As a doula, I hear a lot of different opinions about birth plans. One thing I used to hear a lot is that a birth plan is a “ticket to the OR.” I also sometimes hear, “Well, you can’t plan a birth.” And it’s true: childbirth is unpredictable. But a birth plan isn’t a plan for what will happen, it’s a communication tool to let your provider and other caregivers know what your wishes are, and when people joke about them, what they’re really doing is dismissing the pregnant person’s right to have a say in her birth. Nothing makes me happier than seeing a nurse carefully looking over a birth plan to make sure she knows what a birthing mother wants. And I’m happy to say that in the hospitals where I normally attend births, I’ve been seeing birth plans being read and followed lately. Here are a few tips for making a birth plan that will work for you.
Do your research.
It may seem obvious, but before you make a document expressing your wishes about birth, you need to know what your wishes are! It’s really helpful to read up on what the evidence has to say about common practices in childbirth. Some of my favorite places to look are Evidence Based Birth, the Cochrane Reviews, and Childbirth Connection. These sources and others can give you a good idea about the pros and cons of different labor interventions and help you make informed choices.
Know your real life options.
You may have a great list of wishes for your birth, but do they fit with the birthplace and provider you’ve chosen? It’s important to know what options are actually available to you. For example, you may want to labor in a bathtub, but if your hospital doesn’t have tubs or allow portable ones to be brought in, you will either have to change your birth plan or change your venue. The same thing goes for your provider. Some providers are completely comfortable with catching a baby when mom is pushing on her hands and knees or kneeling on the floor. But some providers are not willing to do that. It’s important to talk with your doctor or midwife about how they practice so you can know if they are a good fit for the kind of birth you want.
Don’t mention things that are in your control.
Do you want to use music during your labor? Great! Bring it with you. But don’t include it on your birth plan. It has nothing to do with what your nurses or provider will need to do. When you leave off things that are in your control, you leave a list of wishes that cut to the chase and are relevant for your medical team.
Leave off wishes that are in line with default hospital policy.
I will tell a story on myself. When I was getting ready to have my first baby, I wrote a birth plan that included things like, “Please do not give me an enema.” After spending hours on my carefully constructed document, I presented it to my doctor. He looked kind of confused. Why? Because they don’t normally give people enemas when they arrive in labor. Nor do they give them a shave. They might have done so fifty years ago, but not any more. I didn’t need to have those things on my plan. When you leave off wishes that are already in line with hospital policy, you leave room for more important items, and you also keep yourself from looking uninformed.
Plan for the unexpected.
You may be planning for an all-natural, unmedicated, vaginal birth, but sometimes birth will throw you a curve ball and interventions can be truly needed. Because birth can be unpredictable sometimes, it’s good to include some points in your plan about what you want if things take a different path. For example, it’s a good idea to include any preferences you might have in case a cesarean becomes necessary.
Keep it SHORT– One page with LOTS of white space.
This is a tough one for some people. They have so many things they want to make sure the staff knows! But I’m here to tell you if you don’t already know that nurses do NOT sit around playing cards, they are BUSY. And you want to make a document that they can scan over in a minute and comprehend quickly. If you write a treatise, it will most likely go unread. The very best birth plans I’ve seen lately have been short, bulleted lists of what the moms did and didn’t want for their labor and for their baby. That’s what the nurses really want to know: What do you want? and what do you want to avoid?
Share your plan with your provider ahead of time.
This is where the rubber starts to meet the road. After you’ve drafted your plan, show it to your doctor or midwife at your next appointment. This is one of the main reasons to make a plan: to communicate your wishes to your provider. This gives them a chance to let you know if they have concerns with your plan, and it lets you see how comfortable they are with your preferences. If things go well in this discussion, you can go into your birth encouraged that your wishes will be heard. If your provider seems to hedge a bit when discussing some of your wishes, that lets you know that you might not get the kind of cooperation you are hoping for. And of course, sometimes there are legitimate medical or safety concerns that you might not have been aware of previously. If you feel confident that your preferences are reasonable, but your provider doesn’t feel comfortable with them, you will have to decide if you want to stay with your provider and give up some of what you want, or if you will change providers to find someone who is a better fit.
Tell the nurses about your plan as soon as you arrive at your birthplace.
Many mothers arrive at the hospital with no particular plan or preferences (and that’s ok!), so if you come in when you’re in labor and you give the nurse your printed plan and a quick verbal rundown of your main goals, they will know that you want something a little different from the default way of doing things. Maybe this will mean not automatically starting an I.V., for example. More importantly, they will try to put you with a nurse who is good at working with patients with your preferences. If you are hoping to avoid an epidural, for example, you don’t want to be with a nurse who is really uncomfortable with mothers who are out of the bed and moving around.
Remember: YOU are in charge.
At the end of the day, legally and ethically, you are in charge of your body and your birth. Your provider and other medical professionals can tell you what they think, but the decisions lie with you. With that in mind, it can really help if you state what you would like to do instead of asking for permission. It’s super easy in our culture to think of nurses and doctors as having authority over us. We’re kind of conditioned that way. It can be so automatic to say, “Is it OK if I…,” or “Will I be allowed to…,” when really, YOU are the decider. It can change how you and others think about your wishes when you voice them less as a question and more as a statement. Phrases like, “I would like to…” or “We are going to…” are more confident and can be more successful than asking for permission.
Be flexible.
We all know that birth can be unpredictable. Sometimes, even when we have done all our research and are well-prepared physically and mentally, things don’t go as planned. Labor can be long, and a mom who was hoping to go unmedicated may need an epidural so she can rest. Emergencies happen, and sometimes the safest way for baby to be born is surgically. If you are very rigid in your wishes, these changes to your plan can feel impossibly overwhelming. But if you go into birth with a flexible mindset, you can roll with the changes with less fear and come out less emotionally battered by the experience.
Did you use a written birth plan when you had your baby? Were your wishes followed by your caregivers? Share your experiences in the comments.
