Tuesday, June 5, 2012
When my patients are around 35 weeks of pregnancy, I ask them how their birth plan is going. With first time moms, the most common response includes a look of confusion, followed by, “my plan is to have the baby.” A lot of people don’t know what a birth plan is, or more importantly- why they need one.
Why you need a birth plan is to control as much of your surroundings as possible during a very vulnerable time in your life. It is not uncommon for you to feel scared or helpless during labor, and having control over small details can help. Having a birth plan is not only about small details such as mood lighting and sounds. It is also about big details like how you feel about pain medications, episiotomies, and what is done to the baby after birth.
When starting from square one, I first suggest a woman and her partner get their hands on as many birth stories and videos as possible. Whether this includes watching “A Baby Story”, reading Ina Gaskin’s “Guide to Childbirth”, or renting some educational videos, you may not know how broad the spectrum is for typical births now a day… and how are you supposed to know your options or what you prefer without witnessing/reading about it? Perhaps you prefer being able to walk around freely during contractions, or dim lights, or a waterbirth. Even if you envision giving birth to the 90s hit sensation group “Boys II Men” blasting in the background, it’s your damn birth plan and you can want whatever you want.
That being said, if you’ve decided to give birth in a hospital, you may want to discuss your ideas with your obstetrician before falling in love with any one thing, as many hospitals have rules on what is and isn’t allowed during labor. For instance, a very common “demand” by laboring women is to be able to eat and drink freely during labor to keep up their strength. This may be a black and white, “no” from the hospital as it is their policy to have you prepped for surgery at any given point during labor. But every hospital is different, so just find out the rules of yours.
Once you and your partner have established what you like and dislike about some births and then cleared what is and isn’t allowed with where you’re birthing, then you begin forming your own birth plan. The invention of the internet has made this one of the easiest steps. There are many very helpful websites when it comes to building a birth plan that allow you to just check off boxes from a variety of options and press print. Here is a couple that I send my patients to:
When reading through some of the options provided, you may get the sense that you’re being bossy and telling the doctor or midwife what to do. Although I fully support people taking charge of their birth experience, it is important to be respectful when talking to your doctor. Some of these statements are like telling your accountant “I would like to get a big tax return this year.” Some things are just out of their control and when reality strikes- it doesn’t matter what your plan was. To be honest, I see more birth plans hit the fan once labor starts rocking and rolling- but that still doesn’t mean you shouldn’t have one.
Here are a few of my favorite items to have on a birth plan:
· -Laboring at home as long as comfortable/safe
· - Avoiding inductions at all means possible
· - Eating and drinking freely to keep up strength
· -Moving around freely
· - Controlling surroundings like temperature, lighting, smells, and sound (perhaps you dig aromatherapy and want to diffuse lavender oil)
· -Not being offered pain medications unless the couple seeks it out
· -The ability to try alternative labor augmentation like nipple stimulation before Pitocin or membrane rupture is suggested
· - keeping the hospital “interventions” to a minimum. Every time you need to stop your flow and get your blood pressure checked, checked for dilation, or asked a question- it interrupts what your body is trying to focus on. The more a woman can go inside her own head and tune out everything around her, the faster the body will progress.
· - No episiotomy unless the baby appears to be in danger
· - No forceps, vacuum, or greedy little OB hands pull the baby out. The force from pushes and uterine contractions is usually more than enough to push the baby out. An OB or midwife should simply be there to guide the baby out
· -Baby should go directly to mom’s chest- skin to skin contact is proven to be best for the baby
· - Give the baby a chance to take his or her first breaths on their own without sticking a suction bulb down their throat
There are so many more options and details available to a mother, and these are just the tip of the iceberg.
The last suggestion is even if you don’t think it’s necessary, write your birth plan down and bring copies to your birth. Some people feel that just because they discussed their wishes with the doctor ahead of time, that their birth plan is communicated to everyone on their birth team. Unfortunately this is not usually true in a larger birth setting like a hospital. Over the course of a labor, you may go through numerous nurses that never sat down personally with you or your doctor to discuss your needs and wants. If you find yourself butting heads with a particular nagging nurse- feel free to hand her a birth plan and tell her where to shove it.
Ultimately, remember that a birth plan is just that- a plan. Birth is exciting and unpredictable, and never feel guilty or embarrassed if your birth doesn’t go as anticipated.