Going Into It With a Plan

Here is a copy of the Birth Preferences I submitted to my doctor for her 4 minutes of overview. She shot down my ability to eat or move freely. Not that I'll be ordering pizza or running sprints, but c'mon.

Birth Preferences
Hobbyhorse
Due Date: December 1, 2007
Patient of Dr. Lady Whosa / BlanketyBlank Hospital Center
November 3, 2007

Dear Doctors and Staff of BlanketyBlank Hospital,
Partner and I are looking forward to sharing our birth experience with you. At the recommendation of many, we have chosen BlanketyBlank Hospital for its outstanding facilities and reputation. We're glad to have Doctor Whosa and the Women & Children's Health team assisting us throughout this joyous occasion. Our goal in this birth is to fully experience all aspects, free from interventions, pain medication or anxiety-producing time constraints. While we would love your help in making our daughter's entry into the world a beautiful, natural experience, we realize that every birth is different. Rest assured that your expertise will be trusted in the unlikely event of complications. It's very important to us to be informed of any procedures in advance- including risks, benefits and necessity- and to be allowed the chance to carefully consider and give informed consent. In our desire to have the happiest and most memorable birth possible, Partner and I have outlined some of our preferences below. We would appreciate you reviewing this plan, and would be glad to do so with you. This is not intended to be a list of dictated demands, but is written in a concise manner for time and ease. Please feel free to ask if you have any questions or concerns. We really appreciate your help! Thank you!

Please Note
My bloodtype is Rh- (Rhesus Negative), and I was given Rh immune globulin at 28 weeks.
I would like to wear contact lenses or glasses at all times when conscious.

Labor
I expect that doctors and hospital staff will discuss all procedures with me before they are performed.
I would prefer to sustain my energy by eating lightly throughout labor, if desired.
I would like to remain hydrated by drinking moderate amounts of fluids (water, juice, ice chips).
I would prefer not to be catheterized at any time.
Please do not administer an IV or heparin lock unless there is a clear medical indication that such is necessary.
*Testing positive for Group B Streptococci (and hospital policy) indicates that an IV will be inevitable. I understand that antibiotics are only effective when administered during labor, because of the rapid re-colonization rate of the bacteria. I would like to politely request that, given my apprehension toward intravenous activity, rise in maternal heart rate not be considered an indication of fetal distress.
*As part of the 25% of pregnant women who are carriers of GBS, and given my history and otherwise healthy condition, I would like to politely request that doctors and staff not consider the presence of Group B Streptococci (and resulting bladder infection) an anomaly indicating high-risk pregnancy. 
As long as our baby is doing well, I prefer that fetal heart tones be monitored intermittently with an external monitor or doppler, even if the membranes have ruptured.
To preserve my privacy and dignity, I would prefer that everyone knock before entering.

Labor Augmentation/Induction
I would like to avoid induction unless it is absolutely medically necessary.
*Induced labor tends to be more intense and painful, often leading to the increased use of pain-relieving pharmaceuticals, which for me, would cause undue anxiety, slow the progression of labor, and eliminate my body's ability to measure its signals and react accordingly. An increased likelihood of cesarean section delivery has also been associated with induction, and for these reasons, I would prefer that as long as the baby and I are healthy, induction prior to 42 weeks not be considered.
It would be best for me to have as few, and as gentle as possible, vaginal exams, to avoid premature rupture of membranes, especially given the presence of potentially harmful bacteria in my body.
Please do not rupture my membranes artificially unless medically indicated.

Anesthesia/Pain Medication
Please do not offer anesthesia/analgesia unless I ask for it.
If I ask for pain relief, please feel free to offer nonmedical choices for coping and/or remind me how close I am to the birth.

Delivery
I would like the freedom to push and deliver in any position I like.
I would like to have a mirror available and adjusted so I can see our baby's head crowning.

Cesarean Section Delivery
I feel very strongly that I would like to avoid a cesarean delivery.
I would like to try methods other than induction &/or surgery to increase the likelihood of a successful vaginal delivery if breech presentation is discovered, such as external version or, if the discovery is made early enough, waiting for the baby to turn on her own.
In the event that a cesarean must be performed, we would like:
*hands to remain unrestrained
*low, transverse uterine and abdominal incisions
*to discuss the choice of anesthesia and post-operative pain relief
*the option to view the birth
*to have the baby stay in the room
*24-hour visitation for Partner

Perineal Care
I prefer not to have an episiotomy unless it is medically indicated (i.e., our baby's life is at risk).
I would rather tear than have an episiotomy.
Please administer local anesthesia when repairing any episiotomy or tear(s).
Please suture tears only if necessary, and with my consent.

Immediately after the birth
Please place our baby on my stomach/chest immediately after delivery.
I would like to breastfeed our baby immediately.
Partner would like the option to cut the cord.
Please allow the umbilical cord to stop pulsating before it is cut.
I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.
Please show me the placenta after it is delivered.

Newborn Care
I would like to hold our baby through delivery of the placenta and any repair procedures.
If possible, please evaluate our baby on my abdomen.
Please delay eye medication for our baby until we are well past the initial bonding period (at least an hour after the birth).
Please do not give our baby supplements (including formula, glucose, or plain water) without my consent, unless there is an urgent medical necessity.
Please do not give our baby a pacifier.

Postpartum Care
I would like permission for access to my chart and our baby's chart if desired.
I would like to meet with the staff lactation consultant.

Thank you for your assistance, kindness, and support in welcoming our baby girl into the world!
Sincerely,


________________________ ______________________
Hobbyhorse and Signif. Other

______________________
Lady Whosa, MD


Please make this plan a part of my office records and preregistration file