MAKING A BIRTH PLAN: Giving birth with a flexible vision
You have probably heard of a birth plan. Some swear by it, others hate it. These days we also call it a birth preferences letter, or even a birth map.
Whatever you choose to name it, the idea is not to ‘trap’ you or force a caregiver into an idealized view of birth. A birth plan is a piece of paper that helps your nurse, doctor, midwife, as well as any member of your birth support team (spouse, doula, friend, parent, etc.) know who you are and what you want. It is an excuse for communication.
You may know what you want, but your birth team may not. This ‘plan’ is a map of your vision and a reminder to all of how you have prepared, what drives you crazy, what you want to be reminded of, what you strive for, and what your spouse needs to advocate for when you are gone into ‘labour-land’.
A ‘birth plan’ is an ideal vision—it is what you are striving for. Creating an ideal has its place as it helps you identify what you want and encourages you to become educated and responsible for your care. It also helps you have clear goals and encourages you to keep them. It is an incentive, and any athlete or business person will tell you that having goals and a 5-year plan is the only way to get anywhere. There is nothing wrong with aiming high as you will stand a better chance of falling quite close!
However, plan flexibly too. When you create a birth plan, you always want to use caution and honesty. You do not want to write a birth plan that may look like you have lost your mind. You do not want your doctor to think you are in a world of fantasy. In an ideal world, it would be wonderful for all of us to have empowered, satisfying, graceful, orgasmic births. However, reality can hit loud and hard at the moment of labour. “Oh, I was not expecting that!” you may think as contractions start. It may be easier than you thought, or much harder. It may require every inch of support you have available or surprise you on your kitchen floor with an unplanned, unassisted birth.
Because it is difficult to predict how your birth will unfold, or how you will react (especially for first- time birthing mothers), you want to make sure you are prepared and have taken the time to face up to your truths.
Search within yourself for your most honest answers to questions such as these:– Do I have people who are supportive of my wishes? – Does my caregiver give me lip-service, or do I want to believe s/he is supportive so I don’t have to deal with anything? – Do I advocate for what I want, or do I do what people ask me to do because confrontation makes me feel awkward? – Is my plan my spouse’s plan for his/her birth, or my own plan for my birth? – Do I know what to do to cope with the labour? – Do I know how to cope with disappointment or Plan B or C? – On what basis do I make decisions? To please, out of fear, or based on facts? – What is my plan for situation A, B and C? – Will my people cheer me on and keep me on track? – Will my people sway me away from my plan at the first opportunity, or will they advocate for my ideal? – Have I read, watched DVDs, spoken with birthing mothers, eaten healthy food, kept active, brought my baby down into my pelvis, and had regular visits to the massage therapist, acupuncturist, chiropractor? – Am I being physically active? Am I going for walks, taking yoga classes, swimming, going to the gym? If not, why not? – Is my baby high in my pelvis during my last trimester? Do I know how to bring my baby down? – Am I being sensual and/or having sex? Why not? – Do I know how how much it makes a difference to be sexually active? – Am I happy? – Am I angry? – Am I depressed? – Do I have hidden fears? Am I afraid of birth? – Am I ignoring my fears? Am I pushing them aside and not dealing with them? – Am I concentrating on buying furniture and baby supplies? If so, why am I not also educating myself and plannign for the birth? – Am I feeling too busy to educate myself? Would I consider going on holiday, taking a weekend or a day off to focus on my pregnancy and the birth? – Is my partner uninvolved? If so, how is this affecting me? – Do I feel loved and cared for by my partner, family, and community? – What am I doing to have a better pregnancy? Life? – Do I need to see a counselor or a hypnotherapist to reduce my anxieties and deal with past trauma? – Do I want to have an ideal birth experience but have not done anything to make it happen? – Have I truly taken the time to prepare myself? – Have I been honest with myself?
