Twin Birth Plan

This is such a comprehensive Birth Plan that I have decided to post it after, of course, requesting permision from the couple who did their homework.

The illustration below is a humerous take on the birth plan scenario and is not meant to imply that this mother wishes to have an epidural. In fact, this mother has specifically stated that she does NOT wish for an epidural!

All names have been changed or omitted to protect the privacy of this team.

Susan and James are having twins and want a natural birth. Susan gave birth to their firstborn at home two years ago and it was a wonderful homebirth experience. This time round the stakes are a little higher, a natural birth is still at the top of the list as long as the twins are healthy during the labour. this twin birth plan was adapted from http://www.hypnobirthing.com/the Mongan Hypnobirthing method.

Twin A is lying on the right with vertex deep in the pelvis. Twin B lies on the left, also head down. A water/homebirth would be the dream, but this birth plan is geared for the hospital situation.  Herewith:

Birth plan

17/05/2011


My husband and I have chosen you, our medical advisor, and you, our birthing facility staff, as the people whom we want to attend us when our babies are born.  We have chosen the Hypnobirthing method of quiet, relaxed, natural birth, and we believe that you will do your utmost to help us attain our wish of a joyous, memorable and satisfying natural birth of our dizygotic twins.

The information that follows is a copy of our birth preferences.  We have given careful consideration to each specific request in the plan which we feel represent our wishes at this time.  We realize that as labour ensues we may choose to change our thinking and wish to feel free to do so.  We understand these choices presume a normal pregnancy and birth.

Should a situation arise that constitutes a medical emergency, please know that you will have our complete cooperation after we have had an explanation of the medical need and have had sufficient time to discuss the decision between ourselves.  We wish to have clear explanations of all procedures, of the progress of labour as it is assessed, and of any possible special circumstances if they occur.  In the absence of special circumstances, we ask that the following requests be honoured.

Please attach this to my prenatal record and make it available to all physicians/staff who may be attending the birth should you not be with us.

Your support and understanding are much appreciated.

Pre-admission requests

We request:

• To complete all required paperwork during a pre-admission visit to eliminate interruption during relaxation of labour.
• To consider artificial initiation of labour only if labour is unusually delayed and there is medical urgency
• To delay artificial induction of labour for a reasonable period after the release of membranes if there is no sign of infection.
• To remain at home for as long as possible before going to hospital

Hospital admission

• Ideally we would like to have a home birth but we are aware of the risks associated with birthing twins, so if we relocate to hospital we would like every effort to be made to keep the birth as calm, quiet and natural as possible. We would prefer to have only our personal private midwife, assistant midwife/doula, my husband and sister in attendance.  We ask that the attending obstetrician be on standby in case of emergency but not necessarily in the birthing room with us unless specifically requested.

We ask for:

• The patience and understanding of caregivers to support our wish to refrain from having any practice or procedures throughout labour and birth that, in the absence of medical emergency, could unnecessarily stand in the way of our having the most natural birth possible.
• To return home until labour progresses if less than 4 cm dilated and if there are no situations that warrant admission.
• In the absence of our private midwives, to be assigned a hospital nurse/midwife who is supportive of natural birthing.
• To self-hydrate and decline routine IV prep upon admission.
• To use natural means of inducement, moving to minimum doses of artificial induction only if medically urgent, and that artificial induction drugs be removed once uterus is naturally thinning and opening.
• To have a private labour and birthing room with a bath, subdued lighting, and total quiet.
• To have only intermittent monitoring (EFM) of FHR after the mandatory 20 min strip at admission.

First stage labour

• I would like to go into labour naturally without being induced so that my babies are born on the birth-day of their choosing, and that labour be allowed to take its natural course without reference to “moving things along”.
• I do not wish to have the amniotic membrane ruptured artificially unless signs of foetal distress require internal monitoring.
• I would like to be able to move around and change position at will throughout labour, and get in and out of water as needed.
• I would like vaginal exams to be kept to an absolute minimum.
• I would like to be free of IV drip lines or spinal catheters, unless deemed absolutely necessary for the safety of the babies or myself.
• I request that staff refrain from using the words “pain”, “hurt” etc. nor offer medication or labour-enhancing procedures unless requested.
• I would prefer to be allowed to use natural oxytocin stimulation – nipple or clitoral – in the event of slow or resting labour.
• I would like to be fully apprised and consulted before the introduction of ANY medical procedure – augmentation, amniotomy, membrane stripping etc.

