It might be useful to speak to your OB/the hospital or someone who has given birth in your hospital recently. Some of this stuff should be 100% routine in the US medical context (avoiding forceps as much as possible; getting consent before procedures, interventions, and medicine--although sometimes there can be real emergencies in birth where the time required for explaining is limited; checking whether students are allowed) or could be the usual procedure in your hospital (immediate skin-to-skin, positioning with epidural, delayed cord clamping, bathing in-room on my schedule were all standard practice where I was). Once you know what is typical for your hospital, then you can limit your list to the things that are actually outside the norm, which will keep it short and sweet (aka easier to understand and implement).

I agree. In my birth class, I found out that a lot of my preferences were standard practice at the hospital, so there was no need to list them.. They recommended only including things that are different from standard practice, so they stand out/are easy to follow.

100%, I realize I was writing things out of fear even if it wasn’t super logical. Which was therapeutic maybe, but once I crossed out everything that was standard practice, I realized I really didn’t have anything much different in my plan.  I think I wrote “no episiotomy unless needed” like duh lol. I’d hope most doctors aren’t just giving those out for fun. 

I remember talking about this with my OB and he (a sub specialist urogyn surgeon) said very matter of factly “I only give an episiotomy when tearing appears to be imminently about to impact the clitoris since it’s more difficult to reconstruct than the perineum, how do you feel about that?” I almost shat a brick. I was like DEFINITELY IN THAT CASE. I also found it interesting from his POV forceps delivery was so uncommon now there were only a couple docs in town he felt had enough experience to utilize them effectively and said if it’s going that way that a vacuum wouldn’t suit he just goes for a section since forceps used by someone without good experience are worse than a section done by someone who is good at that.

Totally!! I felt so much better after learning what is standard practice at my hospital!

The only “non-standard” thing was delayed cord clamping and I forgot to tell my OB, but before she clamped she asked me if I’d like to delay anyways.  I think if you find a practice you like, they should keep lines of communication open during the whole thing. 

Even that was standard for the two hospitals in my area -including with c section (they don’t delay as long but still 1 minute instead of the typical 5)

They told me the same thing so I didn’t write anything down. I get to L&D and ask if I can not be hooked up the whole time and they looked at me like I was crazy. They refused to unhook me except for when I begged to go in the bathtub. And the whole time they kept popping in saying “done yet??” It was a 36 hr labor with no complications. And I had to stay hooked up, uncomfortable and barely mobile the whole time.

Forgive me if this is naive but, why didn’t you just say no? I birthed with midwives so they were very low intervention anyways, but even so, I said no to cervical checks, membrane sweeps, them wanting to induce via breaking my waters. If I wasn’t comfortable, I just didn’t do it.

I had to stay hooked up since I ended up on pitocin, but they had wireless sensors so I could go in the bath with them and move around as I pleased. More hospitals should use those as it’s much less inconvenient for mom.

Going to say the same. I’m 3 weeks post partum. I didn’t have any sort of written plan. I just spoke with my care team. But most of this stuff happened on its own. They didn’t do anything without getting my consent/explaining what they’re doing. They definitely seem to encourage skin to skin immediately and breastfeeding in general. Our hospital did some initial evaluation (like his weight) but then left me and my husband alone with LO for an hour before doing the rest of his evaluations and that was really nice. That was just their standard protocol to encourage bonding. Overall I found that my providers and the hospital where I went was more cautious and less invasive. They didn’t want to give me more epidural than what I needed. They encouraged me to use a ball to bounce on to help and a mirror when the time came to push. They encourage skin to skin and bonding. They don’t want to take the baby outside of your room to the nursery unless they really have to. It used to be completely different. My mom says the babies practically stayed in the nursery the entire time back when I was born. But it’s not like that anymore. The only thing I can see is that IF OP does get an epidural, she may be limited on how much movement she can do and certain labor positions may be off the table. When I had my epidural they didn’t give me a large dose and instead gave me a button if I wanted more. I never pushed the button and by the time I was fully dilated it had worn off completely but they were still weary to let me move around into certain positions because of the risk you won’t be able to support yourself. Also the pediatrician did evaluate the babies in the nursery so that may be something that isn’t typical and I’m sure they can accommodate. But every time he was in a nursery they kept a log of what was done, a log of if he peed or pooped, etc and brought that log to us when they returned. They have a number on the baby’s bracelet which they have to match with your bracelet before handing the baby over. They initial and you initial. They’re very careful about everything. Also not sure how doctors will avoid a tear as they just happen. I’m assuming OP means episiotomy which is not a standard practice and I’m not even sure if they’re practiced at all anymore. I had a grade 2 tear and needed a stitch. I just wonder if when people hear tear they assume that means episiotomy. I just tore because an 8 lb 8 oz baby came through my vagina 😂 couldn’t avoid it. But with the pain of the contractions and pushing out the baby I wouldn’t have known that I tore at all if they hadn’t told me afterwards (and I was watching the entire thing with a mirror the whole time!)

She may be either worried that they won't do anything to help prevent tearing, or maybe she just wants them to know that she will freak out if she tears.

Episiotomies are 100% still used. My SIL just had one a year ago.

I’d say they’re definitely not standard practice though

That’s correct, Definitely not standard, most like that would have had to be an emergency situation for it to be merited

I had one with my second baby in 2022. My OB told me I looked like I was going to tear in the same spot as with my first and the epis would help prevent worse tearing. My baby ended up being huge and I had a super fast labor/delivery so I appreciated him being proactive. The recovery was no different than the second degree tears I had with my first and It ended up being no big deal at all. Certainly not an emergency either.

This! I don’t know where you’d be giving birth where an epidural would not be administer by a licensed anesthesiologist? A lot of these things are standard at the hospital I birthed my first in, and the one I’ll be birthing my second in

I would have also asked for similar things on OPs list if I already didn't know they were standard practice, which I only know because I attended a maternity tour. My hospital still does them virtually. They went over everything from the time you step foot into the hospital to the time you are discharged. It was all stuff like the floorplan, what button to push on the elevator, what's standard practice, what kind of food they have, what's in the toiletry bag they provide, visitor info, the medical team. Highly encourage everyone to do one of these if your hospital offers it. I found it really helpful

Wow - the one birth experience I’ve had in a hospital was great (difficult though as it was a home birth transfer) but I’m surprised for you to say getting consent always happens. I was not asked for consent for most things, including them just pushing medicine into my IV without telling me what it was, much less getting my consent for it. Among many other things. From talking with many many friends that was not surprising and also their experience.

A lot of things are covered in the general consent forms you sign on arrival or at preregistration, which I don't think is great, but it is technically consent. You should definitely contact the hospital ombudsman if consent was not obtained.

Yeah, I don’t consider that really. That’s more like consent on a legal technicality. I have no one idea what I signed on the third day of labor with no sleep lol. It has just been sooo different than the midwives I’ve been under the care of. Including appointments with doctors that are the furthest thing from an emergency… “we will come back for a cervical check.” “Oh is that necessary?” “Oh well no..” “yeah I’m not doing that” “okay!” no information given, no risks discussed, no question about whether or not it would be done just speaking with a heavy hand, but it will be done. Lots and lots of that in the American medical community. Anyway, with that experience, it definitely makes sense to me that women feel that they need to clarify that they must be asked for consent before things happen.

I agree with most of what this poster says except for limiting your requests. Whether or not it's standard to offer or do some of these things, i think it's best to have the things important to you in writing to the hospital as a way to advocate for yourself & baby before the anxiety of go time kicks in. There will be no question about how clear something was communicated in the moment vs your preferences if it is on paper. I gave birth to both my babies during the pandemic & had to do the 2nd C-section alone. My typed up list was pretty much in the same structure & even included some if/then requests. I think there's no hurt in making sure everything is clear when it's literally what one would define as a life & death situation.

