Archive for the ‘Birth plan’ Category

Scavenger Hunt Contest

Monday, December 3rd, 2012

Preparing for Birth is having an online scavenger hunt to ring in December.

 

You could win this cute pocket diaper.

 

Here is the scavenger hunt:

Answer:

1)      How many births has Desirre Andrews attended?

2)      Name a doula that is working through Preparing For Birth?

3)      How many on average gel capped pills can be made from a placenta?

4)      What breast pump brand does Preparing for Birth have for sale?

 

Answer these and provide a link to the source:  

5)      What is the most common risk of induction?

6)      What is an evidence based reason for induction?

7)      What is the Bishop Score used for?

8)      What are Daniel Berwick’s three principals of patient centered care?

 

Find:

9)      A picture of a child nursing in a funny position.

10)   A picture of artwork that’s at least 100 years old depicting a woman in labor.

 

Bonus Questions:

1)      What is your favorite pregnancy or childbirth related blog?

2)      What is your favorite pregnancy or childbirth related book?

Send your entry to nichole@prepforbirth.com by 9pm Wednesday December 5th.

The winner will be announced Thursday, December 6, 2012, and must be able to pick up the prize in person. Everyone who enters will get a coupon for a free birth or postpartum plan session with one of the doulas from Preparing For Birth.

F.E.A.R.

Thursday, August 30th, 2012

I have been thinking on the F.E.A.R. (False Evidence Appearing Real) acronym.  What else can it mean? Fear itself can be a positive or a negative. Fear can be a stumbling block or a motivator.

I enjoy coming up with affirmations and words that alter the view especially as it relates to pregnancy, childbirth and postpartum. I have been and know so many who have fear thrust upon them by friends, provider, family, strangers or have deep fear from previous experiences or from the unknown lurking ahead.

Take my words, come up with others and make your own acronyms to work with the FEAR surrounding you, inside you and take away its power.

 

F                      E                     A                     R

Feeling, Freedom, Fix, Fire, Fierce, Forge, Find, Fortitude, Frame, Fight, Force, Free, Forever, Forgive, Feel, Fearless

Everything, Exist, Eradicate, Excite, Envelop, Empowered, Encourage, Enhance, Expectation, Effort, Exquisite, Endearing, Encourage, Enhance, Effort, Expectation, Exquisite, Equal, Excel, Expert, Ease, Engage

Admit, And, Am, Advocate, Amplify, Armed, Above, Answer, Awareness, Act, Assist, Attitude, Ally, Appear, Admire, Ask, Alter, Apprehension, Action, Alive

Rest, Respect, Rise, Release, Rage, Rights, Ready, Resonate, Relief, Repair, Rely, Resist, Rejoice, Roar, Risk, Release, Re-frame, Rephrase, Remain

 

Please share additional words you come up with!

Social Media and You

Sunday, October 16th, 2011

Get your pregnancy, birth or postpartum story heard!

I am looking to interview several mothers/families who have been positively changed, supported or impacted emotionally, physically, socially, educationally and/or spiritually during the perinatal (pregnancy, labor, childbirth, postpartum) and/or into the first year of mothering/processing birth outcomes through the use of/participation in social media outlets (Twitter, Facebook, Google+, Forums, Message Boards, etc.).

Purpose: Information will be used to complete a speaking session about birth and social media, as well as, material for additional writing, educational sharing opportunities.

If you are interested, please email me by October 31, 2011 with your contact information, when due if pregnant, how old your baby is if in the postpartum period and how you were affected by social media.

Contact: Desirre Andrews – Owner of Preparing For Birth LLC, birth professional, blogger, mentor, healthy birth advocate and social media enthusiast. Site: www.prepforbirth.com

Email: desirre@prepforbirth.com

Writing Your Own Birth “Plan”

Sunday, October 16th, 2011

A birth plan has more than one purpose. It begins as a value clarification exercise, then becomes a communication tool with your care provider and ultimately a guide of needs and desires during labor, delivery and postpartum. Even if your birth location does not ask for birth plans, it is a good idea to write one for your own benefit.

Step 1

Clarifying your needs, wants and desires. Here are the  Birth Menu of Options and Assessing Your Feelings we use in class  to begin the value clarification process.  The birth menu is most helpful when you begin by crossing out what you are not interested in, highlighting the items you know you want and circling what you need to research. The AYF worksheet is for you and your husband/partner/non-doula labor support person to go over together to ensure you are on the same page and open up conversation. Doing this prior to 35 weeks of pregnancy gives you more time to coordinate with your care provider or birth location. If you have a doula or are taking a childbirth class, she/he can help you in this part of the process as well.

