Management plan for pregnant women and childbirth. How to write a correct birth plan? Clamp the umbilical cord only after the placenta is delivered

A birth plan is a list of your wishes regarding the management of labor and the first hours of meeting your baby after he is born. When drawing up a birth plan, you need to take into account that childbirth cannot take place according to a pre-planned scenario; changing circumstances or doctor’s decisions may make adjustments. Therefore, the birth plan must be flexible.

Today, a birth plan is not mandatory in any country in the world. Nevertheless, in countries such as the USA and Canada, the practice of drawing up a birth plan is common. Doctors try to take into account the woman’s wishes, but, of course, no one can guarantee the implementation of the plan. If a serious deviation occurs during childbirth, the doctor acts depending on the circumstances in the interests of the woman and the child.

In post-Soviet countries, drawing up a birth plan is a new phenomenon, but nevertheless positive. The plan is part of the psychological preparation for childbirth; it allows the woman to feel more confident and calm in anticipation of the birth of the baby.

Unfortunately, the attitude towards women in labor in our maternity hospitals is far from European ones. Not all health care providers will agree with a woman's choice, and not every doctor will take your birth plan into account. However, in some maternity hospitals, the wishes of the woman in labor, for example, regarding the birth position, are taken into account. You can also count on your birth plan being taken into account if you make arrangements with your doctor about the birth in advance.

Sample birth plan.

1. The place where you will give birth. This means not only which maternity hospital, but also whether you need a separate room after childbirth. What living conditions are acceptable to you? For example, a shower in the room, a refrigerator, an extra bed for the husband, and so on.

2. Attendance at childbirth. Will you give birth on your own or with a partner, and who will be next to you: husband, mother, doula, and so on. Do you want your partner to be with you throughout the entire period of labor or only during contractions?

3. Delivery room environment. Each maternity hospital usually has several delivery rooms. Some have delivery rooms for family births. What would you like to use during childbirth: a fitball, a birthing stool, a shower, and so on.

4. Preparatory procedures. What do you think about enemas, shaving?

5. Pain relief. Will you agree to pain relief and under what circumstances? What anesthesia would you prefer if a caesarean section is necessary?

6. Body position. Is it important for you to walk or move your body into different positions during labor to ease contractions? How do you want to give birth: vertically or horizontally?

7. Blood transfusion. Under what circumstances would you agree to a blood transfusion?

8. Medical interventions during childbirth. How do you feel about induction of labor, episiotomy, forceps, vacuum extraction? Do you agree to use these methods if there is a danger to the child? Do you want the doctor to inform you about all the interventions he is going to undertake?

9. Third stage of labor. Do you want the doctor to wait up to an hour to separate the placenta, if the situation allows?

10. Postpartum period. If you are having a cesarean section, do you want the baby to be given to the dad (or another relative) after birth? When do you want the umbilical cord to be cut: immediately or after the pulsation stops? Do you want the baby to be placed on your stomach immediately after birth and left for at least an hour?

11. Breast-feeding. When do you want your first breastfeeding to occur (ideally within half an hour after birth). Do you agree to give your baby formula milk or do you want to feed him only breast milk?

12. Vaccinations. Do you agree to have your baby vaccinated in the maternity hospital? On the first day, a vaccination against hepatitis B is given, on days 3-7 BCG (against tuberculosis).

Even the most well-thought-out birth plan cannot insure you against unforeseen circumstances. You cannot control nature and influence the rules adopted in the maternity hospital. You can’t even know which team will give birth to you, and how the doctor and midwife will react to your plan. So be prepared to be flexible.

If you agree on childbirth with a specific doctor, then the likelihood that all your wishes will be taken into account is much greater. Just make sure you agree on your birth plan with your doctor in advance.

OPTION 1 - according to this Plan I gave birth:

BIRTH PLAN

Moscow, Maternity hospital No. 4

I, Last Name First Name Patronymic, on the basis of Articles 32, 33 and 34 of the FUNDAMENTALS OF LEGISLATION OF THE RUSSIAN FEDERATION ON THE PROTECTION OF CITIZENS' HEALTH, I request that the birth be carried out in accordance with the following Birth Plan:

Dear obstetricians!

