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?

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

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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.

Creating memories when you don't know if your baby will come home from the hospital

*I modified the below entry & GAVE it to a local hospital to hand out to parents who have lost a little one while in the hospital*

Before the hospital we:
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* started a baby book
* started writing in a journal
* gathered some ultrasound pictures
* had Owen's brother choose a stuffed animal that he would give to Owen in the hospital (I bought 2... one for big bro to 'give' to Owen & the other for inside Owen's casket). we also secretly got a different stuffed animal that we packed in our suitcase & gave this other animal to Owen's brother - from Owen - in the hospital.
* purchased two (identical) super soft blankets. one for owen in the hospital and one for in his casket.
* put together call lists & scripts for family members to make calls for us
* purchased grave spaces (so we will all be together)
* I put together a CD of music (this is what we played at Owen's funeral)
* maternity photos (hired a photographer through nilmdts)
* videotaped some ultrasounds. these are priceless to me - I love seeing Owen dancing around while in utero.
* received an approx quote on our custom birth announcements (we only had to send Owen's footprints in & modify some wording, but changed very little - see it HERE. This is the lady that did THEM. We slipped in a small paper we made ourselves that invited people to Owen's funeral service)
* printed out address labels for the birth announcements

We took a big bag to the hospital & gathered:
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* pictures (nilmdts & personal)
* video
* we brought an extra large ink pad & paper to get lots of foot prints and hand prints
* small seal-top bag for hair clippings
* small seal-top bag for nail clippings (+ put a nail clipper inside the bag)
* Precious Impressions (to make one foot and one hand mold)
(+measuring cups, spatula, disposable container for mixing)
* the newspaper from the day Owen was born
* Owen's comb, aspirator, information/isolette card
* hospital ID bracelets
* hats, blankets and clothes for Owen. these were all brought from home, not ones typically provided by the hospital. clothes were all 'premie' sized. (we also brought a couple baby toys and a picture of our family - for Owen's NICU room)
* umbilical cord clip

I ended up with a c-section & my husband also kept the disposable 'cover-all' clothes.

We also brought an extra copy of our birth plan to the hospital, which really came in handy (there was a small mix-up).

A very sweet nurse made a bracelet for owen. It turned out to be a great thing that we named him owen - a longer name might not have fit on the bracelet!

After the hospital, we kept the newspaper from Owen's death notice and his obituary. We also kept all cards (even the ones from flowers that were sent). We have several things from the funeral home (guest book, folders, clothes, etc).

I wanted to minimize any later regrets, so in the hospital I wanted either my husband or I to:
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* caress his soft skin (I really had forgotten how soft a baby's skin and hair are!)
* rock owen
* kiss owen
* tell owen how much we love him
* sing to owen ('wheels on the bus' or 'twinkle, twinkle' anyone?)
* bathe owen (later smelling the soap really reminds me of him)
* put lotion on owen (later smelling the lotion really reminds me of him)
* diaper and dress owen
* carefully study all of his adorable baby parts
* comb owen's hair
* hold owen all night
* walk outside and feel the sun or rain or wind or warmth or cold
* read a book to owen (yes, I packed Green Eggs And Ham in our suitcase!)
* had owen been alive for longer, I would have really liked to try to nurse him
* if I'd had a girl, I would have also brought fingernail polish to the hospital & painted all ten toes!

Recently, I bought a necklace for both my husband and I from THIS local woman. They just arrived yesterday & are really great keepsakes!

Birth Plan

Parent's wishes for the birth of Owen Thomas _

Owen is a miracle and gift from God. His birth is an occasion for rejoicing. Please treat it as such, even if he is still born or dies soon afterward. Please refer to him as Owen and share our joy and sorrow with us. Our wish is that if he dies, dad or mom are holding him. As a result, we ask that all possible procedures be done in our presence or delayed until his condition is assessed to see if he is stable. Our intent is to provide Owen an opportunity to ‘stay with us’ on primarily comfort care with minimal intervention. We truly appreciate your help and support, and ask that you understand if we seem indecisive at times. We also appreciate and find great comfort in your expressions of grief, be it through tears or humor.

Delivery (Possible vaginal birth or c-section):

Mom would like an epidural and pain relief. We also want the baby to be monitored as well as mom. Mom wants to be aware, alert and present for the delivery and afterward. Should Owen become distressed during a vaginal birth, then mom wants a c-section.

We desire to have a third person (in addition to dad and mom) in the delivery room/OR to take photographs and/or video. We do not wish to have any unnecessary hospital staff in our room at any time (ie students, interns, etc). Only hospital staff that are performing medically necessary exams or procedures are to examine our son in life or death.

We desire no circumcision, inoculations/vaccinations, and no eye ointment at any time. Please delay vitamin K, footprints, weighing & measuring until after both parents have held Owen. Immediately after birth, perform standard suctioning, rubbing, and vigorous drying to aid in his respiratory and cardiac efforts. We desire that the following guidelines be observed:

1) Assess Owen's respiratory effort after drying, rubbing, and suctioning. Keep in mind that due to his lung mass, Owen may need oxygen.

a) If he breaths well and has a heart rate above 100 bpm, weigh & measure; then, give him to mom or dad.

b) You may follow standard newborn resuscitation procedures (up to and including PPV (either bag & mask and/or CPAP), chest compressions and administration of medications (ie epinephrine, morphine, etc.) and oxygen). An umbilical catheter or IV are okay. We probably do not desire for Owen to have a tracheal tube inserted, nor mechanical ventilation. If you come to this point in resuscitation efforts, please discuss with dad and/or mom. We will probably just want to hold, comfort and love him – but we want to be given the information in case we change our mind.

c) Any tests should be discussed with parents and done with parents’ permission only.

2) We do not wish to participate in the Washington or Oregon Newborn Screening Program and want no part in any testing, donation or research of any kind (genetic or otherwise, irregardless of whether it’s coded, anonymous, identified or de-identified).

3) We desire that mom or dad be holding him at all possible times.

4) We desire that no procedure be done without parents' presence. Dad is to be with Owen at all times. As soon as is practical, please have Owen join mom in the recovery room.

5) We desire full rooming in (no NICU, transition nursery) for at least first several hours. We understand that hospital policy may not allow for this with some of the minimal interventions/monitoring that we are requesting.

6) We desire that dad and mom bathe Owen themselves if possible. If not possible, please bathe him in the same room with the parents.

7) We desire that our child and other relatives be allowed in to see Owen ASAP for as long as we wish.

8) We desire that mom try to nurse Owen. Request that the lactation consultant visit as soon as possible for assistance (mom has nursed one previous child). If Owen is unable to nurse, mom will express breastmilk using a pump and this should be given to Owen via a feeding tube. If mom is not producing enough breastmilk/colostrom (or Owen’s blood sugar is too low), formula and/or IV fluids are okay. If Owen’s esophagus isn’t connected to his stomach, then no further attempts at introducing nutrition are to be made.

9) If Owen stabilizes, we desire to take him home ASAP on comfort care.

In case of death:

If Owen dies during our stay, please notify staff members as soon as appropriate. Mom will be recovering and will probably be best cared for on the maternity floor, but the staff should be sensitive to the situation when possible.

In Owen’s death, please respect our wishes in point 2) above. We do not wish to have an autopsy.

If he dies before being bathed, we desire to bathe and dress him ourselves.

After he dies, we desire that Owen be with us as long as we desire. We also desire that our child and relatives be allowed to be with us during that time. We request Owen stay with us until the funeral home arrives.

Owen's name, Owen Thomas _, must be on the death or still birth certificate.