Birth plans

Birth plans get such a bad rap. A common joke around L&D wards is: "When a woman comes in with an extensive birth plan, might as well start prepping the OR for her c-section." And many expectant mothers will scoff, "My 'birth plan' is to show up and have a baby."

Maybe it's the ridiculous name. Any woman who has been through birth will tell you that it cannot be "planned." The awesome (and totally terrifying) thing about birth is that you have to give yourself over completely to your body and your baby. "Plans" be damned.

But a (good) birth plan is not a minute-by-minute account of how you want your labor to go. It's more of a list of philosophies and preferences that you want to guide your labor. The value of a birth plan is not really the plan itself, but the research and discussion -- with your partner, your provider, and any other parties that might be present (e.g. your doula or family members) -- that goes into it.

In many cases, the problem with a birth plan isn't the birth plan itself, but the communication (or lack thereof) around this. It's like writing a plan for a party that includes a catered meal, but not talking to the caterers about what kind of meal you want -- and then being upset when they serve a five-course sit-down dinner, when you were envisioning a hamburger/hot dog buffet. You might conclude, "Party plans are stupid. Nothing ever goes according to plan." But the meal mix-up really wasn't the fault of the party plan...

My current doula wrote an excellent post on birth plans that talks about this in general: http://bellyupbaby.blogspot.com/2011/04/birth-planning.html.

I'll talk about what I've done specifically.

With Littles
My husband and I had never heard of birth plans until we took our Bradley classes. As part of our class series, we had to write our own birth plan. This is what we came up with:

1. I am hoping to have a drug-free childbirth. Please don’t offer any pain medication. My husband will let you know if I need it.

2. I am GBS positive. I wish to have a hep lock for my antibiotics, not a constant IV. [This was added after I tested positive for GBS at 36 weeks.]

3. I wish to be allowed to drink freely and eat light snacks during labor.

4. I would like to be allowed to move around freely during labor. To this end, I prefer to avoid any IVs, with the exception of my antibiotics.

5. Please monitor the baby intermittently if possible. If constant monitoring is necessary, I prefer external monitoring to internal monitoring.

6. I would like to be allowed to give birth in any position that feels comfortable.

7. I would like to avoid having an episiotomy. If an episiotomy is necessary, I would prefer a pressure episiotomy with no local anesthetic.

8. I do not want time limits placed on labor and delivery (e.g. only two hours of pushing).

9. Above all, I want a healthy baby. If any of my preferences above conflict with this goal at any time, please discuss with me, my husband, and my doula prior to performing any procedures.

That's it. Hardly a minute-by-minute "plan" of my labor.

At my next OB appointment (around 30 weeks, I think), I went over this plan with Dr. K. I never showed her the written document. I just asked her questions, such as, "Will I be able to eat and drink during labor?" Thankfully, just about all of her answers lined up with my preferences, and so I went into labor pretty confident that my preferences would be honored, without having to make a big to-do about my "birth plan." In fact, I don't think I even brought a printed copy to the hospital with me. No need.

I'll eventually get around to telling Littles' full birth story, but in short, most of this "plan" went out the window, because I had to be induced at 42 weeks. Still, Dr. K did a fantastic job of continuing to honor the spirit of my preferences, even if she couldn't honor the letter of them due to the induction. For example, I had talked with her about wanting the option to labor in the shower. A few hours into my induction, she breezed into the room and asked if I had gotten in the shower yet. Um, no: I was hooked up to a constant Pitocin IV, constant fetal monitoring, etc. She said to the nurses, "Take her off all that stuff and let her get in the shower." And they did. I wasn't able to stay in there for very long, but it was just the break I needed to keep going. I don't think Dr. K would've given me that break if we hadn't had extensive discussions prior to the birth about my desire to go epidural-free.

With Noob
Prenatal care preferences, from when we were planning hospital birth:

· I want minimal cervical checks prior to starting labor. In fact, I’d prefer not to have my cervix checked at all. If you do need to check my cervix, you can note my dilation/effacement statistics in my chart, but please do not tell me what they are. The only exception is if we start discussing induction for any reason.

· I do not want any sizing estimates performed via ultrasound. My daughter was 9 lbs 7 oz, so I’m fully expecting this baby to be big as well, but I’m also confident in my ability to deliver a large baby. I feel strongly that sizing estimates will only serve to shake this confidence. If you do need to do a sizing ultrasound, please do not tell me the estimated size unless it dramatically changes our course of action.

