“My doctor told me to keep my birth plan short and to the point, how do I fit in everything I want to include? I don’t want to be too demanding.”
“You can’t really PLAN labor, won’t my care provider tell me what I need to know?”
“A friend of mine brought a bunch of copies of her birth plan to the hospital when she went into labor and no one even looked at them!”
“I’ve read online that care providers and labor and delivery staff laugh in the face of birth plans. Should I even write one?”
“My sister is a labor and delivery nurse, she warned me that moms who write long birth plans are the ones who end up with a bunch of intervention and babies born by c-section.”
As a doula and childbirth educator I work closely with women, and their partners, as they prepare for the intimate life event of birth. I encourage every family I work for to develop a birth plan as part of their childbirth preparation, and as an integral step in their personal journey to becoming better informed consumers of maternity care.
The dismissive messages that often characterize discussions around birth plans undermine their many benefits and true purpose as a communication and information gathering tool. The process of writing a birth plan serves in at least three ways:
- To help you to identify your needs and wants for labor, birth, and postpartum care.
- To begin, or continue, a dialogue about your needs and wants with your care provider in the context of her practice style, and the policies and procedures routine to your chosen birthing place.
- To engage your birth team to facilitate and support your birthing goals.
Reframe the value of your birth plan as the PROCESS by which the document is created and the degree to which you utilize it as a communication tool before labor begins. To merely present a birth plan document to Labor and Delivery staff on admission to your birthing place is to miss out on many of the benefits of having created the document in the first place.
You may have heard the saying, “If you don’t know your options, you don’t have any.” In birth this is especially true. A thoughtfully drafted birth plan empowers you with the information you need to have informed choice.
So, what is the process to developing a birth plan that will serve you well and better inform your birth experience?
Step 1: Explore Your Options:
Pregnancy, Labor, Birth: Learn about the common interventions used to induce, augment, and manage late pregnancy, labor, and birth. Consider how each intervention can impact the physiological processes of normal birth. Understand how each intervention may benefit or risk your health, or the health of your baby, and under what circumstances they may be considered medically necessary. Understand the Cascade of Intervention—a term used to describe the chain of events that occur when the unintended consequences of one intervention lead to or necessitate additional intervention—and develop an appreciation for the ways in which your options in birth can be limited by these unplanned and unwanted side effects.
Newborn Care: Research your options around the newborn care topics of: cord clamping, skin-to-skin care, vitamin K injection, hepatitis B immunization, erythromycin eye ointment, and baby’s first bath. Learn about the evidence-based practices that promote breastfeeding and bonding immediately following birth like placing baby skin to skin, uninterrupted time, and rooming-in.
Cesarean Birth: Consider your options (you still have many!) and identify your priorities in the case that your baby is born by cesarean section or other unexpected event like preterm birth.
If this first step feels overwhelming, here are a few ideas on where to begin:
- Enroll in an independent child birth education course
- Read The Thinking Woman’s Guide to a Better Birth
- Download a copy of the Business of Being Born, you can also stream it on Netflix
- Talk to your Doula for information, guidance, and additional resources. (Need a doula?)
Step 2: Identify Your Birth Values and Beliefs
Consider everything you know, take note of what you may still have questions about, and discuss with your partner what feels right for you assuming an uncomplicated, normal labor and birth. Discover together your shared birth philosophy. Along the way you will develop a position on how you would like to have handled variations of normal labor and birth, as well as any unexpected situations that may come up.
Write a Draft Birth Plan that incorporates your desires and priorities from late pregnancy to the immediate postpartum period. Resist the urge to sensor your desires to fit in with what you think your provider will allow. This is your baby and your birth. It is appropriate to articulate what you need without reservation. If you want to eat and drink to ensure that you are well-nourished and hydrated to do the work of labor, write it down! If you prefer to forego routine IV preparations, wear your own clothes, and have freedom to labor and push in whichever positions feel most comfortable, write it down!
There are many online resources that may help you to organize your thoughts on paper. I really like The Win-Win Birth Plan by Penny Simkin, The Ideal Birth exercise, and these sample plans.
Step 3: Share Your Draft Birth Plan with Your Care Provider
Once you have researched your options, discovered your birth philosophy, and written it all down in an organized brainstorm, now it is time to use your Draft Birth Plan to begin a conversation with your care provider in order to better understand how she will help you to meet your goals.
Through this dialogue you will gain a better understanding for your care provider’s style–her attitudes, values, and personal beliefs around birth. You will learn more about your birthing place’s routine policies and procedures. You may discover that your philosophy is different from your provider’s, or that your birthing options are limited by the policies in place at your chosen birthing location. You will need to decide if and where you feel you can compromise and also determine your care provider’s willingness to adjust her care practices to accommodate your needs.
If you find that your birth plan is written to protect yourself, or your baby, from your care provider or chosen birth place, listen to your intuition. Consider switching providers to hire someone who more closely shares your personal philosophy. Choosing a care provider and choosing a place to give birth are two of the most important decisions you will make as you prepare for your baby’s birth.
Step 4: Revise, Revise, Revise
When you feel you have a good idea for what you can expect from your care provider and birthing place, revisit your Draft Birth Plan and review what you’ve written.
To help you to pare down the content DELETE the items that you know are considered standard or routine at your birthing place, unless you feel very strongly about them and wish to emphasize your preferences by retaining them.
Continue to revise and discuss with your partner and care provider until you have all the information that you need to feel confident that your birth plan is relevant to your birthing environment and accurately reflects your birth philosophy. It may take two to four revisions (or more!) to arrive at your Final Birth Plan.
Step 5: Create a Final Birth Plan:
Your Final Birth Plan should be succinct, easy to read, and one page in length. Before labor begins: share copies with your care provider, doula, and any friends or family who may be present in a supportive role for you and your partner. Print off enough copies (5-8) to share with nursing staff, student learners, and to accommodate any shift changes that may occur. Bring the copies with you to your birthing place in order to quickly and effectively share your birth goals with your team and supportive staff on Birth-Day.
