The Birth Plan should be filled out with the principles you learned in units 2 and 3 of the Main Course in mind. If you look at Case Study 1 and Case Study 2 , this gives you an idea of what I’m looking for. They begin with the assessment and continue on with the doula actions implemented. Keep in mind, that during labor you are continuing to assess and re-evaluate the goals. Below is a list of the forms that I would like you to use to complete your birth plan. A less formal birth plan can also be typed up and given to the hospital personnel (optional).
· Assessment Data – gathered from your client interview. This should also include a paragraph that discusses what you talked about with the care provider at the prenatal interview.
· Needs Identification
· Goals – based off of your clients’ goals and your needs identification. Prioritize these according to Maslow’s Hierarchy of Needs.
· Doula Actions – This will happen before and during birth.
· Self-Evaluation – How did your actions affect your client? Where they are helpful? Not helpful? If they were not helpful, go back to the beginning of the process and start a new
This case contains a hypothetical woman that has come to the hospital with specific medical complaints. As a doula, you will be providing care that is non-medical in nature. This case study shows how the roles of different birth professionals differ, as well as how they compliment each other. It also shows how doulas can use critical thinking skills during the birth.
Case 1
Reading assignments
· Read the medical terminology for Unit 1 (Medical terminology is for your own knowledge only; you will not be tested on it nor required to master it for certification purposes.)
· Listen to the OBGYN Morning Rounds case study for chorioamnionitis (from audio player below). Audio is taken from: http://obgynmorningrounds.com/blog6/rounds/hospitalized-patients/chorioamnionitis/
· Below is a summary of what you should have learned from the case study for chorioamnionitis.
· Medical Care Given
· In this scenario, there are various medical procedures done. These include assessing for disease by checking uterine tenderness and noting symptoms that might indicate disease, performing cervical exams, inserting a straight catheter, ordering and performing labs, monitoring fetal heart rate, prescribing medication, starting IV, pitocin and epidural.
· Needs Identification, Prioritization and Doula Actions
· Through New Beginnings you will learn how to assess and identify needs that you will be able to implement. This format is based off of the nursing process and Maslow’s Hierarchy of needs(both of these will be taught later in the course).
· Physiologic Needs
· Hunger
· Actions implemented: If planned beforehand with the medical provider, suggest easily digestible foods. Peppermint tea can be offered to help relax smooth muscles and aid in digestion. Peppermint oil may be used for a similar purpose(make sure you follow the safety rules regarding the use of essential oils). If food is not desired, clear liquids like jello, broth, or Popsicle may be given.
· Fatigue
· Action implemented: Assess the mother’s fatigue. Try helping her find positions that may be comfortable for her to sleep in. If the mother is expected to be in the hospital long, a pad of some sort to put on the laboring beds will aid with comfort. In addition, it is important her pain is eased enough to rest. This may include non medical means such as positioning, hot pads, or water. But you may also want to discuss medicated options if desired to help to allow her to sleep if needed.
· Thirst
· Actions implemented: If planned beforehand with the medical provider, give her water or juice. She may have an iv bag already going. If that’s the case she may not need as much liquids, but might appreciate ice chips or small sips of liquids.
· Safety Needs
· Pain related to medical diagnosis of chorioamnioitis
· Actions implemented: Hot pads or ice packs may help where it hurts the most. To help decrease the pain, try different positioning.
· Pain related to labor
· Actions implemented: While movement is great for normal labor, this may not be true in a labor with an infection. Try different movements, but only if it helps. To help release her own natural endorphins, try massage. Lavender, rose, or jasmine oils can be used if the woman is full term(again make sure safety rules are followed).
· Body temperature fluctuation related to fever.
· Actions implemented: Discuss with her care-provider if there may be something they would do medically. In addition, ice packs and fans can be used if desired.
· Pain related to cervical check.
· Action implemented: Encourage a discussion between the woman and her care provider regarding the number of cervical checks needed or desired. For those that are needed, help her start some deep breathing exercises and visualizations before, during, and immediately after the exam. Balling up her fists and placing them behind her hips during the exam will tilt the cervix closer, making it easier to reach.
· Pain related to catheter insertion.
· Action implemented: Deep breathing and visualizations will help with this procedure as well.
· Pain related to iv.
· Action implemented: Warm or cold compresses where the iv is inserted is sometimes helpful. Additionally, warming up the hand before the procedure will help make it easier to find a vein.
· Fear.
· Actions implemented: Knowledge helps to alleviate fear. Make sure that she has all the information she needs to understand what is going on. Since this baby is early, she is going to need information on what to expect. Assess and enable her to use any spiritual resources available. Things like prayer, meditation or other spiritual practices can help when she is feeling fearful. Focus on the actions and conditions she does have control over.
· Social Needs
· Opportunity for enhanced social network.