Step 2

Write down in order of labor, delivery, immediate postpartum and in case of cesarean needs and desires. Your plan really needs to be within one typed page for easy reading and digesting by care provider and staff. The only items that must be listed are care options that are outside of usual practices, protocols or standing orders. Here is the Sample Low Intervention Birth Plan we use to help you see a finished format and types of pertinent information that may be necessary to list.

Step 3

Take your written plan into your care provider. This is a conversation starter, a beginning, a partnering tool. As I encouraged above, early to mid 3rd trimester gives you more flexibility in communicating with your provider and setting your plan in motion. It also gives you opportunity to change providers or birth location if you cannot reach a comfortable agreement.

Step 4

Make any changes.Finalize.  Print out final copy.  Give one to care provider, have one in your bag for labor and birth, give one to doula (if you hired one). Though this is not a binding or legal agreement it can go a long way toward the type of care and birth you want.

Step 5

Gestate peacefully until labor begins!

Low Intervention Birth Plan

Sunday, October 9th, 2011

A birth plan has a few real purposes. It can act as a values clarification exercise for you and your partner. Then it is a vehicle to open communication with your care provider about your needs, desires, wants for labor, birth and postpartum.  What you want and need matters.

 A brief one page plan with an opening paragraph with bullet point information specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

I advise you take the written birth plan to a prenatal visit at least a month prior to your given estimated due date. This gives time for conversation, to have a clear understanding of expectation and agreement.

If it becomes apparent that you and your provider are not on the same page, you then have time to seek out another provider that fits you and you fit with.

Remember it is not a legal document that your location of delivery or care provider must adhere to.

=======================================================

Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

I am planning on a no to low-intervention labor and delivery.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

  • I plan on wearing my own clothing. I will ask for a gown if I change my mind.
  • I would like a saline lock in lieu of a running IV.
  • Limited vaginal exams after initial assessment.
  • In the event an induction and/or augmentation is medically necessitated-
    • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
    • Pitocin – A very gentle and slowly administered dosage increase.
    • AROM – will only consent to if an internal fetal monitor is a must.
  • Spontaneous pushing and delivery in any position I am most comfortable with.
  • External pressure and/or compresses instead of any perineal or vaginal stretching.
  • No cord traction or aggressive placental detachment, including deep uterine massage.
  • Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance while still attached to me).

Postpartum and Baby Care

  • Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
  • Delayed bathing
  • Delaying vaccinations including eye ointment and vitamin k.
  • Exclusive breastfeeding, no pacifiers, sugar water, or formula. I will hand express if necessary. I will hand express if needed to syringe feed my baby.
  • No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

  • Only essential conversation related to the surgery and delivery
  • Lower sterile drape or have a mirror present so I may see my baby emerge
  • Only one arm strapped down so I may touch my baby
  • Pictures
  • Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
  • Baby to stay with me continuously in OR and recovery
  • If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
  • Breastfeed in OR and/or recovery
  • Delayed immunizations
  • Delayed washing and dressing of baby
  • No separation from me except what is absolutely medically necessary
  • I am willing to hand express if baby cannot get to breast right away.

This “plan” may be copied, pasted and edited  for use by others.

A Guide to Finding Your Doula

Tuesday, August 2nd, 2011

Building a labor support team is part of conscious preparation during pregnancy for your labor,  birth and life with the very newborn. Hiring a labor doula continues to gain in popularity for the expecting family. Your doula comes alongside you in pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula is a great addition.

Step 1: Finding a Doula

  • Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle, Cloth Diaper store), childbirth educators, care providers, prenatal massage therapists, prenatal exercise instructors, lactation experts and chiropractors for referrals.
  • Use your favorite search engine and type in your city or area name with the keyword doula
  • Search training and certifying organizations such as CAPPA, DONA, ICEA ToLabor , Birth Works and Birth Arts International
  • Search general doula sites such as All Doulas, Doulas.com, About.com, Doula Match or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is  to make contact. You will likely find that most doulas are women though occasionally you will find a male doula in your area.  After visiting any websites; phone or email only the doulas that most interest you and fit your particular needs.  Generally there is not much need to contact more than three perspective doulas.