I was prepared for childbirth at Mom's School ( in the Birth Plan for my second birth I added: and I have successful experience of the first natural vertical birth), I can well imagine the course of the birth process, and I would like my (second) birth to proceed (also) naturally vertically.

Stage 1 of labor (contractions, full dilation of the womb up to 10-12 cm):

1. I will go to the maternity hospital with dynamic contractions at an interval of 15-10 minutes.

2. Before giving birth, I ask you to give me a cleansing enema and shave my perineum.

3. I ask you to carry out vaginal examinations as rarely as possible to avoid premature rupture of the bladder.

4. I ask the medical staff to enter the room only when necessary.

5. Please do not let any unnecessary personnel, including trainees, into my room.

6. I refuse any injections or interventions in the birth process without my informed WRITTEN consent.

7. Please do not use stimulant drugs during childbirth (if this is necessary for health reasons, please provide me with full information about the reasons for the intervention and take my WRITTEN consent).

8. I refuse labor pain relief without indications (according to indications, only with my WRITTEN consent).

9. Please reduce the brightness of the light.

10. Please give me the opportunity to behave freely during childbirth.

Stage 2 (pushing):

1. I ask you to give me a natural vertical birth.

2. Please do not perform a Caesarean section, forceps, vacuum, amniotomy or episiotomy without my informed WRITTEN consent.

3. When fully opened, w. m., if there is no pushing, please do not force me to push, but wait for the natural urge to push.

4. Please do not put me on my back and do not use the Kristeller maneuver, because this technique puts pressure on the aorta and reduces blood flow in the femoral arteries, which sharply disrupts blood circulation in the uterus and placenta, and at the same time reduces the access of oxygen to the baby, which leads to hypoxia...

5. Please do not give me trial horizontal pushing (lying on my back), but when the time comes to push, immediately bring me to a vertical position.

6. If necessary, please give me a perineal massage with oil to avoid labor ruptures.

7. When the back of the head is teething, please give me the opportunity to touch the back of the head and the baby’s hair.

8. Please do not cross the umbilical cord until it is completely pulsating.

9. I ask that immediately after birth, place the baby on my stomach and help attach it to my chest for up to 60 minutes.

10. I ask that all medical and hygienic procedures with the child be carried out after the first contact with me, and in my presence.

11. If a child is born with a short frenulum of the tongue, I ask you to cut the frenulum for full breastfeeding.

Stage 3 (placenta):

1. I ask that the baby be placed to the breast immediately after birth to speed up the birth of the placenta.

2. Please do not use Pitocin or manually pull the umbilical cord without my informed WRITTEN consent.

3. I ask that after giving birth, you carry out all the necessary medical and hygienic procedures for me.

Stage 4 (postpartum development):

1. If necessary, please give me up to 8 hours of sleep after childbirth.

2. Please provide the opportunity for full (or partial) stay with the child. When staying partially with the child, I ask you to bring the child to me at night for feeding upon request.

3. I ask that you give me the opportunity to breastfeed my child and not give the child complementary foods and water without my WRITTEN consent.

4. Please provide the opportunity to ventilate my room, and not use an additional heater.

5. Please provide the opportunity to use disposable diapers.

6. Please provide me with informational assistance on breastfeeding and breast pumping.

7. Please provide me with informational assistance on the care, hygiene and development of the baby.

8. I ask that your child be vaccinated with BCG-M and heel screening.

OPTION: ( 8. I ask you to give your child all the necessary vaccinations: Hepatitis B, BCG-M and Heel Screening.

OR: I refuse all required vaccinations for my child. I ask you to do only a heel screening for your child. )

9. Please give me the opportunity to have a mobile phone with a charger with me.

10. I ask you to allow transmissions (and, if possible, visits only from the husband).

11. Please provide me with a length of stay in the maternity hospital of up to 6 days or longer for medical reasons, to prevent complications.

12. Before discharge, please do an ultrasound of the uterus.

Sincerely, ___________ Last name Initials

OPTION 2 - joint birth:

BIRTH PLAN

Moscow, Maternity hospital No. 4

I, Last Name First Name Patronymic, on the basis of Articles 32, 33 and 34 of the FUNDAMENTALS OF LEGISLATION OF THE RUSSIAN FEDERATION ON THE HEALTH OF CITIZENS, I ask that the birth be carried out in accordance with the following plan (my husband (full name) will be present at the birth as a legal representative):

Dear obstetricians!