· Actions implemented: Discuss with the woman who she really feels comfortable having at this birth as well as whether or not she wants outside distractions like the phone or computer network. Help the spouse or significant other to feeling included in the birth process.
· Esteem Needs
· Opportunity for enhanced self-esteem.
· Actions implemented: Encourage her to express her needs or desires, even if they don’t seem significant.
· Opportunity for enhanced decision making.
· Actions implemented: Encourage her to ask questions and discuss what she would like to have happen. Make sure that she is OK with any procedure that is being done. Before any procedure is done (e.g., vaginal exam, iv, medication), make sure she gives at least her verbal consent.
Case 2
This case study is presented to show how a woman utilizes the different modes of thinking to make decisions before and during birth. It also shows how a doula helps to facilitate this decision-making process.
Goals
· To understand how to apply knowledge of the different modes of thinking.
· To provide an example of the role the doula works with the mother to make decisions.
· To provide an example of how birth plans can be fluid and workable when unexpected situations arise..
Reading assignments:
None for this case study.
Assessment
When I first met with this client, she knew exactly what she wanted help with and how she wanted her birth to go. Most of this came from how her previous birth had gone. For her births she held the belief that medication should only be used when needed. She felt like her body was able to do what it needed to do. On the other hand, pregnancies were hard for her. While she did not feel like Pitocin was what she should do, she choose to use castor oil with her first birth. It was a long labor after that.
She would have liked to labor more without the iv, but because she was gbs+, her midwife said that antibiotics were necessary. This made her feel like it was important to go in early enough to get that done. She had originally wanted to see if she could go without an epidural, but after 24 hours of labor, she was very tired. At this point she decided to get an epidural, which she was grateful for because she at least felt like she could sleep.
During her first labor, her mother had come to help, but this client felt like she was not helpful at all and wanted to make sure that her mom was not with her during birth for her next labor. She also had her baby taken away for a long period of time with her first baby and wanted to make sure that it did not happen with her second unless medically necessary. At this point in time, she as planning on getting an epidural with her second, but wanted to be able to move around as much as possible until she got the epidural.
I gave her information on intermittent monitoring. We also discussed waiting to have to cord cut until it stopped pulsating. She liked both of these ideas and decided to discuss them with her care provider. Not only did these ideas fit in with her own ideas of the roles of medication, but they made sense to her that these would provide the kind of care that she wanted. We also discussed roles her mother could play that would allow her to feel like she could help, but not be in the way. My client decided that the best thing to do would be to ask her mother to babysit her son. That way she could help, but not be there for the birth, which made my client nervous. Comfort measures were not discussed much, as my client felt like she didn’t need that.
Needs Identification, Prioritization and Doula Actions
After the first meeting, a care/birth plan was made that included my clients preferences and desires. These are the needs originally identified.
Client goals:
1. Keep her baby with her immediately afterward.
2. Keep her mom out of the birth room.
Physiologic Needs
Changes in bowel movements related to castor oil use. Doula Action: Bring depends or use hospital pads so that she does not have to worry about any accidents.
Safety needs
Opportunity for enhanced communication related to making decisions in conjunction with healthcare providers. Doula actions: Discuss the need to talk with their care providers about movement during labor, but also make sure everything is okay with the baby.
Social Needs
Opportunity for enhanced communication. Doula Actions: Have client discuss what she wants her mother to do with her. Discuss having her watch the other child while mother is in labor.
Esteem Needs
Desire for control related to decisions regarding infant care after he is born and movement during labor. Doula Actions: Educate client on delayed cord clamping and other newborn procedures related to care of infant afterward. Educate client on the use of intermittent fetal monitoring to allow more movement. Encourage communication with care provider to discuss these options and perhaps schedule a time that you, as the doula, can meet her provider to discuss these options also.
Opportunity for enhanced empowerment. Doula Actions: Discuss options and choices available concerning the ability to make decisions in their labor and birth.
Because her first labor had been so slow, she was expecting this one to be the same. She decided to take castor oil again because it worked well with her first one, but she thought she would have another long labor before she went into the hospital. It turns out, that the Castor oil proved to be very effective, and she was laboring hard and strong within a few hours. She was not anticipating this, and was glad that she had a doula there to help her work through her labor unprepared. At this point, there was a change in birth plan due to necessity. The hospital was 45min away and she had not been prepared to deal without an epidural.
Once she got to the hospital, she asked for the epidural and was able to receive one quickly. When the baby was born, she was able to have him with her immediately afterward.
| Decision Made | Problem Solving Technique Used |
| She chooses not to be induced with Pitocin | Critical thinking, intuition, scientific thinking |
| Used Castor oil | Critical thinking |
| Went in early when she was gbs+ | Critical thinking, scientific thinking |
| Choose to use the epidural | Critical thinking, trial, and error |
| Choose to keep her mother out of the birth room | Trial and error |
| Choose to have her baby with her after | Trial and error, critical thinking, intuition, scientific thinking |
| Planning on epidural with second birth | Trial and error, critical thinking |
| Choose to have intermittent monitoring | Critical thinking, scientific thinking |
| Choose to take castor oil the second time | Trial and error |
This case study is presented to show how a woman utilizes the different modes of thinking in order to make decisions before and during birth. It also shows how a doula helps to facilitate this decision making process.
