Friday, August 2, 2013

Is Having a Baby REALLY That Expensive? Part 2


So I wanted to make a post chronicling my own pregnancy and birth costs, as I was unable to get an actual number from my stepdaughter last year.  Lets just start with how it's been less than I expected, and only some of that has to do with excited grandparent spending, since though she's spent more than me, my mom really hasn't spent that much.
So lets go ahead and break this down - I'll give you approximate costs of what I've spent and then I'll add in a bit on how much things I would have bought if someone didn't buy them for me cost.  Because those Justice League onesies may be cute, but I would NEVER have spent $15 on a piece of baby clothing that may only be used 3 times.

Pregnancy and Birth Costs

At Home Pregnancy Test: $0.10 for eBay purchased Wondfo strips (original bulk 100 pack for $10, purchased long ago for TTC), and currently available on Amazon for $0.38/count in a 50 pack

Prenatal Vitamins: $39.96 for a 280 day pregnancy @ 2 per day, my on sale CVS brand gummy prenatals required just over 6 bottles at $9.99 BOGO, so I will eventually be paying for 4 bottles total.  I should note how I could have gotten these free from the health department, but those make me nauseous, so I splurge for gummies.

Supplements/Herbs: $0 so far.  I have been taking Magnesium/Calcium, Iron, Vitamin D, and a few herbs for mah Pregnancy Tea, but so far I haven't had to buy anything I didn't already have on hand.  I'll update costs when I do.

Prescription Drugs: $41.99 so far.  That is mostly for some anti-nausea medicine for the first 4 months, as I ended up vomiting so much I lost 20 lbs by 10 weeks.  I also tried a script for heartburn which didn't work, one for a yeast infection which wouldn't go away via more natural treatment, and one I kept up for my preexisting disability.  I'll also note maybe $14.99 shouldn't count, since after having picked up my weekly 50,000 IU doses of Vitamin D for the first 2 months I was pregnant, I got a seriously stressed out sounding nurse call me and inform me they fucked up, and it should have been on the "DO NOT CONTINUE" list, not the,"Oh yeah, that's fine, whatever" list.  But hey, we paid for it, so there it goes.

Prenatal Care: $3.  Total.  That's because I'm on full Medicaid due to disability (so not Pregnancy Medicaid).  I paid $3 when I went to this one midwifery practice because they charge each visit, while most places that accept Medicaid it turns out don't bother, and just let that fee go.  BTW, I did not like that practice and stopped going.  I'll link to a post about our exciting journey through 8 care providers as soon as I get it up.

Maternity Clothes: $16.99 for a belly band.  Mixed feelings on this one - we were in Target, had the money, and I just so wanted to get something, back when I wasn't even showing yet.  I very very very quickly developed a hatred for pants, even before I couldn't fit in them, so it was really only useful for bridging the gap under shirt bottoms I was growing out of, and a few pairs of zipper skirts.  Also, I can't fit in the same size anymore at 34 weeks, and now that it's July in the South, I can't deal with the heat of it anyways.  If I were to do this again, I would buy two used ones IF I were going to be big in the cold months.

Doula - Birth and Postpartum: $0-75.  We went through a local program that provides free and sliding scale doulas to local women.  Our birth doula is seeking her certification and will be doing our homebirth for free.  The postpartum doula is on a sliding scale of $0-25/hr.  We are going to try and pay $5/hr for the 15 hours they provide in order to support their group, but aren't required to, so mostly it will be about seeing where our finances are after the baby (aka tummy minion) comes.

Books: $8.55 in postage for several books I've picked up via swap.  Since I received 3 books on pregnancy through this, I've just counted 3 books worth of postage, since that's all I actually had to pay.

Baby Stuff Costs

Baby Clothes: $6 for some pants and a long onesie.  Ok, again I didn't really need these since I've gotten a ton of free hand-me-down clothes, but they were cute (tiny skeletons!) and very cheap.  So I splurged.

Baby Carrier: $3 for a carrier, but I wouldn't buy it again having now researched how some carriers are really bad for baby hips and spines.  Luckily I can save this one by modifying it with a scarf to hold minion in a better position, so it won't be a total waste.

Onwards!

