One Approach To Birth Planning

There are many ideas out there on what is the best way to prepare a birth plan and just as many ideas and opinions on whether or not an expecting couple should even write one. It can be difficult and overwhelming to rifle through all the conflicting information out there.

Some couples are discouraged from writing a birth plan as they feel they cannot predict how their labour will go and don’t want to feel disappointed because they got attached to the idea of how they wanted to go. More couples tend to believe though that even if they end up disappointed that their birth did not play out as they had planned, they were still better off than if they had left the events of their birth to chance. In the end they feel they still accomplished more of what they hoped for than if they would not have written out a plan. In the end they will not be able to blame themselves because they were unprepared. In my opinion a birth plan is incredibly valuable and the more simple it is the better.

It can easily feel like there are a million different decisions to make in regards to birth and postpartum preferences. Do you want pain medication? What are your options? Do you want to eat and drink freely or have a Saline lock or IV fluids? What are the options in your birthplace of choice? How do you want your perineum cared for in birth? What are the options? If you end up having a prolonged active labour what are your options? Where and when do you want the newborn exam carried out? What are your options? There is just SO much to know and to think about. It is much better to digest all the information and make educated decisions about your preferences prior to labour than in between contractions.

A birth plan can be beneficial regardless of the type of birth experience you desire or have planned. Whether you aim for an un-medicated birth, medicated birth or planned caesarean birth it is still important to communicate your preferences and what is important to you in every scenario.

In taking the time to sit down and think through your birth and what you really want it to look like, it is easier for you as a couple to get on the same page and from there you can communicate together what is important to you and what your needs are. The more you can communicate what you want, the more likely you are to attain it and the more clear you are, the better! It also makes it easier to determine if a care-giver’s way of doing things lines up with your vision and ideas for your birth.

What do medical professionals think about birth plans?

While most midwives welcome and encourage birth plans, they seem to have mixed reviews in hospital labour and delivery units. It really depends on the individual nurse or doctor and on what the birth plans says or more importantly how is says it. Doctors, midwives and/or nurses as a whole want just as positive a birth experience for a birthing woman as she does for yourself but sometimes their ideas on the best way to get there may differ and this can be where the apprehension comes from.

No one appreciates someone coming into their workplace and being told how to do their job. On the other hand a couple does not have a baby every day, it is a very personal and special time and so there is a balancing act that needs to take place. It requires a lot of open communication and this is where a birth plan can be very effective when communicated the right way. If a couple can develop a good relationship with their care-giver and hospital staff and gain allies in birth rather than enemies, their chances of a more positive birth experience are much higher. It is likely wise to avoid a long list of “I do not wants” or to write from a defensive place and to be sure to be respectful in their communication of what is important to them in their birth in order to be truly heard and understood.

What should be included in a birth plan?

An Introduction

Include a brief introduction of yourselves and a general description of your approach to birth and who is on your birth team.

Your Vision

Take the time to really envision what you want this labour and birth to look like. If there were no restrictions and you could have everything go your way, what would it look like? Maybe your husband proposed to you at the top of a mountain. If you want to picture hiking up that mountain while in labour, hugging a tree during every contraction and having your precious one at the top once you get there then envision that with all your heart. Is that likely how your labour and birth will unfold? No, but the important thing to notice is what about that vision can you bring into your labour. There is a reason why your heart wants to birth that way and since your body and your emotions are so closely linked in labour, the more you can do to make your vision a reality the better.

You do not need to include your trek up the mountain in your birth plan but take some time to think about what is it about the mountains and that specific place that is so appealing? Nature? Perhaps this overall vision communicates your desire to be very active in labour and/or to have your husband close by at all times communicating his love to you. Wear your husband’s favorite hiking shirt, download an app to your phone that plays sounds of nature, and bring a picture of that special place. Maybe asking for time for you and your husband to be alone is desirable. These are all things you can either include in your birth plan or make a mental note to have your support team assist you with in labour.

Your Preferences

Do what you can to gain some knowledge about what options are available in a normal labour & birth and what options are available if unexpected labour events arise or unexpected events with a newborn arise. A doula and/or childbirth educator can be a valuable resource in this regard. They have a great deal of knowledge on hospital policies and procedures and what options are available in different birth places and can guide you through a list of birth preference options and help you in asking the right questions to narrow down what is most important to you.