I am aware that the Birth Plan is an approximate list of wishes, and any unforeseen situations may occur during childbirth, therefore, in the event of complications, I guarantee full confidence in the medical staff.

1. I refuse any injections or interventions in the birth process without my informed WRITTEN consent (or the consent of my legal representative).

2. I ask you not to use stimulant drugs during childbirth (if this is necessary for health reasons, please provide me with full information about the reasons for the intervention and take my written consent).

3. I refuse labor anesthesia without indications (if indicated only with written consent)

4. I ask you to lower the brightness of the light (create twilight) at the time of the birth of the child and give the opportunity to turn on calm music.

5. Please do not use the Kristeller technique.

6. Please do not perform an amniotomy or episiotomy without my written consent.

7. I ask you to carry out a vertical birth and give the opportunity for free behavior during childbirth.

8. Please provide the opportunity to eat and drink during the first stage of labor.

9. Please do not cross the umbilical cord until it has completely pulsated. I also ask that immediately after birth, place the baby on my stomach, attach it to my chest, and do not take him away for measurements and weighing for at least an hour after birth.

10. I ask that after childbirth, you carry out all the necessary medical and hygienic procedures for me, including postpartum cleaning of the uterine cavity.

11. Please do not give your child complementary foods and water without my written consent.

12. As the legal representative of a minor child, I refuse vaccination against Hepatitis B and BCG.

13. Please provide the opportunity to use home clothes for the child and reusable diapers made from biomaterials.

Sincerely, ___________Last name Initials

Compiled on 1 page, in 2 copies.
----

Why I decided to give birth vertically, watch the video:

For the convenience of medical staff, try to fit the “Birth Plan” on 1 page.

The date on the “Birth Plan” is the date when I printed it.

If you have not taken a course on preparing for childbirth, do not write that you have!
I took a course on preparing for childbirth, that’s why I indicated this.

When giving birth together, the husband must have test results with him: AIDS, syphilis, hepatitis and fluorography. And also rubber slippers. He will receive a robe and cap at the RD (or, at the request of the RD, bring his own).

For joint births, I highly recommend taking a course on preparing for joint births, so that your husband (or mom/dad, girlfriend...) does not stand stupidly in front of you and does not interfere with the doctors’ work, but actively takes part in the process together with the doctors.

The “birth plan” can be even longer/shorter, at your discretion.

I think it’s right to do vaccinations and screening, so I indicated so.

It happens that doctors intimidate... You just have to be prepared for this.
In this case, it is very polite to refuse with a sweet smile, with the words: “I would like to try without... But if it doesn’t work out, then we’ll do it your way.” Under no circumstances refuse rudely and categorically, this will only set the doctor up. obstetrician against yourself!

It is very important to state several times in the Plan that your WRITTEN consent is required for the manipulation, so that the doctors do not later say: they thought that you agreed...

The finished “Birth Plan” must be agreed upon with your leading doctor from the housing complex, so that the doctor can adjust it taking into account the characteristics of your body and baby...

Print out the “Birth Plan” in 2 copies: 1 copy. give it to the Reception Department along with other documents, and 1 copy. will stay with you or your husband (or mom/dad, girlfriend...).

An absolutely ideal option is to take a familiar doctor or, at least, a person who knows the birth process well, as the Legal Representative for the birth, so that he can soberly evaluate the doctors’ advice, because sometimes interventions in the natural birth process are really necessary.
----

Kristeller's maneuver is a manual obstetric maneuver to speed up the expulsion of the fetus. Consists of pressing with hands or elbows on the fundus of the uterus (on the stomach under the ribs) through the abdominal wall, while pushing during the eruption of the head.
Prohibited on the basis of Order of the Ministry of Health of the Russian Federation No. 318 and Resolution of the State Statistics Committee of the Russian Federation No. 190 of December 4, 1992 “On the transition to the criteria for live birth and stillbirth recommended by the World Health Organization”: “The use of the Kresteller method ... is contraindicated!”