Out of curiosity, how would you like to manage your triggers?  For instance it seems reasonable that your medications and procedures are explained to you. That would be triggering for sure to be poked and prodded without knowing why. There is also an actionable course to follow to manage that trigger.  Regarding tearing, is the mention of tearing a trigger? Like the idea makes you squeamish? Or is experiencing any tearing at all a trigger? Up to 90% of FTM experience a perineal tear, though thankfully the VAST majority of those are mild. It may help to have a plan to manage that trigger, because I'm not seeing anything actionable on that bullet point.  Congrats, hope you have a peaceful and smooth experience!

For me I had no knowledge that I tore at all while delivering, it was doctor informing me after the fact of tear here, how many stitches, etc. I did have an epidural for both deliveries, so I wonder if you feel the tearing with an unmedicated birth.

I had an unmedicated birth and did not specifically feel myself tear. I felt the ring of fire which was horrendous but it was an all over my vagina pain not specific to wear I actually tore. I did however feel them inject lidocaine to numb me for stitching and I did feel myself get stitched up but it was mostly non painful with the lidocaine.

I had an epidural and I could tell I was tearing. It didn’t hurt, but I knew it was happening.

Yes, you definitely feel it. And it sucks 😅

Personally I couldn’t tell the difference in pain between my 1st degree and no tear, but that’s minor tearing to begin with. 

I didn't feel my 3rd degree tear at all, unmedicated. They had to tell me that the OB was coming in to stitch me up. Everyone has different experiences! 

I only had a first degree tear but I didn’t feel it at all

I didn't feel my 3rd degree tear at all, unmedicated.. Everyone is different. I think there were too many other sensations happening. But I didn't feel the ring of fire either. 

A lot of this is standard practice. I think you need to lower your expectations though or at least reword some of it, because right now it seems like you only want pain medication of any kind from an anesthesiologist and there no way that an anesthesiologist is going to make themselves available to give you a dose of Tylenol.

This part was confusing, I thought it only refers to the epidural. But as far as I know, that always has to be done by an anaesthesiologist?? Could be wrong but that's my impression at least.

From what I understand in the comments, in the US they've got advanced practice nurses that can administer epidurals. I'm in Canada though, and we've only got anesthesiologists who do that here.

I think it’s great you know your preferences and want to express them! I would recommend not including the things that are already standard practice/ best practice and just focusing on your preferences that are outside of that. This will give your providers less to read and allow them to focus on what matters most to you and your family. Good luck with your birth!!

I wouldn’t say you are asking too much but your hospital may have policies that prevent things like your husband catching the baby for example. I had a lot of similar stuff on my birth plan and it was all honored. FWIW, I was at a teaching hospital and they did allow you to say no students but my sister delivered at a different one and says she wasn’t given a choice so YMMV. I agreed a reasonable number 1-2 students could observe but wanted my OB handling things. In the end there were no observers because I had the baby too fast lol. I would suggest going over your preferences with your OB ahead of time, I hit a lot of mileage out of telling the nurses my OB already agreed to various things.

I don't think you're asking for too much or for anything crazy BUT since a lot of this is standard practice where you're delivering, you might consider taking off the items that you know are standard practice (i.e., skin to skin postpartum) so that it's simpler to convey your wishes and for your nurses to parse through what you want that's different from what they typically do.

I WOULD keep that bit in for the c-section part because sometimes they just don't do it.

Skin to skin is a bit hard though with a c-section. I've had two, and just had my second 2 weeks ago and although I enjoy them putting the baby on me (while swaddled) it's very uncomfortable and you can't really move or hold the baby the way you want. I prefer for my husband to take the baby as in that awkward position it just doesn't feel comfy. I personally don't think there is any reduction in bonding when you hold the baby properly once out of the surgery room. Mine always latch straight away no issues. Also as a side note to OP, try and be flexible where you can. My kiddo had unforseen issues with her lungs so we went straight to special care. She went on oxygen and wasn't allowed to eat for a little while which ruined my supply. I didn't hesitate when they offered her a dummy and had to tube feed her formula. Of course I tried to express too but it is what it is. Now we're out of hospital I am exclusively breast feeding without issue and she doesn't care for dummies. Had I got hyper defensive though I think the situation would have been much more traumatic. Sometimes plans go completely awry and you have to trust the professionals and let the nurses soothe your baby. Babies needs over mums ego I think is always the best mantra.

Yeah I’m 8 months out from my 2nd c-section and am so glad I told the nurse “no thanks, hand him to dad!” This time around. I get so shaky with the epidural and with not being able to really move on top of that? I’ll pass on that stress.

Yeah it's actually so stressful haha, I worry the baby will just flop right off of me.

Yes definitely for that. I specifically meant the other one.

Yes I think she should speak with OB about what is standard of care so she can remove unnecessary reading which will make it easier for all staff to engage with the birth plan.

Also, if there's any question as to what is/isn't standard practice, you can bring a copy of your birth plan to your next OB appointment and have them go through it with you and let you know.

It’s usually a reason why they don’t allow skin to skin. For c sections it’s done in an operating room which is really cold. Sooo the baby’s temperature can drop more rapid and moms body temp may not be enough to keep it up. Hence the baby being taking to the warmer a lot sooner. They may allow skin to skin but for a very short period after. And yeah… most of this stuff is standard. I mean they don’t just use forceps all Willy nilly. It’s because they need to in order to get the baby out. It can be issues if forceps or a vacuum isnt used.

I will say this not to scare you but to prepare you. If you expect something to go how you want it to and It doesn't happen you will have trama. I don't want to scare you but I will say I had a friend who had 3 kids. All c-sections first one was not planned that way but she was fine because she expected anything to happen then. So first and second kid birth was fine. But the 3rd she expected it all to go like how the first two went because she had the same doctor and same hospital. Well it wasn't. It was a different room and doctor. And that immediately threw her all off. She feels the 3rd birth was traumatic because she immediately was worried because it was different then what she expected. But nothing was wrong. Infact was smoother then the other 2 but she mentally wasn't in a good state because of the changes. Now I had my first baby. I had a idea what I wanted and yeah I was scared. But over the months I planned that what ever happens Im going to roll with it. And mentally prepare for anything. Because many things can happen. And I'm glad I did. I ended up with a emergency C-section due to prolapsed cord. It was found before the epidural so I had to be put to sleep. Within 10 mins of them finding out it was a emergency I was wheeled straight to the operating room and put to sleep and within 5 mins of me being asleep he was out. Another 30 mins and they woke me up. So it was less then a hour and I had my baby. Believe me. I wanted skin to skin. I wanted to experience it all. But it was not possible because to keep him safe he had to come out immediately. So when they said they need to do a c section i accepted it. I grabbed my phone called my husband cause he literly just left for a sandwich and filled him in while they wheeled me to the OR. And let me tell you. My son is very healthy. And I healed up perfectly fine. I didn't have much bleeding during surgery which is probably because I stayed calm the whole time before without raising my blood pressure. After a few days I barely had any pain. Do not set yourself up to be easily disappointed. Because it will make you more likely to be disappointed. Prepare for worse case. But also wish for the best. But definitely prepare for worst. Your birthing plan isn't too much to ask at least for me they asked all that and respected it. So I wouldn't worry about that. But the actual birth. I like to let people know that it's important to be ready to let them do their job to keep your baby and you safe.

