Alternate Birth Plans

Creating An ‘Alternate Birth Plan’

For the Birth that doesn’t go as Originally Planned

 

Before continuing, go the main Choices tab and click on it–and read the comments about Informed Consent.

Introduction:  Most often, babies grow well within the nourishing warmth of mother’s womb; most often, mothers give birth safely, and welcome healthy babies in perfect time.  Yet we can never be 100% certain that your birth will be able to continue safely at home, or that you and your baby will be healthy enough to remain home after birth.  So, creating an Alternate Birth Plan allows parents and their helpers to know how they will care for mother and baby safety if either needs medical assistance.  Your Alternate Birth Plan should include elements to help you receive respect for your wishes, as much as possible (depending on reasons for transfer).  Some families will wish to write out a birth plan to share with their midwife, other helpers, and the hospital staff.  But whether you choose to make a written plan or not, families benefit by considering a ‘Plan B’ as part of preparing for birth.  Below are some basics to consider and discuss together.

Medical Treatment and Informed Consent:  Most hospitals and care-providers do not automatically give patients full information to seek your informed choice on each treatment offered.  They instead have patients sign a General Consent document when people sign into the hospital for care.  When you sign the General Consent, you empower the doctors and the hospital staff with your ‘general permission’ to do all that they see fit for mother and baby’s health–you give them ‘blanket consent’ in advance, to all treatments they choose for you.  This does not meet the requirements of specific informed consent under the law—nor does it honor your natural right to know what’s being offered to help you or your baby, and your right to refuse or give consent for treatments. 

Upon being presented with the General Consent Form in the hospital, you can modify it before signing to improve your chances of receiving Informed Consent from staff.  In your own handwriting, place an asterisk at the statement that you are giving permission to the hospital to provide all necessary medical care.  Then, find a space in the margin to write in your condition of signing: “only upon informed consent of all/any treatments”, also with an asterisk and your initials.  Make sure that staff is aware of this modification, so they will be more mindful from the start about serving informed consent; so they will not assume that you have given them your ‘blanket consent’.

Medical people may attempt to force your consent by saying that you or your baby could die if you refuse a treatment, even if that is untrue in the immediate moment.  You can prevent this from happening to you, if you respectfully ask for informed consent from the start.  Your midwife or other support people can help you by adding their respectful requests, but the family must speak as well, to assure medical staff respect for their request for informed consent.  The first question to ask when a doctor is recommending treatment, however urgently, is ‘How much time do we have to make this decision?’  Even a few minutes can be enough for parents to consider options, or prepare for unexpected but perhaps needed intervention.  True life-threatening emergencies during birth are rare, especially for mothers who have taken care of their own and baby’s health throughout pregnancy.  Yet occasionally urgent medical care is needed—and if a true emergency arises, then you’ll probably be glad to accept treatments offered, even if you do not entirely understand these treatments.  However, in most cases of hospital transport, families do have time to learn about offered treatments and the alternatives.  If you do have a bit of time, then you can also tell the doctor (or other staff): ‘we refuse to give consent right now.  But we’ll think about what you’re saying and get back to you in the time you gave.’ 

Medical Back-up:  some families find a doctor or nurse-midwife to provide back-up for homebirth, one who is comfortable with homebirth and willing to meet you at the hospital should you need them.  However, you might not find a homebirth-friendly provider nearby; some families hire one they do not tell of their homebirth plans.   The family only notifies the provider of being in labor, if they decide to transfer to the hospital during labor.  If you do hire medical backup, be sure you tell them your preferences on mother and baby’s care in the hospital—even if you don’t say that you’re hoping to give birth at home.  Some families might choose not to arrange pre-established medical back-up; if medical assistance is needed at any point, they just go to the nearest hospital and accept services of the any staff on-duty that day.  Be sure to discuss this with each other and your midwife ahead of time,  making sure you’re all on the same page concerning that possibility of transferring care.  

Your Midwife’s (& other helpers) Role During Transport and at the Hospital:  Discuss with your midwife in advance, both the things she feels are cause for transfer to hospital care during or after birth, and what her role might be in the event of transport.  There may be circumstances where she feels it is safest for mother or baby if she accompanies transfer to give life-saving care or give report to hospital staff; there may be other transfer issues where you all agree her help isn’t strictly ‘necessary’.  However, your midwife may be willing to provide other services such as labor support,  helping you understand treatments options and supporting your efforts to communicate your wishes to staff.  You will also want to talk with others at your birth about what you want from them in case of transport, how best they might support a calm and timely tranfer of your care.

Hospital Protocols—all hospitals have routines that they conduct at birth and after.   You don’t have to accept them all for mother or baby; they are not universally needed or beneficial.  Some families try to become familiar with their chosen back-up hospital’s routines in advance—by talking to other families and even with maternity-floor staff before their birth.  They think ahead of time about those routines, which ones make sense or might be refused if the family does choose to transfer their care.  You can also choose to wait, and only learn about those routines as you are faced with them if you transfer care.  You can ask for information as care goes along, accepting or refusing treatments/routines as seems best under the circumstances. 

Know that a great deal of hospital routines and some treatments can easily be accomplished while you hold your baby, or at least in your own room.  Taking a healthy baby to the warming table or nursery is most often for staff (and machine) convenience only–it doesn’t help mothers or babies at all, and their needless separation can create problems for both.  You can safely ask to delay some routines and treatments; you can also state your preference for baby to stay with you instead of being taken to the nursery.  If you believe your baby’s health requires a nursery visit, you can also state your wish for the other parent (or member of your team) to accompany and hold the baby, or at least be very nearby at all times.

 

If you need a cesarean delivery:  a few mothers will need a caesarean surgery for their own or baby’s safety.  If surgery is needed in a true emergency, then the mother could receive general anesthesia; this makes the mother unconscious but is the fastest-acting anesthesia, used when time is of the essence.  In case you should birth by emergency surgery under general anesthesia, then you’ll need to decide how to best serve mother’s and baby’s care, following birth.  In rare cases, mother, baby or both are in so much danger that you accept whatever treatments the medical staff offers.  But you will still have options; for instance, partners may want to arrange to stay at the hospital as long as mother does, or both parents to stay as long as their baby does.  Even if the mother remains in critical care following her surgery, the other parent has a right to informed consent about all decisions made for mother and baby’s ongoing care. 

For most mothers who receive a necessary but non-emergency caesarian section, you may choose spinal anesthesia that numbs you from the waist down while you are still conscious.  In many hospitals, even if the baby is fine at birth or rapidly stabilized by immediate medical actions following birth, babies are taken to the nursery until surgery is complete and the mother has finished ‘recovery’ (where she’s observed for stability for about an hour following surgery).  You may state that you want your baby to stay in the same room with mother following cesarean birth, in her arms if both are in stable condition; if mother is unstable but the baby is fine, then you may say that you want the baby held by a family member rather than in the nursery or in an isolette. 

 This document is far longer than your Alternative Birth Plan needs to be, if you plan to write one.  Discuss with your midwife what help she might give, and that you’ll want from her in a transport, and ask for what you might want from any other helpers as well.  Having advance understanding will help reduce the stress of transport, and help all go as well as possible in the hospital.   Finally, make sure that everyone understands that if transport occurs, the plan could change without notice–we should be prepared, but ultimately we must live and choose with the demands of the moment.

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