During your initial phone conversation or in your email be sure to include:

  • Full name
  • Contact information
  • Estimated Due Date
  • General location where you live
  • Care Provider
  • Birth Location
  • Top needs and desires for birth
  • If referred, by whom
  • Any financial considerations

Step 3:  Setting up the Interview

I encourage after the phone or email contact and response, set-up in-person interviews with the doulas you found most compatible with you.

  • Unless the doula you are meeting has her own office, interviews are usually held in a public place such as a coffee house, restaurant, library, park, or shopping center. If you meet at a place where beverages or food will be ordered you can offer to pick up the tab for everyone if you desire, but it is never expected.
  • Your partner, husband or other support who will be attending the birth needs to be at in-person interview if at all possible.
  • Expect the interview to be approximately an hour and to be free of charge.

Step 4: The Interview

The interview is to gain more detailed information from the doula, as well as, share more  about yourself and what you want.  It is customary for the doula to either email ahead of time her client packet or bring it with her to the interview. It may include her professional profile, client agreement, services, and support details, as well as, additional offerings.

Suggested Interview Questions:

  • Why are you a doula?
  • What is your philosophy of childbirth?
  • Where did you get your training?
  • Are you certified? Why or why not?
  • How long have you been a doula?
  • What is your scope of practice?
  • What types of births have you participated in?
  • What types of birth locations have you been to?
  • How many births per month on average do you attend?
  • How many clients would max you out in a month?
  • Have you ever missed a birth? Please explain why.
  • Do you specialize in working with a specific type of clientele or birth plan?
  • What has been the most challenging birth you have attended? Why?
  • How do you work with my husband/partner/other support?
  • Have you worked with my provider before? If yes, please describe the experience.
  • How many prenatal visits would there be?
  • In general, what is covered in the prenatal visits?
  • Will you help me make a birth plan?
  • Please explain how your fee is structured.
  • Do you accept barter?
  • Do you have a back-up and do I meet her ahead of time?
  • When do you go on-call?
  • Do you labor at home with me?
  • What do you do if I am induced or need to schedule a cesarean?
  • When will you see me postpartum and what does it include?
  • What are your expectations of me as a client?
  • How long do I have to decide before you would contract with someone else around my EDD?

Of course that is a fairly long list of overview questions. Brainstorm some of your own. The interview is not meant to be a free prenatal visit, it is simply to find out if you and the doula are a fit personality wise and in how she practices.  Most doulas do not expect to be hired on the spot. You  need time to think and process after each interview. If a doula is pressuring you to hire on the spot because she fills so quickly, that could be a red flag and cause for you to take a pause.

Step 5: Hiring the Doula

Within 1-2 weeks,  contact the doula you would like to hire and proceed and those you did not choose to let them know you have hired someone else so they will not be holding your EDD space open any longer.

Details to be clear about when initially hiring your doula:

  • Sign and return the agreement/contract she gave you at the interview (if applicable).
  • Return any intake paperwork by mail or email.
  • Payment  – First portion of fee is usually paid upon hiring a doula.
  • Ask her usual business hours and contact preference for non-emergencies or labor related needs.
  • Let her know your contact preferences and all phone numbers to reach you and your spouse/partner or other support.
  • Set the date and time for the first prenatal appointment. Give her directions if your home is not easy to find.
  • Get clarity on what routine contact she would like from you (updates after care provider appointments, etc.)

Happy doula-ing!

Picking Your Care Provider – Interview Questions

Thursday, July 28th, 2011

Being an active participant in your pregnancy and birth journey begins with choosing your provider. You can begin the search for the right provider fit prior to becoming pregnant, in early pregnancy or anytime before your baby is born. So much of how your pregnancy and birth unfold are directly related to your care provider so this is really a key element. Every provider is not the right fit for every mother and vice verse. If you already have an established provider relationship, these questions can be used as a re-interview tool.

When asking these questions, take care to really listen to the answers. If a provider will not meet with you prior to you becoming a patient, that can be a red flag.

______________________________________________________________________

Begin by expressing your overall idea of what your best pregnancy, labor and birth looks like to provider.