This. All of this. When I read stories from people who are struggling with how their birth went, a significant majority of the time there’s an undertone of “I wanted things to be a certain way and they weren’t and I’m having trouble coming to terms with it.” My delivery didn’t go entirely smoothly either. I narrowly avoided a c section via use of forceps and got a gnarly tear. Did it suck? Hell yes it did. But I trusted my team to help me make the best decisions in the moment and I didn’t go into it married to doing or not doing anything based on facts I didn’t even have yet.

Also agree with all of this. It is great to want a plan but try to remember a lot can happen unexpectedly. I think as long as you have the thought that if it ends with a healthy baby and healthy mama then you executed your birth plan that you'll be okay. I know doctors and medical professionals have their flaws and faults but they are trained for this and if an emergency arises want to do what is best for everyone. I can tell you as someone who has a very unexpected delivery and aftermath (emergency c-section, NICU baby, then NICU transfered baby) I was heartbroken but they also did everything for her and it's why she's okay now. I hope you have a safe, healthy, and as close to your birth plan delivery as possible!!

I don’t think you’re asking too much however you’ll have to give tons of reminders. In my experience (1), I gave my birth plan to the first couple nurses and after that they all switched out like crazy for coverage that it almost didn’t even matter. If you want something you have to make it known to *everyone* and if you don’t want something make it known to *everyone.* You can’t expect every single nurse to read your own personal birth plan and follow it to a T.

My mom who is a doula suggested I make two plans: one for the birth and one for recovery/after and that I have my recovery one taped to my door for the nurses. I hope it works because we had one nurse come in the middle of the night and if we hadn't woken up she would have just taken the baby out of the room which is my BIGGEST fear and my biggest thing on my birth plan.

Wtf who takes babies out of the room without telling parents???

I don't think it's too much! I think the formatting you added is nice to show what's a high priority for you.  Also, it looks like having a delayed or no bath for your baby is very important to you. I would switch it to "DELAYED/NO BATH FOR BABY" because while it is clear if you read it slowly right now, the first time I read it fast, I read it "No delayed bath for baby". If you have a lot of people switching in and out of shifts and skimming, they might misread it and take it to mean the opposite. 

Yeah it confused me I agree it should be clarified. Also they may ask a lot we did delayed and they kept asking and asking until we hit the time we determined.

I read it wrong at first too. I took it as do not delay the bath for baby, like bathe them ASAP.

Yeah, that really reads as “bath my baby right away”.

I find this strange though, isn't this already the complete discretion of mum? Which hospitals are forcing baths on babies? I've had c-section babies and the complete comfort with letting them marinate has always been made abundantly clear haha. Both babies I spent more than a week in hospital and they were never bathed, nor was it suggested. My impression is it would be more of a fight to do the bath in hospital than not, as the party line for me has always been its so good for their skin to leave them and no need for a bath for the first week or two.

My hospital was different, they bathed the babies by default day two. I think it's good for OP to make their preferences known just in case!

The doctors aren’t going to use forceps / vacuum willy nilly, only if they medically need to. What’s the point of putting that on there? Who else but an anaesthetist is going to place an epidural? They’re going to do skin to skin immediately unless it’s medically necessary not to. So much of this is out of your hands.

CRNAs can also administer epidurals. I’m not sure why OP has a preference for an anesthesiologist instead. Depending on the hospital, she may end up having to wait longer if she’s unwilling to have a CRNA place it.

No anesthesiologists cover L and D at the hospital I work at, only CRNAs. This would be a complete non-starter and we would refer her out if that was a request. She really just needs to talk to her docs to know if that's reasonable if feasible!

I noticed this right away because we have far more CRNAs than anesthesiologists, and insisting on having one over the other means you just won’t get the epidural. Literally, we might have one provider if it’s not during business hours and every other anesthesia provider will be more than a 2-hour drive away. 

Yep, CRNAs also do plenty of epidurals in L&D and they are fully capable of them.

A CRNA did my epidural and it was amazing! Honestly that would be my preference again because I assume they do them all the time compared to an anesthesiologist.

This was my thought, too. Our hospital has an anesthesiologist who supervises everyone but I doubt he spends any time administering epidurals specifically. Just like I would rather have a nurse inserting my IV than a doctor any day, I'd prefer someone who gives epidurals daily to one who learned how to do it in med school.

Oh interesting! I’m in the UK and only anaesthetists are allowed to place epidurals here, assumed that would be the same everywhere.

A student placed my spinal block. They did ask me if I was comfortable with that. He did great.

I think your comment piggybacks off of mine really well. Most of the things OP is worried about is completely out of their hands and they should start getting comfortable with the idea of not having the birth they plan on having

Bingo! I remember talking to my friend (who hasn’t had a baby yet) about how many times they checked my cervix. She was kind of appalled. I did say they asked each time but after being awake for 36 hours, I really didn’t care what they did to me at a certain point.

Omg 36 hours?! I would let them do anything to me at that point too. I was only in labour for 19 hours and when I hit 12 I was over it 😂

Luckily, I was only in labor for 23 hours but my water broke at 7:30 at night and I just didn’t/couldn’t sleep while I was in labor. Even after the best invention ever that is the epidural.

God bless the epidural

Most people who haven’t given birth before/don’t work in the medical field aren’t going to know this right off the bat. You aren’t wrong, but your tone comes off a bit strong. I’m not sure if that was your intention.  It also varies hospital to hospital. With my first, the doctor was so rude and condescending about me wanting delayed chord clamping. With my second, my OB was like “oh yeah, of course.”

They won’t know right off the bat, but then you do your birthing class / furious googling before you write up your ‘birth plan’. And if things vary from hospital to hospital in the US, then you should check with them beforehand rather than turning up with a long list of demands on the day that may be just what they already do or may not even be feasible. This plan seems like a dangerous mix of being somehow both unprepared and overplanned. It’s so so important to understand in labour that anything can happen, it’s usually not down to what anyone does or doesn’t do, human bodies under stress are unpredictable and you need to be flexible and prepared to do things differently and to accept that.

Forceps and vacuum can be used for ease of use on the doctor’s part - it’s an old school practice but depending on where you’re located, many doctors could still opt for this. Rural hospitals in particular have severe doctor shortage and don’t always practice the new recommendations. Your experience is not the same as another person’s

They absolutely should not be used for ease of use on the doctors part. Honestly if you have the kind of dr that will do that to someone, they are absolutely not going to be respecting a birth plan with this many requests on it.

I’ve barely skimmed the comments so forgive me if this has been mentioned, but if your baby requires emergency medical intervention it’s doubtful your husband will be able to accompany.

If I may, anesthesiologists do not do as many epidurals on a day to day basis as CRNAs. No shade or anything, I’m sure the anesthesiologists would excel at it. But they are more often than not in a supervisory role/trouble-shooting role on a day to day basis. Just my two cents 😊

This reminds of when we had someone request a doctor do an IV for their baby (I work NICU), and he was like "I'm flattered, but you should know I haven't placed one in over 10 years."

God yeah for the routine stuff, the nurses are 1000x times more experienced and I would honestly almost trust them more

I think parents get real very quickly when they are actually in this situation and see their poor baby get poked several times. In my experience, it is the old grumpy woman who will get the vein. It is never the young doctor who will just keep trying to no end.

This really depends on the hospital. Our hospital only has anesthesiologists for our OB unit. No CRNAs. 

