Our birth plan, with annotations about what actually happened.

Birth plan
Judy Anderson
Twins

Obstetrician: Dr. Beth Hardiman, 725 Concord Ave. Cambridge. 617-497-9500
Pediatrician: Dr. Eric Levin, 450 N. Main St. Sharon. 781-784-0403

Thank you for helping with the delivery of our babies!

Goal: Natural, vaginal birth free from medication and intervention. (We had a vaginal birth free from pain medication. However, we had vacuum extraction for both babies, because Dr. Hardiman was concerned that they were not doing well.)

We understand that labor is unpredictable and that any plan is subject to change. However, as much as possible, we would prefer the following.

Labor:

Persons to be present (vaginal birth or Caesarean): Ken Olum and Valerie White. No non-essential hospital personnel. (Dr. Hardiman asked if she could bring in a medical student, and the medical student was extremely helpful.)

No interventions unless absolutely necessary. Except in cases of emergency, we want to approve interventions in advance. (She asked us about every intervention, and we approved everything she wanted to do.)

We'll ask for pain medication if we want it. (She did ask us if we wanted an epidural, making clear that it was our choice, and we declined.) No episiotomy. (We didn't have one.) Natural methods for dealing with slow labor. (Dr. Hardiman did not rush to induce labor, but was willing to wait 48 hours after membranes ruptured. The cost of this was that Judy got an infection, but on the other hand induction also has many dangers.)

Food: Judy to be allowed to drink both water and calorie-containing fluids. (No ice, please.) (She was too sick for anything but water.)

Ability to vary position (use tub, etc.) to speed labor and reduce pain important. Heparin-lock in IV. Continuous fetal monitoring only if it does not interfere with mobility. (Once she got to the hospital, she wasn't well enough to get out of bed. She mostly labored lying on her side.)

Care of babies

Cord may be cut by care provider. Cord blood to be collected in New England Cord Blood Bank kits provided by us; some in DNA Center genetic testing kits also provided by us. (Cord blood collection only if it does not interfere with mother's and children's health and safety.) (All this took place as planned.)

No non-emergency procedures performed on babies in first hour. Delay eyedrops; Vitamin K orally. (The pediatricians showed up when the birth was imminent and set up all kinds of fancy equipment in case of need. They examined the babies, pronounced them healthy, and departed. The kids went for their initial procedures in an hour or so. The hospital only had injectable vitamin K, but it didn't seem to matter much. The kids objected more to diaper changes than to all their injections, IVs, and so on.)

Immediately after delivery, babies to be skin to skin with Judy and attempt first breast-feeding. (Dr. Hardiman said that Judy needed to recover a bit from the delivery first. Instead she put them to breast after about 3 hours.)

Babies NPO (nothing by mouth) except breast milk (even if Caesarean, even if premature, unless impossible). No pacifiers. (This went as intended. However, Jocelyn did not nurse very well, and I think it might have been better to pump and feed her breast milk (i.e., colostrum) by bottle.)

No circumcision.

If babies must be separated from mother, Ken will go with them and Valerie will stay with Judy.

Babies to stay with Judy, not in nursery unless absolutely necessary. If all goes well, we and the babies will leave hospital early and Dr. Levin will do PKU test, etc. (They did stay with us, except for a few hours in the night when they were in the nursery so that Judy could sleep. We did not leave early because Judy had to recover and Jocelyn needed antibiotics.)

kdo@cosmos.phy.tufts.edu