  • What are your core beliefs, training, experience surrounding pregnancy and birth?
  • Why did you choose this line of work?
  • What sets you apart from other maternity providers?
  • How can you help me attain my vision for pregnancy, labor and birth?
  • If I have a question, will you answer over the phone, by email or other avenue outside of prenatal appointments?
  • How much time will you spend with me during each appointment?
  • What routine tests are utilized during pregnancy? What if I decline these tests?
  • What is the average birth experience of first time mothers in your practice?
  • How do you approach the due date? What do you consider full term and when would I be considered overdue?
  • What are your patient intervention rates? (IV, AROM, continuous monitoring, episiotomy, etc.) Cesarean rate? VBAC rate? Induction rate? What induction methods are used? When are forceps/vacuum used? These numbers are tracked.
  • What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than reclined or McRoberts positions?
  • How do you feel about me having a birth plan?
  • What if I hire a doula? Do you have an interest in who I work with or restrictions? If yes, why?
  • Do you have an opinion on the type of childbirth or breastfeeding class I take? If so, what and why?
  • Are you part of on call rotation or do you attend your own  overall? Will the back-up or on-call CP honor the requests we have agreed on?
  • Are there any protocols that are non-negotiable? If you cannot refuse – you are not consenting.
  • What if I choose to decline a recommended procedure or intervention in labor or post birth, how will that be viewed?
  • When will I see you during labor?
  • What postpartum care or support do you offer?
  • Will I be able to get questions answered or be seen before the 6 week postpartum visit?

Points to ponder afterward:

  • Did you feel immediately comfortable and respected at the interview? If already with a CP, do you feel comfortable, respected and heard at each appointment?
  • Were there red flags or white flags?
  • Was or is care provider willing to answer questions in detail without being annoyed?
  • Is choosing your care provider based on your insurance or lack of insurance?
  • What are you willing to do in order to have the birth you really desire? Birth location?
  • How much responsibility are you willing to take for the health care decisions for you and your baby?

A Cesarean Plan

Wednesday, July 6th, 2011

Cesarean is often the last thing we want to think about during pregnancy. Most of us think it will not happen to us. Having a plan, an idea of what to ask for, to know there are ways to bridge the gap between Plan A and Plan C can be very beneficial to both mother and baby.

There is no way to make a cesarean just like a healthy vaginal birth, and frankly, that ought not be the goal. It can be however a much more family centered, family bonded, more respectful and humane experience.

Speak to your provider ahead of time about needs and desires. If you know you are having a cesarean ahead of time, meeting with the Nurse Manager and the anesthesiology department can be useful in obtaining what you want. Have the conversations, create partnerships.

Below is my latest version of a family centered cesarean plan  that can be used for a planned or unplanned cesarean delivery. All requests may not be feasible in all areas, but even small changes can be helpful.

It may be copied and pasted into your own document for personalization, however I do ask that you credit the source if you are an educator, doula or related professional using it as a sample.

——————————————————————————————————————————-

Name: Jane Doe

Estimated Due Date: January 1, 20XX

Care Provider: XXXXXX

We are seeking to make a cesarean delivery as special, low stress and family centered as possible.In the event a true emergency and general anesthesia is needed, I understand that some of my requests cannot be honored.

JUST PRIOR TO/DURING DELIVERY / RECOVERY –

  • I would like to meet each staff member in the OR by name who will be participating in the cesarean.
  • I may ask my _________ for aromatherapy to help with nausea, surgical smells and stress.
  • I ask that only essential conversation be allowed.
  • I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
  • I would like my ______________ to take photos and/or video of the birth of my baby.  I respect that the surgeon and anesthesiologist may not want the entire surgery on video, however I would like a record of my baby being born to make it as special and personal as possible.
  • Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
  • Please lower the drape so I may view my baby coming out of me and hold my baby up so I can see him/her at the moment of birth.
  • Request my arms not be strapped down so I may touch my baby freely.
  • I would like my baby to remain connected to the placenta after manual extraction, as the cord will continue to pulsate for some time. I would like my ___________ to cut the cord after 10 minutes post delivery or the cord has stopped pulsating near the umbilicus.
  • I would like my baby placed skin to skin on my chest immediately with basic assessments being done while on me. My husband (partner/family member can hold baby there with a warm blanket over my baby and help maintain the sterile field.
  • I would like to breastfeed in the OR or as soon as possible in recovery.
  • I would like for my ________________ and baby to stay in the OR with me while surgery is completed and remain in recovery with me.
  • If the baby needs medical assistance requiring leaving the OR, I’d like for another person (doula, friend or family member) to attend me in the OR while my ___________________ goes with the baby, so my baby nor I will have to be alone.
  • In the event baby needs to leave the OR, I would like the wipe down towel(s) to be placed against my chest skin and baby to be pressed on me for fluid and odor transfer.
  • Asking for a delay in eye ointment and Vitamin K until after the first hour of bonding time or I am waiving all immunizations and eye ointment.
  • In the event of a hysterectomy, please do not remove my ovaries or anything else that is not medically necessary