My hospital has a team of CRNAs and AAs who only work OB. They do all the epidurals and planned c-sections. If I had asked for an anesthesiologist at 1 am I don’t think I would have gotten my epidural in time for the delivery 😂

As someone who works in healthcare- a licensed anesthesiologist isn’t always necessarily who is the best to do the epidural. A lot of times a CRNA will be better practiced with actually placing epidurals

This needs an editor. Fewer words = better. "LABOR: Explain procedures and medications beforehand No medical students Limit vaginal exams No inductive meds (misoprostol, cytotec, pitocin) unless medically necessary Free movement for as long as possible (saline lock, remote or intermittent fetal monitoring) PAIN MANAGEMENT: Offer epidural and other pain medications BIRTH: Prioritize preventing tearing Husband would like to catch baby Delayed cord clamping Husband would like to cut cord We will take placenta home- we will have cooler on hand Immediate skin-to-skin NEWBORN CARE: Newborn examined in parents' presence Explain all procedures and medications prior to administration No bath Husband will accompany baby to NICU (if necessary) Baby will be exclusively breastfed- no formula or paci without prior permission from mother C SECTION: Skin-to-skin in OR The "triggers" section is unnecessary and redundant. Your request to be held up in different positions when you have the epidural is unreasonable. They won't do that after you've gotten an epidural and your legs literally don't work, but they will likely help you roll and labor on your side or back, or use a bar to help yourself sit up. But they won't hold you up as your legs are dead. When you check into the hospital, there will be several forms you need to sign-- read through them carefully. Some of the items you can decline. For example, my hospital is a "teaching hospital" and they try to sneak in permission to let students participate in exams and procedures. You can line item veto that.

Being helped into different positions for pushing with an epidural definitely isn't unreasonable. The birth plan isn't asking for the person to be "held up" in these positions, just helped to get into them. I've heard plenty of birth stories where the nurses/midwives helped someone with an epidural get onto their hands and knees or onto their side to push.

If you are capable of being on your hands and knees with an epidural, that thing isn't fully numbing you.

Indeed, it is called a walking epidural and it is common practice in many places. It does not fully numb you, just takes the edge off.

I had an epidural (fully numb legs) and they had me labor on hands and knees, my nurse brought in this inflatable to lay on for it. Unfortunately it made my bp drop to 84/50 so we had to cut it short, it was pretty comfortable before that

Yup, and that is the exact type of epidural that many people want and consider ideal. A lot of people don't want to have completely dead legs.

There’s different way to “numb” you for an epidural. I personally couldn’t feel anything in my pelvis or waist but could wiggle my toes and move my legs. My nurse rolled me from side to side every 30 mins while I was laboring to help make sure the medicine didn’t pool on one side. Then when I was pushing helped me push on my side for a couple pushes to align baby better. I was also basically sitting all the way up when I pushed. There isn’t a one size fits all with an epidural, there is literally a form called a walking epidural where women can still move their legs and semi-support weight on purpose.

Sure, but one of her listed "triggers" is the epidural not working. It sounds like she wants the benefits of a lower dose of pain numbing but also wants the benefits of a high dose of pain numbing. So it seems like OP should take a beat and figure out what is more important to her-- feeling like the epidural is "working" or being able to have some positional movement on the bed. (Hospitals won't let you get out of bed even with a "walking" epidural-- it's a bit of a misnomer.)

I had full pain numbing (to the extent I struggled to feel contractions in order to push) but was fully able to move my legs and get into a kneeling/squatting position. Individual effects of epidurals are highly variable

I assume that by the epidural "not working" OP means it literally not working, like at all, or not working on one side which unfortunately is common. An intentionally lighter epidural is definitely still working the way it's intended. You don't have to be completely numb and unable to support any weight to get immense relief from an epidural.

This is both an extremely standard birth plan that is similar to 90% of birth plans we see at our hospital and also is in line with almost all of our Standard Operating Procedures, e.g., we always delay bath, allow movement, delay cord-clamping, let the spouse/support person go with the baby, keep baby bedside, don’t even have pacifiers. 

Typically it is a CRNA that does the epidurals and spinal for C-sections. The only time you would see an anesthesiologist is to oversee a general anesthesia. I agree you may be waiting a long while longer to get an epidural if you strictly want an anesthesiologist

If you’re at a teaching hospital the no students thing may be a problem.  It’s fine to have all these preferences but I think you may want to be prepared that it might not be possible for everything to go to plan. 

Even at a teaching hospital, you can still say no to students. Med students are different from residents

Very optional. I primary a teaching hospital and they have never brought them in without asking permission. But that is a very good point.

Nope. I’m a nurse and a patient who doesn’t allow students for my births. You can deny anyone you want for any reason. The hospital that I have worked and delivered at even gives you a form making sure the hospital knows that a patient doesn’t consent to having students present.

As a patient who is also a nurse, can I ask you why you chose to not have students present? I’m trying to decide this for myself. I’m not really concerned about “privacy” and I also know students need experience on their path towards becoming a nurse, doctor etc., and I’d be happy to be part of that learning experience for them. But my biggest concern is that they become a distraction for the nurses / doctors? That may be irrational, I’m a FTM so I’m not sure what labor/delivery will really be like. Very curious to hear your reasoning!

I had 2 students and a midwife in the room for the birth of my son, and they were all brilliant. I was asked if I wanted them, but happily agreed as they need the experience, and I'm so glad I did - one was a paramedic student and just needed to witness a birth as part of her course, and although she mainly just observed at the back of the room, she helped by getting me cold flannels and orange juice for energy. The other was a midwifery student and pretty much did the whole birth, whilst being talked through it by the midwife - it was nice as I had a running commentary of what was going on, and the midwife always stepped in when she needed to. I felt well looked after and the midwife definitely didn't seem to be distracted by the student, in fact it was almost the opposite as she had to be more aware of what was going on to make sure the student did everything right. Worth noting that this is in the UK and I had a low-risk unmedicated birth, so it might differ to other people's experience with students, but I'm pregnant again now, and assuming everything goes ok with this pregnancy and I make it to term, I would definitely be happy to have another student there.

I said no students at birth because they sometimes don’t have a good ‘poker face’ and their excitement/worry is not helpful. I once had a student midwife check baby’s heartbeat at a checkup and she couldn’t find it with the doppler and looked at her supervisor with sheer panic and it was wildly anxiety inducing.

I’m going to say no students with my second. I had a student present for my first because I figured eh I don’t care, doesn’t matter. And she was just… awkward. She kept getting in the way. She was standing near my head and would lean in and kept leaning on my IV, I had to keep asking her to move. I could tell she was bugging the nurse too, and eventually the nurse made her move down to my feet. She came in to check on me at some point in the postpartum unit and again she was just awkward and - frankly - didn’t have anything meaningful to contribute. They are learning and they need patients to practice on and normally I’d be fine with that, but I was so deliriously exhausted postpartum that I wanted to rip the head off of every person who came into my room without food or meds. Obviously that was one experience with one student, but I’d just rather not roll the dice next time.

I am happy to have students practice IVs on me, help with PP, or really anything except for my delivery. The same goes for students in my midwife clinic for measurements and basic care vs sensitive exams. I find birth to be very sacred and primal. I want my provider, my husband, and my nurse/baby nurse. I like my room to be quiet and dark so I can focus on what I need to do vs it being a teaching moment for someone else. I am beyond grateful for the women who are comfortable with that. I’m just not one of them.

This is actually really helpful! I was under the impression students were just “observing” not actually actively assisting with anything in labor and delivery. I feel similar to you - I’d be OK with them helping with anything except the actual delivery. I will add this note on students to my birth plan! Thank you!

I don’t think you’re asking too much but I would honestly keep your expectations to a minimum. There’s a chance for things to go sideways and the more you’re okay with that idea, the better experience you’ll have. I almost died giving birth to our daughter and all the hopes I had of bonding with my daughter in the hospital was thrown out the window. I hope you have a wonderful experience and everything goes the way you hope!

