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Writing a Back-up Birth Plan: If You Have to Transfer From Home

If you’re planning a home birth, obviously you expect (and hope) that everything will go smoothly and you’ll deliver a healthy baby at home.  However, sometimes that isn’t the case.  In some situations, mothers need to be transferred to the hospital.  Most of these situations are for “exhaustion” in the mother or failure to progress.  A few are emergencies.

Regardless, if you end up needing to transfer, you will need to have a birth plan in place.  It’s easy to say “I don’t need one” (which you probably don’t, if everything works out at home), but it’s always best to have a back-up plan, just in case.

Here’s what you should include in a back-up birth plan:

*The name of your back-up doctor, if you have one

This is crucial, because otherwise you will get stuck with whoever’s on call.  If you’re okay with that, great; if not, make sure to list (and call) your back-up doctor.

*Your midwife…listed as your “doula” if you’re in a state where homebirth is illegal

Yes, it’s dumb.  But your midwife could get in trouble for practicing medicine without a license if homebirth is not legal in your area.  Listing her as your doula ensures she won’t get in trouble and she can stay with you during the birth (though she won’t be able to deliver you, of course).

*Your preferences in case of emergency

Do you want the doctor on call to make the decisions?  Do you want the staff to inform you, your husband and/or your doula of the options so you can make the call?  Let them know.  In extreme emergencies (like cord prolapse), you may not have a choice, though.

*Your preferences for pain management

If you’re transferring to a hospital, it’s likely because you’re exhausted.  In this case, would you like to get an epidural?  Let them know what you would prefer to do.

*IV and fetal monitoring

Again, if there’s an emergency you may not have a choice.  But if you’re going in for exhaustion, do you want these things?  Do you want continuous or intermittent fetal monitoring?

*Birthing positions

Emergency again, maybe no choice.  But if you do have a choice, do you have a preference?  It’s especially important to state if you do not want to be flat on your back, as that is the routine position in many hospitals.

*Newborn procedures

Which do you want?  Which don’t you want?  Your baby will be given vitamin K, Hep B, and erythromycin in the eyes after birth, as well as given a bath.  His cord will also be cut immediately, so if you want this delayed, write it down.  If you want to opt out of any or all of these, write this in big letters on your birth plan and make sure you tell the staff repeatedly.  Often times they don’t even check, they just do it because it is routine (and they may not mean anything by it; they are just trying to do their jobs).

*Immediate bonding

Assuming your baby is born healthy, do you want to hold him immediately?  Breastfeed?  Let them know how you’d like to handle this.

*Nursery

Do you want your baby to go to the nursery?  When?  How often?  Some moms want to have their babies in the nursery at night, but with them during the day.  Others want them in their rooms all the time.  And while in the nursery, can they give your baby a pacifier or bottle?  Write it down.

*Discharge

Assuming a normal birth, how soon would you like to leave?  Many hospitals require at least 24 hours, but some will discharge you after 6.  Write down how soon you’d like to leave.  If you have to have a c-section, you will be there at least a day, probably two or three.  If your baby is born with some issues, write down whether you’d like to stay until he is ready to leave (if possible; you won’t be able to stay if he needs to be there for weeks) or if you’d like to be discharged as soon as possible.

*Medication

Do you want to be offered any routine pain medication after delivery?  Typically you will be given Pitocin for awhile (to contract the uterus), ibuprofen, and a stool softener.  If you do not want these, write it down.

*The name of your baby’s pediatrician

Hopefully, if you’re planning to use one, you’ve chosen one already.  The hospital will call him or her and s/he will come and check your baby if s/he has privileges at that hospital.

*Copies of your blood tests and medical records

If you have them.  Bring these with you, because the hospital will have a “starting place” and not have to subject you to basic lab work while in labor.

What else did/would you write in a back-up birth plan?

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