Caryn Douma, RN, a clinical neonatal nurse specialist at Texas Children's Newborn Center, offers a 3-step birth plan that will help you feel confident and collected when the labor contractions begin.
As a neonatal nurse, I often meet women who are expecting for the first time and don't know how to begin planning for their baby's arrival. The first thing I tell them is to take a deep breath and start thinking about "the three Bs": The Big Picture, the Basic Plan and the BUMP (Baby Urgent Medical Plan). Each "B" is an important step toward preparing for delivery day!
The first step in preparing your birth plan is to think about your philosophical beliefs about birth and determine how you can have the most satisfying experience possible coupled with the best care available. To begin, start thinking about how you envision your birthing experience.
Each doctor and hospital operates under different philosophies of care. You'll want to familiarize yourself with the various birthing options in your area to find the right environment and caregivers for you and your family. For example, some hospitals practice a more traditional model of care where mom and baby are cared for individually and are separated during the "transitional" period just after birth. At St. Luke's Episcopal Hospital and Texas Children's Hospital, we offer family-centered maternity care, where parents are involved in all aspects of the birthing process, and the mother is encouraged to express her preferences. In addition, with family-centered maternity care, one nurse cares mother and baby together, pediatricians perform exams and care in the mother's room so families can participate and learn and babies are never separated – even after a cesarean section delivery – unless it is medically necessary a trip to the nursery is requested.
When assessing the big picture, I suggest you make a list of your preferences and philosophies about labor, delivery and the first few hours with your newborn, followed by a list of questions to ask the people and organizations you are considering. When you start to see that others around you respect your wishes and share your ideas, you'll know you're on the right track.
Once you've given some thought to your birth beliefs and overall goals and have your list of questions ready for hospitals and caregivers, you should prepare a list of your preferred basics – or rather, the who, what, when, where and how of the birth.
In terms of the "who," there are numerous options available to you. You may choose to see an OB/GYN or midwife for prenatal care and delivery and you may want to add a doula – or birth support person – to your line-up of health care providers. Regarding technique (or the "how"), you may choose all medication options available, or you can express your desire for a more natural birth. While "when" you deliver isn't always within your control, there are times when you can choose to be induced on a particular date, but you should discuss this with your doctor as some studies have shown that scheduled inductions are not always best for baby. As discussed above, to determine the "where" it's important to choose a hospital with a maternity program that meets the needs of you and your baby.
After you have made the your list of preferences, I recommend making appointments to visit the hospitals you are considering– most offer a free tour for expectant parents – to learn more about their services and philosophies. Make sure to have your list of questions handy in order to ensure that you find the right center and caregivers for you and your baby.
Hopefully, your pregnancy and birth will go smoothly and as planned. But even with the healthiest and most "normal" pregnancy, an unexpected complication can arise which is why it's important to have a Baby Urgent Medical Plan, or BUMP, prepared. This way, should a complication be diagnosed during your pregnancy, or arise at birth, you will already have an emergency plan in place.
The first thing you'll want to understand when preparing your BUMP are the different levels of neonatal intensive care units (NICUs) and what each level represents. NICUs can be designated level 1 through 3, based on differences in how they are staffed, level of medical expertise and services. For example, the highest-level NICUs (NICU IIIC) guarantee a neonatologist on-site 24/7 and a wide-array of full-time pediatric specialists and advanced technologies to care for your baby's specific medical needs.
By identifying the NICUs in your area and familiarizing yourself with what services are offered at each, you'll be one step ahead should a complication arise. Many people don't realize it, but if your baby needs a higher level of medical care, you as a parent have the right to request that your baby be transferred to the NICU of your choice. So it's good to research the options available to you. You should write down the addresses and phone numbers for the highest-level NICUs in your area and keep them with you – just in case!
If a complication is identified before birth, you'll want to talk with your doctor to determine ahead of time if delivery at a high-risk center is a better option for you and your baby, and what, if any, in-utero intervention options are available. This is important because studies have shown that delivering at a high-risk center has increases the chances of a positive outcome for babies with complications.
While most women never need the BUMP, having one ready to go can provide peace of mind as you embark on this new and very exciting time in your life.
Ranked #7 nationally for neonatology by U.S.News &World Report, Texas Children's Hospital is the leader in the Southern United States in the treatment of babies born complications or prematurely. The physicians at Texas Children's Newborn Center are international leaders in neonatology and neonatal surgery. Texas Children's Newborn Center is home to one of the largest Level IIIC neonatal intensive care units in the country and is committed to providing premier, complete treatment for newborns in need. For more information, visit www.texaschildrens.org.
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