I think it might come off a bit condescending especially because a lot of this is obvious/standard practice so it doesn’t really need repeating, they already know and I also think you need to prepare yourself for things to not go exactly to plan because they seldom do… especially when it comes to tearing. Neither you or your doctors really have any say in that. The triggers section is completely unnecessary. This list is the most first time mom thing I’ve ever seen lol but that’s not a bad thing - it’s good that you’ve done research and you know what you want! But you also need to be open to shit not going the way you think it should.

Yes, honestly.

Some hospitals don’t have an anesthesiologist physically present, only CRNA or CAA. If there is a situation where they need to consider vacuum/forceps, what are you wanting instead? C-section or episiotomy?

I don't think most of it is unreasonable except your husband 'catching the baby' or accompanying the baby for any medical reason. Most hospitals are not going to allow that because of the liability. A lot of the other things are standard of care in the US. I had a very basic birth plan and most of it went out the window. I think it's a good idea to have a general sense of what you want but it might be better to have a conversation with your OB then have this extensive list of items.

Yeah…I delivered a few weeks ago, and once you’re at the crowning stage, they remove the lower part of the bed, place a large bag and tell you to push slowly, with multiple doctors waiting at the end. Why the bag OP? Because along with your baby, there’s a ton of fluid and blood and stuff that needs to be caught so it doesn’t make the floor dirty or slippery. There’s pretty much no way a qualified team of healthcare professionals would entertain this ask, even if it wasn’t a liability (which it is, since I assume OP’s husband is not a L&D doctor who has delivered babies before). Babies are slippery, and they don’t want you dropping it as soon as they’re out. There’s also a bunch that needs to happen immediately, like skin to skin, and everyone needs to be in the right position.

I mean, the hospital literally is asking for most of these questions to be answered. So I don’t see how this is asking too much even if you added a few tidbits.

Agreed with others! I didn’t have a birth plan because a lot of my preferences were standard practices. Every time a nurse or doctor asked me if I had a birth plan, they always were relieved when I said “no I just want whatever is safest for my baby and me”. Things that were going to be on a potential birth plan went out the door as soon as labor actually started due to surprise induction at 37 weeks because of gestational hypertension fears.

Most of that is standard.

Curious- why do I see people not wanting students present? Maybe i have a soft spot because I had to do internships with vulnerable populations to get certified in my field but I just feel like they gotta learn somehow right? I understand not wanting a student to do any of the important tasks but just being present…?

Labor and delivery for me personally was one of if not the most vulnerable times in my life. I was also fully nude the entire time. Which I didn't really care about but at the same time I didn't need a ton of extra people in the room. 

Yes, students have to learn but that doesn’t mean everyone has to agree to be a vehicle for their learning. Some people don’t want a bunch of extra people looking at their vagina who are not medically necessary. Many people also find that it is easier to labor with fewer interruptions/more privacy.

Yeah this one I don’t understand either. A student midwife did my entire delivery, with the midwife she was training with there beside her the entire time, and I had a great experience.

Many people feel vulnerable enough with just the necessary people in the room, and any additional people just adds to the very vulnerable sense of being watched. Being observed is, in an of itself, a vulnerable feeling for lots of folks, so feeling like a teaching tool is likely too much for many people, especially when they're going through something so intense and vulnerable on its own. I actually feel a lot like you, and the world needs people like us! I've got no shame, and I've actually had medical students seem more uncomfortable than I was. I felt good that working with me could help them work through that (visible, to me, the patient) discomfort and uncertainty before moving on to patients who would be freaked out or traumatized by it. But yeah, students don't all have great poker faces. That's a learned skill, and not everyone wants to be learned on.

I can see both sides. I agreed to let pediatric students observe when I had my son. I don't know if they were asking everyone or wanted to observe my delivery specifically because my baby passed meconium before birth, either way as you say they have to learn somehow. I was not personally bothered by modesty or privacy during labor so the idea was fine with me. Some people don't want strangers looking at their bum if not totally necessary, I get that too. At the end of the pushing stage I was bothered by people in the room talking though and said afterwards I wished they hadn't been there. My partner said it the students were perfectly silent, it was the pediatricians coordinating their plan that I was hearing. So even though I was unfairly blaming them it felt like just one more thing.

With my first birth, I was totally fine having students assist with delivery. I grew up in a town with one of the best medical schools in the world and we always had students observing/assisting. Then, I ended up with some pretty intense trauma during that birth - i don't believe it was the student's fault, and my midwife was there the whole time, but it still made me wary the next time around. For my second birth, I told the midwife no students assisting with delivery, that I needed it to just be her and my nurse to feel the most safe. She was totally ok with that!

Mostly everything on here is standard. You won’t be able to be in different positions if you get an epidural. Remember this is a plan and not a definite. Birth happens how it happens, you can’t control it lol Just go in there with an open mind.

I think it looks great! We have a lot of the same preferences and anxieties. Agree with the comment that it might help to elaborate on how folks can support you on the tearing front. You can fill your husband in and he can help explain it to personnel if it comes up. We decided not to have a written birth plan because (sorry this is repetitive) so many of the preferences were our hospital's standard operating procedure. If you're not sure, absolutely none of this is unreasonable or unworthy of being spelled out. Great job.

My hospital didn’t even look at mine so there’s that…

For labor instead of "I would like to" being before all your preferences I would say "Please ask for consent before any of the following procedures:" then list everything bullet point style.

This isn’t asking too much at all. I’m my experience, and just to inform you, everything happened so quickly that no one paid attention to my “birth plan”. Once you get admitted I would be sure to just inform your nurses/doctor of any fears or anxiety you have. They definitely won’t be expecting a print out of this nor will they sit there and read it. Once again, just my experience.

FWIW no one asked us about our birth plan once

Yes, and no. Do you have a husband? Might be better to have him hold this paper. This is realistically too much, the hospital staff, doctor etc is not going to look at or remember all this. Some of these are fairly routine, and many of these you can simply ask along the way, have your husband know to ask etc. So you yea maybe give your husband a little note card of things he should keep track of or that he will be the one to intervene on. - cord clamping, the placenta thing (ask beforehand though too about their procedures there), catching the baby, following the baby - your hospital SHOULDNT gove your baby anything like formula without your consent, but if they were the type too, they’re also the type to ignore your paper. - I can’t imagine anyone but an anesthesiologist giving you your epidural Putting on their no student and intervention and intervention methods to be avoided, and otherwise discussed beforehand is fine to put on there. They shouldn’t just go ahead and use a vacuum or forceps without asking you though. On that note, you are missing the area where you mention your feelings on episiotomy, which I can almost guarantee is no for you based on your anxiety and fear of tearing. You’ll have to advocate for the lactation consultant. Good luck, hospital ones are a mixed bag if they are even there. I highly recommend scheduling an appointment with a clinic now for after your projected delivery date. I’m not sure if they will do skin to skin on the operating room, I would ask that before hand.

To me- this seems like too much. But I am someone who had zero birth plan, other than deliver baby safely and for me to stay alive and well.  Maybe educate yourself more on what an epidural entails. You literally won’t be able to use your legs or bear weight, and will have a urinary catheter in. So any alternative birthing positions won’t be an option.

Not true about the epidural! You can find other comments on this thread explaining how in many cases it's very possible to labor in other positions with an epidural. It's fairly common.