Below I've listed things other people have paid for.  Mostly this has been my mom.  I'm not going to note things I would have never bought, but I am taking into consideration what was actually helpful/useful

Childbirth Education Classes: $75 after Medicaid.  I have to say that though I would have paid for this myself going in, I still would have regretted it.  Turned out to be a total waste of time even for someone just somewhat familiar with birth.  A couple good local referrals to pregnancy related resources were to be had, but the rest was a waste of time that left me feeling anxious for the first time during pregnancy, and my poor husband ready to stab himself in the ears with chopsticks over the CRAZY excited educator.  I'd like to note this was also billed as a fairly "crunchy" class, with homebirth moms, talk to lotus birth, very pro-natural labor and what not, yet still managed to seem like dumbed down idiot proofing to me.  Be careful what class you go too, and make sure you will actually get something out of it before committing!

Birth Supplies: $55 for tinctures and herbs.  I'll come back with a comparison of what I would have gotten on my own vs. this, as well as if any of it would have come from different sources, but this is what happened between an opportunistic trip to the co-op and a planned (if late) trip to an herb festival where we found some live plants.

I will continue to list things as we get them, but seriously, this post will NEVER go up if I don't get around to this now.  So check back in for updates in the next few weeks.



And here's a picture of my belly, entirely just because.

Sunday, February 19, 2012

Doula Update

Hey all, so I'm finally getting my shit together and applying for doula training scholarships from the toLabor Birth Doula Training and the CAPPA Postpartum Doula Distance Program. I also just got accepted to do the local Open Umbrella Collective's training for Full Spectrum Doulas. Not to mention my off-chance application to Open Arms Perinatal Services. So yip-yip, it's essay writting time, and since I am woefully neglectful of this blog, I plan to share my stories with you all (though I will spare you the woe-is-me financial statements).

So, on my to-do list of questions are:

How will you benefit from being at toLabor and participating in this program?

How do you plan to share your new skills with others in your community?

What abilities or experience do you already possess that will enable you to effectively share these skills with others?

Why do you want to receive certification in your chosen field?

Explain any work you have done and training you have received in the field of childbirth, postpartum, and/or lactation issues.

Tell us a little about yourself. How do you identify racially, ethnically and/or
culturally (optional)? Do you speak a language in addition to English?

Tell us how you came to want to be a doula.

Is there a particular community that you wish to serve? What is your interest in this
community?

Please describe how you plan to balance your home/family/work life with the
unpredictable schedule of doula work.

Ok, I feel like I'm pretty well set up for getting these, since my main goal is to work for free or on a generous sliding scale with low income and disabled women in my community, but I still have to figure out how to make that all sound peachy-awesome for an application that may be up against fuck knows how many others...

Sigh.

Wish me luck.



Monday, January 9, 2012

No Fucking Flowers - A Review of Maternity Clothing, Part 1

This post has been in the works for some time now. Many a time have I scoured the internet looking for cool maternity clothes. The good news is, every time I go online there seems to be more stuff available out there. Bad news, it's probably not sold in your local shop, and it's probably expensive as hell. But there are some things out there to awesome to pass up, so if you have the means, treat yourself. If not, never fear, I am including quite the list of DIY maternity fashion tips and tutorials in Part 2.


Ok, lets just start with the sites that sell stuff straight up.

Bashful Bump sells maternity bodysuits, which really just means a fancy maternity leotard that isn't made entirely out of spandex or velvet. The sell them in tank top, t-shirt, and 3/4 sleeve varieties, and they have the exciting color choices of black and white. They range from $44-$48, but theoretically you would only need one if you own a wash machine and know how to use a panty liner or just don't give a shit about crusties. They also have the non dancewear added bonus of snapping in the front, right where the top of your underwear normally sits, which will really help if you don't feel like getting naked every time you have to pee, but are aware that even when not pregnant it can be hard as fuck to re-do those crotch snaps on dancewear, plus having snaps on your puss ain't fun at all.

Next up is Etsy Maternity, which obviously is going to range in price, anywhere from $3.50 for a belly band to $1,800 for a custom designed coat. Etsy can be a bit overwhelming at times, what with over 6,000 items in Maternity Clothing currently, and my favorite way of sorting is with key words, such as goth, punk, emo, Japanese, retro, funky, and whatever else you can come up with to describe your style, and then going through the menus All Items -> Handmade -> Clothing -> Maternity. Another way to search through Etsy is to search for "long", "stretchy", "yoga", or "one size" and then go into shirts to find regular shirts, dresses, and pants that will cover your ginormous boobs and bump.