Complications for the child:
- broken arm bones and collarbones; - spinal cord damage; - compression of the spine; - nerve damage; - breathing disorders; - increased intracranial pressure, etc.

Complications for the mother:
- broken ribs; - risk of rupture of the muscles of the uterus and anus; - breathing disorders; - liver damage, etc.

Good luck with your birth!

________________________
P.S.: For those who doubted that I would be able to give birth according to my “Birth Plan”, read the post about My birth:

Nothing is impossible.
There is only: I know - I don’t know And I want - I don’t want, the rest are excuses !

I somehow didn’t even know what a birth plan was. When I went to the maternity hospital, there were no specific wishes, except for the naturalness of the process. Having read Grof’s perinatal matrices, having a certain scheme and sequence of thoughts in my head, I really wanted to follow those ideas in order to make the birth of a baby as easy as possible. And I didn’t think about anything else. But it turns out that recently it has become fashionable and considered quite progressive to make a birth plan. So what is it? A birth plan is an agreement between you and the doctor who will deliver you. In this document you can clarify your wishes regarding all the details of the birth of the child. Unfortunately, or perhaps fortunately, this plan does not have legal force in our country. Your OB/GYN is not required to sign it or strictly adhere to its instructions. The doctor’s attitude towards the birth plan will depend on how well it is drawn up and, most likely, on the conditions under which you are going to give birth.

Before you start writing a birth plan...

Remember, this document must be yours personally, and not a friend’s or downloaded from the Internet.

Gather as much information as possible. Sign up for childbirth preparation courses at your local antenatal clinic or paid classes with good recommendations and ask the consultant to explain to you all the unclear points.

Talk to women who have given birth at home, in a maternity hospital or perinatal center. Ask about the difficulties they had to face and the level of medical care.

If your birth will be a partner birth, discuss with your husband what seems to be the correct birth option and find out what he sees as his own role in the delivery room.

Write down all the information you gather to create your own wish list. This will be your birth plan.

Here are the main points that women usually pay attention to when making a birth plan.

How long after labor starts you would like to stay at home.
What food and drink would you like to consume during active labor?
Your companions during childbirth. Which of your relatives or loved ones will go with you to the delivery room? Should this person be with you throughout the entire birth or only up to a certain point? Is the presence of other family members, except the husband, allowed during childbirth, the presence of older children during childbirth or immediately after it.
Is it possible to use contact lenses during childbirth? In your birth plan, indicate the stage of labor at which your partner should leave the delivery room.
Choosing a room for childbirth.
Is it possible to have an individualized atmosphere of childbirth (music, light, objects brought from home).
Is it possible to use a camera or video camera?
Is it necessary to use an enema, remove pubic hair, use an IV, catheter, or painkillers?
Anesthesia. Describe what means of pain relief you would like to use during contractions: shower, massage, compress, fitball, aromatherapy, etc. Clarify your attitude towards epidural anesthesia - “no”, “undesirable” or “possible”. At this point in the birth plan, you can indicate that the doctor should not give you pain relief, even if you change your mind during childbirth and ask for it.
Will external (continuous or periodic) and internal monitoring of the condition of the fetus be carried out?
Desirable position during childbirth. Write in the birth plan what position you consider most comfortable during contractions and during childbirth. Do you want to be active, move, walk, stand, or do you prefer to stay in bed?
Is it possible to make a perineal incision or replace it with other procedures to avoid a perineal incision?
Obstetric aids. Indicate your attitude to opening the amniotic sac, intravenous induction of labor (is it possible to use oxytocin to enhance the contracting role of the uterus), the use of forceps or a vacuum extractor. The gynecologist’s decision will depend more on the current situation, but the doctor will not go into open conflict and insist on certain manipulations without vital necessity, knowing in advance about your desires.
Is there a need for a caesarean section?
Is it possible for a newborn to be freed from mucus by the father?
Will it be possible to hold the baby immediately after birth and breastfeed immediately after birth?
The final stage of childbirth. You can choose whether you want an injection to expel the placenta or whether you prefer to have it expelled naturally.
Should the child be weighed only after the first extrauterine contact between mother and child?
Is it possible for the mother to be present during the weighing of the child, eye drops, pediatric examination or first bath.
Feeding the baby. At this point in the birth plan, you should indicate your attitude towards feeding your baby glucose or formula. If you insist on exclusively breastfeeding without using bottles, write about that too.
Is circumcision possible?
Special needs. If you have any special needs due to your health condition, you must name them and indicate what kind of medical assistance could help you in this case. Also mention your religious beliefs here if it is important to you that a certain ritual be performed during childbirth. Medical personnel are obliged to respect the religious beliefs of patients, if they do not contradict the sanitary standards of childbirth.
Postpartum care. Write about how you see staying with your child after birth: the type of room, the presence of neighbors, the possibility of assistants or guests, examinations of the baby, for example, only in your presence. Note the importance of vaccinations for you or your negative attitude and prohibition on putting eye drops in your child’s eyes, vitamin injections and vaccinations.
Will other children be allowed to visit?
What are the therapeutic actions after childbirth regarding mother and child.
Length of hospital stay, preventing complications.

