How to write the correct birth plan? Plan for the management of the pregnant woman and the course of labor.

06.04.2020

Childbirth should be carried out conservatively, through the natural birth canal.

First stage of labor:

In the first stage of labor, you should monitor the general condition of the woman in labor, count your pulse and blood pressure (necessarily in both arms). Monitor the nature of labor - frequency, strength, duration of contractions, rhythm. Monitor the fetal cardiac activity using a stethoscope or cardiac monitor while simultaneously recording the contractile activity of the uterus.

Vaginal examinations should be carried out no more than once every 4 hours, in other cases strictly according to indications (rupture of amniotic fluid, bleeding during childbirth, signs of intrauterine fetal hypoxia, the appearance of pushing).

Provide adequate labor pain relief. Analgesia of labor with medications should begin in the 1st stage of labor if labor is regular and the cervix is dilated by 3-4 cm. For pain relief, use analgesics. During labor, bladder and bowel function should be monitored. Empty your bladder every 3-4 hours.

Second stage of labor:

During the period of expulsion, you should monitor the general condition of the woman in labor, the color of the skin and visible mucous membranes, the frequency and nature of the pulse and blood pressure. Continue recording the nature of labor: frequency, strength and duration of contractions, pushing, movement of the head along the birth canal. In this woman in labor, the head should not be allowed to stand in one plane for a long time in a large segment for more than 2 hours.

Listen to fetal heart sounds at the beginning of the 2nd stage of labor after 15 minutes, and then after each effort, pay attention to the frequency, rhythm and sonority of the tones.

From the moment the head erupts, begin providing manual assistance for cephalic presentation.

The first point is to create an obstacle to premature extension of the head.

The second point is to remove the head from the genital slit, without pushing.

The third point is to reduce the tension in the perineum (preventing the threat of perineal rupture)

The fourth point is the regulation of pushing.

The fifth moment is the release of the shoulder girdle and the birth of the fetal body.

If, when providing manual assistance, there is a threat of perineal rupture, it is necessary to perform a perineotomy or episiotomy.

After the baby is born, evaluate it on the Apgar scale at 1 and after 5 minutes. Start toileting your newborn.

Third stage of labor:

The succession period should be conducted actively and expectantly. Prevention of bleeding in the 3rd and early postpartum period of labor by administering Sol. Oxytocini 10 units IM). Allowable blood loss is 3500. Watch for signs of placenta separation.

For the first time I came across the real application of the Birth Plan in Finland, at the perinatal center in the city of Pori. My colleagues and I went there to do internships and exchange experiences in the obstetrics system.
A Finnish midwife told us about the many non-drug pain relief methods they use during childbirth. For example, subcutaneous injections of saline are given around the Michaelis diamond, which causes a burning sensation, but it is this effect that helps reduce back pain. They also use needles (in Austria, acupuncture is also going great) or a Darsonval-type device, which the woman herself controls during contractions.
Of course, medicinal methods of pain relief are also used - epidural anesthesia or laughing gas. I was then worried about the question - how do they choose what to offer a woman? To which the midwife, raising her eyebrows in surprise, replied, “We follow the woman’s Birth Plan!”
A birth plan is a mandatory document with which women go to a meeting with a doctor. They discuss and fill it out together, and this plan is pasted into the birth history! It is from the Birth Plan that the doctor and midwife learn about the mother’s preferences regarding positions in the second stage of labor or pain relief, as well as about feeding and caring for the baby.
I did not raise this topic by chance. Now many women come to me with a text on A4 sheet - a birth plan, which they drew up without a doctor or midwife. Some simply bring a list of their wishes and preferences. Others draw up very strict plans, with references to laws, and in some way, in my opinion, similar to an order. Because in the plan there are no words “I would like, I plan...”, there are more often “I don’t want”, “I demand”.
At one time I had the opportunity to draw up a sample birth plan. One of my listeners was preparing for childbirth with me, but went to the USA to give birth, and her doctor, when meeting her, asked her about the Birth Plan. This was the first time she had heard about it and she wrote to me asking me to send her a sample. In Russian practice, such a document is not used; we had to look up foreign literature on preparation for childbirth.
Of course, English-language birth plans have specifics, which I slightly adapted to our realities and, as an option, I compiled a universal Birth Plan that can be changed at your discretion:

What is important when drawing up a birth plan?