REGARDING BABY

  • In the event the baby requires medical attention beyond that of a healthy baby, please inform me (husband/partner/family member) verbally what is needed or will be needed so I can actively participate in choices made for my baby’s care.
  • In the event of  a need for separation of my baby from me:
    • Limit the number of persons who touch or attend my baby to only those on staff as needed and my _____________.
    • Request my baby not be bathed or fully dressed until I have the opportunity to smell, touch, cuddle, etc. with my baby and I am able to participate in the bathing.
    • I plan to breastfeed exclusively, so no pacifier, formula, sugar water should be given to my baby.
  • No tests shall be performed or medications administered, etc. without my ________________ consent & prior knowledge

Thank you for honoring my requests for me and my baby.

Preparing For Birth, LLC

All Rights Reserved 2011

Know Your Score – Before an Induction

Wednesday, March 23rd, 2011

Knowing your Bishop’s score prior to agreeing to an induction when not medically necessary or setting the stage for a medically necessary induction can make a great difference in expectations, additional interventions and understanding for the process as a whole.  Knowing your score can help you determine the type of induction or whether or not to be induced at all.
Your score is based on a vaginal exam that takes into consideration the areas listed in the chart below.


Dilation, Effacement, Consistency and Position all have to do with your cervix. Station is telling where the presenting part of baby is in relation to the ischial spines. (sitz bones).

Are you a good candidate for induction based on your score? Do you need a ripener? Are you a VBAC mother?  What other factors are working in your favor or against success?
Induction is not an easy or guaranteed process. You can see the criteria toward success is telling even without discussing the additional risks leading to additional interventions, medications and/or cesarean.

Additional links and information on induction can be found in this previous post http://prepforbirth.com/2009/08/12/preparing-for-labor-induction/.

Birth Plan Sample

Monday, February 28th, 2011

A birth plan is designed to facilitate communication between you and your provider, especially necessary if you are  birthing outside the home environment.  Secondly, it is to offer information on the individualized care you as the mother would like during labor, birth and immediately postpartum for you and your baby.

It should be brief (no more than one page) and only have the bullet point information that is specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

It is important to take a written birth plan to a prenatal visit at least a month prior to your given estimated due date in order to have a clear understanding of expectation and agreement. If it becomes apparent that you and your provider are not on the same page, this gives can give time to seek out another provider that fits you and you fit with. Remember it is not a legal document that your location of delivery or care provider must adhere to.

 =======================================================

Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

 

Labor

I am planning on a no to low-intervention natural birth.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

  • I plan on wearing my own clothing. I will ask for a gown if I change my mind.
  • I would like a saline lock in lieu of a running IV.
  • Limited vaginal exams after initial assessment.
  • In the event an induction and/or augmentation is medically necessitated-
    • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
    • Pitocin – A very gentle and slowly administered dosage increase.
    • AROM – will only consent to if an internal fetal monitor is a must.
  • Spontaneous pushing and delivery in any position I am most comfortable with.
  • No cord traction or aggressive placental detachment, including deep uterine massage.
  • Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance while still attached to me).

Postpartum and Baby Care

  • Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
  • Delayed bathing
  • Delaying vaccinations including eye ointment and vitamin k.
  • Exclusive breastfeeding, no pacifiers, sugar water, or formula. I will hand express if necessary.
  • No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

  • Only essential conversation related to the surgery and delivery
  • Lower sterile drape or have a mirror present so I may see my baby emerge
  • Only one arm strapped down so I may touch my baby
  • Pictures
  • Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
  • Baby to stay with me continuously in OR and recovery
  • If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
  • Breastfeed in OR and/or recovery
  • Delayed immunizations
  • Delayed washing and dressing of baby
  • No separation from me except what is absolutely medically necessary

This “plan” may be copied, pasted and edited  for use by others.