Now let's take a closer look at some points that require clarification.

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 installed.

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 may entail the use of other obstetric interventions: vacuum extraction, forceps. This is also important to consider when creating a birth plan. In general, about any anesthesia, I would like to say that the use of anesthesia, but during childbirth, carries with it both benefits and risks, so use it only when it brings more benefits than risks.

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 herself. 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. The operation is performed under epidural, spinal anesthesia, or endotracheal anesthesia. The question of staying with the child in the event of a cesarean section, as a rule, is not raised, at least in the first couple of days.

Selection criterion: caesarean section

"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 anesthesia, 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 and childbirth with your doctor

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.
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 the baby to the care of the sisters from the children's department.

Selection criterion: mother + child wards

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 pushing period. 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.

And finally:

The birth plan should not resemble strict instructions that tie the hands of the medical staff. This is not an ultimatum, but your attempt to actively participate in the planning process. A good doctor will certainly appreciate your conscious preparation for childbirth and take into account your wishes, if possible. Because the best birth plan cannot become a script to blindly follow. For medical reasons, even in countries with a legally legalized birth plan, the doctor has the right to push this document aside and conduct the birth based on the interests of the mother and child. Do not forget that you should not make decisions in advance that cannot be changed, since complications at the last moment can change plans, necessitating emergency surgery and the use of anesthesia.

And you still need to understand that since you have drawn up a plan for your birth, having previously talked with your doctor, summarizing all your thoughts, experiences, perhaps even summing up previous experience, then you also share all the responsibility of this difficult but wonderful event. And you will not shake this piece of paper in front of the medical staff, and your spouse will not give instructions to your doctor. A birth plan is an opportunity for beneficial and mutually beneficial cooperation between two interested parties, and the result of this work will be your long-awaited baby, born in an atmosphere of mutual understanding, sensitivity, and kindness. Good luck to you!

Based on materials from miss-vip.ru, materinstvo.ru

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

PREGNANCY MANAGEMENT PLAN

1) prevention of fetal RDS (2 doses of betamethasone IM at 12 mg every 24 hours or 4 doses of dexamethasone IM at 6 mg at an interval of 12 hours; or 3 doses of dexamethasone IM at 8 mg every 8 hours)

2) prevention and treatment of chronic infection;

3) dynamics of blood pressure, blood pressure to detect gestosis;

4) prevention of premature birth;

5) delivery with increasing signs of intrauterine suffering of the fetus.

BIRTH MANAGEMENT PLAN

I period - cervical dilatation

1. In the prenatal room, clarify the medical history, conduct an additional examination, a detailed examination of the woman in labor, including external obstetric examinations.

2. Carefully monitor the condition of the woman in labor in the maternity ward. Find out the state of health, the condition of the skin, listen to the fetal heart sounds, and calculate the heart rate. measure blood pressure, pulse.

3. Delivery through natural means.

4. Controlled. HELL.

5. Observe the nature of labor, monitor the frequency, duration, strength and pain of contractions

6. Observe the condition of the fetus, listen to fetal heart sounds by auscultation every 15-20 minutes, when amniotic fluid is released every 10 minutes. If the heart rate is less than 110 and more than 106, check the CTG.