Another valuable resource is the book “Pregnancy, Childbirth & the Newborn” by Penny Simkin, Janet Whalley, Ann Keppler, Janelle Durham & April Bolding. There are chapters dedicated to labour pain options, types of medications in childbirth, complications and comfort measures. Although this resource cannot tell you specifically what options are available to you in your choice of birth place, the information can provide you with a general idea of what to expect. You can also find much of the information at http://www.pcnguide.com/labor-and-childbirth/.

It’s important to remember that a five-page birth plan that lists off fifty things that are unacceptable to you is unlikely to be received well or even read in full. Focus on the things that would drastically affect you and your partner’s perception of your birth experience such as holding your baby immediately after birth or having the cord clamping and cutting delayed. Although indicating these preferences in your birth plan is no promise that they will happen (as emergency procedures may take precedence) imagine how devastated you would be if these important things were never communicated and they cleaned and weighted your baby before you got to hold him/her or the doctor cut the cord before it had finished pulsating never knowing you didn’t want that to happen. Everyone in the room would likely feel pretty terrible.

With a planned caesarean birth your options may be less and your birth plan will not contain the same type of preferences through the first and second stages of labour but can contain much in the post birth sections. You may even wish to add a section for when you are back in the postpartum area to include preferences to encourage bonding between you and your new little bundle. Including requests for skin-to-skin contact as soon as possible or a request to room-in together or specifics on immediate newborn care may be important to you to include.

Special Circumstances

It is also valuable to spend some time considering any special circumstances around your labour and birth. Do you have allergies? Anxieties? A fear of needles? Are you a survivor of abuse? Are there religious customs that are important to you to include? Has your past included infertility? Do you have past birth experiences that are negative or traumatic? Is this birth a VBAC? Are you a very modest person? Are you comfortable with students and/or residents being present at your birth? Do you know the sex of your baby? How do you want it announced? Are you having multiples? What sort of additional support or options will assist you in your birth?

Putting It All Together

Gather all the information you need and put it all together. One page is ideal and try to include what is important to you for each stage of labour, in postpartum and in unexpected situations.

Remember to communicate in a way that is inviting and respectful of your care-giver and their support while communicating in a straight forward manner what is important to you in this birth. It is your birth remember! While there should be plenty of open dialogue about anything that comes up while in labour, the birth plan will give you a place for everyone to begin, get on the same page and work as a team in accomplishing the best birth possible for you and your baby.

Introduce yourselves to the staff when you arrive and offer the birth plan as soon as possible with a thank you. It is a great idea to review it with your care-provider beforehand if possible as well.

A Sample

My name is Lucy and my husband’s name is Rob and this is our first baby. We are       planning a natural birth. We are very nervous but well prepared. We will be       accompanied by my sister Lena and hope for your support, thank you.

Beginning Labour:

  • I would like to begin labour naturally and if my bag of waters breaks I would like to wait for contractions to begin on their own.
  • I would like to remain in my own clothing throughout labour.

First-Stage of Labour:

  • My husband and I would appreciate occasional moments alone.
  • I would appreciate it if staff did not offer pain medications to me. I am aware they are available and will ask for them if I feel I need them.
  • It is very important to me to be able to move around and remain as active as possible, changing positions as I desire.

Second-Stage of Labour:

  • I would appreciate the option of squatting or using positions that promote descent, as well as being able to move around and remain as active as possible.

Postpartum:

  • It is very important to me that I hold my baby immediately after birth and that all newborn procedures are postponed until we have bonded and attempted to breastfeed.
  • Please delay the cord clamping and cutting until it has finished pulsating.
  • In the event our baby requires medical attention we would prefer he/she remains with us if at all possible. If he/she requires a trip to the NICU we request that my husband go with him/her and that we are able to care for the baby ourselves as much as possible.
  • We also request that our baby receive my breastmilk only. I will hand express or pump if necessary.

Caesarean Birth:

  • I would like to avoid a caesarean. If one becomes necessary I would appreciate the doctor or my husband describing the events of the birth to me as they are happening (if possible).

Other Considerations:

  • I am a very modest person and would appreciate being covered as much as possible and having the door kept shut.
  • It is really important to my husband and I to discover the sex of our baby together. Please do not announce the sex of our baby to us.

We appreciate your support and thank you in advance,

Lucy & Rob

 

Written by Jenn Dabrowski

Belly Bloom Birth Services

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