Worksheet Template For Preparing Your Birth Plan With Samples Page 2
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14Pregnancy, Childbirth, and the Newborn
Options for Unexpected Labor Events
General
Induction (pages 277–283)
Maternal exhaustion (pages 175–176, 284–287)
__ Avoid induction unless medically necessary
__ Rest, relaxation skills
__ At mother’s or caregiver’s convenience
__ Bathtub, dim lights, privacy
__ Self-induction methods
__ Narcotics or sedatives for sleep
__ Stripping membranes
__ Epidural anesthesia
__ Cervical dilators
__ Artificial rupture of membranes
__ Cervical ripening agents (prostaglandins)
__ Induction agents (Pitocin, oxytocin)
Prolonged active labor (pages 284–287)
Prolonged second stage (pages 290–292)
__ Walk, change positions, take a bath
__ Rest from pushing
__ Nipple stimulation
__ Change positions
__ Artificial rupture of membranes
__ Directed pushing
__ Medication (Pitocin, oxytocin)
__ Pitocin
__ Vacuum extraction, forceps, and/or episiotomy
Suspected fetal distress (pages 288–289 and 305)
Prolonged third stage (pages 293)
__ Mother changes position, uses oxygen
__ Placental separation encouraged by breast stimulation
__ Fetal scalp stimulation to evaluate fetal well-being
__ Baby suckling on the breast
__ Amnioinfusion
__ Upright position
__ Continuous electronic fetal monitoring, internal scalp electrode
__ Hastened with fundal massage
__ Cesarean delivery
__ Hastened with medication or manual extraction of placenta
Cesarean Birth
Timing of cesarean (pages 302–303)
Participation by mother
__ Planned before labor begins
__ Mother watches delivery of baby (window in screen or screen
lowered)
__ Planned after labor begins
__ Doctor explains events during surgery
__ Unplanned during labor, only done if medically indicated
__ No description of events during surgery
Anesthesia (chapter 10)
Postoperative medications for trembling or nausea (page 309)
__ Regional anesthesia (spinal or epidural)
__ Only at mother’s request
__ Regional anesthesia with or without sedation or tranquilizer
__ Medications with least effect on consciousness and memory
__ General anesthesia
__ Medications at doctor’s discretion
Presence of partner/others (page 310)
Contact between baby and mother/parents (page 308)
__ More than one supportive person present
__ Held by partner after birth, for mother to touch and see
__ Father or partner only
__ Baby taken to nursery for well-baby observation
__ Partner sits or stands to watch or photograph surgery
__ If baby goes to nursery, partner goes with baby
__ Partner not present
__ Partner remains with mother
__ If two support people, one goes with baby while other stays
with mother
Postpartum Hospital Options for New Mother
Infant feeding (chapter 18)
Controlling pain (page 311)
__ Breastfeeding
__ Use of self-help techniques to avoid medications
__ Formula feeding
__ Medications (patient-controlled IV or oral)
Visits by family and friends
Dietary preferences
__ Unlimited visitation desired
__ General diet
__ Limit who will visit
__ Vegetarian/vegan
__ Limit when visitors can come into room
__ Kosher
__ Hours or amount of time limited by hospital
__ Food allergies and sensitivities
__ Early solid foods after cesarean
__ Other
Educational needs
Plans for follow-up from staff after discharge
__ Breastfeeding
__ Availability for clinic or home visit with mother-baby nurse
__ Infant feeding
__ Availability of lactation help and support
__ Baby care
__ Availability of phone call to/from hospital nurse
__ Postpartum care for new mother
__ Amount of follow-up care desired by parents
__ Other
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