Whether you’re delivering your baby at the hospital, birthing center, or at home, planning ahead can reduce stress and help to make the new arrival go as smoothly as possible. Hospital deliveries come with some special considerations and here are a few tips to avoid problems when the time comes.
1. Talk with your doctor or practitioner early. Be sure to review your birth plan with your practitioner early in your pregnancy in case you need to change practitioners. Make sure they are comfortable with things like not vaccinating, no vitamin K injection, delayed cord clamping, etc. Finding this out early will help if you need to find another practitioner as many will not take you on as a new patient if it’s late In your pregnancy. Be respectful, but ask your practitioner directly if they are comfortable with all items on your birth plan. Let them know you will not want to encounter difficulties on delivery day. It’s important that you work as a team.
2. Select a setting that meets your needs. If you’re in a high risk group, you may have limited choices. If you plan to deliver at home, be sure to find out where you would be taken if you needed assistance from a hospital. The best way to find out which hospital you would be taken to in an emergency is to call your closest firehouse/EMS. Be sure you contact that hospital and talk with the nurse manager to let them know you will be delivering at home and want to find out information about being brought to that hospital if needed. Touch base with them again when it is closer to your due date.
3. Keep your birth plan simple, one page if possible. Be sure the most important items are listed in bold letters across the top. The doctor or nurse should be able to quickly identify your non-negotiable items immediately. Contact information and emergency phone numbers should be included as well. Email a copy to the nurse manager ahead of time to be sure there are no problems honoring all your requests. Email copies to your emergency contact list so they are aware of your plan and provide extra copies to your partner for day of delivery. Don’t assume this will “be on my chart”. Keep a copy in your room and post it on the wall if necessary. Be sure all staff is aware you have a birth plan and that they have reviewed it.
Texas State Rule 97.136 Prophylaxis against Ophthalmia Neonatorum
(a) A physician, nurse or midwife or other person in attendance at a childbirth shall apply or cause to be applied, to the child's eyes a 0.5% ointment in each eye within two hours after birth. If this ointment is not available due to the disruption in the distribution or manufacturing, a physician, nurse or midwife or other person subject to this section shall apply or cause to be applied to the child's eyes and alternative treatment included in guidance issued by the Department of State Health Services or the Center for Disease Control and Prevention.
(b) Failure to perform is a Class B misdemeanor under the Texas Health and Safety Code.
Most hospitals require your baby to stay a minimum of 24 hours if healthy. If there is something they want to follow up on, such as a lab or some symptom your baby had, they will probably want the baby to stay at least 48 hours. Removing your baby from the hospital before 24 hours will probably result in the doctor calling social work to contact CPS. Remember, they want to be sure the baby is stable. Be sure to know what policies are in place at your hospital. Make an appointment or phone appointment with the nurse manager to discuss your birth plan and ask questions.
5. Vitamin K injection and circumcision. If you are having a boy and plan on circumcision, be aware that most practitioners will not perform this procedure if the baby has not received the Vitamin K injection. This injection is given to reduce the chance of bleeding occurring in the brain, however, many doctors will not do the circumcision without it since one of the primary risks for this procedure is bleeding. If you do find a physician to perform the circumcision without the baby previously receiving the injection, be aware that any change in your baby’s condition or if that doctor is unavailable at the time of your delivery, you may need to make different choices. Be prepared for the possibility of revising your plan. Oral Vitamin K is an option, however, will seldom change the doctor’s plan to not perform the procedure. If you would like to give your baby the protection of oral Vitamin K, here is a good reference with some studies and information about practices in other countries. http://www.birthwithlove.com/categories/itempage.asp?prodid=vitamin+k+1+(vit+k+1+)oral+vit+k
6. Things to think about. If your baby needs advanced care and requires a stay in the special care nursery or ICU setting, be aware that there will be different physicians caring for your newborn. These doctors will probably be unfamiliar with you and your birth plan and you may need to review those items again. Any change in your baby’s condition would warrant you to review your needs, however, this does not mean you are not entitled to informed consent for all procedures. Work with your team of doctors and nurses to ensure you understand all the information needed to make the right decisions for your baby. If your baby needs to be transferred to another hospital for a higher level of care, and you are not able to be discharged at that time due to your own recovery, have a plan with your partner, family or friend for someone to follow the baby to the new location. If you have not had a cesarean section and you are stable, your doctor may discharge you prior to 24 hours in this instance so you can be with your baby. Knowing this ahead of time will ensure you have a plan in place.
7. Coordinate with your nursing staff. These are the people who will be getting you through the delivery and help you to coordinate with doctors and other members of the team. They really do want to take good care of you. Every hospital room has some type of dry erase board on which they write their names and phone numbers. Use this board to communicate important items from your birth plan. If you’re asleep or busy with the work of bringing baby into this world, every staff member that enters your room will be able to see your requests. Things like “exclusively breastfed” or “no injections of any kind” can be written on the board. This is another way to communicate the same message.
8. Know your patient rights. Every patient has rights and responsibilities. It’s important to have realistic expectations from each type of delivery setting. Having your baby in the hospital requires you to learn about how the policies and protocols affect you and your baby. Being aware of your patient rights is the first step. If your team is not comfortable with all the items on your birth plan, knowing this early and finding a setting that workswith you is the best option. To learn about your patient rights go towww.jointcommission.org and download your patient rights pamphlet. It is available in English and Spanish. http://www.jointcommission.org/Speak_Up__Know_Your_Rights/
Being prepared is the best way to avoid challenges on the day of delivery. Communicate clearly with your practitioners being precise and using terms that don’t leave room for misinterpretation. Saying “I will not” is not the same as “I don’t want to.” Confirm your practitioner is comfortable with meeting your needs. State that you are planning ahead to avoid any confusion during a time you will want to concentrate on bringing baby into your life. Know which items in your birth plan can be revised in response to the situation and which ones cannot. Being clear and respectful in communicating your needs is the best way to be sure your team will all be on the same page when the exciting time comes!!