IN THIS CHAPTER
Understanding the basic idea of a birth plan
Considering all your options
Planning early — before contractions begin!
Making informed choices
Steering clear of birth-plan snafus
You may be wondering how anyone can “plan” birth. Although you obviously can’t plan every aspect of what will happen when you give birth, you actually have many options. Creating a birth plan gives you an opportunity to research and consider the many aspects of childbirth that can be planned, many of which you may not have known about otherwise. After your plan is put together, you can use it to communicate your wishes to your birth team.
This chapter introduces you to birth plans and their benefits, gives a general overview of birth and postpartum options, explains how you can make informed decisions, and provides tips on avoiding common birth-plan pitfalls.
What’s a Birth Plan? And Why Would You Want One?
Put simply, a birth plan is a document you create to communicate your wishes and requests to your medical practitioner, the birth team, and your support team (whether that’s your partner, a doula, or someone else). You write the plan months before labor begins, when you have time to research and think through your options — preferably before contractions make concentrating difficult! Planning ahead also allows you to switch medical practitioners if your current doctor or midwife isn’t on board with your plans.
Despite the name, a birth plan also includes your wishes for the immediate postpartum period, like how you intend to feed your baby and where you want her to sleep if you’re giving birth in a hospital. Birth plans also cover the fun options, like who will announce the baby’s gender and who cuts the cord. This section explains the reasons you should consider writing a birth plan.
Making informed choices with a clear head
You may wonder why you should bother considering all the many options for dealing with events that may not even happen during your birth. The reason is simple: Thinking straight is much easier when you’re not in labor. And unless you bring your laptop into the labor room, researching your choices is difficult when you’re in the trenches, so to speak.
Technically, whenever your medical practitioner recommends a birth intervention — like induction, or attempting to initiate active labor — he should also tell you the potential risks and benefits. In an ideal world, you’d also be given alternative options to consider. For example, on the subject of induction, your doctor could explain the choices of giving you oxytocin (Pitocin) intravenously, trying something natural first, or taking a “wait and see” approach before augmenting labor. If he thoroughly explains all three options, you can give true informed consent, which means agreeing to a procedure only after understanding what’s involved.
In practice, informed consent for many procedures is covered extremely quickly, way too fast for you to process the information and make an informed decision. Frequently, procedures are not explained at all, especially if they’re routine (which doesn’t necessarily mean risk-free), or the procedure is presented as if you have no other options. Even if you have an amazing medical practitioner who really explains your risks and alternatives, you may have difficulty thinking through decisions when you’re in the middle of labor.
Creating your birth plan allows you to research your options when you’re feeling calm and collected. You still may have to make difficult decisions in the midst of labor — after all, birth isn’t completely plan-friendly — but at least for straightforward issues, you’ll be ready.
Visualizing your ideal birth
Everyone’s ideal image of birth is different. One mother may consider the perfect birth to be in a well-equipped hospital with an immediate epidural, and another mother may consider her perfect birth to be at home, with no drugs, and in a birthing pool. There’s nothing necessarily right or wrong about these different visions (although most people think their ideal birth is the best one!). Every birth choice has its risks and benefits, but many birth choices have more to do with comfort and personal philosophy than statistics.
Don’t panic if you’re thinking, “But I have no idea what I want. I don’t even know what my options are!” Lots of moms and dads have no idea what they want at the beginning of the pregnancy. In fact, their “ideal birth” may change from pregnancy to pregnancy. As you find out more about birth and about birth plans, you’ll get a better idea of what you want. For a general overview of your options, skip ahead to the section “Your Birth-Plan Options: An Overview.”
Putting what you want on paper for your care providers
A written birth plan helps you communicate your concerns and wishes to your medical practitioner. Discussing your plans for childbirth before you go into labor is essential, and having a written plan in hand can be a huge help.
Never assume your medical practitioner’s idea of the perfect birth is similar to your own. Even if your chosen care provider shares your birth philosophy, you should still write down your wishes to prevent misunderstandings.
If you’re giving birth in the hospital, you have very little control over which nurse you get, and you get very little time to discuss your birth plans with her. Most nurses want their patients to have a healthy and positive birth, and a written birth plan makes it easier for them to provide you with what you want.
Just writing your plan down won’t magically make your birth wishes a reality. Not every option is available in every birth location or with every medical practitioner. Even if the option is available, you still need to advocate for yourself beyond handing your nurse, midwife, or doctor a written birth plan.