7. Monitor bowel and bladder emptying every 2 hours.

8. Thorough toileting of the external genitalia after each urination and defecation.

9. Eating easily digestible food.

10. With elevated blood pressure above 160 mm Hg. perform an amniotomy.

11. When labor weakens, labor is enhanced with oxytocin.

12. If signs of heart failure appear, a cesarean section is performed.

II period - expulsion of the fetus

1. Monitor the general condition of the woman in labor.

2. Observe the nature of labor, monitor the frequency, duration, strength and pain of contractions.

3. Conducting an obstetric examination to determine the progress of the presenting part of the fetus along the birth canal.

4. Monitor the condition of the fetus (heart rate after each push)

5. Monitoring the condition of the external genitalia and the nature of vaginal discharge

6. Regulation of pushing

7. Reducing perineal tension.

8. Monitor the correct course of labor.

9. Control the biomechanism of labor in posterior occipital presentation:

The first moment is flexion of the fetal head. In the posterior view of the occipital presentation, the sagittal suture is installed synclitically in one of the oblique dimensions of the pelvis, in the left (first position) or in the right (second position), and the small fontanel is directed to the left and posteriorly, to the sacrum (first position) or to the right and posteriorly, to sacrum (second position). The head bends in such a way that it passes through the entrance plane and the wide part of the pelvic cavity with its average oblique size (10.5 cm). The leading point is the point on the sagittal suture, located closer to the large fontanel.

The second point is the internal incorrect rotation of the head. An arrow-shaped suture of oblique or transverse dimensions makes a rotation of 45° or 90°, so that the small fontanelle is behind the sacrum, and the large one is in front of the womb. Internal rotation occurs when passing through the plane of the narrow part of the small pelvis and ends in the plane of the exit of the small pelvis, when the sagittal suture is installed in a straight dimension.

The third point is further (maximum) flexion of the head. When the head approaches the border of the scalp of the forehead (fixation point) under the lower edge of the pubic symphysis, it is fixed, and the head makes further maximum flexion, as a result of which its occiput is born to the suboccipital fossa.

The fourth point is extension of the head. A fulcrum point (anterior surface of the coccyx) and a fixation point (suboccipital fossa) were formed. Under the influence of labor forces, the fetal head extends, and first the forehead appears from under the womb, and then the face, facing the womb. Subsequently, the biomechanism of childbirth occurs in the same way as with the anterior view of the occipital presentation.

The fifth point is external rotation of the head, internal rotation of the shoulders. Due to the fact that an additional and very difficult moment is included in the biomechanism of labor in the posterior form of occipital presentation - maximum flexion of the head - the period of expulsion is prolonged. This requires additional work of the uterine and abdominal muscles. The soft tissues of the pelvic floor and perineum are subject to severe stretching and are often injured. Prolonged labor and increased pressure from the birth canal, which the head experiences when it is maximally flexed, often lead to fetal asphyxia, mainly due to impaired cerebral circulation.

10. Provide obstetric assistance during childbirth:

Obstetric benefits during childbirth are as follows:

1. Regulation of the advancement of the cutting head. For this purpose, while cutting in the head, standing to the right of the woman in labor, place the left hand on the woman's pubis, using the end phalanges of four fingers to gently press on the head, bending it towards the perineum and restraining its rapid birth.

The right hand is positioned so that the palm is in the perineal area below the posterior commissure, and the thumb and four other fingers are located on the sides of the Boulevard Ring (thumb on the right labia majora, four on the left labia majora). In the pauses between attempts, the so-called tissue borrowing is carried out: the tissue of the clitoris and labia minora, i.e., the less stretched tissues of the Boulevard Ring, are brought down towards the perineum, which is subjected to the greatest tension when the head erupts.

2. Removal of the head. After the birth of the occiput, the head, with the region of the suboccipital fossa (fixation point), fits under the lower edge of the symphysis pubis. From this time on, the woman in labor is prohibited from pushing and the head is brought out outside the pushing, thereby reducing the risk of perineal injury. The woman in labor is asked to place her hands on her chest and breathe deeply; rhythmic breathing helps overcome the strain.

