Triplet Birth Plan: Draft

Lately I have been in a "birth plan state of mind."  So while my three girls were napping I decided there was no time like the present to put my thoughts on paper.  I have been hesitant to write anything down for a few reasons 1) compared to my other births 20w feels so early to do a birth plan, particularly with a provider who has "proved" himself in my previous births.  2) I don't want to appear naive or even flippant to the uniqueness of my pregnancy and my birth.  3) I have only experienced "normal," low risk births and an unnecessary cesarean.  So I wasn't sure I knew what was "allowed" in a triplet birth.  Then I began to think about my VBACs.  I did everything I could and  asked all the questions I could imagine so if it came down to my birth plan taking a major detour I could feel confident that I took care of things on my end.  I knew that I wouldn't have lingering feelings of doubt.  So then why should this birth be any different? Why shouldn't I be able to ask for the moon and work from there?

 So I drafted this birth plan in a similar way to my singleton births.  Without asking for things I can't have a dialogue with my care providers.  Having a dialogue with a care provider throughout the pregnancy, especially one in which things can change from visit to visit, allows the mother and provider to establish a greater degree of trust, allows the provider to better understand the desires of the mother and the mother can understand the skill set and comfort of the provider.  In this type of birth, and with most other births, I believe it is important for a mother to maintain a certain degree of flexibility.  But along the way it is paramount that the dialogue remain open and honest.  The provider must present the facts, not over dramatizing nor down-playing them, and always discussing how they would handle situations as they arise in the birth.  It is equally important for the mother to express her concerns and wishes as the pregnancy progresses as well.

So as I said, this birth plan is a draft and will likely undergo changes based on developments with the babies and conversations with the provider.  I hope to be able to provide in future posts conversations that my providers and I have had about various components of the birth plan.

Birth Plan for Hannah Birchman and Triplet Birchman Girls:

Due to the nature of my triplet pregnancy I am aware that there are many variables at play.  I have informed myself of the risks and benefits of a vaginal birth, breech extraction, and cesarean (planned and emergent).  I am aware that things can change quickly.  Therefore, I have prepared my birth preferences for several different birth outcomes.
 I have carefully selected my health care providers and believe they will act in the best interest of myself and my babies.  However, every decision regarding my care and that of my babies should not be made without my direct consent, or that of my husband if I am physically unable to consent.  It is within my rights to change my decisions at any point during the birth.

During the various stages of the birth, please limit those attending to necessary personnel only.

Vaginal Birth:

Stage One:

*Do not ask me to asses my pain.

*Use of various comfort measures: ball, stool, toilet, shower, and freedom to move around.

*Intermittent fetal monitoring.

*Cervical checks by the OB only or upon my request.

*No stripping of the membranes without my consent.

*No breaking my bags of water without my consent.

*Please do not offer an epidural, unless I use my code word/phrase “Give me a c-section.”  However, due to the nature of my birth…  Please allow either my husband or doula to be present if an epidural must be administered.

*Ability to eat and drink through the course of labor. 

*No Hep-lock

*No artificial augmentation of labor.

Stage Two:

*Freedom to push in any position that will allow my pelvis to open completely.  Should an epidural be used please help me get into the most optimal position for pushing.

*Use of an ultrasound after each baby is born to determine their positions.  Should any of the babies present breach I am comfortable with a vaginal birth.

*If Baby B or C is presenting breach but appears to be responding positively to contractions and is progressing please allow the baby to be birthed with little to no interventions.

*Mother-directed pushing.  No counting.

*Use of a mirror to see the birth. 

*Please allow me to grab each baby as she is birthed.

*Massage of the perenium and use of lidocaine.  Please do not cut an episiotomy.

*Delayed cord clamping.

Stage Three

*Provided there are not emergent situations with the babies I would like Immediate skin to skin until it is time to birth the next baby.  Then allow my husband to hold the baby.

*Allow my husband the opportunity to cut the cord.

*Natural birth of the placenta.  No Pitocin, unless it is apparent that it is medically necessary.

Baby Care:

*We do not want to bathe the babies and want to keep as much of the vernix on the babies as possible.

*We do not want the Vitamin K drops, Hep B shot, or the PKU test.

*I plan to breastfeed and so please do not give formula or sugar water unless direct consent has been provided.

Birth Plan for a Cesarean:

*Please do not put any IVs in my right (dominant arm).

*Freedom to move my arms.

*Drop the curtain and have a mirror so I am able to view the birth.

*Please be respectful that while this may be a routine procedure it is a major procedure for me and so please be mindful of your conversations.  I would like to be informed of what is going on during the surgery.

*Immediate skin to skin with me or my husband.  I would like to give the babies the opportunity to nurse as soon as possible.

*I would like either my husband or myself to remain with the babies when at all possible.