Goals
· To understand how to apply knowledge of the different modes of thinking.
· To provide an example of the role the doula works with the mother to make decisions.
· To provide an example of how birth plans can be fluid and workable when unexpected situations arise..
Reading assignments:
None for this case study.
Assessment
When I first met with this client, she knew exactly what she wanted help with and how she wanted her birth to go. Most of this came from how her previous birth had gone. For her births she held the belief that medication should only be used when needed. She felt like her body was able to do what it needed to do. On the other hand, pregnancies were hard for her. While she did not feel like pitocin was what she should do, she choose to use castor oil with her first birth. It was a long labor after that.
She would have liked to labor more without the iv, but because she was gbs+, her midwife said that antibiotics were necessary. This made her feel like it was important to go in early enough to get that done. She had originally wanted to see if she could go without an epidural, but after 24 hours of labor, she was very tired. At this point she decided to get an epidural, which she was grateful for because she at least felt like she could sleep.
During her first labor, her mother had come to help, but this client felt like she was not helpful at all and wanted to make sure that her mom was not with her during birth for her next labor. She also had her baby taken away for a long period of time with her first baby and wanted to make sure that it did not happen with her second unless medically necessary. At this point in time, she as planning on getting an epidural with her second, but wanted to be able to move around as much as possible until she got the epidural.
I gave her information on intermittent monitoring. We also discussed waiting to have to cord cut until it stopped pulsating. She liked both of these ideas and decided to discuss them with her care provider. Not only did these ideas fit in with her own ideas of the roles of medication, but they made sense to her that these would provide the kind of care that she wanted. We also discussed roles her mother could play that would allow her to feel like she could help, but not be in the way. My client decided that the best thing to do would be to ask her mother to babysit her son. That way she could help, but not be there for the birth, which made my client nervous. Comfort measures were not discussed much, as my client felt like she didn’t need that.
Needs Identification, Prioritization and Doula Actions
After the first meeting, a care/birth plan was made that included my clients preferences and desires. These are the needs originally identified.
Client goals:
1. Keep her baby with her immediately afterward.
2. Keep her mom out of the birth room.
Physiologic Needs
Changes in bowel movements related to castor oil use. Doula Action: Bring depends or use hospital pads so that she does not have to worry about any accidents.
Safety needs
Opportunity for enhanced communication related to making decisions in conjunction with healthcare providers. Doula actions: Discuss the need to talk with their care providers about movement during labor, but also make sure everything is okay with the baby.
Social Needs
Opportunity for enhanced communication. Doula Actions: Have client discuss what she wants her mother to do with her. Discuss having her watch the other child while mother is in labor.
Esteem Needs
Desire for control related to decisions regarding infant care after he is born and movement during labor. Doula Actions: Educate client on delayed cord clamping and other newborn procedures related to care of infant afterward. Educate client on the use of intermittent fetal monitoring to allow more movement. Encourage communication with care provider to discuss these options and perhaps schedule a time that you, as the doula, can meet her provider to discuss these options also.
Opportunity for enhanced empowerment. Doula Actions: Discuss options and choices available concerning the ability to make decisions in their labor and birth.
Because her first labor had been so slow, she was expecting this one to be the same. She decided to take castor oil again because it worked well with her first one, but she thought she would have another long labor before she went into the hospital. It turns out, that the Castor oil proved to be very effective, and she was laboring hard and strong within a few hours. She was not anticipating this, and was glad that she had a doula there to help her work through her labor unprepared. At this point, there was a change in birth plan due to necessity. The hospital was 45min away and she had not been prepared to deal without an epidural.
Once she got to the hospital, she asked for the epidural and was able to receive one fairly quickly. When the baby was born, she was able to have him with her immediately afterward.
| Decision Made | Problem Solving Technique Used |
| She choose not to be induced with pitocin | Critical thinking, intuition, scientific thinking |
| Used Castor oil | Critical thinking |
| Went in early when she was gbs+ | Critical thinking, scientific thinking |
| Choose to use the epidural | Critical thinking, trial and error |
| Choose to keep her mother out of the birth room | Trial and error |
| Choose to have her baby with her after | Trial and error, critical thinking, intuition, scientific thinking |
| Planning on epidural with second birth | Trial and error, critical thinking |
| Choose to have intermittent monitoring | Critical thinking, scientific thinking |
| Choose to take castor oil the second time | Trial and error |