Your Birth-Plan Options: An Overview
Congratulations on one of the most exciting times of your life: pregnancy and the birth of your baby. Like for any big event, you need to do some planning if you want birth to go smoothly. A birth plan not only helps you to cope during labor and delivery; it also helps you think clearly and logically about the kind of birth you want and what that requires.
Topics your birth plan covers
This chapter mentions birth-plan options a lot, but maybe you’re wondering what those options actually are. Here’s a list of the basics:
· Where do you want to give birth? You may give birth at home, in a hospital, or at a birth center. You also should consider which hospital or birth center to choose. Finding out whether delivering at home is legal in your state is also important.
· What kind of practitioner do you envision? You may decide on an obstetrician or a midwife. You may or may not want to stick with your current gynecologist or midwife. Refer to Book 1, Chapter 2 for tips on choosing your medical practitioner.
· Who will support and advocate for you during labor and delivery? Your significant other is not the only option for labor support. You may consider hiring a doula to work with your partner or as your sole support. You may also choose a friend or family member for this role.
· Whom do you want to invite to the birth? You can invite friends and family members to the birth, either to wait down the hall or be by your side in the delivery room. You may even consider including your older children at the birth. Or you and your partner can be alone, inviting family after the baby arrives. Rules for how many visitors can be present during the delivery vary from facility to facility and can change based on emergent situations.
· Do you want a natural childbirth? Women choose natural childbirth for a number of reasons, from concerns about epidural risks to wanting a “natural experience.” If you decide to use pain medications, you have a number of pain-relief options, from epidurals to walking epidurals to IV narcotics.
· What comfort techniques will you try? Pain drugs are only one way to get relief from labor pains. To name just a few other options, you can use massage, hydrotherapy, or hypnosis. Even if you plan an epidural, you probably won’t be able to get one right away, so having an arsenal of comfort techniques is important.
· What birthing tools or props do you want to use? Birthing props and comfort tools are not only fun but also extremely helpful! You may decide to use a birthing pool, a squat bar, a birth ball, or massage tools. Even your music choices can be important for the birth. Checking with each facility to see what’s available and what you can bring to the hospital is also a good idea.
· How do you expect to stay active during labor? If you assumed you’d be lying in bed for the entire labor, think again! Many positions and movements can be helpful during labor, and remaining active has lots of benefits.
· Will you accept an IV for hydration, or do you hope to drink fluids on your own? IVs are routine in many hospitals but not all, and you have options. You may even be able to eat and drink lightly.
· What kind of environment do you hope for during delivery? Perhaps you’d like a meditative environment, with ocean waves playing in the background. Or perhaps you want upbeat music to energize you.
· What kind of monitoring do you want? If you’re getting an epidural, continuous monitoring is required, but if you’re hoping for a natural birth, you may be able to have intermittent monitoring.
· How do you feel about induction and speeding up labor? Induction is a controversial topic, especially when done for convenience or when scheduled before your due date. Labor augmentation (speeding up labor) is another touchy topic, and your medical practitioner plays a big role in your options.
· How do you want to push? Surprise: You don’t have to push while lying on your back! In fact, you’ll probably have an easier time if you don’t. You may even choose to have a water birth.
· How do you envision the delivery of the baby? Are you hoping to help guide the baby out (with the help of your practitioner)? Do you hope to watch the delivery in a mirror? If you don’t know the sex, do you want your medical practitioner to announce it, or do you want your partner to tell you?
· Do you prefer to receive an episiotomy (surgical incision) or to tear naturally? Some (but not all) women prefer to tear rather than be cut, and in an emergency, an episiotomy isn’t always an option.
· What are your feelings about cesarean section (C-section)? Some women are fearful of C-section, whereas others actually opt for one (sometimes without medical reason). In the past, after you had a cesarean, you always had to have a cesarean with subsequent babies, but now many women can try for a vaginal birth after cesarean (VBAC). If you do need a C-section, you have options — yes, even for a cesarean! — like lowering the drape to watch the delivery or breastfeeding on the surgical table.
· Who will cut the cord and when? Do you want the baby placed directly on your chest after birth or cleaned up and weighed first? A number of birth-plan choices are relevant to the moment your baby is born.
· What do you want to do with the placenta? You even have options regarding the placenta! For the delivery of the placenta, you may request that the medical practitioner not use controlled traction and allow a natural delivery of the placenta. You also may request that the birth team save the placenta for you so you can make a “placenta print” or bury your placenta in the back yard.
· Do you plan to take pictures or video of the birth? Some parents want pictures only after the baby is delivered, but others want photos of the entire birth experience.