Discuss it with your doctor.
A plan is a project, but the real situation may be different and you need to be flexible on many points of your birth plan.

Use the expressions “I would like” and “I plan” instead of “I am against” and “I don’t want.”
Include items in your birth plan about urgent and emergency situations during childbirth.
Introduce your plan to your partner, midwife, or doula.
Pay special attention to important moments during childbirth.

It is better to build a birth plan chronologically, starting with the first stage of labor, then the second, third, and the very last points to cover the postpartum period. Wishes for child care, issues of vaccination and breastfeeding can also be highlighted separately.

What does a Birth Plan do for your doctor?

For the doctor who will conduct the birth, these are reference points that you can immediately, without wasting time, pay attention to and discuss. It is difficult to guess what will be key for this patient in her satisfaction with her own childbirth, and having a birth plan, the doctor has a guideline for what needs to be discussed with you and dotted.
The doctor will be able to understand your expectations and ideas about the birth process and evaluate your preparation. We often come to the doctor with a very vague idea of what can be implemented in a maternity hospital and what cannot. Our knowledge about medical procedures, their necessity, benefits and harms is also very superficial. When discussing the birth plan, the obstetrician-gynecologist and midwife will answer all questions, which will help establish constructive and trusting relationships at the very beginning of the journey.

What does the Birth Plan give us?

1. We structure our own expectations for the upcoming birth and wishes for the process.
2. We will know exactly what needs to be discussed when meeting with an obstetrician-gynecologist.
3. Immediately after seeing the doctor, you will understand what is realistic from our wishes, and what should be completely excluded from the Plan and trust the specialists.
As we create a birth plan, we can reconsider what areas we are willing to be flexible about and what areas we would rather not be flexible about. In this case, you need to answer yourself the question - what will happen to me if this does not happen? What if it is not possible to wait for the end of the umbilical cord pulsation due to the need for resuscitation for the baby? Your birth plan is a good opportunity to have an open dialogue with your chosen doctor and midwife. By getting answers and discussing each point, you will better understand each other in advance, which is very important for a trusting relationship.

Who can help create a birth plan?

If you find it difficult to write a birth plan yourself, you can do it together with your doctor, midwife, specialist with whom you prepared for childbirth, or draw it up together with a doula.
If you are confident in your abilities, the Birth Plan template will help you!

Have you used the Birth Plan? How were they compiled? On your own or with someone's help? Write me!

Victoria Chebotareva

I bring to your attention a Birth Plan drawn up by one of the mothers as part of my preparation for the Lotus birth in the maternity hospital. It contains many important points that help make childbirth closer to physiological, each point is politely and thoroughly discussed. I propose to sort it out together with the future dad, study the statistics, and draw up your own Birth Plan in order to approve it with your doctor and midwife.

BIRTH PLAN

Our names are Full Name (Mom) and Full Name (Dad). In an effort to ensure that childbirth becomes a joyful event for us, we have compiled a list of our wishes. In the event of unforeseen circumstances or absolute medical indications, we guarantee complete trust on our part in the medical staff, but initially we were determined to give birth according to this plan.

For me, as a future mother, everything in this regard is very important. I respect the opinion of doctors, but if my plan is not carried out without good reason, I will be nervous, and being nervous during childbirth is very harmful and can lead to extremely undesirable consequences: for example, weakening of labor and even a caesarean section.
I ask you to treat me with kindness and understanding, despite the fact that my plan is very detailed and even boring. I really appreciate and approve of the activities of medical workers, but this does not prevent me from having my own opinion on some issues.

GENERAL POINTS:

1. Please reduce the brightness of the light (create twilight) both before the birth of the child and after. Dimmed light calms the hypothalamus (mother's body), which is necessary for a successful birth. The baby also needs dim light so as not to experience unnecessary stress.
2. Please give me an opportunity turn on your music .
3. I ask that medical staff enter the room only when necessary. I am against the presence of interns and interns.
4. Please do not interfere with photo and video shooting .
5. I even ask do not offer me stimulant medications during labor (oxytocin, pitocin, etc.) and procedures without honey. testimony and do not conduct them without my written informed consent (or such consent of my husband).
6. I even ask do not offer me labor pain relief without honey. testimony and not conduct it without my written informed consent (or such consent of my husband).
7. I even ask do not offer me an amniotomy (bladder puncture) without honey. testimony and not conduct it without my written informed consent (or such consent of my husband).
8. I even ask don't offer me an episiotomy (perineal incision) without honey. testimony and not conduct it without my written informed consent (or such consent of my husband).
9. Please not to use any other injections, infusions, drugs or interventions during childbirth without medical indications and without my informed written consent (or such consent of my legal representative - that is, my husband).
10. I against epidural anesthesia, except in the case of caesarean section.
11. As the legal representative of a minor child, I refuse all vaccinations for my child.
12. Whenever a procedure or injection is prescribed to a child Please inform me about the name of the procedure (drug), indications for use, contraindications, side effects and obtain my consent to perform it.
13. Please provide an opportunity using home clothes for yourself and your child and reusable diapers.

