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What About Birth Plans

Posted by Sarah Stogryn on

As women near the end of their pregnancies they begin to think more about what they hope (or fear) their labour and birth experience will be like, and about whether they need a birth plan.

Some women, especially those approaching labour for the first time, feel like they don’t need a birth plan because “as long as the baby is healthy nothing else matters”.
…. A healthy baby is of course important and it’s almost ridiculous to imply otherwise.  No mother in her right mind that I have ever met would for an instant consider making a choice that truly compromises her baby’s well-being. That being said - how you remember your birth experience will impact who you are and how you mother for the rest of your life. A healthy mother (one who is truly well in body, mind, and soul) is important and your first birth will influence any future births so it makes sense to consider what you can do to help that first birth unfold well. 

Conversely, just because you've 'done this before', doesn't mean it will be the same again.  As we learn and grow as women our needs and desires in birth will also shift, and new information is always emerging.    

Some women feel its enough to say “I want my birth to be as natural as possible”.
.... that phrase has so many potential variations that it is rendered essentially meaningless.  First, what do you mean by ‘natural’?  Are you looking for a birth that is alone and undisturbed like a mammal in nature would experience?  Are you looking for a birth in water?  A birth that is orgasmic?  A birth that is intervention-free? That is medication-free? That is vaginal as opposed to cesarean? That if cesarean mimics aspects of a vaginal birth…? Secondly, and just as importantly – what is “possible” depends on who you ask.  ;)  Some caregivers don’t believe it is possible for women to give birth without their water being broken or without an episiotomy or without medical pain relief. Some caregivers don’t believe it is possible for a woman with size five feet to give birth vaginally. Some caregivers don’t believe it is possible to deliver the baby with spontaneous pushing rather than directed purple pushing.  When you say you want your birth to be as natural as possible and leave it at that, you are essentially leaving your birth entirely to the discretion of your medical caregivers and what their beliefs and experiences have led them to be most comfortable with. 

Some people will tell you that creating a birth plan is just setting yourself up for failure or that only control-freaks make birth plans because birth can’t be planned. 
…. I suppose if you create a birth plan and tell yourself that unless it is followed to the letter you will have failed, then you would be 'setting yourself up for failure'. So don’t think of your birth plan as absolute requirements.  Think of it as you expressing what is important to you and why.  If the point is to communicate your desires, so that you have the greatest chance of creating a positive healthy birth experience, then ‘failure’ and ‘control-freakishness’ simply aren’t part of the equation.  You make the best choices you can for the circumstances you’re in, and no one can ask for more than your best.

Some people will tell you that when you hand over your birth plan to a nurse she automatically puts you on the list for a cesarean and will treat you badly.
…. I think nurses have a pretty good sense of who will end up in surgery and who won’t, regardless of whether you hand over a birth plan because they work with laboring women every day and their instincts are honed by experience.  And there may be nurses out there who cringe when they receive negative condescending birth plans – who wouldn’t?  Nobody likes being told how to do their job.  If a nurse is made to feel defensive right from the start there’s a good chance it will affect the way she provides care for you.  BUT – most of the time – when a nurse receives a birth plan which respects who she is and is stated positively then she is open to hearing it.  If she’s not, she knows enough to pass you to another nurse on the floor who is a better fit for you so as to make both your lives easier.  I’ve even seen nurses say “Oh really? You don’t have a birth plan? Well then can you tell me what things are most important to you about this birth?”

Finally, some women believe they don’t need a birth plan because they feel their doula or husband or mother or friend etc will remember all that they’ve discussed and advocate for them. 
… I am relatively confident that whoever you choose to be part of your birth team will do their very best to remember what you want and speak up on your behalf.  But then again, they might for any number of reasons be unable to advocate for you at the time you need them to. 
If you’ve chosen a midwife as your primary caregiver it is possible that in a hospital setting you will still have nursing staff involved in your care, particularly if you arrive at the hospital before your midwife does and always if medical interventions like an induction, epidural, or cesarean birth take place.  In these cases your priorities for birth need to be available to the hospital too so a written birth plan is still a good idea.

I view birth plans as an educational opportunity and a communication tool. The process of writing a good birth plan can allow you to discover what things are standard of care in your community (so you don’t need to include them in your written plan). It can help you discover what your options are beyond standard of care (so you can discuss them with your caregiver in advance and figure out how make them possible). They can open you up to new ways of looking at birth and allow you to assess your own priorities (so that when things inevitably change along the way you’ll know WHY things were important to you and be able to consider other appropriate options if needed). Creating a birth plan doesn’t automatically mean you are an inflexible control-freak, or that you think you know better than your caregivers. Creating a thoughtful birth plan means you have taken the time to understand the issues and what they mean for you personally – after all, you & your baby are the ones who will live with the outcomes for the rest of your lives.  A thoughtful birth plan respects the knowledge, experience, and wisdom of your caregivers while still respecting who you are and your priorities.

