Bidan Kita



Hari ini saya kedatangan klien dari Italy, dia ingin homebirth, waterbirth dan gentlebirth.

selama kehamilan dia selalu report ke saya tentang perkembangan janinnya juga riwayat kesehatannya.

akhir bulan ini adalah due date-nya dan dia menyempatkan diri untuk bertemu muka dengan saya untuk mencari “camistry” karena ini sangatlah penting.

dan saya sangat suka dengan klien ini karena dia sangat kritis dan saya suka dengan klien yang seperti ini.

dia menuliskan Birth Plan-nya dan ini bisa Anda contoh untuk birth plan Anda.

(*** contoh ini masih dalam bahasa inggris..jika ada kesempatan saya akan menuliskan versi bahasa indonesia untuk Anda)


(notes with questions and “flow of thoughts”, to be omitted in the final plan, are marked in red italic)

Name: S N

Passport Number: DA0008145, issued in Italy

Address: Jalan Cimahi, no. 15 Menteng 10310 Jakarta Pusat – Indonesia

Doctor: I S, SpOG

Husband”s Name: S P

1st child”s name (daughter): XS PN


EDD: 26th November 2011



Birth Plan


I wish my birth to be the healthiest possible experience for me and my baby, physically and emotionally speaking. Which means

Natural (possibly water) birth without medical interference unless necessary for survival and/or to avoid permanent damage to me and my baby.

Note: At any stage of my labor, should the above necessity arise, please discuss any proposed intervention with my husband (or doula) and I before proceeding.

Any pathology/situation leading to the intervention should result clearly in my/my baby medical record.

If any point below conflicts with the hospital protocols and any legal or any other type of difficulty may rise after my plan, please discuss it with me as soon as possible during pregnancy. (I am not sure whether it is clear, but with this last statement I want to say that doctor should be clear in case he”s not convinced with some of my points, for example: “You don”t want episiotomy in any case, but I assure you that according to my clinic experience it may be needed in these cases:….” Just to avoid: “Of course, as for me you can deliver hanging from the chandelier” and then, during labor the doctor does what he wants)

(note: since it”s very easy to a doctor to mention fetal distress, or weak heartbeat, or any other scaring circumstance, for this purpose I wish to reach the best possible knowledge for a non-professional on the situations leading to cesareans, assisted birth, induction or any other medical intervention. For example, I understood that umbilical cord prolapse it”s a serious and real cause for cesarean, as is abruptio placentae. I still have to learn a lot to understand when the danger it”s real and can be avoided with intervention –be it c-section, ventuose, induction…).

Labor – 1st stage of labor:


1. I would like to wait my labor to start spontaneously until EDD + (at least) 10.

2. I prefer my waterbag to break via SROM, unless Induction becomes necessary. Therefore, I prefer to limit vaginal inspections to check cervix dilation in order to avoid accidental rupture of waterbag.

3. In case induction becomes necessary, first of all I need a clear explanation on the grounds and pros and cons of further waiting in order to give my consent. I prefer compassionate use of induction, as follows:

A. From week 40 to 41 I would like to use non-pharmaceutical methods to kick-start labor, as gymnastics (long walks, stairs…), sexual intercourse, nipple stimulation, acupressure, showers, castor oil (maybe!) or enema (others?).

B. At week 41 + 3 and at week 41 + 5 BUT ONLY IF ultrasound scans shows that the amount of amniotic fluid is lower than normal (less than 5 cm depth – makes sense?) I would prefer have my membranes swept to stimulate labor to start;

C. Should labor not start by 42 weeks + 2, I would prefer to use 2 or 3 dosages of Prostaglandin tablet (Prostin, not Cytotec) over 18 hours (is it correct as LOW dosage?) to soften and ripen the cervix;

D. After which, if labor has not started or is very slow to progress, I would prefer AROM and wait up to 24 hours before;

E. After which, I agree to use Synthetic Oxytocin, increasing the dosage (8 ml. I have to check the details) slowly, every 30 minutes, to liken the labor to a natural labor.

4. From the time my waterbag breaks be it via SROM or AROM, I would like to wait 24 hours before labor needs to be augmented and antibiotics administered.

In case I am GBS + (test should be preformed as close as possible to due date), I would prefer in that case intrapartum vaginal flushings with chlorhexidine instead of in vein antiobiotics.

5. In case Induction becomes necessary for circumstances different than 42 week pregnancy or 24 hours after SROM/AROM, I and my husband would like to be actively involved in the discussion about the need of Induction, and given the possibility to understand the grounds and check medical record.

