Wednesday, December 10, 2008

Questions for creating a birth plan

This cannot and should not replace advice from a perinatologist and neonatologist. I strongly urge you to discuss these questions with your husband or partner, then go talk to the neonatologist and perinatologist about these. Whatever your final birth plan (ie wishes) looks like, make absolutely sure that the doctors that are attending your delivery are 'on board' with your plans. If they are not, it is perfectly okay to switch to another doctor that will honor your wishes. The last thing you want to do on the day of delivery is argue with a doctor, or worse - not have a doctor honor your wishes.

1. What is the baby's full name, as you want it to appear on the birth and/or death certificate?

2. What are the specific medical issues that we know our child will have?

3. What are the possible surgeries and treatments (and what would be their pain level and what
is the prognosis)?

4. What kind of birth do you want? (home, water, hospital, vaginal, c-section, etc.) Consider
that birth is stressful on both the baby and mother. If the baby has serious heart or organ
challenges, a regular birth could increase the likelihood that the baby will pass away during
birth. On the other hand, a c-section is a major abdominal surgery with many serious risks
and a long recovery period. You can refuse a c-section. Part of a baby's lung development
inutero is that they 'breathe' in amniotic fluid. During a regular birth, when the baby
squeezes through the birth canal - it helps get the amniotic fluid out of the lungs. Because the
squeezing doesn't happen with a c-section, it can make a baby less responsive and need a
little more assistance to get going. Whom will attend the birth?

5. Do you want both the mother and baby to be monitored? You can refuse monitoring for
both. If monitoring indicates that the baby is in distress, what do you want to happen?
Again, you can refuse a c-section.

6. Did you bring a music CD to be played during delivery?

7. If it's a regular delivery, do you want a mirror - so you can see the baby coming?

8. Do you want an IV, episiotomy, pitocin, forceps or vacuum extractor?

9. Do you want to be induced a little early (ie 37 weeks), or do you want to let nature take it's
course? Are there any risks (ie pre-eclampsia or placental abruption) to either you or the
baby if you are induced early or if you wait until later?

10. Do you want pain relief? (breathing exercises or medications like an epidural, demerol, etc)

11. Can the doctor cut the cord, or do you want someone else to cut the cord?

12. Do you want all possible medical interventions, or comfort care only, or somewhere in
between? Consider if s/he isn't breathing, doesn't have a heart beat or has a low heart beat.

13. Consider possible medical interventions: what exactly are they and how do they feel for an
adult (pain or discomfort level)?
  • Suctioning
  • Rubbing/Drying
  • Blow-by or bag and mask (with or without oxygen)
  • PPV or CPAP (with or without oxygen)
  • Tracheal tube
  • Mechanical ventilation
  • ECMO
  • CPR or chest compressions
  • Umbilical catheter or IV
  • Regular IV
  • Medications (Epinephrine, Morphine, etc.)
  • Other Fluids (formula, IV fluids - what if their blood sugar level is too low, or you aren't producing enough colostrum/breast milk)
  • Oxygen (usually given by nasal cannula)
  • Feeding Tube
  • Catheter
14. Do you want a rabbi, pastor, etc. to do anything? (bless, pray, baptize, etc.)

15. Do you want pictures and/or video taken? If yes, when and by whom? Consider that you
should discuss this with the doctors involved & make sure it's okay with them. For many
hospitals, the anesthesiologist has the final say in the Operating Room.

16. If this is a teaching hospital, is it okay if interns, students, residents, etc. are involved with
your family's care (including exams)?

17. Do you want the baby to have inoculations/vaccinations, a vitamin K shot, eye ointment,
tests, etc? If yes, when?

18. At what point do you want the doctors to stop the medical interventions? Are you willing to
put a Do Not Intubate (DNI) or Do Not Resuscitate (DNR) in writing?

19. At what point do you want to hold the baby?

20. At what point do you want s/he to have footprints, weight and measurements taken?

21. If you're having a boy, do you want him circumcised?

22. Many states have mandatory (without informed consent) newborn screening programs.
These screen for rare metabolic disorders that are lethal if not detected early enough. Do
you want to refuse participation in this program? It is common practice that whenever a baby dies before being born or within a short time after being born that the placenta be sent to a lab to be analyzed. Analysis can include many different things, including obtaining genetic information. If you are a privacy advocate, you may want to specify that the placenta must be incinerated (which is what they normally do with a 'normal' placenta/after-birth) and that you do not wish for any testing to be performed.

23. Should at least one parent be present at all times? Only when procedures are done?

24. With your desired level of interventions, can these be done by the hospital you're delivering
at? Some smaller hospitals require that you go to a larger hospital (with a NICU). Which
interventions can be done while the baby is 'rooming-in' with you? For some hospitals, even
for the baby to be on oxygen or IV fluids, hospital policy requires that the baby be in the
NICU. If your baby has to be in the NICU for an extended period of time, what does the
NICU look like and what kind of privacy is there (ask to go on a tour)? In most hospitals the
NICU is one big room with rows of babies in isolettes (very little privacy)... In some newer
hospitals, each baby's isolette is in their own room (lots more privacy).

25. Do you want to bathe, diaper and clothe the baby yourselves? Or at least offered the
opportunity to do it yourselves?

26. Do you want friends or family members to be allowed in your room? If yes, when?

27. Do you want to try to nurse the baby? If yes, do you want a lactation consultant to help?
Do you want to use a breast pump?

28. At what point do you want to take him/her home?

29. If the baby dies, do you want friends or family members to be allowed in your room?

30. Would you want an autopsy?

31. Do you wish to donate his/her body or organs to another family or for medical research?

You may want to keep a separate checklist of things you want to happen to make lasting memories in the hospital (see THIS POST).

Although this isn't part of creating a birth plan - in case your child doesn't come home from the hospital, please consider: (I, personally, was thankful that we planned for the worst, while holding out hope for the best. It made for fewer decisions while we were in the moment of losing our child.)

Do you wish to be buried or cremated?

Do you want your child to be buried or cremated? Think about if you move quite often, being buried means that you will not be able to visit your child's grave often.

If you want your child to be cremated, what do you think you will do with the ashes? Spread them, wear some in a keepsake necklace and keep some in a figurine/urn in your home, or utilize one of many options at a cemetery?

If you want your child to be buried, where will you bury them? Do you want him/her in the children's section, or will you purchase additional spaces, so that you can all be together? Will you have a viewing (if yes, do you want the funeral home to use makeup)? Will you have a funeral service (if yes, where & whom will perform the service)? Will you have a graveside service (if yes, where & whom will perform the service)?

Do you want an obituary?

We made the decisions about the poem for the folders for Owen's funeral service and which casket after we had gotten out of the hospital.

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