On Birth Plans

Some people love them, some people hate them, and some doctors even post notices in their offices that they won’t allow them; but one way or the other most pregnant women have probably heard of writing a birth plan.
What is a birth plan? Most simply put, it is a way for the mother/parents to make her/their preferences known to the birth providers. The typical care provider has many patients at any given time, and can’t really be expected to remember every little thing that you want for your labor and delivery. Some attendants (such as hospital nurses) don’t usually meet the mother until she is already in labor, and have no way of differentiating her from any other laboring woman. Particularly if you want something that breaks from the routine of your chosen provider or location, it’s good to have it written down so that everyone knows.
I have heard some mothers say “oh, well, I’ve had babies with this provider before and everything was great last time” or “but I’m having a homebirth” and they assume that this means they don’t need to write anything down. As I said before though, I think it’s always worth writing things down. YOU may remember your last birth with clarity, but I suspect that Dr Fantastic has attended a few hundred deliveries since then, and he may or may not remember yours very well. Likewise, your adored midwife may have to send her partner if you go into labor at the same time as another mother, and she can’t very well be aware of your contingency plan preferences if you never tell her about them!

Every birth plan is a little different, but here are some basic suggestions for what might be included on one:

• Your name (and—in a hospital—your provider’s name) should be right at the top. You don’t want your plan getting mixed up with someone elses!
• Vital medical information such as allergies, high-risk status, or special concerns about yourself or the baby.
• Who you want present for the birth (or if there are certain people that you want kept out).
• Your preferences for labor—lighting, noise/music, privacy, eating, IVs, internal/external/intermittent fetal monitoring, movement, medication, attendants, etc.
• Your preferences for birth—episiotomy, birthing positions and locations, watching with a mirror, touching the baby’s head during crowning, who will catch the baby, etc
• Your preferences for immediately after the birth—cutting the cord, announcing the sex of the baby, skin-to-skin contact with the newborn, breastfeeding, and standard newborn routines (such as bathing, medications, tests, and shots).
• Your preferences from birth until discharge—rooming with the baby vs the nursery, visitors, binkie-usage, circumcision, or early discharge.
• Your contingency plans/preferences (more on that in a coming post)

Here are a few tips about writing birth plans:

• Keep it simple & short ~ I used bullet points. The version I gave to my doula and doctor was 2 pages, and I went over the items with them each at prenatal appointments. I made a 1 page version for the hospital staff because a nurse had told me that they don’t ever have time to look at multiple pages, and rarely even finish the first one!
• Keep it positive & polite ~ Try to word things with “I prefer____” rather than “Don’t do ____” because the last thing you need is for your attendants to feel defensive. I used phrases like “If possible” “I would prefer” and “Please.”
• Keep it practical ~ Realize that your choice of provider and location is going to dictate a few things, so if you’re birthing at a hospital try saying “I prefer minimal vaginal exams” rather than “Don’t do internal exams unless I ask for them”
• Bold or underline the vital things ~ Remember how they won’t have time to read the whole thing? If you have any drug allergies, put them top, center, and underlined. If you can sum up your other desires in one sentence, put that top, center, underlined, and boldfaced! (Mine was “Please discuss with us the benefits, risks, and alternatives of any procedure before doing it to me or the baby.”)