The Importance of Writing a Birth Plan

Not too long ago, having to write down a birth plan would have seemed ridiculous. Birth was simply birth, and there weren't many options or choices in the matter. Fast forward to the 21st century and the wonders of modern medicine have made giving birth an event filled with decisions that must be made. To begin with, do you choose a professional midwife, a nurse midwife, a doctor ... or do you decide to go it alone? Do you want to be at home, in a birth center, or in the hospital? If pregnancy goes beyond 40 weeks, do you induce, or wait it out? Do you want a "natural" birth with no pain medication or IVs ... or do you want oral pain meds, an epidural, or even a c-section? What kind of monitoring would you like? Do you want the baby suctioned after delivery? What about vaccinations, the vitamin K shot, and erythromycin ointment? While some women will have absolutely no preference on some of these decisions - most women do have a preference. And those preferences, as much as humanly possible, should be followed. Remember: this is YOUR body and YOUR baby. Making sure that baby goes directly onto your bare chest after delivery instead of getting swept away in a nurses arms to be weighed and measured matters. A lot. If you choose to decline or postpone the Hepatitis B vaccination during the first few days of your baby's life - that decision needs to be known and honored.

Sitting down and writing out your birth plan not only helps you better visualize what type of birth you want to have, it also forces you to consider some of the options you might not have even realized you had. It also ensures that you, your partner, and other supporters (such as a doula and other family members) are on the same page so that they can better support you during the labor process. When you are in the middle of transition and focused only on getting through each contraction, your spouse or doula can gently remind the nurse and doctor that you prefer the lights dimmed, or that you only want to be checked for dilation if absolutely necessary (instead of routinely).

Writing a birth plan will also help you make more educated decisions on the various options you will face. For example, what are the pros and cons of erythromycin ointment? What are the pros and cons of having regular checks for dilation? What are the benefits of an epidural - and what are the setbacks? Why might you want to have your baby suctioned after delivery, and why might you not? Rather than simply accepting whatever practice is considered "the norm" for a particular hospital or doctor (and yes, these practices do vary greatly depending on who your hospital, doctor, or midwife is), you get to make an educated decision on what is best for YOU and what is best for YOUR baby. And what is right for you may not be what is right for the mother that delivered just before you, or the mother that will deliver just after you. That is the beauty of writing your own birth plan ... it is individualized, just for you!

Discuss birth plan preferences with your provider early on. If they are unsupportive of your birth plan, you may consider finding a different provider that will be supportive. For example, many doctors will require that you be monitored on the fetal heart monitor and that you deliver laying down in bed. If this is not what you want, consider talking to another doctor, nurse midwife, or professional midwife.

Several weeks prior to your due date (usually around 36-37 weeks), make plans to thoroughly discuss your birth plan with your doctor or midwife. Give a copy to your provider. If you have a doula that will be attending your birth, make sure she also has a copy. Print out several more copies to take with you if you are going to a birth center or hospital. Have your partner give one copy to your nurse upon arrival, and tape the other copy somewhere in the room where nurses and doctors can easily see it. Because nurses and doctors change shifts every 8-12 hours, it is very likely that you will not have the same nurse upon admittance that you have during delivery. Making sure everyone has access to your birth plan is very important and will help your nurse, doctor, and midwife better support you in the labor process.

I recommend reading through your birth plan at least once daily. This helps serve as a sort of "visualization" of how you would like your labor to progress. Make sure that you leave room for flexibility, however, for unforeseen circumstances. For example, I preferred not to have Little Bear suctioned after delivery. However, because she was not a crier and her lungs sounded more gargley than the midwife was comfortable with - I allowed her to be suctioned based on the midwife's recommendation. Because I knew and trusted my midwife, I felt comfortable adjusting my birth plan preferences under her recommendation. I also preferred to tear naturally, rather than have an episiotomy. However, I did state in my birth plan that if my midwife felt that performing an episiotomy for the safety of my baby was necessary - I would allow that (sometimes this is necessary to allow for a faster delivery). This was not necessary during Little Bear's delivery, but I trusted my midwife to make that decision. As you can see, having complete and total trust in the individual delivering your baby helps make the process much easier!

