Guide to Create a Birth Plan

Your Guide To Giving Birth Safely

Most women experience normal, healthy pregnancies and births, however, that is not always the case. Out of all medical malpractice payouts last year, more than half of victims were women, and 23 percent of those cases were due to pregnancy and delivery complications. Whether your pregnancy is your first, second, or third, childbirth is far from simple. Arming yourself with information to prepare for delivery can help you facilitate a complication-free birth. One important tool to avoid becoming a plaintiff in a birth injury malpractice lawsuit is a birth plan.

How to Create a Birth Plan

A birth plan is a written document provided to your doctor in advance and to the hospital or birthing center when you're admitted that details your preferences and expectations for your own care and your infant's care. In this guide, you'll find questions to explore that will help you create your birth plan and links to relevant resources with more in-depth information.

What to Look for in an Ob-Gyn

What to Know:

• Are they in your insurance network?
• Do they have admitting privileges at your preferred birthing location?
• Do they agree with your preferences regarding use or avoidance of pain medications, including an epidural?
• Is the doctor a solo practitioner or in a practice with other ob-gyns? What will happen if your ob-gyn is not available at the time of your baby's birth? Do all doctors in the practice share the same birthing philosophy?
• How do you get emergency care after office hours?
• How liberal/conservative are they with medical interventions such as induced labor or vacuum extraction?
• What childbirth classes do they recommend? It's important that the class you take aligns with their style of birthing.

Resources:

1. Judy Koutsky, "Doctor Right: How to Choose an Ob-Gyn or Midwife," Parents.com
2. "What to expect from an Ob-Gyn Visit," WebMD.com
3. American Congress of Obstetricians and Gynecologists Physician Lookup
4. Lamaze International YouTube Channel
5. "The First Prenatal Appointment," WhattoExpect.com

What to Look for in a Birthing Center or Hospital

What to Know:

• Are they in your insurance network?
• What is the distance and travel time there from your home?
• Are there alternate driving routes available in case of congested traffic, roadwork, or closures? Is an anesthesiologist on call twenty-four hours a day?
• Do they have a full NICU (neonatal intensive care unit)?
• Can family, friends, or other support people be present during labor and birth?
• Are there time limits for the room?
• How many staff members will be in the room at time of birth?
• Which post-birth procedures can be done while you're holding the baby?
• Are they open to delaying post-birth procedures for up to an hour while you hold your newborn?
• Do they support rooming-in with the baby around the clock?

Procedures to Know Upon Being Admitted:

Nurses should complete a focused assessment, including, but not limited to:

• Fetal heart rate
• Amniotic fluid
• Maternal vital signs
• Contractions
• Progress of labor
• If impending birth is evident, the assessment will be shortened and other information will be collected after birth.

Questions they should be asking you:

• Name and names of support person(s)
• Name of your physician or midwife
• Number of pregnancies and prior births, and if those births were vaginal or c-section
• Status of membranes
• Expected due date
• Any problems during this or other pregnancies
• Allergies to medications, foods, or other substances
• Time and type of last meal
• They should take note of any pain you are experiencing, including the location, intensity, duration, whether constant or intermittent.

Consent Forms to be signed:

• Anesthesia
• Vaginal birth and/or c-section
• Blood transfusion
• HIV Test
• Tubal
• Consent for newborn care
• Circumcision of male

What should be monitored in Mother post-birth:

• Observing for hemorrhage
• Vital signs
• Funds
• Bladder
• Lochia
• Perineal and labial areas

Procedures list source: Foundations of Maternal-Newborn and Women's Health Nursing by Sharon Smith Murray, Emily Slone McKinney Before you, your partner, or your newborn leave the delivery room, all of you must receive matching labels displaying your name and other identification details. After you verify that the information is correct, you and your partner will be given wristbands with labels and the baby will receive an ankle bracelet with an identical label. That label should be checked to see that it matches yours every time the child enters or leaves your room in the hospital. Nurses will also administer antibiotic or antiseptic eye drops or ointment to your baby to prevent eye infections from bacterial exposure in the birth canal. This will either be done immediately after delivery or later in the nursery.

Resources:

1. American Association of Birth Centers, Find a Birth Center Near You
2. ACNMWEB, "Midwives in Hospitals: A Great Choice for Childbirth," YouTube video
3. "Choosing a Birth Setting: Questions to Ask When Touring a Birth Center," Childbirth Connection
4. "Choosing the Right Hospital for Your Delivery," FamilyEducation.com
5. "Delivery Room Procedures Following a Normal Vaginal Birth," HealthyChildren.org

What should be communicated prior to, during and after birth?

Unfortunately, one-third of all medical malpractice claims involve communication failures. Just as in any other relationship, communication is key between you and your care provider. Making sure you are on the same page and that you completely understand everything they are telling you are the most important steps in establishing trust and ensuring you know exactly what to expect going in on birthing day. Create a written birth plan and go over it with your care provider prior to your due date (see the first item in the Resources section below for a printable plan template). This makes your wishes explicit and also provides a reference that can speak for you if you're not in a clear state of mind to answer questions.

What to Know:

• If birth occurs so quickly that an ob-gyn from your practice is not available, who will cover?
• What is the best way to communicate the wishes in my birth plan to the hospital or birthing center?
• Your health history, and related birth risks
• Backup plans-will you need one in the event of unexpected complications?
• Under what circumstances might induced labor be recommended?
• At what point might an episiotomy be suggested?

Resources:

1. "Tool: Birth Plan," thebump.com
2. Labor and Birth Glossary, American Pregnancy Association website
3. "Stages of Labor: How Your Baby is Born," About Health
4. "What to do during a traumatic labor and birth to reduce the likelihood of later Post-Traumatic Stress Disorder," Prevention and Treatment of Traumatic Childbirth website
5. "Tips & Tools: Labor Pain," Childbirth Connection website
6. "10 things your OB-GYN May Not Tell You," LifeScript.com
7. "What to ask your OB/GYNn at your 6-week appointment after birth," TapGenes.com
8. "Episiotomy: When it's needed, when it's not," Mayo Clinic website
9. "6 Simple Steps for a Healthy & Safe Birth," Lamaze International website