Second stage labour

• I would prefer that the natural, expulsive pulsations of the body be allowed to facilitate the gentle descent of each baby, with mother-directed birth breathing to crowning.  My husband will offer prompts if needed, but not coaching.
• I would like to give birth to both of the twins in the bath/birthpool if possible.
• I request the use of warm oil compresses to avoid episiotomy, and no perinatal massage to perineum.
• I would like to complete birthing before suctioning of the baby’s nose and throat.
• In between giving birth to the first and second twin, I’d like everyone to remain very quiet and focused as we will only be at the halfway point.
• I’d like to breast feed the first twin and wait for contractions to restart naturally for twin 2.  When these begin I’d like my husband or my sister to kangaroo-carry twin 1 until twin 2 is born.

Delivery

• I would like my husband to support me and my legs as necessary during the pushing stage.
• I would like a mirror available so I can see my babies’ heads when they crown.
• I would prefer not to have an episiotomy unless absolutely required for the babies’ safety.
• Even if I am fully dilated, and assuming my twins are not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
• I would like my husband or myself to catch the babies, if possible.
• I would like immediate skin-to-skin contact with each baby placed on my stomach/chest (or my husband’s)immediately after delivery. No wrapping or washing of babies.
• We would like the cord to be clamped or cut by my husband only after it stops pulsating.
• I would like to wait for natural placenta delivery, and that each baby is brought to my breast to facilitate this process.
• I request gentle uterine massage every 15 minutes to assist in placental expulsion, and no cord traction, manual removal or use of Pitocin for removal of placentas unless absolutely necessary.

After Delivery

• I would like to have my babies examined in my presence and the vernix left on.
• If either of my babies must be taken from me to receive medical treatment, my husband or some other person I designate will accompany the baby at all times.
• After the birth, if it is necessary to catheterize me, I would prefer to be given a few moments of privacy to urinate on my own before hand.
• I would like to go home as soon as possible, or to have a private hospital room if available.
• I would like to store the stem cell blood if possible, or donate it.
  For the babies

We request:

• To have bright lights removed at the moment of birth.
• To allow vernix to be absorbed into skin; delay “clearing” or “rubbing”, and the use of a soft cloth, not terry, when rubbing is appropriate.
• That the babies remain with the mother and father.
• Delay use of ointment in babies’ eyes to allow optimal sight for bonding.
• Oral vitamin K to be given rather than injection.
• That father and babies stay with mother throughout the hospital stay.
• Breastfeeding only. No bottles, formula, pacifier or artificial nipples.

Anaesthesia

• I do not want any kind of anaesthesia offered to me during labour, though I would like it available if the birth becomes difficult (e.g. a posterior position) and I specifically request it.
• I do not wish to have an epidural/spinal unless an emergency caesarean is required.

Caesarean

• If my primary care provider determines that a Caesarean delivery is indicated, I would like my husband present at all times, and I wish to have an epidural/spinal for anaesthesia.
• If my babies are not in distress they should be given to me, my husband or sister immediately after birth.
• I would like my husband and my labour support to be allowed to remain with me in the operating and recovery room.
• If I am unable to hold the babies, I would like my husband and my sister to hold them after C-section and bring them to me for viewing and eye-contact.  In absence of urgency I’d like the babies to continue to stay with them for bonding.

Photos

• I would like to have film and photographs taken (without flash) of labor and birth.

Other

• My labour support people are my private midwife , my doula, my husband and my sister, and I would like them to be present (but not necessarily all at the same time) during labor and/or birth.  Depending on how I am feeling, I may also want my little sister to join us so that she can experience the wonders of a natural birth.

We thank you in advance for your support and kind attention to our choices.  We know you join us in looking forward to two beautiful births and celebration of these new lives.