Hot Mama Ink has a nice collection of funkiness in their Maternity category. I'm especially partial to their tunics, but they also have slings their signature flash tattoo designs. Most of their designs run $20-$40.

Similar styles plus some lovely gothwear can be found over at MamaSan, which is quickly becoming the end all in alternative maternity. Need a little black dress that will fit your growing belly? Check out the Cross Bones Dress for $57. I also really love their (drool) Betty in Stitches Tank Top going at $28. They also have some standards many of us couldn't go without, like the black and white striped Chic Savage Anti-Tank Top ($29), and the Pirate Punx Black and White Striped Tee ($25).

And now that we've done some "alterna" sites, remember that not all "regular" sites suck balls - case in point, both Babies N Bellies and Pickles & Ice Cream have some cool stuff if you have the patience to page through their stock. Now a lot of the stuff from these sites could be done pretty easily at home or would need some snip snipping to make them wearable, but in the interest of rich grandparents and tustafarian friends, a couple examples are the Nirvana Slashed Sleeve Maternity Top ($58), Corset Hearts Maternity Shirt ($24.99), Tied Front Maternity Top ($29.99), Striped Sweater Pocket Maternity Tunic ($32.99), Lace up Maternity Yoga Pants ($34.99), Lilac Maternity Green Maddy Long Sleeve Tee ($46), and even score a maternity bathing suit that doesn't look like shit ($68).

Ok, and now to move on to the exciting land of copying shit via screen-print/iron on. For this, you just need to buy some basic plain color tees/tanks/whatever from a thrift store, online, or a place like Target which has maternity tanks for $9.99, and then get you some inkin' supplies. You can buy iron on for stretchy clothing paper at most any craft store, or get onto a site like Instructables to find an easy at home screen printing guide. Then set back on the internet and browse to your heart's content. This is most easily done for newbie screen printers with words instead of pictures, so novelty shirts are your best bet for inspiration. I personally love CafePress for this, simply due to their enormous selection of novelty shirts. And if you don't want baby bump humor, you can also search their regular collection. My favorites are of course the gamer shirts, being a huge D&D geek myself, and after all how often do you get to see a pregnant woman in a shirt like this? Another ok site for browsing is My Baby Rocks in the maternity wear section, though of course don't let it stop you from going to town and screen printing a bunch of little onesies.

Okay, again, moving on into cheaper and cheaper territory; just a few tips for using preexisting clothing without getting into sewing. Wear an ass load of accessories since that isn't going to change in size, and you might as well show off your silky soft hair. Also, high boots like Doc Martens give extra ankle support that can help achy momma feet. And you can try raiding the men's section for over-shirts designed to fit the skinny-arm-big-belly crowd, as well as some awesome old man suspenders that can ease the task of constantly re-hemming the bands on your preggo pants.

Well, that's all for now, but come back soon and check out Part 2: DIY Maternity Clothes That Will Rock Your World (But Not Your Wallet)!

Tuesday, January 3, 2012

Is Having a Baby REALLY That Expensive?


I stumbled across a great article the other day on Stand and Deliver, a awesome blog I have come to really appreciate for it's forthrightness about many "DIY" or "natural" alternatives to pregnancy and birth. In the post What Does A Pregnancy Cost, author Rixa Freeze catalogs how much she spent on her last pregnancy. Her breakdown covers most of the basics - clothes, doctors, medical supplies; but doesn't take into account the things that first time parents might need to buy, especially young people in towns that aren't quite so fortunate as my Asheville in their lack of any sort of community birth support. She totaled in at $787, which to most middle class persons probably seems like a whopping cheap amount. But for me and my poor as hell comrades out there, that is a little more than my standard monthly income, which puts a little more pressure than most of us would like, especially since she hasn't taken into account anything after birth, specifically the dreaded insanely priced diapers of doom.
But ok, still pretty damn cheap when you break that bad boy up over the entire pregnancy, and assuming you found out about 6 weeks in, you still come in at a little under $105 a month. On the other side of the coin, I decided to go check out a standard "reputable" source and see what they thought having a baby should cost.
Ok, because there was a decent bit of wading to get to the nitty gritty of this one, I'll spell it out for you:

At Home Pregnancy Test: $9.62

Prenatal Vitamins ($10-20/month): $90-$180

Out-of-Pocket Prenatal Care: $2,000
or
In the Pocket (of the Insurance Company) Prenatal Care: $3378*

Maternity Clothes: $300

Body Pillow: $60

Childbirth Education Classes: $50-$200

Baby Shower: $100-$1,000

Doula: $650

Hospital Vaginal Birth: $9,000
or
Hospital Vaginal Birth (w/Ins): $463

Hospital C-Section: $15,000
or
Hospital C-Section (w/Ins): $523

When we add all this up, you end up paying an average of $5,700 if you have insurance, and $15,830 if you don't, just for your pregnancy and birth, with the major difference being in the cost of the actual hospital birth, not the difference in prenatal care. The main point being though, whichever way you look at it, Rixa is detailing a birth that leaves out that huge, gaping cost of the hospital swallowing up all your money, of which your birth only costs them about 30% of what they charge you.