If you are working with a doula, be sure to ask her about creating a birth plan as she is likely to have a system or method that she recommends.  If you don’t have a doula though, or she doesn't have suggestions, I recommend that you start big and keep working your way down until your birth plan can be quickly and easily reviewed on a single page as it is more likely to be read, remembered, and implemented that way. This may mean having more than one ‘plan’.  I for instance had one plan for home, one for hospital, and one for cesarean.  My midwife had all three on file.

I suggest starting your birth planning process early in your pregnancy with *good* books or websites. Some of the decisions you make early in your pregnancy will influence what your options are at the end. There are many great resources available now, but there is also a lot of garbage out there so if you can, talk to a local doula or independent childbirth educator to see what they recommend for you based on your interests and beliefs about birth.  Below are a few of my top resource picks:

Recommended Books:
**Gentle Birth Gentle Mothering**
Birth Sense
Orgasmic Birth
Ina May’s Guide to Childbirth
The Natural Pregnancy Book
Pregnancy Childbirth & The Newborn

Can You Plan Birth?
The Pitfalls of Going With The Flow in Birth
The Business of Being Born
Indie Birth
Mothers Advocate
Evidence Based Birth
Childbirth Connection

Once you’ve done some background reading and have a sense of what your priorities in birth might be, I often recommend the birth plan worksheet which accompanies Penny Simkin’s book “Pregnancy Childbirth & The Newborn” as it includes page numbers which correspond to the book so you have solid information to look at when making decisions. I don’t recommend handing it over as your birth plan though.  It’s a worksheet to get you started and help you explore options, not a final draft. You can download the birth plan chapter from Pregnancy Childbirth and the Newborn for free here

1 – Once you have a completed first draft or worksheet, go through and highlight what things are most important to you.  If there are elements that are important to you that are not on the worksheet, add them in yourself.

2 - Talk with knowledgeable friends in the birth community (or your doula or independent childbirth educator if you have one) about which of those things are already standard for your caregiver/birth location and remove them from the list.

3 - Once you know which things you want that are NOT standard, sit down with your midwife or doctor and talk about how to make them happen.

4 - Keep the language positive. For example: "I would like the baby immediately placed skin to skin on my chest provided s/he is stable" VS "Do not take the baby to the warmer unless you have to." Or "I would like the clamping and then cutting of the umbilical cord to be delayed until it is thin, white, and limp unless the baby requires supportive measures by staff" VS "Don't cut the umbilical cord until its ready." Nobody likes being told what they can't do, so by reframing your language people can be more receptive to it.

5 - Consider having separate birth plans for both a vaginal birth and a cesarean birth.

My experience as a doula has shown me that birth is natural, normal, beautifully intricate, and a force of nature worthy of our respect.  My experience as a doula has also shown me that firmly held birth plans and birth reality don’t always cross paths.  The preparation of a birth plan can be a useful learning and communication tool, but making a plan and handing it to your caregiver doesn’t mean that your plan will be realized.

Preparing a birth plan can help you sort out what you really want, and whether or not your desires are compatible with the practices of your chosen caregiver and birthing location. If what you want is already the standard of care, there is no need to write it in a birth plan.  If what you want is NOT the standard of care, just writing it down is not sufficient.  You will need to communicate with your care provider and negotiate for your desires in light of their policies, procedures, and preferences.

It is important to think about what things are most important to you, which things are not important at all, and WHY.  If you know WHY something is important, then you can look for alternate opportunities to creatively integrate those important things, if necessary.

Working through a birth plan allows you to explore the pros and cons of all the options. Then, if you have to make a choice you weren’t expecting - a choice that deviates from your expectations and plans of birth - you will already know what your options are and be more prepared to make choices that are right for you.

And sometimes, no matter how carefully we plan, prepare, and negotiate for birth - - things may take an unexpected turn. 

No matter what happens though…. No matter how quickly or slowly your birth unfolds…. No matter how small or large a change you have to make in your expectations and hopes for your desired birth experience…. Whatever happens…. When in doubt…. You can breathe. 

You can choose to soften and relax your body; to keep the pitch of your voice low and open (think about sounding like a mama bear) and you can choose to breathe in a way that nourishes and sustains you and your baby.  You can find a rhythm and a ritual that are meaningful and helpful to you in the moment. Your breath is literally the breath of life to your child, and it is a gift you can continue to give your baby, no matter how your birth experience unfolds.


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