With the right hand they continue to hold the perineum, and with the left they grab the fetal head and gradually, carefully unbending it, remove the perineal tissue from the head. In this way, the forehead, face and chin of the fetus are gradually born. The newborn head is facing backward, with the back of the head facing forward, towards the womb. If after birth the head is found to be entangled in the umbilical cord, carefully pull it up and remove it from the neck through the head. If the umbilical cord cannot be removed, it is crossed between Kocher forceps.

3. Release of the shoulder girdle. After the birth of the head, the shoulder girdle and the entire fetus are born within 1-2 attempts. During pushing, the shoulders rotate internally and the head rotates externally. The shoulders change from transverse to straight size of the pelvic outlet, while the head turns with its face towards the right or left thigh of the mother, opposite to the position of the fetus.

When the shoulders are erupting, the risk of injury to the perineum is almost the same as when the head is born, so it is necessary to very carefully protect the perineum at the moment the shoulders are born.

When cutting through the shoulders, the following assistance is provided: the front shoulder fits under the lower edge of the symphysis pubis and becomes a fulcrum; after this, carefully remove the perineal tissue from the back shoulder.

4. Removal of the body. After the birth of the shoulder girdle, carefully grasp the fetal chest with both hands, inserting the index fingers of both hands into the armpits, and lift the fetal torso anteriorly. As a result, the body and legs of the fetus are born without difficulty. The born baby is placed on a sterile heated diaper, and the woman in labor is given a horizontal position.

11. After birth, the baby is placed on the mother’s stomach and 1 ml of oxytocin is administered intramuscularly.

12. Maintain sterility to prevent purulent-septic complications.

13. Prepare a table for the newborn, notify the neonatologist and resuscitation specialist about the birth of the child

14. Prepare a ventilator, electric suction, catheters

15. Perform the first toilet of a newborn

16. Assess the condition of the newborn using the Apgar scale

17. Assessment of blood loss during childbirth.

III period - successive

1. Active wait-and-see tactics

2. Monitoring the condition of the woman in labor

3. Definition of VSDM

4. Bladder catheterization

5. Estimation of acceptable blood loss

6. Signs of placental separation:

· Schroeder's sign: immediately after the birth of the fetus, the uterus is round and its fundus is at the level of the navel. If the placenta has separated and descended into the lower segment, the fundus of the uterus rises up and is located above and to the right of the navel, and the uterus takes on an hourglass shape.

· Alfeld's sign: a ligature placed on the umbilical cord at the genital slit of a woman in labor, when the placenta has separated, falls 8-10 cm and below the vulvar ring.

· Dovzhenko's sign: the woman in labor is asked to breathe deeply: if, when inhaling, the umbilical cord does not retract into the vagina, then the placenta has separated.

· Klein's sign: the woman in labor is asked to push; if the placenta has separated, the umbilical cord remains in place; if the placenta has not yet separated, then the umbilical cord is retracted into the vagina after pushing.

· Chukapov-Kustner sign: when pressing with the edge of the hand on the suprapubic area, when the placenta is separated, the uterus rises up, the umbilical cord does not retract into the vagina, but rather comes out even more.

· Mikulicz-Radicky sign: after detachment of the planet, the placenta may descend into the vagina, and the woman in labor may feel the urge to push.

· Hohenbichler's sign: when the placenta has not separated during uterine contractions, the umbilical cord hangs from the genital slit and may bleed into the veins

If there are positive signs of placental separation, the placenta is released on its own.

Biomechanism of placenta separation: after the birth of the fetus and the discharge of the posterior amniotic fluid, the volume of the uterus is greatly reduced and at the same time the internal surface of the uterus sharply decreases. As a result, a spatial discrepancy (displacement) of the areas of the uterus and placenta is created, since the tissues of the latter do not have the property of contraction inherent in muscle tissue.

When these ratios change, “folds” appear on the inner surface of the uterus at the location of the placenta, which gives impetus to the detachment of placental tissue. At the same time, intrauterine pressure also decreases sharply. This leads to the fact that the placenta gradually separates from the wall of the uterus, and then completely emerges from its cavity to the outside.