Now, being that I'm fairly horrified at the idea of a hospital birth, I will also note that a popular local Midwifery Practice does home births for a flat rate of around $1,000 - and if you simply replace the uninsured cost of hospital birth listed above with said fee, you end up reducing your cost down to $4,830 - suddenly less than it would cost to have an insured hospital birth. And changing the insured hospital birth to an insured home birth adds only $507 to the average cost - which doesn't seem like much if you can afford insurance, right?

But of course, that is the big point here - most weirdos cannot afford insurance, and many of us would never want it even if we could. For those of you who even might be poor enough, I would urge you to look into getting Medicaid. Carol Sakala, director of programs at Childbirth Connection, a national nonprofit organization that works on behalf of mothers and babies to improve the quality of maternity care in the U.S. says that “While 13% to 35% of the pregnant women qualified for Medicaid coverage, many either didn’t qualify or didn’t apply, finding private insurance or paying out of pocket,". Link Lots of people don't even consider the fact that they might qualify for Pregnancy Medicaid, WIC, Work First, and many other programs available through local Health Departments and Department of Social Services offices.

In 2011, the Federal Poverty Level was $1,226 for a family of 2, but many programs only require you to be under 200% of the poverty level - $2,452! Personally, my family doesn't even hit the first one, and 200% of the poverty level seems like a vast fortune we could live easy on. $29,420 a year? Yowza!

So what would it cost someone like me (or our lovely step-daughter, who is due in July) to have a baby while actually taking advantage of state support, local community groups, family networks, etc.?

At Home Pregnancy Test: Kinda silly, if you really want to cut corners, but I got about 20 free on eBay when I bought 100 OPK's for $5 - ($0-$5)

Prenatal Vitamins: Free at most local Health Department, with no paperwork - $0

Prenatal Supplements: I prefer food and herbs for use during birth and pregnancy, my personal favorite being The Wise Woman Herbal for the Childbearing Year, which I've used to make tasty syrups for most common pregnancy complaints in the past two weeks, and on the cheap, even though it's winter and I had to buy all my herbs from the local co-op - $30

Medicaid Co-Pays ($3 per visit): $27

Books: Utilize your local thrift and used book stores, but first look to Midwifery or Alternative Medicine practices to see if they have lending libraries. I just got a slew of baby books by contacting my local Doula Association and asking my loan list to be passed around at their next meeting. As always, remember to ask friends an family who are in a parental way, and never forget the public library - $0

preggo or heavyset friends - $50

Body Pillow: A quick Google search finds us a plethora of DIY pregnancy body pillow's, here and here, for about $10

Childbirth Education Classes: Often free if you look for community run ones or ask about scholarships. Medicaid ones cost around $10, and if you look, you can even find things like this parenting transition class that is a research study where you can win $250 - ($0-10)

Baby Shower: Potluck that bitch, and for the cost of a few phone calls and a Facebook Event page, you can get lots of lovelies (hint hint - specify that hand-me-downs will be appreciated to even get stuff from your ne' er-do-well friends) - $0

Doula: Look for a doula in training, or ask about scholarships, or offer (even partial) work/trade (art? babysitting her kids while you're pregnant? some awesome veggies from your garden?) for some deeply discounted rates - $0-$200

Birthing Tub: Some people will tote how much better actual birthing tubs are, but for us strange ones, bathtubs and kiddie pools will often do. You can buy kiddie pools online or locally during the summer at Mega-Stores, mom and pop places, or the local flea market, but I would suggest looking to your young'un having brethren for a loan. Just make sure it's a high walled soft or blow-up pool, not the hard plastic things. Think about how deep you want it - 30" pools run around $40, though consider some with unusual designs if you think it will provide a more comfortable place for you to lay - $0-$70

