cheese under a balsamic vinaigrette dressing

-Toasted Panini withgoat cheese, basil, sundried tomato with seared artichoke dressing

-fresh roasted summer squash orzo salad

-Molten chocolate cake with hazelnut caramel sauce and fresh whipped cream

3. Dinner:

-Bruschetta with fresh tomatos and mozzerella

-Grilled fresh salmon with a lemon-herb glaze

-Scalloped potatoes with fresh rosemary and herbs

-Chocolate, mocha swirled tiramasu with a mint raspberry sauce

BREASTFEEDING

• I plan to breastfeed the baby and would like to begin nursing within minutes of his birth.

• Unless medically necessary, I do not wish to have any bottles given to the baby (except for the sacred water from the Niger river I collected when I was in Timbuktu – I will provide this to the baby).

• I do not want the baby to be given a pacifier, even if he is screaming his head off and can't be calmed by any other means.

• I would like to meet with a Lactation Consultant each time I breast feed to ensure that I am doing it properly.

CIRCUMCISION

• I do not want the baby circumcised – this is a horrible, medieval practice that only a barbarian could perform

OTHER

• I would prefer that no students, interns or residents be present during my labor or the birth.

• My primary support people are Stephen and Arwen, however I believe that birth should be a community experience and have invited the following people to be in attendance:

  1. my parents (Pam and Bill Seed)

  2. Stephen's parents (Irene and Joe Ruda)

  3. My sister (Tammy)

  4. Stephen's sisters and brothers (Janet, Paula, Lorraine, Tom, Brian, Nancy, Claire, John)

  5. Stephen's nieces and nephews (Audrey (age 9), Emily (age 7), April (age 11), Arlene, Christina, Theresa, and 7 others I can remember the names of)

  6. My friends from residency (all of whom are physicians and can help with my intrapartum management (Pramita, Katrina, Justin, Jess, Amy)

  7. The staff from UIHS and Sutter Coast Hospital (all are welcome – please allow space for their participation)

I appreciate your willingness to help me achieve the birth that I have envisioned. Please let me know if you don't believe you will be able to accommodate all of my preferences/requests.

You are also a saint if you have read this entire document and not already fired me as your patient or transferred me to a higher level of care (is there a hospital for neurotic, high-maintenance women?).

Although I had a ball creating this document (especially the gourmet meal menu) my true “birth plan” is simply: to roll with it, have a healthy baby and try to keep smiling along the way. Thank you for being a part of the fun!

Sincerely,

Christy Seed

(and Stephen too)

I managed to give it to my OB with a straight face - he initially looked a little shocked... I don't think he expected me to be the type to have an 8 page birth plan. But, his look of serious concern slowly softened into a smile and then laughter as he realized that it was all a joke! Hee, hee. Hopefully he won't feel the need to find a way to get back at me.