Contractions for a day or two or three are normal, not a reason to speed up and stimulate labor, not a reason in itself for epidural anesthesia, caesarean section, or the use of sleeping pills, with the exception of serious medical conditions. indications.
Informed consent – this is when a person was informed about the name of the procedure (drug), indications for use, all known contraindications and side effects, and his consent was obtained.
Medical indications – this is when such procedures or drugs are permissible only in case of absolute vital indications.

FIRST STAGE OF LABOR

1. Please conduct vaginal examinations (cervix, for example) as rarely as possible to avoid premature rupture of the bladder, infection or stopping labor, i.e. no more than once every 6 hours or with key changes during labor: breaking of water, pushing, etc., i.e. for medical reasons.
2. Please do not give me a CTG, I want the child’s heartbeat to be listened to with a phonendoscope. I would like to avoid CTG, since it is an ultrasound technology, and it is possible that it can itself change the parameters of the behavior and heartbeat of the fetus, and thereby provoke it into unnatural behavior. This is an intervention in nature. If CTG is absolutely necessary for serious medical reasons. testimony, and what kind of testimony will be explained to me or my husband, then I will give my consent to the CTG. Even in this case, please perform CTG as rarely as possible, and under no circumstances lying on your back, but in an upright position or sitting. I can hold the sensors myself, or my husband can do it. Lying down makes my back, lower back and especially my sacrum hurt, I don’t want to experience these pains during childbirth, and I also don’t want to slow down labor with a horizontal position.
3. I ask for the opportunity to carry out the birth vertically and use freedom of movement, massage, various positions (even during CTG), a fitball that relieves pain during contractions, warm compresses and other methods that alleviate the condition of the woman in labor.

SECOND STAGE OF LABOR

1. Please provide me with freedom to choose a position when pushing, comfortable positions: standing upright, on all fours, squatting, holding on to something, etc. If possible, I only want vertical poses; for me it doesn’t matter where: on the bed or on the floor, the main thing is that the pose is vertical.
2. Please don’t force me to push, but wait for natural urges push.
3. For to prevent ruptures and episiotomy, please massage my perineum with oil. Or, if you don’t do this, give my husband the opportunity to give me such a massage. I am against episiotomy, except in cases where there are serious medical indications; if there are no such indications, there is no need to cut under any circumstances. If there are medical indications, then pain relief is not necessary.