Homebirth: Again, ask often and apply early for scholarships, network through community birth groups, local food co-ops, and don't be scared to ask every strange looking person you see with kids or a bump if they know of someplace for you to hook-up with some delicious freeness - $0-1,000
or
Freebirth (aka Unassisted Birth, DIY Birth): Maybe on your own, maybe with your partner, or maybe with a doula and your 20 closest friends, this really just means there isn't a "medical" professional there. That is the free part, though you will need some supplies, which you can find in kits, or scramble those individual supplies together. Again, you can find creative ways to make some of these things on the cheap (cloth pads v. disposable, or getting bulb syringes from feed stores instead of medical supply websites, cuz sterile is sterile), and you can look to local community groups for loans, but these costs can vary a lot depending on how much you want to work for it, and how much stuff you feel you need. $0-$200

Now to end this monetary rambling rampage, I will sum up planned costs for my husband's step daughter's (and my future) pregnancy. On the higher end, including a fully paid Midwife for your Homebirth, you would pay $1,402, and on the free(ish) Freebirth end, you would pay $117 if you can get a tub and supplies for free, but still only $387 even if you buy a new tub/pool and a birth supply "kit". Thus ends this rant, with my personal conclusion on the sanity of freebirth still upheld.

*Ok, trying to track down any semblance of "average" health insurance costs is nearly impossible, but some searching and personal experience unearthed these numbers:
$183 a month / $2,935 deductible
$490 a month / $500 deductible
So lets assume some sort of average between those, at $336 a month / $1717 deductible
And maybe if you're lucky, you've met about 1/2 of your deductible, leaving you $858 to pay off. Even assuming you have no co-payments (which is highly unlikely) after you find out at week 6, you still have 7 1/2 months of premium to pay off, ringing your total insurance costs in around $3378. So much for not having to pay those "huge" out of pocket expenses for prenatal care, huh?





Thursday, December 29, 2011

New Babies in Our Family!

Okay, I know, I know, I need to get better about posting on here, but maybe this will be the kick in my ass I need to get on it - my husband's step daughter from his first marriage and her best friend are pregnant! We really have sort of adopted them both, being 19 and 20, respectively, though due to being only a few years younger than me I have a weird part step-mom/part friend place in their lives. But it is awesome, and wonderful, and I'm possibly looking forward to it more excitedly than they are. We already started attending meetings with the Asheville Holistic Birth Collective (something else I just needed a kick in the ass to go do), and had an ill fated attempt at trying to get into the system at the local free clinic so as to procure Medicaid, WIC, free shit, etc.
For now, I'm renewedly interested in a subject I felt like I needed to take a break from after two years of fixation while trying to conceive. I'm hoping (fingers crossed) that with this new group meeting I will finally find some resources to try to get the zine up and going. So expect some more chatter, and linking to Asheville and internet sources for birth and pregnancy.

Saturday, September 17, 2011

Endometriosis and Infertility

     So I am once again navigating the treatment of endometriosis with surgery.  A little bit of background, I was diagnosed with endometriosis at 17, but I remember having pain as early as 14, and my mom recounts unusual cycles from the very begining, at 11.  I had one surgery at 17, another at 20.  I have been on just about every birth control know to exist, as well as myriads of painkillers, along with bouts into all sorts of alternative treatments from acupuncture to massage to biofeedback to TENS to physical therapy.  I have made diet changes (no gluten or dairy), and I've been charting my cycles for 2 years.  In all this time, all that has managed to happen is maintaining the status quo, or periodic bouts into much worse.  The end result of all this?  I think the ultrasound tech at my last appointment said it best - "Its all messy in there.".

     Definitely not something you want to hear while trying to get pregnant, but I've been under no illusions - there's a reason I've been unsuccessfully trying to get pregnanct for going on two years.  I had actually been rooting for a surgery for some time now - I'm finnaly ready to have children, and pregnancy and breastfeeding can be one of the best treatments for endometriosis.  Such a fundamental shift in hormones and the way your body functions is a lot more powerful, and a lot safer, than most things which can be offered by the medical community.  A big issue of course being that it's been damn hard to get pregnant with all that stuff going on.  What I've been desperatly wishing for is a reset botton of some sort, something only surgery can provide.  If I could just get rid of the pain for awhile, I could get off the drugs, could have the energy to eat better, to do physical therapy, make sure to follow my diet to a T, excercise, all the things that can help keep illness at bay, but that anyone with a chronic pain causing disease knows is virtually impossible when its all you can do to get out of bed most days, and all you can eat some weeks is applesauce and ginger ale.

