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The best laid plans Labor & Delivery

The best laid plans

Is it wise to outline your ideal birth experience beforehand—even if baby’s debut might take an unexpected turn?

In 2012, I waddled around the halls of a sterile-but-friendly hospital on my highly anticipated birthplace tour. My husband and I proudly toted our birth plan and a list of questions, eager to gather information and piece together the puzzle of our baby’s imminent arrival. But when I posed a question to our tour guide and referenced my birth plan, she scoffed and suggested I might as well tear it up—“Birth plans never go as planned!”

This pessimistic outlook crushed my hopeful—albeit naïve—attitude and left us feeling helpless. What was the purpose of attending our natural childbirth education classes and working so hard on our birth plan if it was only going to be thrown out the window?

For good reason
A birth plan is an outline of your ideal labor, delivery and postbirth  experience. It’s a written document that details your preferences and brings your birth team up to speed on your desires—both in terms of what you want to happen and what you don’t. Although they can occasionally be controversial, there are plenty of positives that can come out of writing one.

For starters, the process of creating a birth plan provides the opportunity
for expectant couples to learn about and prepare for the various events that could take place on the big day. It encourages parents-to-be to learn the ins and outs of their options, so they can decide what’s best for their family.

Take time to discuss some of your preferences with your partner in advance. This will help you both avoid feeling caught off guard in the moment. How do you want to cope with labor pains? What interventions are you OK with? Who will be allowed in the delivery room? Would you like a mirror to see the birth? Will your partner be cutting the cord? Maybe even catching the baby? Do you want to save baby’s cord blood? How soon do you want to hold your baby after birth—right away? After a quick cleanup? There’s a lot to think about!

Whether self-taught or instructor-led, couples who are knowledgeable about the many choices they have can ultimately describe their preferences in a birth plan.

“[Birth plans] are effective only if the mom and partner are educated on the birth process and interventions that may be used if the need arises,” explains Atoosa Benji, certified Bradley Method childbirth educator and doula in the Los Angeles area. “A birth plan is ineffective if … the person checking off the boxes does not understand that certain options are mutually exclusive of others.”

A well-written birth plan can help couples stand their ground during labor when pressure from medical professionals might sway them to deviate from their intentions. But it should also be flexible enough to accommodate a medical emergency when time is of the essence.

Mom’s and baby’s health are always paramount, but under normal circumstances, birth plans bridge the gap between the couple’s desires and the birth team’s usual practices. It’s a meeting of the minds in which the couple states their wishes.

Where to start
The keys to writing a great birth plan are personalization and brevity. Start with a welcoming sentence or two introducing yourself and
your birth team.

“I like to advise clients to start with a short paragraph thanking the providers in advance for helping [them] meet [their] goals for labor and birth,” says Jami Hain, CNM, MSN, owner of Nativiti Family Birth Center & Women’s Health Associates in The Woodlands, Texas.

Include the name of your prenatal education class and your ultimate goal of ensuring the health of you and your baby. Next, organize your plan by categories: labor (first stage), delivery (second stage), and aftercare for mom and baby (postpartum). Use bullet points to concisely express your preferences.

A recent study in the Journal of Obstetrics and Gynecology Canada
determined the most salient points of a birth plan cover: “pain management, comfort measures (e.g., mobility during labor), postpartum preferences (e.g., breastfeeding), atmosphere (e.g., privacy) and birthing beliefs (e.g., cultural views).”

Remember to include notes regarding C-sections, in case one should become necessary. Additionally, if you’re planning to deliver at home or at a birth center, indicate which hospital you’d like to transfer to should the need arise.

Your birth plan should be no longer than one page. Particularly in a hospital setting, medical staff has limited time, so keeping birth plans to one page is not only courteous, but it also ensures your providers get all of the important information quickly. (You wouldn’t want doc to miss something crucial because it was buried on page three.)

Presentation is everything
After writing your birth plan but before giving birth, discuss it with your health care provider, so she can sign off on your decisions. You want to be sure you’re on the same page when the time comes.

For the best results, don’t think of it as a “you vs. doc” scenario. Instead, go into the appointment with a good attitude, and introduce your birth plan in an assertive manner, not an aggressive one. Lead with positivity, and your requests will more likely be met.

Make it clear that you share the end goal of delivering a healthy baby, and support your decisions by briefly explaining your reasoning behind them—what you learned in birth class, what you read in the prenatal literature you picked up and what you’ve discussed with your partner. Explain that your birth plan depicts a normal scenario and that you’re comfortable with deviating from it if medically necessary.

If you share your birth plan and your provider is dismissive or unaccommodating, don’t be discouraged. You’ll have your partner (or mother, or BFF, or doula) to support you on the big day. Just make sure these key players are familiar with your plan ahead of time, so they can communicate your wishes when you’re in the throes of labor. If you’re truly uneasy about how your birth plan was received, it may be time to consider a switch in providers.

Worth writing
The value of a birth plan stems from the process of writing one. Whether you
envision a home birth, a scheduled cesarean or something in between, a birth plan allows you to describe your preferred birth story. The formative moments that occur during the process nurture your commitment to your growing family.

The 40 weeks of pregnancy allot you plenty of time to research your options, write them down and ultimately discuss them with your partner and care provider. This process enhances intimacy and openness among everyone involved.

A birth plan is a guide—a concrete method to communicate your wishes, not
a magic eight ball. Approach it with an open mind, remain flexible, and keep your expectations realistic—because no matter how thorough your research or how detailed your plan, bringing a baby into the world is rarely straightforward or predictable. You, your partner, your birth team and your baby determine how your experience unfolds. But if there is education, trust and communication, there will be confidence in how your birth story is created.

Molly England is a certified Bradley Method natural childbirth educator.