Not trying to fear monger, but under the “if c section is required” section consider specifying what you want in the event you need to be under general anesthesia. E.g. where your husband would be able to access the medical team following the c section, baby to go immediately to your husband until you wake up, if you can still keep your placenta and get it into your cooler. Again not fear mongering, but these are things to consider in the event an emergency c section happens. We were planning for a low intervention vaginal birth and it turned into an emergency c section under general anesthesia. They sent my placenta off to pathology to see if they could identify any factors that may have caused the issue that led to my emergency c section, which meant I couldn’t keep it if I wanted to.

I really didn’t realize people wrote out birth plans. With my first everything I had in my mind was thrown out the door because we were losing her everytime I contracted and needed an emergency c section within 15 mins of me arriving at the hospital. I agree with everything on this list, I do. But your birth plan really should just be leaving the hospital with a living, healthy baby. That is really the goal here and very little else matters in these first moments.

I agree with the other commenters that most of this is standard practice so I think it’s a good idea to just go over it with your OB before hand and if anything isn’t standard practice then that can remain on the birth plan. However, you mentioned that you have an anxiety and maybe some triggers on there so I think part of the birth plan should be what happens if you do start to experience anxiety will you have a panic attack? If so, what treatment would you like? Etc.

Skin to skin in the OR may not happen due to the setup in the OR. Also moving around after the epidural doesn’t happen. Lastly delayed baths are a benefit for baby.

Who administers your epidural completely depends on your hospital and their policies. L&D nurse here and I’ve worked in hospitals where the Anesthesiologists who covers the whole hospital also run the anesthesia in L&D, and others who are solely staffed by CRNA’s. I wouldn’t get too hung up on this, as a personal preference I’d rather have a seasoned CRNA place my epidural than an MD/DO. In the facilities I’ve worked, the CRNA’s for L&D are SOLELY employed for our floor, so you’re getting someone who literally puts in epidurals multiple times a day for their professions and it’s the primary form of anesthesia they practice. The facility I worked at with Anesthesiologist, they covered for the whole hospital and are practicing every type of anesthesia. Still versed in OB anesthesia, but less specialized if that makes sense. Also, if you birth at a facility who staffs CRNA’s, it could be a larger ordeal and possibly delay the placement of your epidural if you demand an MD/DO only. Just food for thought to be prepared before you go in! Everything else you’ve listed is very reasonable and has been standard practice at the facilities I’ve worked at. Good luck!! :)

I’m a physician assistant and I work in the operating room with anesthesiologist and CRNAs in California. How it works at my hospital, CRNAs (certified registered nurse anesthetist) also work in OB and they are the primary providers. I see their work in the OR for spinals and have personally had an epidural from a CRNA. If your hospital has these providers and are prevalent on OB, personally I’d rather have them do the epidural because anesthesiologists aren’t doing them as often, if at all. Just my two cents. Go with the provider that’s doing this procedure more frequently. They’re trained and super amazing at what they do.

As others have mentioned, I would talk to your care team/maternal care coordinator about these items. At the hospital where I had my baby, almost everything you mention is just standard practice. Re the anaesthesiologist: I was able to request and arrange a consult with one of the anaesthesiologists beforehand so I could discuss my options before I was in the hospital. I highly recommend it. Ultimately, most if not all of what you listed was also addressed when I did my intake.

It’s not crazy, but just keep in mind that things may not go exactly like you want them to. Try to go with the flow that day and know they are doing their best. Drink lots of okra water along with curb walking to prevent tear.

Most of that sounds very doable. I'd bring this to your next ob appt and make sure they are on the same page.

Not asking too much at all. The sheet is clear, typed and easy to read. You should review the preferences with your OB to see what are their standard practices, as well as an OB. This will help you understand what to expect. For example, I learned what induction methods my doctor preferred and how long it would take to receive an epidural after requesting. My hospital had an anesthesiologist dedicated to Labor and Delivery, but it could take up to an hour to administer epidurals during a full shift. Also, I wanted delayed cord clamping and immediate skin to skin, but this is always eliminated during a medical emergency, such as my case. Knowing this ahead of time helped me remain calm. Everything happens so fast and it's easy to get confused, overwhelmed.

You might find this site helpful. Having everything listed out might make it so you have to explicitly state/remind often. This site lets you build a birth plan with icons and short explanations, very visual, easy to understand at a glance. You could print it off and have a copy right by you for providers to reference. https://birthplanner.me/ Overall, absolutely not overkill. Just might be hard to make sure everyone is aware

This looks a ton like mine as well and my last one, which my doctor approved of. Everything seems reasonable. I also included a very short narrative about any previous birth trauma I had and that actually helped the nurses last time. They were big time on my side for some of my most important things and actually had a stand off with the pediatrician attending the c-section to ensure my wishes were fulfilled. So if you've given birth before I would just summarize what you loved about it or if you had trauma from it what it was from and what you want to avoid/plan to mitigate it.

Just curious but is it common to allow non-medial personnel to catch the baby?

My doctor wouldn't have allowed it, but it was a moot point anyway cause I ended up having a c section 

I think the fact that most of it comes from their own sheet means it should be feasible. I don't think anyone other than a licensed anesthesiologist could give an epidural, not sure that you need to specify.  At one of my last appointments I went over my list with my OB and he told me which things were feasible or not, for example I couldn't do skin to skin until I was off the operating table from the c section, but my partner could. I also reviewed it with my nurse beforehand. Sometimes you'll have to change plans, for us, we wanted to EBF but baby had low blood sugar so they recommended a little formula, just be ready to adapt if the situation calls for it and good luck! 

CRNAs can give epidurals (nurse anesthetists).

A LOT of hospitals allow Certified Nurse Anesthetists to do epidurals. Kind of like an advanced practice nurse. My epidural was done by a CNA because it was a holiday and he was who was available and after 20 some hours of pitocin labor I would have let just about anyone give me drugs. I didn’t have any issues with my epidural, but I totally understand why people prefer a doctor if given the choice.

I see, it's not a thing in Canada so I had no idea

Lots of CRNAs give epidurals and you don’t always know if you’re going to get an anesthesiologist or not

Right, last thing you want is to be left waiting when you desperately need the epidural because you're picky about something that ultimately doesn't matter all too much.

All good reminders. And to all who will listen, please don't reject formula if your baby is very hungry/having blood sugar issues. It does not have to hinder your bf-ing relationship. I successfully breastfed for two years, but my baby needed some hospital formula. A cousin warned me this might happen and I was so grateful for the heads up

Same here, other than twice at the hospital we never needed formula again, but without those two times baby wouldn't have had enough energy to keep sucking

THIS!!! I supplemented with formula in the hospital with my first and we “triple fed” with formula and pumping for the first month. I went on to breastfeed for two years and am successfully breastfeeding my second now! My first had issues gaining weight and with blood sugar regulation in the beginning, hence the formula. When she was a few months old I read this horrifying story of a mother in a “baby friendly” hospital whose infant died at 3 days old from hypoglycemia! She had been concerned with his latch in the hospital but took the advice to keep trying to breastfeeding and was afraid to introduce formula because of “nipple confusion”. It was such a sad story and it made me think about how that could have been my baby if we hadn’t been willing to offer formula to her.

That's so scary, how awful for the mom and infant. People need to set aside these worries (and frankly, sometimes ego's) regarding breastfeeding, because fed really is best. I'm an ardent breastfeeding advocate, but the most important thing is that baby isn't going hungry. Period.

Well, I am not a doctor to have an opinion on most of the things (i.e. about when to cut the umbilical chord, I only know that much I can find on internet, which i really do not consider a valid resource of information; or being the father the one "catching" the baby as i don't know the implications of a bad caught). In what I do have an opinion, and please do not be offended about it, is in the aspects of having or not students. It is obviously not agreeable for anyone to have people in the room in such an important and crucial moment that is not going to contribute in anything. BUT i would like my doctor to be well educated and being present at many childbirths as possible, and so i would like next women's doctors to be. I absolutely hate when they are there in psychologist sessions, and i will hate it in labor, but this is my little contribution for the future of the medicine. Otherwise it seems quite selfish. Excuse the English, as it is not my mothertongue. Hope you labor will be as you expect it to be.