· How do you plan to feed your baby? Will you breastfeed, bottle-feed, or do a little of both? Some bottle-feeding moms face bottle guilt, but breastfeeding isn’t always possible or desired. Some hospital routines unintentionally sabotage breastfeeding mothers, but your birth plan can include requests to avoid some potential problems. See Book 5 for more on nourishing your baby.
· Where do you want your baby to sleep?Full rooming-in means your baby stays with you around the clock, while partial rooming-in means your baby sleeps in the nursery.
· What drops, shots, and tests do you want for your baby? If you have a baby boy, do you want the hospital to do a circumcision? Vaccinations are a hot topic in the United States. Some parents decide to forgo all shots, while others accept them all, choose selectively, or delay them. Circumcision is also a hot topic, and parents who decide to snip may or may not want to do so right after the birth or at the hospital.
Considering alternative birthing methods
More and more women are expressing interest in nontraditional or alternative birthing methods, and more and more options are available. Certainly, the following options aren’t for everyone, but knowing what’s possible can be helpful.
Delivering without anesthesia
Natural childbirth usually refers to giving birth without any medications or anesthesia. (It’s probably not the best terminology, because using pain medication doesn’t make the birthing process unnatural.) The theory behind natural birth is that childbirth is an inherently healthy and natural process and that women’s bodies are made to handle childbirth without the need for medications.
Natural childbirth allows you to have a great deal of control over the childbirth process and your own body. It emphasizes having you choose which positions are comfortable, how mobile you want to be, and which techniques you want to use to be as comfortable as possible. Natural childbirth can be practiced in a hospital setting, in a birthing center, or even at home. Some practitioners aren’t comfortable with every aspect of natural childbirth because they don’t want to be limited in doing what they feel is medically necessary and important. Discuss with your practitioner what he feels comfortable with so your delivery can be as great of an experience as possible.
Giving birth at home
For some women, a home birth provides an ideal environment to deliver their baby. Common reasons for choosing a home birth are the desire for a low-intervention birth; a desire for control over the birth process; a desire to give birth in a familiar and comfortable environment, surrounded by family and friends; living in a rural area with lack of access to a hospital; and economic, cultural, or religious issues. Typically, a midwife usually attends a home birth, and an obstetrician is on call in case problems arise. Home births are certainly more appropriate for women who are at very low risk for complications. Although some studies demonstrate that home births are associated with greater risks for both the mother and baby, others show that home births are at least as safe as hospital births for healthy, low-risk women.
Home births are still relatively uncommon in the United States, with fewer than 1 percent of women choosing to deliver at home. Although respecting the right of women to make medically informed decisions about where they want to deliver, the American Congress of Obstetricians and Gynecologists, in agreement with the American Academy of Pediatrics, believes that hospitals and birthing centers are the safest settings for births and has published the minimum criteria for planning a home birth, which include the following:
· A singleton pregnancy with the fetus’s head down
· No medical or obstetrical conditions
· No contraindications to vaginal birth
· A licensed obstetrical caregiver to administer the prenatal, labor, birth, and postpartum care
· A backup hospital within 15 minutes of the home
In addition, and of prime importance, is that women completely understand that although the absolute risk of home births is low, home birth is still associated with a two- to threefold increase in neonatal death when compared with planned hospital births. Also, home births aren’t legal in all states.
Using a doula
A doula may be a friend, relative, or trained companion who provides nonmedical, continuous support during labor and delivery. Doulas often meet with prospective moms before delivery so they get to know each other. During labor, they provide both emotional support and physical support — helping to get moms into comfortable positions, massaging their back or legs, getting water or ice chips, and so forth. Some studies have shown that labors attended with doulas may actually be shorter in length, although there is no effect on cesarean delivery rates. Women who used doulas also seemed to have a slightly better overall birth experience and were more likely to rate their labor and delivery as “very good.”
Immersing yourself in a water birth
In a water birth, much of labor is spent immersed in water, and the baby can even be delivered in the water. Water births usually take place in a birthing center with the help of a midwife, although some hospitals may provide birthing pools or baths. The water temperature is kept about the same as the body temperature, and the woman’s temperature should be monitored throughout labor.
A recent review of randomized trials found a somewhat lower rate of anesthesia when water immersion was used in the first stage of labor. Interesting, prolonged immersion for more than two hours may actually slow down labor by decreasing the production of oxytocin. Although some professionals in the medical community feel that a water birth is a safe procedure, others have more serious concerns about its safety for both the patient and newborn. Water immersion during the second stage is not well studied. There have been a few cases reported of water aspiration and snapped umbilical cords, difficulty regulating body temperature, and infections in the newborn. Also, not all facilities are equipped for water births.