Below I have listed a number of questions to answer in your birth plan. It is definitely not a complete list, but it covers many of the options/choices you will face as you go through the labor and delivery experience. Depending on if you plan on having a hospital, birth center, or home birth - some of these questions may or may not be relevant. Many of these topics I have discussed in previous posts - or plan to discuss in future posts. Please feel free to contact me at oregonmother@gmail.com with any questions you may have. Otherwise, read-up on the issues, discuss options with your partner, and write up a birth plan that will work best for you!

1.     When do you plan to come to the hospital? How far along in labor would you like to be?

2.    Would you like to be able to eat and drink during labor? Many hospitals require women in labor to only have ice-chips or sips of clear liquids.

3.     Would you like to be able to be out of bed during labor? Would you like to use the tub, shower, etc?

4.     What sort of lighting and atmosphere do you prefer in the room? 

5.     Do you want an IV and continuous fetal heart monitoring? If not, does your hospital allow you to decline these interventions? If you do not want continuous fetal heart monitoring, what type do you want (doppler, intermittent with a strap around your abdomen, fetoscope)?

6.     What type of pain management do you want to use? Consider your various options including: verbal support, techniques learned in lamaze classes, water therapy, oral medications, epidural, etc. (Remember that while many hospitals will offer epidurals as a first option for pain management, there are many non-pharmacological options available that have less side affects on mother and baby.)

7.     Would you consider induction of labor after 40 weeks, or do you prefer to wait? Many mothers go 42 weeks before labor begins. What sort of induction would you be okay with? Having a doctor or midwife strip your membranes is very different than being given a drug to induce labor. Consider your options.

8.     Would you be okay with a routine episiotomy? Most providers are moving away from this practice as evidence shows that it is more harmful than helpful in most situations. However, some providers still practice this technique. In what situation would it be okay? 

9.     Presence of others in the delivery room ... who do you want to be allowed in the room? Do you want your children there? Your mother? Just your spouse?

10  Are you okay with an AROM (Artificial Rupture of Membranes)? This technique may be used to help speed up labor. Consider the pros and cons, as well as when it might be appropriate and when it is not.

     Are you okay with intermittent vaginal checks to measure dilation? 

1   Suctioning of the newborn: Do you prefer that your baby's nose and throat be cleared of fluids with a bulb syringe? Or do you prefer that no intervention be done? If you prefer no suctioning, would you be okay with it if meconium is in the amniotic fluid?

1   When baby arrives, do you want her placed on your bare chest? Do you want her wrapped and swaddled first? Do you prefer that the newborn assessment be done while baby is on your chest? Do you wish to wait one hour or more before baby is weighed, measured, etc? 

1   Cutting of the umbilical cord: Who do you wish to cut the cord? Do you wish to wait until it stops pulsating before it is cut (this is the recommended practice currently, though it is often not done)?  

1   Do you prefer that the afterbirth (placenta) be delivered naturally, without intervention? If so, how long are you willing to wait? What would you like done with the placenta? (Many cultures save the placenta and plant it under a tree, etc.). 

1  What would you like administered to your baby? Vitamin K, erythromycin eye ointment, and the hepatitis B vaccine are all routinely given to newborns in their first hours and days of life. Parents may sign consents stating they do not want these interventions. 

     

     Do you plan on breastfeeding your baby? If so, allowing baby to suckle on your breast during the first hour of his or her life will help both of you. 

     If you tear naturally during delivery, do you prefer to heal naturally, or do you want stitches?

     When do you wish to give baby his or her first bath? Do you prefer it be done the first day - or do you wish to wait 2-3 days? 

     When do you plan on going home? Do you wish to go home soon or stay longer (most birth centers allow you to go home within 4 hours after delivery; many hospitals require you to stay 24-48 hours).