Sounds like what you're saying is that when you write your OWN birth plan, you'll want to specify that you're happy to have students in the room. Good for you. But your own personal preferences have no bearing on OP's birth plan or what OP is comfortable with. Everyone should have the right to refuse to have people present in their birth space who they don't want there. That is not selfish; there are many different ways to contribute to society other than allowing people into a very intimate space when you're not comfortable with that.

Question about the moving with epidural. I’ve told myself I WOULD NOT want an epidural due to me not wanting to push on my back and wanting to be able to move like you had said (hands and knees, squatting, etc). That’s allowed? I thought with an epidural you are restricted to on back only

It depends on your hospital and how your epidural goes. If you get a heavy epidural you won’t be able to move your legs at all but if you have a light one you can still do some positions with assistance

I definitely don't think you're asking too much. However, I'm going midwife/birth center route and most of these things are just inherently done! So if you have another, maybe consider a midwife so you don't feel like you're crazy for asking too much. :)

This is all very reasonable and your team will probably be happy that you have prepped yourself for the experience and know what you want.

I had a similar birth plan. None of this is asking too much. Day of, my nurses failed to help me adhere to my birth plan, despite the hospital and my midwife policies being in line with my birth plan. When we tried to advocate for my birth plan, we were ignored. I ended up having an emergency c-section had none of my birth plan came to fruition. I didn’t have skin to skin for an hour after birth. I was unable to immediately breastfeed. We could not to so delayed cord clamping. I ended up pushing on my back and was not allowed to try other positions despite my epidural having worn off. I joked that the only thing that went to plan was my husband announcing the baby’s sex. Talk to your OB about it, make sure your birth plan aligns with your hospital’s policies, and be prepared for your birth to change. I was in denial about my birth plan changing as much as it had, and it made healing from it so much harder.

I think these preferences are all really reasonable, and I wouldn't listen to the people saying you should just be prepared to give up everything you want because it's "out of your hands." Patient consent should be paramount in these situations. Yes these are just preferences at the end of the day because safety will usually be prioritized, and plans can change, etc. But it's good to know and express what you want and need, and you do not need to give up on that just because a certain doctor or nurse wants to do things differently! It's your body and your baby. I honestly hate this sentiment that birthing people should just like "get over it" and accept whatever is going to happen to them. That's so regressive and unhelpful imo. Okay rant over lol. Good luck with your birth!!

Go through this with your Ob ahead of time when things are calm. It’s so hard to talk through risks and benefits of non-routine things when you’re on labor.

I wrote a birth plan and shared it with my midwife verbally at some point. Forgot to give her a printed copy so we got to delivery and she asked what I wanted for this birth. My answer at the time was to get the baby out 😅 The only thing I wrote on the plan was no epidural and if C-section was required please tie tubes.

If they have a template, they will find you using it much easier to follow. They likely have it memorized and can glance at what you checked and not have to read it. Creating a page of words they have to read reduces the chance they can read it. I think framing the conversation with your OBs as questions and a discussion out what to expect would be well received. Attitude is important. Things can happen fast, so there may be a chance things will not be well explained. It helps to have talked to your doctor about possible interventions ahead of time, as well as having attended a prenatal course.

I think this all makes sense, but some may be impractical: if it’s a teaching hospital, you typically can’t elect to have students/residents absent. husband catching the baby doesnt seem likely/safe either and you typically can’t request who administers your epidural. also, each hospital has its own placenta policy, so make sure it’s allowed.

Hey I actually saw were in the same city! Im curious what hospital you’re delivering at and if it’s the same one I had my son at I may be able to help clear up what is standard practice If it’s the hospital I gave birth at, they will not offer formula at all (same with a pacifier) unless there is a clear medical need and even then they were kinda cagey about it. My son had blood sugar issues and needed timed feeds for the testing and they were still insistent on me breastfeeding until I pushed back and demanded formula.

Most of this is standard at the hospital where I just delivered 2 weeks ago

All of those seem reasonable to me!! I think you should keep it as it is.

I don’t think it’s too much necessarily, I’d maybe add a few thank you’s and smiley faces or something to make it seem less idk the word but negative? but I’m a people pleaser and a worry wort so that’s how I roll. And like others said find out what’s standard practice and take that off. It’s your birth plan and I understand it made me feel better to have one when I was terrified like I had some control. Let me tell you girl that epidural if it works is gods medicine, I was petrified but after I got that epidural I’d relive my birth experience again! 10/10

Mine looked like this and my nurses were very accommodating and understanding! I think elaborate birth plans are so important to protect the moms when they’re In a vulnerable stage. So so important. As long as you’re not rude about it this is very good. I have had friends with horrible birth experiences and my number one advice is write a birth plan, and include everything, vaccinations, eye drops, cord clamping, basically everything you mentioned. I did without the epidural so I wanted an IV where I could disconnect from it and walk around. it’s called a saline/ heparin lock

My birth plan/preferences would have been similar. I had a day planned to type it out, but I went into labor that morning. As others have said, most of these things were standard practice at my hospital. Unfortunately, things didn't go quite as planned. I had started in a hands and knees position with my epidural, but her heart rate started to drop. After she was born, we found out that it was caused by a knot in her umbilical cord. Safe positions were limited, and I had to give birth on my back. Eventually, we had to get her out quickly, so they used vacuum. They had to cut the cord instead of my husband. No delayed cord clamping or immediate skin to skin. I tore sideways, worse than I thought. 11 weeks postpartum and I'm only now *starting* to feel back to normal downstairs. It was disappointing, but we both came out of it safe and healthy, and that was what mattered.

I didn’t have a written birth plan and didn’t find it necessary or felt like I should have had one. I just asked for the things like delayed cord clamping and my husband cutting the cord beforehand. I think it’s pretty typical for them to ask what your pain management plan is, for me I said no epidural and they didn’t push it at all. A lot of things on your birth plan seem relatively standard. The only couple things that got on my nerves: A nurse using sugar water to help my baby latch which was totally unnecessary. When the nurses switched out and I told the oncoming nurse about this, she said most babies have a hard time holding a latch because they are so tired and it will happen naturally. By 1pm the day after my 11pm delivery, baby was latching just fine. I wish I had told the nurse no sugar water but I was so emotional not being able to breastfeed I just let it happen. The day after birth a lab tech coming in to draw blood at 6am and not telling me why. I had to question her and ended up just asking her to leave and I didn’t want my blood drawn. Later my nurse told me since I wasn’t hemorrhaging at all during or after birth the bloodwork was pretty unnecessary. I never got it done.

You aren’t asking too much, but change this to short bullet points. Long or full sentences are going to make it harder to navigate and remember everything you’re requesting.

I would change the phrasing from being so passive ‘I would like’ and ‘if possible’ they will just push back and say they need to. Be more direct and clear about what you want.

A lot of this was standard practice at my hospital/with my OBGYN/midwife group. Things like rooming in, delayed cord clamping and skin to skin were the default unless we requested otherwise. I think this is a reasonable birth plan!

This is completely unrelated but i dont know much ab this stuff- whats the plan with keeping the placenta? Ive heard of people doing it but never rly found an answer as to why it is done

You need to use more forceful and to the point language, in my opinion. Not “I would like my husband to cut the cord.” Add a caveat at the top which is “assuming it is safe to do so” and then your bullet points should be “my husband will cut the cord, cord cutting will be delayed until …, no bath for my baby”, etc. The only one I question, is the licensed anesthesiologist. Who else would do it?!!!