BIRTH OF A CHILD

1. Please lower the brightness of the light (create twilight) at the time of birth of the child and after. The baby needs dim light so as not to experience unnecessary stress.
2. I am against using forceps and a vacuum extractor. I am categorically against helping my child by pulling him out by the head! I want my child to be born naturally without unnecessary acceleration and manipulation. If honey the staff says that there is a need for such an appointment, I want my husband and I to be explained whether there are alternatives (and their side effects) and what the risks of waiting are.
3. Please, under no circumstances do not cross or clamp the umbilical cord without my consent. My husband and I want to decide when to cut the umbilical cord ourselves. We plan to cut the umbilical cord only after it has not only pulsated, but also turned white, which means that all the blood intended for the child has flowed from it to the child. When cutting the umbilical cord, we do not want any forceps or clamps to be used, but only scissors. Forceps and clamps are needed for those babies whose umbilical cord is cut too early, i.e. those babies who were not given their own blood. In such babies, if forceps and clamps are not used, blood will flow from the umbilical cord. No blood should flow from the whitened umbilical cord without the use of forceps, so we will not need forceps. This is important for us to see that our child received all the blood from the placenta, which rightfully belongs to him. Scientists have already proven that receiving the entire cord blood helps prevent such serious diseases as, for example, cerebral palsy..
4. I ask that immediately after the birth of the child, if it is clear that there are no pathologies requiring emergency medical care, give me the baby in my arms or place it on my stomach, ensuring skin-to-skin contact. I want peace, so that my baby and I will not be disturbed in any way for two hours.
5. Please Do not take your baby for measurements and weighing for at least 2 hours after birth , i.e. until the umbilical cord pulsates, the placenta comes out, and until the baby finally calms down, namely, until he stops crying and sobbing.
6. Please Don't wash my baby's vernix. Lubricant is considered the best antiseptic and moisturizer, and it is quickly absorbed: in less than a day. There is no need to wash off the vernix, even if there was meconium in the waters, since the meconium of healthy babies is practically sterile.
7. What drops are put into the eyes of a newborn in the maternity hospital? I I would like to give my consent or refusal of eye drops only after they show me the indications, contraindications and side effects of each proposed medicine. In some countries, immediately after birth, all newborns are given prophylaxis for gonoblennorrhea, an eye disease caused by gonococcus and leading to severe complications. Previously, this prevention was carried out with the drug “silver nitrate”, then with a solution of “sodium sulfacyl” (albucid), now it is allowed to use chloramphenicol drops and eye ointment with an antibiotic (tetracycline or erythromycin). The relevance of gonorrheal conjunctivitis is far in the past, but prevention is still carried out, since the mother’s birth canal through which the baby passes cannot be sterile, and is often infected (colpitis, endocervicitis, etc.). I have no gonorrhea (no gonococci), no colpitis, no endocervicitis.

THIRD STAGE OF LABOR (BIRTH OF PLACENTA)

1. Please Allow at least 2 hours for spontaneous delivery of the placenta. I don’t need any acceleration in the form of oxytocin, pressure on the stomach or anything else. The beginning of breastfeeding causes the natural contraction of the uterus, and the birth of the placenta. There is no need to speed up this process. To stimulate the passage of the placenta, I think it is sufficient to increase the level of oxytocin naturally from contact with the baby and sucking on the breast.
2. In case if the umbilical cord is too short, which makes it difficult to attach the baby to the breast, this is not at all a reason to cut it. I want to wait until she pulsates on her own and comes out along with the placenta. The baby will just have to press a little while applying. The attachment, of course, is important, moreover, during the first 30 minutes, BUT it is NOT a priority compared to that precious blood with stem cells that should come to the child from the umbilical cord and placenta.
3. Medical help. personnel may be required only in the event of pathological rotation of the placenta into the uterine cavity or unexpected bleeding.
4. We consider careless and negligent handling of the umbilical cord and placenta unacceptable. We know that there are cases in some maternity hospitals when honey. the staff pulls the placenta by the umbilical cord. The mother in labor may not even notice this. It happens that honey. the staff performs other manipulations to speed up the process of delivery of the placenta. We absolutely do not want this! This should never happen! You can’t pull the umbilical cord, you can’t squeeze it in any way, neither with your fingers nor with clamps! Please pay very close attention to this point as I don't want to have to argue loudly about it.
5. Most of all, I want my child and I to have: peace, warmth, dim light, a sense of security, silence. Only such conditions are needed for the natural separation of the placenta.
6. My husband and I We want to dispose of the placenta at our own discretion. We will take the placenta with us in a special container. Please give my husband the opportunity to wash the placenta. We understand that the delivered placenta must be shown to specialists so that they can assess its integrity and make a conclusion about whether it has all come out or whether some pieces of it remain in the uterus, and also to judge whether there were any infections and other factors that may cause fetal distress.

UNSEEN CIRCUMSTANCES

Possible entanglement of the umbilical cord. You don’t have to use an ultrasound, the main thing is that the midwife listens to the heartbeat every half hour during contractions with a stethoscope, and after each push. If it is within the normal range of 120-160 beats per minute, then there is no tight entanglement (which is what is dangerous).
If suddenly there is a need to perform a caesarean section , then the child should be in my husband’s arms until I come to my senses. Please do not provide any feeding or water to my child. , except in the case of my sudden death. If a decision is made to give the child any food, please give him a sippy cup, a pipette or something that will not spoil the child’s latch on the breast, i.e. Under no circumstances should it be a pacifier.
Of course, doctors are invaluable when the natural process is disrupted. It seems to me that the problem in our society is that few people know that many of the “violations” are not such. Premature birth, post-term birth, and other pathological conditions certainly require serious professional medical intervention, and it is fortunate that in these cases we can count on the help of doctors.