Some caregivers are weary of birth plans because they perceive that you will be unreasonable and will stubbornly soldier on and put yourself and baby at risk. They may be concerned that you will also put them in a position where they will be asked to practice outside of their scope or outside of their comfort zone. In our society, it is very common for caregivers to be sued. Ultimately caregivers have a lot at stake and some may have developed defensiveness in order to protect themselves from certain patients they perceive as a threat. Perception or reality won’t be debated here, but what we can talk about is what a poor or good birth plan can look like.
A poor example of a birth plan would be a woman who has properly diagnosed high blood pressure refusing to have her blood pressure monitored during labour. Asking for zero monitoring will not only appear unreasonable but reckless. Or if a baby is showing unquestionable signs of distress and a woman is not willing to accept reasonable interventions. However, a woman who has no health issues, has a low-risk pregnancy, is coping well with the labour and has a baby with beautiful heart tones—she can reasonably expect her caregivers to respect her birth plan which indicates she wants intermittent monitoring and no drugs.
Know that your own preferences may change because you feel like changing them or because of an emergency. If you approach your birth wishes with some flexibility, you can also demand flexibility from your caregivers!
Making you familiar with some of the common procedures offered at the hospital is another useful purpose of the birth plan. Labour is not the time to evaluate the risk-benefit ratio of the procedure being offered. You will be busy with the labour; thinking and making decisions will be distracting. You may even feel vulnerable and overwhelmed. Keeping centered during your labour will take over all your resources.
Sharing your birth plan is very important. It will help your birth support team be on board and informed about your wishes, so they know how to advocate and keep you on track. You don’t want them to suggest to you, “It’s time for your epidural, honey”, when you were planning an unmedicated birth and are blissed out in labour-land! It will also help your doctor and midwife know who you are and how to support you. They can provide you with further information on certain interventions or how they work. You may find that this deepens your connection and trust. You may also find out that you are not at all on the same page, and it will help you make the difficult, but very important, decision to find a new caregiver.
The birth plan will help your nurse know who you are too. This is true if you have a doctor, as midwives usually work in tandem with another midwife rather than a nurse (at least in Alberta). Remember your nurse has never met you and this is a wonderful opportunity to get to know each other and to make her part of your unique experience. Make sure that someone on your birth team reads it with each nurse who starts her shift. Also, don’t assume your doctor or midwife will remember your preferences; when pushing, for example, you and your partner should be prepared to remind your caregiver of what you want.
When you are creating your ‘birth plan’, concentrate on a few salient points that are quickly identifiable by all. The form should not be more than one page long.
Here are some questions that should help you identify every single part of your birth plan:1. What kind of environment would you like during your birth (lights, warmth, sounds, voices, scents, imagery, music)? 2. Who would you like to support you during the birth? Is there anyone you don’t want to see during labour? Or when you give birth? How do you feel about students or residents being present during your labour and birth? 3. Do you plan to eat and drink during your labour? 4. Do you know the benefits of walking, moving, and using gravity during labour? What are your preferences? 5. Do you know what an induction is? If a discussion about induction is brought up after your due date by your caregiver and the baby is not in distress, what would you like to do? 6. Do you know what monitoring is? Pros and cons of monitoring baby and contractions during labour and pushing? Do you have preferences? 7. Do you know that caregivers have protocols about how labour progresses? Do you understand how these protocols may affect your birth? Do you have a preference? 8. Do you know the pros and cons of vaginal exams performed during labour? Do you have a preference? 9. Do you know the pros and cons of using full immersion during labour and pushing (e.g. birth pools)? Do you have a preference? 10. Do you know the pros and cons of artificially rupturing your membranes (ARM)? Do you have a preference? 11. Do you understand what the pros and cons of an augment are? Do you have a preference? 12. Do you understand what laughing gas, morphine, gravol, fentanyl, and an epidural are? Why they are used? Do you have any preferences? 