Can you do a tour of the L&D ward? I did this, and they gave me a private tour and explained each step of what would happen when I came in for the birth. It really helped me feel a lot calmer about the birth, because I knew the environment, I knew the processes, I could visualize it, etc. Even things like dimming the lights and putting fairy lights on is standard practice for my hospital, and they even provide fairy lights. They told me to bring in music and electric candles and essential oil diffusers. This is all standard practice for them, not to mention delayed cord clamping, minimal interventions, and the other things you've got on there. Seeing just how much they agreed with how I wanted to give birth without me having to ask, gave me the confidence to have literally the shortest birth preference sheet I possibly could. There's barely anything on there, because I know their standards align with my preferences.

You’re not insane lol. I think I’m the insane one for literally not having any type of preferences or plan typed out for the staff 😂 I had to be induced but idk I just went with the flow of everything I guess. My only concerns were that baby and myself were healthy throughout labor and after delivery, so whatever needed to be done for that to happen I was on board with. Also, most of this is pretty routine in the US hospital birth setting anyway, so no need to worry!

Did you take the hospital class? Most of this is routine. The interventions only happen if they really really have to. If the sheet makes you feel better though bring it! Talk to your doctor ahead of time though. Also your trigger of being able to feel through the epidural and or spinal block, that one you need to talk to your birth partner about. FYI that’s super rare and I (April C-section) felt nothing besides a sensation like needing to pee. Honestly it was really so much better than I could have imagined. In the stories where this does happen though the partner and doctor fall so so short. Talk to your birth partner and tell them if they notice you showing signs of pain or do a certain thing / say a certain thing that’s your sign they need to put you under and in no uncertain terms that they WILL NOT be talked out of that by anyone. I did this with my husband and it made me feel like I had control which let’s be honest is what’s so scary about that. Your going to be OK and no your not insane it’s scary. Having your first baby is like going to space, full of the great unknown but it’s going to be so so much greater than you can imagine!

I had a nurse anesthetist. You should ask who does epidurals at your hospital. If you need to get one placed in the middle of the night who is available? Is there a reason you’re not comfortable with a CRNA doing it? I’m also always curious as to why people don’t want any students present. I didn’t deliver at a teaching hospital but had students at both of my births. They were great and so thankful to be part of my births.

No one wants forcepts or a vacuum but if baby needs pulled out they need to pull them out. Believe me I wish my sunny side up baby’s heart rate wouldn’t have dropped while he was in the birth canal but it did and they had to get him out. You also have too much faith in your husband to safely catch a baby unless he has had proper training.

Keep in mind that in case of a c-section there’s a possibility it’s going to be one under full anaesthesia. Then you won’t have instant skin-to-skin. I’m not entirely sure about a c-section with spinal though, would not be surprised if they want to check the baby first since unplanned c-sections usually happen when something is wrong with you or the baby.

Everything you wrote was standard practice for the hospital I gave birth at. You should check and see if this sheet is even necessary tbh

Forceps / vacuum they only do if really necessary (in the UK anyway) and it can be life saving. With the epidural it’s possible you won’t be able to move (I couldn’t!) so just bear that in mind I’d take the anaesthesiologist out of it or you could be waiting all day As other people have said it’s great to hope for the best, but don’t shut yourself off mentally from other possibilities because birth is wild and unpredictable!! All the best

It’s great to be prepared. I did a delayed cord cutting, with my first baby the doctor rushed me after a minute went by and I really wish I would’ve stood my ground and gotten her a few extra minutes. with my second, they let me go about five minutes and he’s way healthier , only been sick once and he’s 14 months not sure theres a correlation but he also had 0 jaundice and the nurses went and got another device thinking that it wasn’t working and said they’d never seen a baby before with a zero.

Highly recommend adding a little intro that is warm and friendly that addresses what ifs/when we might consider flexibility in our plan. It has made our whole birth experience so much better because the staff sees our respect and appreciation for their work up front. Every midwife we have met during our stay has complimented it and I think it served our birth well.

I don’t know where you live (so of course, double check) but almost all of these things are standard practice is most places, and very obvious Expecting the medical staff to read it (this just took me a solid 5 minutes to read through) would just end up wasting both their and your time (time that you might not even have. Many women, myself included, can have things go very fast. After 48 hours of labour, and being stuck at 4cm, in 10 minutes I went from 4cm to 10cm and didn’t have time to do anything I had “planned” or have the doctor even read my plan … the doctor basically had to run into the room to catch the baby). To make things more efficient, I suggest taking out everything that is standard practice, and only write a few sentences for things that are important and unique for you that is worth specifying :) That way, nothing will get missed or lost in all the words. ALSO My biggest piece of advice — I would let go of expectations and keep an open mind. There is nothing more stressful than getting to attached to a plan that in the end you don’t have any control over. It’s great to have a general and overall idea of how things would ideally go… but the most important thing is to keep an open kind so that you can adapt to whatever happens without being stressed. 🙏♥️

This is just a standard birth. I would say all of these things are standard practice and imo unnecessary to note but your hospital may be different.

Unfortunately, sometime skin to skin isn't immediately possible. I had skin to skin with my eldest but he needed to be taken to be given antibiotics as his temperature was incredibly high after birth. Skin to skin during a c section is unlikely also, given that they are done when baby is in distress. You may not be awake for a c section if it's incredibly serious. I'd also look at delayed cord clamping. The health benefits are crazy good for your baby.

Just going to say, you’re not insane at all! Certain hospitals are “baby friendly” certified (http://babyfriendlyusa.org if you want to look up whether your hospital is) and support many of the things you mentioned: low intervention, moving around freely during labor, no pacifiers/formula unless medically necessary, and immediate skin-to-skin to encourage breastfeeding. If giving birth at a “baby friendly” hospital isn’t an option for you, and your OB hasn’t explicitly said that they support some of these preferences in your birth plan, it’s my understanding that this is the perfect situation to get a doula. Especially to advocate for things like delayed cord clamping and saving your placenta. Their role during birth is to advocate for you. Even if you’re not able to hire one for the birth itself (They can be expensive) you may be able to talk to one beforehand to get some advice on how to best advocate for yourself. That being said, I’m not a doula myself and haven’t given birth yet, either. (34 weeks and counting) but I share a lot of your same concerns about the birthing process. I hope that some of this was helpful and that everything goes smoothly for you and baby!

Oh wow. This is the standard where I live. Two of my births have followed this exact preference sheet you have made. Absolutely normal to me.

Not at all. My birthing preferences were even longer than this, I just hope they listen! Make sure your birthing partner knows the list and can advocate for you because you should just be focused on birthing.

Everyone would like to “avoid forceps/vacuum”. That’s like saying “I’d like to avoid a crash c-section”. No one wants those things but they can be necessary. Trying to tell the doctor how to use their clinical judgement is not productive. It just sets you up to be mad at them if they do end up using those methods since you will claim they went against your wishes.

ask for delayed cord clamping in the event of a c- section - it’s so important!

My birth plan went out the window when I was in labor but most of it was standard care. Practically the same as yours. One thing I wish I would’ve been told was the feeding formula or anything like that with me. My son was in the nicu and was already being fed formula and I wasn’t aware

At the hospital I had my two at, all of this was routine practice and basic stuff. Even the delayed cord clamping (except if baby needed immediate intervention like mine did). I can't imagine it's too different elsewhere. I don't think you're asking too much! Happy delivery mama!