Birth Plan Comments

Below are some elements we have seen in many birth plans and our reponses to these items. We are always open to discussing everything here and anything else that you would like to talk about as well!

Birth Plan Items	Physician Comments
Intermittent Fetal Monitoring	This is fine as long as the fetal heart tracing is reassuring. We require reassuring electronic fetal monitoring as part of the routine management of labor.
Walking during labor	If your fetal heart tracing is reassuring, you are free to walk during labor. We do not “strap you down” and for the last 20 years we never have.
Saline lock instead of IV	This is fine as long as you can stay well hydrated during labor. We do not allow a patient to labor without at least a saline lock in place. A clear liquid diet allowing up to 6-8 ounces of liquids per hour is advised. The saline lock can be very important if a sudden emergency happens such as uncontrollable bleeding or sudden fetal distress.
Explain all tests and procedures to me	We always do this. Patients make the final decisions whenever a medical test or procedure might be indicated. We explain everything to help you decide.
Use of Pitocin	This is not done automatically or for no reason, but there are situations where Pitocin usage is very important, such as when the contractions are too weak, or after the placenta is delivered. If Pitocin is used to help your labor, the goal is for your contractions to be effective enough for your labor to progress towards a normal vaginal birth.
Epidural – timing and indications	It is almost never too late for an epidural. This procedure is your choice. Some women feel guilty about choosing an epidural, and this should not be the case. If this is a first labor, there is no way to know in advance how strong the pain will be.
Different positions for pushing	This is fine if you do not have an epidural. You can squat (we have a squat bar), or you can push while lying on the side. Epidurals cause your legs to be too weak to support you, so pushing is usually done in a semi-reclining position, which is actually a very good position for pushing!
Try to avoid episiotomy	Some people begin perineal and vaginal massage weeks before the delivery to try and stretch the vaginal opening to help avoid episiotomy. This might work, but also might cause the vagina to remain somewhat stretched in the future.  We try to avoid episiotomy when possible, but sometimes a bad tear can be more painful and result in more stitches than an episiotomy. Our goal is for you to go home with the fewest stitches possible!
Baby on mother’s chest, skin-to-skin	As soon as the baby emerges from the birth canal, we try to place the baby on the mother’s chest for skin-to-skin contact. This keeps them warm, and moms really like it! Then, the nurse has to perform a brief newborn assessment, check vitals and breathing, and then hopefully bring the baby back to mom as soon as possible.
Clamp cord after it stops pulsing	Ob doctors I talk to do not understand this request. Scientifically it makes no sense, and in fact can be risky. The baby might pump its blood back into the placenta, which is a form of blood loss for the baby. Or, the baby could end up with too much blood, equally risky, as this can cause the baby’s blood to become too thick and not flow well. Lastly, to honor this request, the baby has to be held at the level of the placenta preventing us from placing the baby on the mother’s chest right after delivery.