13. Do you know what a TENS unit is? Would you like to use one? 14. How do you feel about IVs and needles? Do you have a preference? 15. What is your preference when pushing your baby? Would you like to be actively coached, or figure it out on your own? 16. Do you know the benefits of using gravity during pushing? Do you have prefeences about the position(s) you will be using when you are pushing your baby? 17. Do you know the benefits of feeling the baby’s head while you are pushing? Would you like to do it? 18 Do you know the protocols when a baby is about to birth (e.g. hospital staff present, who delivers baby, oxytocin shot, cord clamping, cord cutting, clearing baby’s air ways, wiping baby down, massaging uterus)? Do you have any preferences? 19. Do you understand the pros and cons of tearing and of having an episiotomy? Do you have a preference? 20. Do you have a preference about local anesthesia being injected before tearing or when repairing your perineum? 21. Do you understand what a forceps or vacuum delivery is? Do you have a preference? 22. Do you know the pros and cons of having a cesarean section are? Do you have a preference? 23. Do you have any preferences regarding holding your baby after his/her birth? 24. Would you like to breastfeed in the immediate postpartum time? 25. Do you have any plans for the placenta? 26. Are you familiar with newborn care (weighing, measuring, cleaning, prophylactic eye ointment, and the vitamin K injection)? Do you want every aspect of it immediately, delayed, or do you want to refuse any of it? 27. Would you like to keep your baby by your side for any newborn exam or care? 28. Are there any religious or cultural practices you want people to be aware of? How can we be sensitive and accomodate you?
Go on a date with your partner and have fun answering these questions. You may find out that you do not have answers for all of these, or you may have answers but they are not informed. Make sure that when you are answering them, you are making an educated decision. Once you have answered all of these questions, use them to write your birth plan.
Now that you have written your birth plan, forget about it! Enjoy the rest of your birth journey. Have a wonderful birth.
[YOUR NAME] due [DATE]
Thank you for caring for us on a very special day in our lives. We are very excited to welcome our 2nd baby into our family and are hoping to do so according to this birth plan. We understand there may be circumstances where we will be asked to deviate from our plan and we will consider our options at that time. We appreciate your support, care and encouragement.
BIRTH ENVIRONMENT & PERSONALITY
• Keep the lights to a minimum.
• Allow me time to progress. I would prefer to not be pressured by the clock or fixed protocols around progress.
• I plan to use breathing, massage, and support from my [name of support persons] to get through the birth.
• I am planning to move during labour. If after 15 minutes you have not come back to unhook me from the monitor, I will unhook myself so I can stay calm and in control.
• I would like to use gravity-friendly positions throughout the birth.
• I am very private and need quiet, space, and privacy to stay focused.
• Thank you for helping me by keeping my naked body covered and keeping your voices quiet.
• I have a phobia of needles, please make sure not to use them unless I am in imminent danger, or propose an alternative.
• Encourage me to be positive and to stay focused.
• I plan to use hypnosis techniques during the birth as I had a previous birth which was traumatizing.
• I was raped and would like only female staff present. I do not wish to have any strangers, visitors or any students present.
• As a [Aboriginal, Muslim, Jewish, Mennonite, etc.] woman, it is important to me …
• Keep your voices down during labour, and especially during pushing. I do not want to give birth in an arena-like athmosphere!
• Use intermittent fetal monitoring.
• I do not plan to use any medications. Please do not offer drugs. I will ask for it if I need any.
• I want to avoid interventions and procedures as much as possible. If an intervention is advised, please give 5 minutes of privacy to think about it.
• Do not rupture my membranes without asking me first. Allow me tiem to consider your request.
• I do not desire to have my uterine contractions augmented.
• Do not perform a routine episiotomy.
• Delay clamping of the cord for 3 minutes.
• Keep your voices down.
• I am looking forward to having the baby skin-on-skin right after birth. Please refrain from invading my private space. Encourage myself and my partner to warm and dry my baby.
• I will initiate breastfeeding with baby-led-latch. Please ask me, and wait for my response, if you would like to help me.
• Please delay touching my baby and baby care until I am done with breastfeeding.
• I refuse the eye ointment for my baby. I am informed about this decision.