I need the following things from my husband:
- When they will approach me with questions, if possible, cut them off, and if it is a question that he cannot answer, and I have to answer, he will quietly and calmly explain the options to me, and remind me that this is my choice.
- speak “Everything is going great for you, everything is as it should be, labor is progressing well, everything is normal” in the voice of a knowledgeable and confident person.
- at the right moment, quietly say in your ear: “don’t worry, everything is fine, you can handle it,” and not worry.

Remind that you can just talk to your child and distance yourself from all other people. You need to talk and communicate with the child, to feel him, because he is the one who comes to meet you halfway, with every contraction or push. This helps a lot to focus on your feelings.

Monitor the process of handling the umbilical cord!

Remind about emptying the bladder after the birth of the baby (a full bladder interferes with uterine contractions). Offer to drink an infusion of herbs.

Wash the placenta, wrap it in a diaper, and place it in a container.

Chapter 13 DRAFTING A BIRTH PLAN

A birth plan will help both you and your caregivers. Just a systematic presentation of your thoughts on paper helps you figure out the desired details of childbirth.

No one but you knows what you would like your birth to look like. But no matter how carefully the plan is made, childbirth is always full of surprises. However, in general, the rule is true: the better your plan, the higher the likelihood that the birth will not disappoint your expectations.

WHY MAKE A PLAN?

A birth plan will help both you and your caregivers. Just a systematic presentation of your thoughts on paper helps you figure out the desired details of childbirth. If you tell your doctor or midwife what kind of care you would like, you will be more likely to get your wishes fulfilled - because maternity nurses deliver babies to women with different views. Some people need the help of medications, others want to experience the fullness of sensations.

List of necessary things that will be needed during childbirth

In the back seat of a car

Several pillows (put small plastic garbage bags over the pillows and then put on pillowcases)

Towels

Hot water bottle

Bowl or cup (in case of vomiting)

Baby car seat pre-installed so there are no surprises

Accessories that can make childbirth easier

Comfortable pillows

Clock to track contractions

Player and cassettes with your favorite music

Cream or oil (unscented) for massage, paint roller or tennis ball for back massage

Favorite foods to snack on (lollipops, honey, dried fruits, fresh fruits, juices, granola), as well as sandwiches for my husband

Hot water bottle

Toiletries

Soap, deodorant, shampoo, conditioner (avoid perfume, which may irritate the child)

Comb, hair dryer, hair styling gel

Sanitary napkins (they are also provided at the hospital)

Toothpaste, toothbrush and lipstick

Cosmetics

Glasses or contact lenses (possibly both, since contact lenses may irritate you during labor)

Things for the child for the trip home

One undershirt

Socks or boots

Children's pajamas with legs (for car seat)

Beanie

Romper and warm blanket for cold weather

Diapers

Other

Cameras (video and photo)

Insurance policies

Hospital Pre-Registration Sheet

A handful of change for your phone

Notebook (with phone numbers)

Favorite books or magazines

Birthday gifts for siblings of a newborn

One or more copies of the birth plan

Developing a plan

The plan must be individual. Do not copy it from a book or course manual. Don't forget that handwritten text is much more powerful than printed text. To make sure you and your doctor are on the same page about what you want, make a rough outline, and then work with your doctor to approve the final version during one of your appointments. Add the following sections to your wish list.

Introduction. Start with a brief description of your family, your birth philosophy, and your level of preparedness. State your specific desires or fears, and write down what specific help you need. To create a positive impression, mention why you chose this doctor and this facility.

List who will be present at the birth. This list could include a spouse, assistant (include name and degree if professional assistant), photographer, relative, etc.

Please indicate when you prefer to go to hospital. Specify whether you want to go to the ward yourself, or whether you prefer to be transported in a wheelchair. Ask if you will be able to go home if your cervix is less than 5 centimeters dilated.

Indicate at what times the people listed on the visitor list can be present. Explain that your spouse and the birth attendant can be with you at all times.

Please indicate which setting you prefer(for example, a home-type ward).

List the comfort items you will need or want to bring with you: pillows, shower, birthing tub, bean pillows, foam wedges, etc. (see Chapter 9).

