Cesarean Birth Plan

Birth Team:
Mom: Michelle Gagne
Dad: Jamison Bourque
Baby: Madeline Bourque
Doula: Aurora Christie
M.W: Mia PeltLets have a good time with this. We’ll promise not to “tell you your job” if you’ll agree to treat our surgery as if it were you’re own mom on the table. (assuming you get along with her…) Thank you for performing this surgery, you’re jobs aren’t easy and we appreciate your service.

• Michelle strongly wishes to see the baby being born via mirror or lowering of the drape.
• If this is impossible: Jamison would like to witness the baby being born.
• Michelle would like someone to record Madelines birth on video.
• Michelle does not consent to tranquilizers, sedatives or amnesiac drugs being administered.
• Michelle hopes to have a VABC so a double layer closer on the uterus must be used.
• Michelle do not consent to staples to close the skin layer and instead want sutures.
• Please hold Madeline with caring nurturing touch supporting both the legs and shoulders when she is being birthed.
• Michelle does not consent to weighing, foot printing, eye ointment or other routine tasks except suctioning for the first two hours after birth.  (Blood glucose testing is expected).
• We ask that all equipment (that can) be silenced or turned down.
• We would like to play music and (if possible) have the lights low to create a calming atmosphere.
• We would like Madeline to be placed skin-to-skin ASAP with either Jamison or Michelle.
• Bulb suctioning only unless Madeline shows signs of problems. (Deep suctioning only if needed)
• Michelle does not consent to bathing the baby until at least a few hours after birth.
• Michelle does not consent to any students, interns, etc. watching or participating.
• Michelle does not consent to the administration of any vaccinations. (vitamin K is cool though)
• Michelle does not consent to tying her arms down unless I am unable to control them.
• Please Keep Michelle modestly draped at all times.
• We’d like everyone in the OR to introduce themselves to us. (by name, but job titles are cool too)
• Please try to refrain from “casual chatter” unrelated to the surgery. Please discuss what you’re doing as this is a special event for us and bringing Madeline into this world is a very important job.
• Please administer anesthesia before inserting the catheter.
• Michelle prefers epidural anesthesia
• Michelle do not consent to the use of artificial nipples.
• If Madeline has hypoglycemia, Michelle wishes to use breastfeeding to treat it. Her 2nd choice is pumped breast milk administered using a non-nipple feeding method.  Her last choice is formula.
• Michelle strongly prefers Madeline to remain on mom/dads chest or arms throughout suturing, recovery, etc.
• We intend to keep the placenta.  Please keep it clean and refrigerated for our Doula.
• Michelles preference post-op is to utilize a PCA system for pain management.  If oral medication is used, orders to be written for Michelle to be woken up for timely doses.

_______________________________
signature