· I want to avoid induction. My daughter was born (via induction) at nearly 42 weeks. I’m mentally prepared to go to 42 weeks again. Unless there is a strong medical reason (e.g. pre-eclampsia), please do not even mention induction until at least my 41 week appointment.

I started talking about all of these preferences very early on. I think I asked J about whether she'd wait till 42 weeks to induce at my 10-week prenatal appointment :) These were serious dealbreakers for me, and so it was good to confirm that I was on the same page with my midwives right from the start!

Birth preferences:

I understand that birthing a baby can be unpredictable. Ultimately, I want my health/safety and that of the baby’s to take precedence. In all non-emergency situations, please discuss all proposed procedures with my husband and me, so that we can direct the decision making with informed consent.

Labor:

· I intend to have as natural a labor as possible, including freedom of movement, intermittent monitoring, and a hep lock instead of a constant IV. I am hoping to birth without pain medication, but will let you know if I need it.

· I will be practicing self-hypnosis (Hypnobabies). Maintaining my positive frame of mind regarding birth is very important to this process. Please avoid using words such as “pain,” “hard work,” or other words with negative connotations in reference to birth.

· I’m a former Ironman triathlete and approach labor just as I approach an endurance athletic event. I know that keeping my energy levels up and staying hydrated is important in both! Please offer me clear liquids, such as juice and popsicles.

· I don’t mind cervical checks, but please keep them to a minimum.

· I have rented a birthing tub and would like the option to use it. I would also like a birthing ball.

· I hope to birth without the use of Pitocin. If it is required, I request that it be administered following the low-dose protocol, and increased in intervals no closer than every 30 minutes, allowing my body an appropriate amount of time to adjust and react to each increase.

· If continuous EFM is required, I prefer external EFM to internal EFM.

· My husband and my doula will be present throughout labor. My two-year-old daughter may be present as well, along with one person (other than my husband or doula) to support her. Please turn away other visitors.

Birth:

· I want to “labor down” as much as possible and wait until I feel a strong urge to push.

· I hope to follow my body’s urges to push. Please do not count or otherwise direct my pushing.

· I would like to push in any position that feels comfortable. I welcome advice on positions that might be productive.

· Please allow any visitors present to take pictures and/or videotape the birth.

· We do not know the baby’s sex. Please allow us to see for ourselves, rather than calling it out.

· I would like to have the baby brought to my chest immediately for skin-to-skin contact. Please delay routine procedures (weighing, eye ointment, etc.) for as long as possible.

· My husband will cut the cord. We plan to donate the cord blood.

· I wish to nurse immediately after the birth and would appreciate assistance with this.

Emergencies:

· If the baby and I need to be separated for any reason after delivery, I want my husband to go with the baby and my doula to stay with me.

Again, most of this was discussed with my midwife ahead of time, to ensure I wasn't asking for anything that wasn't possible. For example, the reason I specified that I wanted access to clear liquids was that my midwife told me that hospital policy didn't allow for eating/drinking freely (which is really my preference). The hospital did have birthing balls and allowed mothers to rent birth tubs, hence why I included a reminder that I wanted access to both of those.

Of course, we ended up switching to homebirth. I didn't even bother showing this plan to C, because everything on it was either her norm (such as not calling out the sex of the baby) or not possible in homebirth (such as a constant IV or Pitocin).

With Q
I have even less of a need for a birth plan this time around, since again, most of my preferences are C's norms (assuming a non-emergency situation), and she also knows first-hand how I act and what I need during labor! There's also no need to write anything down; it's not like I'll need to inform some nurse I've never met before of my preferences.

We did do a brief "birth plan" during our home visit, including things like:

• Who will be present? (Me, my husband, midwives, doula, birth photographer. Also, probably both older kids, along with someone to care for them.)
• Water birth or no? (C assumed correctly that I'd like to try it again, although I don't have my heart set on it)
• Who will catch the baby? (Me! I gave first dibs to my husband, but he has no interest :)
• Who will announce the sex? (My husband)
• Who will cut the cord? (My husband and Littles)

Besides those things? My "birth plan" is to show up (well, really, for C to show up) and have a baby :)

In conclusion
If you're writing your own birth plan, feel free to steal from mine, either in pieces or in their entirety. There are also lots of online birth plan generators, such as this one or this one.

Just be sure that you research every point that's on your birth plan, and understand why you are asking for it. Don't copy my birth plan with Littles that talks about a pressure episiotomy if you don't know what that is and why you might prefer it. Remember, the value of a birth plan is not in the plan itself but in the research and discussion that goes into it. If you don't research a particular point, then you can't discuss it at an intelligent level -- and that doesn't help anyone.