A Sample Birth Guide

Jo has kindly shared her birth guide with us all to help others wanting to present their wishes and cocnerns to their medical carers.  Jo had a lovely homebirth of twins on a barge.

Care guide for Joanne (home birth)

–          This is a dichorionic, diamnotic twin pregnancy

–          I am planning a home birth; the address is xxx

–          During labour I will have with me my husband, P, and my midwives Debs and Kim (Chris is my back-up midwife). My son Oliver (5) may also be present, along with my friend C who is there to look after him. I am unlikely to want all these people in the room during the whole of labour; I may banish some or all to the kitchen or (in the case of Oliver and Caroline), away from the boat.

Labour and birth

–          I will be aiming for a vaginal birth using upright / forward-leaning positions

–          I will have a birth pool and will be using water and relaxation / self hypnosis techniques to manage the contractions

–          I would like my midwife to have a gas and air cylinder available in her car, but only to have it if I ask for it

–          I would like intermittent monitoring of the babies and no routine VEs or ARM

–          I am keen to keep my mouth / jaw relaxed and would welcome suggestions of doing “horse-lips”, kisses from Paul etc if I appear to be tense in this area

–          Episiotomy – NO episiotomy unless for acute distress to baby. Mid-line cut to be used if episiotomy is necessary

–          If either baby is breech, I will want to try for a physiological hands-off breech birth

–          When contractions start for the second baby, I am likely to want some help with holding the first baby – Paul likely to do this and may get in the pool

Birth of the placenta

–          If no heavy bleeding NO routine oxytocin for third stage. Cord to be left to pulse and physiological third stage, using upright positions and suckling of babies to facilitate birthing of the placenta and minimise bleeding.

–          I may want some help holding the babies whilst I concentrate on delivering the placenta

Babies

–          NO Vit K unless birth has been traumatic in some way

Care guide for Joanne (hospital birth)

–          This is a dichorionic, diamnotic twin pregnancy

–          I am planning a home birth, so attending hospital means that either I have gone into labour prematurely, or I have needed to transfer for some reason

–          I will accompanied by my husband P and my independent midwife Debs (Kim and Chris are my back-up midwives). Debs (or Kim/Chris) will fulfil the role of my doula whilst I am in hospital

–          I appreciate circumstances may change the wishes I have laid out here but would hope to stay as close to them as possible. I only wish to discuss the choices detailed in this care guide anew if the circumstances have changed significantly. If in doubt, please talk to Debs/Kim/Chris out of my hearing first

General approach

–          I will be aiming for a vaginal birth using upright positions

–          I would like as much privacy, silence and darkness as possible during labour and for as few people as possible to be present whilst I labour and birth

–          I will initially be using relaxation techniques to deal with contractions, but if I need more pain relief I will accept gas and air

–          I would like intermittent monitoring of the babies and will only accept continuous monitoring if the intermittent monitoring shows fetal distress

Labour interventions

–          As I have tested positive for GBS earlier in this pregnancy, if I have other risk factors for GBS I wish to have IV antibiotics during labour, but want to keep any time on a drip to a minimum

–          I will be trying to avoid medical pain relief, but I may choose an epidural if it becomes necessary

–          I do not want routine vaginal examinations, artificial rupture of membranes or augmentation of labour using drugs. If there is a specific reason to consider these, please talk to me about it between contractions.

–          If progress is slow but being made and my babies and I are fine I will carry on without medical intervention, irrespective of any hospital guideline that states time limits.

–          Ventouse/Forceps – last resort, won’t accept just because of time limits. If some progress being made during pushing and clinical signs fine will ask for assistance if I want it.

–          Ventouse preferable to forceps

–          Episiotomy – NO episiotomy unless for acute distress to baby. Mid-line cut to be used if episiotomy is necessary

–          If either baby is breech, I will want to try for a physiological hands-off breech birth. Please do NOT touch the baby as it emerges – assisting flexion of the head is OK if needed. If a breech labour is not progressing, I will have a C-section (i.e. no augmentation of labour or attempted breech extraction).

C-section

–          Last resort only (or if breech labour not progressing)

–          My husband and my independent midwife to be present please

–          I would like to be awake if at all possible

–          Babies given straight to me for skin-to-skin after delivery. Babies NOT to be routinely taken to resusitaire, paediatrian can check babies while with me unless serious compromise to babies or me.  Baby check and weighing to be done later.

–          If no serious fetal compromise and I’m not bleeding heavily cord to be left to pulse for at least a couple of minutes until baby established regular respirations

–          If general anaesthetic has been used, babies to have skin to skin with me as soon as possible and put to the breast if rooting – P or Debs to do this even if I’m still asleep / sleepy

Birth of the placenta

–          Vaginal birth / assisted birth – if no heavy bleeding NO routine oxytocin for third stage. Cord to be left to pulse and physiological third stage, using upright positions and suckling of babies to facilitate birthing of the placenta and minimise bleeding.

Babies

–          Babies to have skin to skin with me immediately after birth unless serious compromise to me or babies – they are NOT to be cleaned or given any routine medication

–          I’ll be breast-feeding my babies. NO artificial milk or fortifiers to be given unless discussed with me first and consent obtained

–          If one or both babies need to go to special care, me to follow as quickly as possible and give as much kangaroo care as possible

–          If the babies can’t be with me immediately post birth, they are to have skin-to-skin with Paul and Debs, NOT left on the resusitaire or in cot.

–          NO Vit K unless birth has been traumatic in some way e.g. assisted delivery

–          NO IV antibiotics for the babies unless signs of neonatal infection

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