Why planning must begin early in pregnancy
Although many options exist, everything isn’t available in every birth facility or with every medical practitioner. Birth location policies and your medical practitioner’s practices have a big effect on your options and on the chances of getting the birth you want. Planning early for the birth gives you time to do the following:
· Interview medical practitioners: If you start planning early, you’ll have more time to consider the right practitioner for you and have time to switch if necessary. Book 1, Chapter 2 discusses choosing a practitioner.
· Tour your chosen birth facility: You can’t make a real decision about where to deliver until you’ve been there. Tour a couple of hospitals or birth centers to evaluate where you’d feel most comfortable. Because where you give birth is often connected to who attends the birth, tour early in your pregnancy in case you need to switch practitioners.
For a home birth, early planning is recommended so you can check your local home-birth laws and find a medical practitioner. Don’t make the mistake of thinking all home-birth practitioners share your birth philosophy. You also need to prepare your home, which may include gathering supplies or renting a birthing pool.
Making Smart Choices When You’re Not a Doctor
Plenty of mothers-to-be are intimidated at the thought of considering the pros and cons of a medical procedure — especially if they then decide to go against their medical practitioner’s protocols or routines. If you feel unqualified to make decisions about childbirth, the good news is you’re not the first person to confront all these choices, and you don’t have to make them on your own. This section explains how you can educate yourself on your birth options and who you can ask for help when you can’t decide what to do.
Getting an education
If you want to make decisions about your birth plan, medical training is not required! You can get the information you need to make informed choices by taking childbirth-education classes and researching birth on your own. Childbirth-education classes aren’t only about teaching natural childbirth methods, though most encourage natural labor and spend a great deal of time on comfort techniques. The rest of class time is spent talking about the mechanics of normal childbirth and the pros and cons of various interventions. Your education doesn’t have to stop there. Reading about birth in books and doing online research can help you write your birth plan.
Consulting the experienced and the wise
Here’s more good news about writing your birth plan: You don’t have to do it alone! You can ask for advice from all the following people:
· Your medical practitioner: Although your medical practitioner has his own concerns regarding your birth choices — including malpractice suits and sometimes his own convenience — he is still an excellent resource when you don’t understand some issues or want more information.
· Your childbirth educator: Most childbirth instructors are happy to help with birth questions and can even help you write your plan or be willing to read over what you’ve put together.
· Your doula: Part of a doula’s job is to help advocate for your birth choices, and that includes helping you with your birth plan. A doula can also give you inside information on local practitioners and birth locations, which can be a huge help.
· Other experienced moms and dads: Anyone who has gone through childbirth can serve as a resource when you’re creating your own plan. Friends and relatives can tell you what they wish they had done differently and what was just perfect. They may also be able to give feedback on local medical practitioners and birth locations; just be sure to ask why they liked a particular place or person. Remember that everyone visualizes the perfect birth differently and that everyone’s circumstances are different.
Avoiding Potential Birth-Plan Pitfalls
Birth plans make pretty great advocacy tools, but they aren’t always perfect. Here are some common pitfalls and how you can avoid them:
· Not making a plan because you feel overwhelmed: Considering all the options for your birth can be overwhelming. So many choices to make! If you feel exhausted just thinking about it, remember that you don’t have to have an opinion on every aspect of birth. Just because you have options doesn’t mean you must specifically choose one or the other.
If you don’t have strong feelings about an issue, you can go with whatever your medical practitioner suggests or whatever feels right in the moment. Creating your birth plan should be an energizing experience and a chance to really take charge (as much as possible) of your birth experience. The key is to feel empowered, not overwhelmed, by all your choices.
· Assuming a birth plan is only for natural births: Many aspects of the birth and the immediate postpartum period have nothing to do with using drugs or not. Even within the option of using an epidural, you have choices, like when to start it, whether you want a walking epidural, and whether you want it turned down when it’s time to push.
· Being inflexible: Critics of birth plans say that they set women up for disappointment. If a couple’s birth goes badly, they may feel they failed in some way, like their plan wasn’t good enough.
Creating a birth plan isn’t about trying to control birth, and it’s not about restricting the possibilities of what’s considered a positive birth experience. If you keep in mind that your birth plan isn’t a contract but more of a flexible guide, you’re less likely to feel disappointed if a few little things go differently than planned.
· Not standing up for your decisions: Writing down your birth wishes is only the first step to getting the birth you want. You also need to speak to your practitioner before labor begins if you want him on your side. During the birth itself, you’ll likely need to work with the nurses and advocate for your plan, especially if your wishes run contrary to the hospital’s routines.