Describe your preferred environment during labor and delivery. List the following factors: light (low if you want it), music (brought by you), silence, absence of extraneous noise, inconspicuous medical equipment, absence of unnecessary personnel, privacy or help if necessary, freedom to express your feelings if it brings relief.

Please, no time limits. Be clear about your desire not to be rushed or put under time pressure if your baby is doing well during labor.

Please indicate which products you prefer. Ask for clear juices and ice cubes, as well as nutritious “snacks” in case labor is delayed. (See Drinks and Food During Labor.)

Please indicate your attitude towards medications. List the types of drugs that are desirable and undesirable for use - “yes”, “no”, “possibly”. Demand that you be able to use self-help tools as an alternative to medications.

List your concerns about interventions. Mention electronic fetal monitoring (20-minute monitoring on admission, no-monitoring, telemetry, continuous monitoring), and demand freedom to use natural alternatives to Pitocin when inducing labor is necessary. Don't forget rupture of membranes (natural or artificial), vaginal exams (frequent or as needed), IV (ask for a heparin or saline lock if an IV is required). Emphasize that you would like freedom of movement during labor and ask that you be allowed to experiment with body positions.

Express your views on childbirth. Indicate the position of the body (vertical, squatting, lying on your side or half-sitting), the presence of a mirror so that you can observe the birth of the child. Demand that you be allowed to touch the baby and control the pushing yourself, rather than acting on command. Mention your desire for the baby's head to erupt as slowly as possible to avoid tearing. Ask for perineal massage and perineal support to avoid an episiotomy, which should only be done if absolutely necessary. Request that you be involved in the decision to have an episiotomy. If you can't avoid using forceps, consider an alternative to forceps, such as a vacuum extractor. It is advisable for your spouse to tell you the sex of the child and cut the umbilical cord; he should be allowed, if he wishes, to place his hand on the baby's head at the moment of birth. Clarify whether the expulsion of the placenta should be natural or controlled. (See section on Expulsion of the Placenta.)

Describe what the first contact with the child should be like. If the baby's condition does not cause concern, have him immediately placed on the mother's stomach and chest. The light should not be bright so as not to irritate the newborn's eyes. Demand that you be allowed to breastfeed immediately, which will speed up the natural expulsion of the placenta. Ask the nursing staff to leave the room for a moment so that your family can be together for a few minutes without others around.

Describe how to care for your child. Indicate your preference - staying in the same room with the mother or in the neonatal ward. Request that the newborn examination and any other procedures be postponed while you interact with the child, and that the child be examined in your presence. Indicate who should bathe the child: the mother or the nurses. Don’t forget about feeding your newborn: only breastfeeding, only formula, whether or not you need to feed formula or give water, give or not give a pacifier. Indicate whether the boy should be circumcised, and if so, with or without local anesthesia. Give permission for visits from the newborn's siblings (indicate age).

Plan Presentation

Don't brandish your birth plan like a terrorist with a list of ultimatums if you want everyone to be on your side. Play up the midwife or doctor's ego by mentioning the reasons why you contacted them. This positive signal will give you extra attention. Consider the following etiquette rules.

Be positive. There are two main ideas you should convey in your plan. Firstly, this is a long-awaited and planned child, and you are prepared and informed parents. You do everything in your power for your own health and the health of your child. Secondly, you expect the same approach from your doctor or midwife. You look at birth as a partnership—you just want everyone to know their responsibilities and follow through with them. In addition, you must demonstrate your flexibility and ability to deviate from a pre-planned plan if medically indicated, but at the same time you want to be informed about the benefits, dangers and necessity of a particular intervention, and are also willing to participate in making these kinds of decisions. Do not forget that the birth plan assumes their normal development - in accordance with the plan. In addition, you should have a backup plan in case you need to make emergency decisions. Don't let yourself get angry if labor doesn't go as planned. Anger can cause a tension-pain cycle (see Chapter 9), leading to further deviation from the original plan.

Don't be negative. A defensive position with a list of “prohibitions” will most likely lead to the fact that you will acquire a reputation among the staff of the medical institution as a capricious client, and childbirth will not bring you the expected satisfaction. What do you think the maternity ward nurse would prefer to hear from the expectant mother: “I would prefer my nightgown and freedom of movement” or “I won’t wear a hospital gown and I don’t want to be confined to a bed”?

