Birth Plan–specific about cord management and placenta

This birth plan was written for baby number three, after experiencing a traumatic birth where her second baby’s cord was cut before birth (causing life threatening injuries) and the active management of the placenta was prolonged and painful.

This birth plan is based on my previous birth experiences and our desire to achieve a spontaneous-onset labour, physiological birth and third stage (natural delivery with no drugs/ synthetic hormones).

Birth companion
Partner ‘E’, may be present at all times and able to take photographs. This is ‘E’s first baby so please feel free to explain and discuss the natural birth process with him, or any need to change plan in event of emergency or injury.

Labour
Walking, leaning over bed or ball. Use of shower and maybe bath/pool if labour is slow.
Minimal lighting and need for me to talk is appreciated.
Past labours have made me nauseous and vomit, so easy access to bag/ bowl or shower is appreciated.

Pain relief
Counter-massage on lower back and rocking – being able to lean forward or be on all-fours
I have a bulging disc in my spine (L5 S1) that can compress on sciatic nerve down left leg. I will assume positions to avoid pressure on disc during labour/delivery. If medical procedure required, please discuss anaesthetic – I have experienced several procedures where local was insufficient and required double-dose/ top ups.

Birthing pool / bath
Happy to use birth pool for labour, possibly for delivery (if it doesn’t affect having a natural third stage)

Monitoring
I would prefer intermittent hand-held devices to allow me to remain upright and mobile for pain relief/ spine.

Transition and delivery
Using an adjustable bed or in bath:

· I may need to rest on my side in a semi-upright position during transition, and then move into a raised kneeling/ all fours position for second stage.

· In the event of nuchal cord, please do not handle or cut. There may be a delay between delivering the head and contractions for delivering the shoulders, to allow time for rotation. If the cord is preventing delivery, please attempt ‘somersault technique’ first.

· We request delayed clamping of the cord – please discuss if there are any issues with the cord during delivery.

Assistance during delivery
Guidance is much appreciated to ease pushing and avoid tearing. Please allow for break in contractions between delivering head and shoulders. I may require assistance to move or lift right leg to deliver shoulders.
Please discuss suctioning if there is meconium stained liquor.

Third stage
Physiological third stage unless complications. Once the baby has established respiration and we have rested, we will commence breast feeding asap to support delivery of placenta.

Post-natal care of baby
We would like warming/ stimulation to be done via skin-to-skin contact with me and baby checks to be done next to me and/or with my partner – possibly after breast feeding.

I have signed consents for immunisations and Vit K.

Feeding the baby
Breast feeding only