     But like most people in this country, I don't have enough money to be healthy.  Two years ago I had insurance, but my co-payment was so high ($490 a month at 22 years old!) that I couldn't even afford to go to the doctor, let alone get surgery.  Then I couldn't afford even that, and I joined the insurance-less masses.  Hello free clinic, goodbye considerate or preventative medicine.  Now, two years later, after a year of not working due to my disability, I've finally won the lottery.  I'm now so poor I get Medicaid.  $3 co-payments and foodstamps have made us miraculously able to consider real options for treatments.  Yes, I have to jump through 10 levels of hoops for referrals to the correct person, but once I do, I get surgery, physical therapy, nutritional consultation, pre-prenatal care, the works.  And guess what?  I can actually afford to eat well now that I have food stamps.  On the one hand it really sucks that I have to get to the point of facing loosing my home or being on permanent disability before our government will give me any help, but hey, now that I have it, I'm pretty psyched not to be somewhere where I would have just continued to fall through the cracks.

     How does this tie into Radical Pregnancy?  Maybe it doesn't, maybe this is just a recollection of my personal struggle to try and attain pregnancy while being weird, on the fringes of society.  But maybe that's the point.  How many other "fringe" women are there out there like me, who want children but have none of the options available to our middle class sisters?  Elective surgery?  Hell no!  IVF?  Not in your life!  The basic requirements of real food, safety, rest, and a limited stress environment so your body can try desperately to heal itself?  If you want it, you are going to need to beg, claw, and work yourself ragged just to lay the groundwork for a community where people like us can give ourselves and each other those basic human rights.

Friday, September 16, 2011

The Four Most Important Words In Labor

In the 90's there was a common "joke" many doctors told - what are the four most important words you need to know for labor? I. Want. My. Epidural. *grimace* That's pretty bad, especially considering that they weren't really joking. I would like to replace those with four different words, which are becoming more and more common as women everywhere are re-learning the fact that they hold power over their births. Read. My. Birth. Plan.


In the past, birth plans have been looked on with scorn, and seen by many doctors as insulting - luckily, they are become more common, and most doctors will readily accept them (except this scary place). Even if you are planning on an Unassisted Birth (FreeBirth) or a Homebirth with a midwife, it's a good idea to have one in place, either to give to your midwife and doula or to take if you end up transferring to a hospital. One very important thing to remember, since if you planned to birth at home, it is probably an emergency which lead you to transfer, is that you have the RIGHT to say NO! If it ever gets to the point of having to do it their way or walk out, you have the right to walk out. Doctors may try to scare you into a c-section when you think you don't need something that extreme, or maybe they say you "have to" have a vaginal exam/fetal monitor/ultrasound. Any person can refuse any procedure for any reason, regardless of the bullying, and sometimes even threatening to call child services some doctor will do to try to get you to do it their way. A surgical or medical procedure in birth is legally performing surgery on you for the benefit of another person. Would you ever think it was okay for a doctor to demand you give a kidney to another person against your will? NO! And they have no more right to do something to your body you do not want just because that person is inside you. As that little person's mother, you have the right to make medical decisions for them until they are 18, anyways, so they cannot use the rhetoric that their decision is because the baby cannot speak for itself. Neither can a one year old, but a doctor would never say they speak for the child rather than their parents.

Here and here are two mainstream articles on basic labor rights, one from the very well respected Pregnancy.org, the other from a wiki page on pregnancy. They both clearly state what I talked about above, with the caveat of getting into informed consent. This can be a tricky matter, since you do have the right to "go back on" your own consent, i.e. the right to change your god damned mind while in labor, but due to blanket consent forms given at some hospitals, you need to pay close attention to what you are signing. Even in an emergency, try to have a support person who knows your wishes read it for you and tell you if they think you would agree to it. Another important thing Pregnancy.org points out is that you can CROSS THINGS OFF of those blanket consent forms. Now I don't know if that is a legally sturdy thing to do, but it would make it very clear to a judge that you did not consent to that measure, and that alone will usually be enough to get a doctor not to scold you for slapping their hand away when they attempt to do it.

Despite all these legal reasons however, women can end up with a doctor or hospital very very mad at them for refusing treatment, and though it is an extreme case involving mental illness, a couple recently had their child removed by court order after a prolonged throw-down with the hospital. You can read about it in depth here, and also see a (IMO) fairly pessimistic political piece from The Birth Activist.