6. Should my labor slow down or stall, I would like to wait as much as possible for it to start or speed up again spontaneously, by changing position, moving if I will feel like it, having a shower, acupressure, nipple stimulation, relaxing to release tension (others?). I would like to feel no urge from my caregivers.

– Only in case my baby is in danger because of the stall/slow down of labor or under my request because I am too tired to go on spontaneously, I would prefer proceeding with AROM and Synthetic Oxitocyn as above (points 3 D and E).

Routine Procedures

8. I want to wear my own clothes during my stay in the hospital.

9. I don”t want pubic shaving and I would prefer to avoid enema unless I require it to help kick-start labor.

10. I want my husband and child (needed for nipple stimulation, as I can breastfeed her in case of stall/slowdown of labor! J ) and my doula to be with me during labor.

11. I don”t want other people to be around apart the necessary staff (midwives and Obsgyn when necessary), I would like to choose the intensity of lights, to listen to music, use aromatherapy (should learn something about it), not hearing people talking loud apart my family, to be checked as less as possible, not to be forced or urged to do things unless following gentle discussion and suggestions, to have all the time for my labor without timelines (unless emergency rise).

12. I want intermittent Electronic Fetal Monitoring preferably wireless or Doppler and I would like that it”s performed leaving to me the choice of the most comfortable position (about the Doppler, I have to get information, no idea on how it works).

13. I would like water labor and birth, and even when I”m not in the tub I would like to have always access to the bathroom for shower, bath or a pee.

14. As pain relief, I would like to use massage and acupressure, relaxation, hypnobirth, changing position. I don”t want to be offered drugs unless I ask for them.

15. I”m not planning an epidural.

Birth – 2nd Stage of Labor

16. I don”t want episiotomy, I prefer to tear. To help prevent tearing, I”m doing yoga exercises to help perineum to stretch and soften and back exercises for the pelvic floor (other ideas?). During delivery I want to avoid the lithotomic position and stay in a position in which gravity can help delivery, like squatting. I would also like to use a warm pack to place on the perineum (other ideas?). In case of tearing, I prefer not to be stitched at all, unless the tear it”s too big to heal spontaneously.

17. I”m oriented to water labor and birth, in any case I want to be able to choose the position I”m giving birth in. Any suggestion from my caregiver is welcome but I should feel free to follow or not the suggested positions.

18. When it comes time to push, I want to follow my body”s urge to push. Any suggestion on it (like not pushing too strong) will be welcome but I would prefer it to be given in the form of positive suggestion (like “Rock your baby!” instead of “Don”t” push!”, in order to have an active alternative) and I want to feel free to follow the suggestion or not.

19. If pushing stage becomes prolonged, I wouldn”t like to consider ventouse or forceps and continue on this stage unless an emergency rise or I am too tired. In case of need of any intervention, I would like I and/or my husband and my doula to be actively involved in the discussion and give previously consent.

20. I would like to catch the baby, or my husband (if present) to catch him/her. However this is not an issue.

21. I want to hold my baby immediately after birth, skin to skin, and let him/her breast crawling. I would like to have all the emergency equipment close to me or easily movable (oxygen, …) in order to have any minor emergency intervention performed while the baby is with me, in order to allow physical connection until the placenta is spontaneously born.

22. I want to have lotus birth in any case. For minor emergencies rising while placenta is not born yet, see point 21 above. In case of need of major intervention I would like to follow my baby and remain close to him/her.

23. Only in the unforeseeable cases (that should clearly be explained to me and/or husband and doula and indicated in medical record) I couldn”t remain close to my baby and placenta is not born yet, I would prefer the cut to be delayed as much as possible, to let it stop pulsing. In this case, I would prefer me or one of my family to cut the cord but this is not an issue.

Birth of Placenta – 3rd Stage of Labor

24. Lotus birth, as above.

25. I want a natural third stage, and I am willing to wait all the necessary time (I read that after a certain lapse of time it”s dangerous, why? How much time? I read of women with a safe 3 hours third stage…)

Baby”s care in the hospital

26. I don”t” want the baby to be routinely suctioned, having the possibility to breastfeed immediately when the baby wants it will be possible to check soon if he/she can breathe well.

27. I don”t want my baby to be administered vaccinations, due to adverse effects occurred to my first child after vaccination.

I prefer him/her not to be administered Vitamin K either.

28. I would like rooming-in for all of my stay in the hospital. The baby should be never taken away from me, even in case of emergency I or my husband would like to be present.