To insure against surprises, ask your doctor, as well as his substitute colleagues, to sign the plan. Register in advance at your chosen hospital or birth center and fill out the required forms. A well-thought-out birth plan will help all of your caregivers. Remember that if you don't have your own plan, the hospital may provide you with one.

Usually in the middle of pregnancy a woman thinks about the question: “Where to give birth?” To solve this problem for yourself, it is advisable to draw up a birth plan, paying attention to those details that are of decisive importance to you. Further, according to this plan, you can make a list of questions that you will ask during the call to the maternity hospital.

Here's a rough outline of questions to ask to get an idea of the maternity hospital:

pain relief (no, yes, epidural)
the opportunity to be observed and give birth by one doctor
presence of husband (yes, no)
pose (lying, any, vertical, in water)
breastfeeding in the delivery room (yes, no)
living together with a child (yes, no)
visits from family (yes, no)
living conditions (good, average, bad)
Availability of a paid branch, price

Natural childbirth with my husband

You believe that childbirth is a natural physiological process, predetermined by nature for every woman. You are focused on giving birth as naturally as possible without drug intervention.

You do not intend to go to the maternity hospital ahead of schedule, even if your antenatal clinic insists on this. Moreover, even with the onset of contractions, you will not rush to the maternity hospital, but will spend part of the first phase of labor at home.

To apply the knowledge you've gained while preparing for childbirth, you want to have freedom of movement in the delivery room, not limited to staying in bed. You have an idea of pain-relieving breathing, postures that promote cervical opening and general relaxation. It is important for you to have a husband or other loved one present who can provide psychological support and perform a pain-relieving massage.

You are convinced of the need for early breastfeeding of a newborn, directly in the delivery room. You know how important feeding “on demand” is for establishing lactation, and therefore you want your baby to be constantly with you, and not in the children's ward.

Oddly enough, this option is not possible in every maternity hospital, even the most expensive. Many couples seeking a natural birth decide to give birth at home. However, if this option is not for you, we suggest you check out our list.

Selection criterion: without anesthesia and stimulation, husband, mother + child

Natural childbirth without a husband

You would like to come to the maternity hospital when contractions begin, but if necessary, you will not be against early hospitalization. If your doctor insists on this, you are ready to wait for your due date in the prenatal department.

You dream of a natural birth without the use of stimulation and anesthesia, which have a harmful effect on the child. At the same time, the thought of your husband’s presence at the birth does not delight you, and he himself is not very eager to accompany you, considering it not a man’s business.

Visits from relatives in the postpartum ward do not play a decisive role for you; telephone communication is enough for you - after all, you are separated for only a few days. By the way, many modern maternity hospitals have video phones.

If this is your option, then the list of medical institutions open to you will be quite wide. Moreover, this option of childbirth can be carried out with very little money.

Selection criteria: no anesthesia or stimulation, no husband, no visits

Availability of pediatric intensive care unit

Your pregnancy is difficult, doctors classify it as high-risk. There is a possibility of premature or complicated labor. You may be having a caesarean section.

In this case, when choosing a maternity hospital, the availability of a good medical base, pediatric intensive care unit, and intensive care unit comes to the fore.

Selection criterion: pediatric intensive care unit

Epidural anesthesia

This type of anesthesia has become particularly widespread recently and is very popular among expectant mothers. Its essence is that the woman in labor is given an injection into the spine, and the painkiller is injected directly into the spinal cord. The lower part of the body (below the waist) ceases to feel pain, while the woman remains conscious.

In the West, this type of anesthesia is widely used for caesarean sections. However, it is also performed during vaginal delivery.

Of course, with epidural (peridural) anesthesia, the woman in labor can only lie down. We are not talking about free choice of positions during childbirth.

The use of epidural anesthesia often entails the use of other obstetric interventions: vacuum extraction, application of forceps. This is also important to consider when creating a birth plan.

Selection criterion: epidural anesthesia

C-section

Caesarean section is used quite often and is performed in all maternity hospitals for medical reasons. In some cases, it is performed at the request of the woman in labor (as a rule, this is paid officially or “in the hands” of the doctor). On average, cesarean sections account for 10-15% of total births.