Detachment of the placenta is accompanied by a change in the contours (shape and standing height) of the uterus. The fundus of the uterus, which was located after the expulsion of the fetus at the level of the navel, after placental abruption rises higher with a simultaneous narrowing of the diameter of the uterus and the formation of a soft elevation above the symphysis (K. Schroeder’s sign), while the uterus changes its spherical shape to an ovoid one, its contours become clearer, and consistency - more dense.

Further, in the process of blood coagulation, which occurs in the placenta, which ceases to secrete the corpus luteum hormone into the uterus and thereby exert a selective relaxing effect on the placental area of the uterus. The own heaviness of the separated placenta, which pulls it down (out); as a result of the “sagging” of the placenta, irritation of the receptor apparatus of the uterus will inevitably increase; The resulting retroplacental hematoma in most cases is a consequence of the onset of placental abruption, and not its cause.

7. The placenta is examined: size, color, degenerative changes, examination of the umbilical cord for the presence of narrowing, true nodes, size.

8. Examination of the birth canal in a speculum, suturing ruptures.

period - early postpartum period.

1. Observe the general condition of the postpartum woman for 2 hours after birth

2. Monitor the newborn

3. Calculation of total blood loss

4. Identification and elimination of possible complications in the postpartum period.

5. Strict compliance with sanitary and epidemiological requirements and personal hygiene rules.

clinical course of labor.

A multiparous woman was admitted, pushing, with regular contractions starting at 01:00. The bright amniotic fluid poured out at 01:55.

The condition is satisfactory, blood pressure is 120/70 mm Hg in both arms. In 10 minutes - 4 contractions of 35 seconds of a pushing nature. The position of the fetus is longitudinal, the head is present, and is embedded. The fetal heartbeat is 128-132 beats/min, clear. The amniotic fluid is light.

02:05 A live full-term hypotrophic girl was born, Apgar score 8-9 points.

Within 1 minute after birth, with the consent of the woman, 10 units of oxetocin were injected intramuscularly.

After controlled traction of the umbilical cord at 02:10, the placenta separated and came out on its own: without pathologies, dimensions 16x15x2 cm. All membranes. The uterus is contracted, dense, moderate bloody discharge. The birth canal is intact. The condition is satisfactory, blood pressure is 110470 mm Hg. Art., pulse 84 beats/min. The uterus is dense. Blood loss 250 ml.

Primary toileting of the newborn was carried out:

1. After the baby’s head passes through the birth canal, the baby is suctioned from the mouth and nasopharynx using a special device or a rubber bulb.

2. After this, they begin to process and ligate his umbilical cord. As soon as the baby is born, two Kocher clamps are placed on his umbilical cord, between which, after pre-treatment with alcohol or iodine, it is cut with scissors. After this, the Rogovin staple is applied and the umbilical cord is cut off. Then the umbilical wound is treated with a weak solution of potassium permanganate, after which a sterile bandage is applied to it.

3. Treat the baby's skin, removing mucus and vernix lubrication from it with a special napkin soaked in vegetable oil. The groin, elbow and knee bends must be powdered with xeroform.

4. Prevention of gonoblenorea. To do this, 1% tetracycline ointment is placed behind the baby's lower eyelid.

5. Upon completion of the primary toilet procedure, proceed to anthropometry: measuring the weight, height and circumference of the newborn.

Postpartum period.

02:15 The condition is satisfactory. Blood pressure 100/60 mmHg, pulse 78 beats/min. The uterus is dense, the fundus is 2 cm below the navel. The discharge is bloody and moderate.

02:30 The condition is satisfactory. Blood pressure 100/60 mmHg, pulse 78 beats/min. The uterus is dense, the fundus is 2 cm below the navel. The discharge is bloody and moderate.

02:45 The condition is satisfactory. Blood pressure 100/60 mmHg, pulse 78 beats/min. The uterus is dense, the fundus is 2 cm below the navel. The discharge is bloody and moderate.

03:00 Condition is satisfactory. Blood pressure 100/60 mmHg, pulse 78 beats/min. The uterus is dense, the fundus is 2 cm below the navel. The discharge is bloody and moderate.

04:00 Condition is satisfactory. Blood pressure 100/60 mmHg, pulse 78 beats/min. The uterus is dense, the fundus is 2 cm below the navel. The discharge is bloody and moderate.