29. For baby care –washing and cleaning, wrapping, etc. I would prefer waiting some hours after birth. I would like to perform it personally or at least to be present (or my husband to perform).

30. I would leave the hospital as soon as possible after birth, may it be one day.

31. Since I intend to breastfeed, nothing as pacifiers, glucose, water and anything else should be given to my baby without my express permission. I do not want to be urged about the growth of my baby or possible lack of lactation onset in order to give formula, as I am aware that for successful breastfeeding some days after birth may pass.

32. My family should be able to stay with me at the hospital.

33. If my baby has jaundice (what are the parameters?) and treatment is considered necessary, I would prefer this to be done in my room rather than in the nursery.

In the event of a Cesarean

34. If a Cesarean becomes necessary, this should be after spontaneous beginning of labor or with Induction (is it possible?), in order to prepare the baby and to let him/her go as much as possible through the birth canal.

36. I would prefer an epidural.

37. I want to hold my baby immediately after birth and follow as much as possible my plan for natural birth as from point 20 onwards, including lotus birth, contact skin to skin and breastfeeding. In this case it will be even more important to postpone any non urgent care like washing to the time I will be able to move.

38. I would prefer my husband and/or doula be in the operating theatre.

39. Before leaving the hospital, I will get a copy of me and my baby medical records.

Noted by:



dan berikut ini adalah wawancara awal yang bisa kita lakukan ke Obsgyn/ Bidan Anda (masih dalam bahasa ingris ya?)

Rate of cesarean, episiotomies, water births in the hospital. In RSIA Bunda, 30 to 40%

Do they depend from the doctor? In case, who will be the backup doctor? His/her data?________________

How is the law in Indonesia about the informed consent? Is it possible to make choice different than hospital protocols? How do you deal with birth plans?_______________________________________

Can I have written protocols?___________________________________________________________

What”s happening exactly? Woman arrives to the hospital, she goes to… (her room, delivery room/labor room)? Monitor? Call Obsgyn? Inspections? Women go directly to labor room, only in case of small dilation they can stay in their room. After 5/6 cm (7 according to midwives) they can enter birth tub if they wish. Midwife recommend to rest lying in bed, although the woman is free to choose the position.

Who is the staff in the delivery room? 2 midwifes and Obsgyn

In which PRECISE cases is a C-section necessary? And episiotomy? And induction? Do you perform compassionate use of induction?_____________________________________________________

Due date: when do you begin proposing induction? 40+10 ___________________________

SROM: when do you begin proposing induction? _________________________________________

What”s your antibiotics policy? 6 hours after rupture of membranes ___________________________

What prostaglandins are used? How much time from AROM to augmentation? ___________________

How do you manage with leaks vs rupture? They should be treated differently because top leak is not possible source of infection…. Both leaking at the top of amniotic sac and sudden break at the bottom of amniotic sac are treated similarly.

When do you propose augmentation? How much time for second stage, assuming that heartbeat is fine?

WHO recommends 1 cm dilation per hour, so second stage should be 6 to 8 hours because long labor implies risk of bleeding. 30 minutes are allowed for 3rd stage (birth of placenta), otherwise the cervix is going to close. (????)

How do you check heartbeat? Doppler? Does the hospital have wireless facilities for monitoring, to allow woman to move and be monitored?__________________________________________________

Use of forceps / ventuose: when?________________________________________________________

Continuous fetal monitoring or intermittent?_______________________________________________

How much time do you allow for transition (from “complete” dilation to birth)? Do you have routine inspections?_________________________________________________________________________

Are natural methods of induction/augmentation/pain relief/malpositioning suggested and under command of your staff?________________________________________________________________

What exams/tests really check and permit to avoid complications during delivery?_________________

Jaundice? Parameters and intervention.____________________________________________________

Vitamin K injection, antibiotics in the eyes (when necessary?), vaccinations are mandatory? Vitamin K is recommended, not mandatory. Vaccinations are administered later, not during birth.

What happens in case of vomit of the woman?___________________________________________

Can be own private midwife present to birth? Yes for a doula

In general, father and elder children can assist birth? Normally, only 1 person, exception can be done for the father and doula to be both present. No children

Lotus birth? Apparently, the Obsgyn never heard about it ______________________________

Stitch “policy”? Indonesian women normally want to be stitched in any case, but we can agree on stitch only in case of big tear.

What”s happening in next visit? When test for diabetes? Test GBS will it be performed? Pap test?_____

How does post partum work?___________________________________________________________


Semoga Bermanfaat

Salam Hangat

Bidan Kita