Now that all the political stuff is out of the way, some particulars that are good to include on a transfer birth plan.

Vaginal Exams: How many, how often, under what circumstance?

Induction: List natural techniques you are ok with, and your preferred medical technique.

Pain: Natural techniques you are ok with, and preferred medications for both c-section and other uses. Do you want the "pain scale" used, or not want to be asked about your pain?

Monitoring: Specify if you want only intermittent monitoring, even if you are undergoing an intervention.

Enemas: Say if you want one, or if you want it available.

Episiotomy: List natural treatments you want, if you would rather tear, what degree tear you want stitches for, and if you want local anesthesia.

Placenta and Cord: Do you want to have a Lotus Birth (where the placenta and cord stay attatched after birth)? When should the cord be cut? Who should do it? Do you want to save the placenta?

Hemorrhaging: Any natural treatments you want to try, such as breastfeeding? Do you want a transfusion before medication?

C-Section: Who has to give consent? Type of anesthesia? Do you want to be kept conscious? Have the baby placed on you? Kept with someone else? Type of incision? Type of stitching? How many people can be in the room? Is non-essential talking allowed?

People: Who can be present during your birth?

After Birth: Who holds the baby first? Is it cleaned? Do you want to breastfeed? Can the baby be taken away from you at any point?

Newborn Procedures: Are there any standard procedures you don't want, like eyedrops, vitamin K, PKU, vaccines? Who holds and accompanies your baby for these? Do you want your baby to be allowed pacifiers, sugar water, fake nipples, formula? Circumcision preference.

Who's In Charge?: Especially important in non-traditional families, you need to state who has control if you are incapacitated, and be clear that they must get the informed consent via signature of that person in any circumstance the birth plan states it would otherwise be needed by you.

Another good thing to think about is the standard use of "polite language" in birth plans. Most people want their plans to be well accepted, but sometimes they can come across as preferences, not decisions you have firmly made. I suggest having two, especially if you have a midwife and plan to labor at home first, or unless there is an emergency. It is becoming very popular to have birth plans be in more of an essay format, which is a great way to connect with a midwife or doula, and can be a nice introduction to a doctor, but if you are in the nitty gritty of a possible c-section after being transported from you planned homebirth, chances are you will not be treated with complete respect, and your birth plan needs to be forceful enough to not be "misinterpreted" by an unrespectful doctor. This does not mean it needs to get nasty, but bullet points, charts, and headings are important for a fast paced situation, and plenty of language such as "absolutely", "under no circumstance", "must", "informed consent", and "signature required" are good things to get your point across. Of course, you could always take the direct approach, as Vita Mutari recollects on her blog a client who handed her an index card stating "Don't F*** with me!".

Edit: Since writing this post I have come across a birth plan critique series from Navelgazing Midwife, which can be found here. I really suggest reading the comments, especially in the first post of the series, where one very good point is brought up by a doula who suggests that her clients call the hospital or take the hospital tour if they are unsure about putting something into their birth plan, so that they don't come off seeing uneducated about their local hospital's policy. Before referring you to this series, I have to note that I disagree with the author and many of the commenters about the importance of birth plans (not very, according to them), but it's because they seem very skeptical that I have to recommend it - the opinions expressed can give you a good idea of what it might be like if you end up in a hospital, and the kind of hostility you might face.

One commenter recommends a single page in 14 point double space. The same woman is a Lamaze educator, and suggest using the idea/term "preferences" rather than "plan", particularly by initially approaching your provider with "concerns", and afterwards writing out your "birth preferences" and sharing them in a prenatal visit. She says this is most often useful as it educates women on what their provider is like, and often leads to them switching providers - I would definitely recommend this if you are working with a midwife, but depending on where you live, you could also go over the same plan with a regular prenatal care doc, and find out who in their practice is on call when. My Medicaid covered OB/GYN comes with the caveat that I see many providers within the practice, but it gives me the chance to meet most of the people who would be on call at the hospital, and find out who I could request when I KNOW more than one doc is available, something that could work even with a transfer.

Resources for Birth Plans

The Home Birth Reference Site
Birth Plan Decision Reference
Birth Planning
Writing A Home Birth Plan
Free Birth Plan Form
Interactive Birth Plan
Transfer Birth Plan Example
Personal Transfer Plan