Most often, the day of the operation is scheduled in advance, although this is not always justified. Modern neonatologists advise, if possible, to wait for the natural onset of labor, since the natural course of at least the first phase of labor has a positive effect on the child. However, for some pathologies, the day of surgery must be scheduled in advance. Usually in this case, the woman is hospitalized several days before the due date, but hospitalization is possible directly on the scheduled day of birth. Most often, the operation is performed under general anesthesia. The question of staying with the child in the event of a cesarean section, as a rule, is not raised.

Selection criterion: cesarean

"Soft" caesarean section

The decision to have a caesarean section must be made together with your doctor (and possibly several doctors). But if all the pros and cons are weighed, and your birth plan is based on this operation, you still have a few details to work out.

Even if a C-section is unavoidable, you can try to make the birth as smooth as possible.

In consultation with your doctor, you can wait until contractions begin naturally before going to the operating room. The timing of hospitalization should also be discussed with your doctor. Early hospitalization may not be necessary.

In many cases, the operation can be performed not under general anesthesia, but with epidural anesthesia. In this case, you will be able to see your newborn baby and perhaps even put him to your breast. In some maternity hospitals, the father may be present during the operation (usually he is in the next room, and after the birth he is allowed to take the baby in his arms).

Of course, after a caesarean section, a woman is forced to lie down, and her ability to care for her newborn is severely limited. However, if the conditions of the maternity hospital allow, a young father or grandmother can be in the postpartum ward with his wife and child. In this case, cohabitation and free breastfeeding can be carried out.

Selection criterion: cesarean + epidural, family wards

Possibility to be observed and give birth by one doctor

For some couples, the decisive factor when choosing a maternity hospital is the opportunity to be observed during pregnancy and subsequently give birth in the same place, or better yet, with the same doctor. Of course, such a service costs money, but at the moment there are maternity hospitals that are ready to provide it.

Selection criterion: prenatal care at the maternity hospital

Joint stay with the child in the postpartum ward

In this scheme, the possibility of staying together with the newborn in the postpartum ward comes to the fore. The main advantage of this system is the free feeding mode “on demand”. The importance of constant contact between the newborn and the mother is no longer in doubt. Unfortunately, many maternity hospitals built during the Soviet years do not have conditions for mother and child to stay together. Mother+Child wards exist primarily on a commercial basis.

Even if you doubt your abilities, you are afraid that you will be too weak in the first days after birth, there is always the opportunity to get some sleep, entrusting your baby to the care of the sisters from the children's department.

Selection criterion: mother + child wards

Decent living conditions

During the birth process, you are ready to rely on the authoritative opinion of doctors; the details of the process (such as stimulation, anesthesia, etc.) are difficult for you to determine unambiguously. Decent living conditions are of decisive importance when choosing a maternity hospital. You want to feel like a person, to have a separate clean room (at most, a double room), with a shower, telephone, refrigerator... It is advisable that the new father and grandparents have the opportunity to visit you, bring something tasty...

Selection criterion: single or double rooms, shower, toilet in the room or in a box

Childbirth with pain relief

“I’ll endure as long as I can, and then let them give me pain relief” - this is a very common way of thinking of an expectant mother. If you feel this way, then most likely you will really need pain relief. Please note that in some maternity hospitals they give a special injection that allows you to sleep for a couple of hours during contractions in order to save energy for the period of pushing (for example, a maternity hospital in Krasnogorsk). It is believed that by the active phase of labor the anesthesia wears off completely and therefore does not have a harmful effect on the child.

As a rule, the use of anesthesia (especially in the form of a drip) limits the mobility of the woman in labor. Most maternity hospitals will not allow you to get out of bed during contractions.

In one form or another, pain relief is provided in all maternity hospitals. The type of anesthesia is chosen depending on many factors: medical history, speed of labor, the phase in which you were admitted to the maternity hospital, your condition and others.

A separate article could be written about the types of pain relief, but that’s not what we’re talking about now. With the exception of a few facilities that insist on giving birth as naturally as possible, most will give you anesthesia at your request. And in any maternity hospital it will be done for medical reasons.

Therefore, if your birth plan is based on this scheme, the choice of maternity hospital will be determined by other criteria (territorial location, living conditions, price, etc.)

Childbirth “wherever you have to”

“I don’t care much about the question of where I will give birth. I’ll call an ambulance and they’ll take you to the nearest maternity hospital.” If this is your train of thought, then you read this article in vain.