Creating a Birth Plan

Elyn Cone

Jada Shapiro of Birth Day Presence and Seleni Institute talks us through the benefits of writing a birth plan that’s right for you.

I remember being pregnant and sitting down at my computer to google the words “birth plan.” I assumed that I was supposed to have one but wasn’t sure how to draw up this very personal document that held the fate of my birth story in its hands. My doctor obliged, but even with those words on paper — “no Pitocin” “no epidural” and “free movement” — my birth plan went haywire and I ended up with a c-section. My birth plan, which looked more like a laundry list of requests, didn’t pan out.

The fact is someone else’s birth plan may have simply been “c-section.”

Everyone’s idea of the perfect birth is different, and chances are it won’t go according to plan (babies are cray that way). So we sat down with Birth Day Presence co-founder Jada Shapiro to get the lowdown on what exactly having a birth plan means. Not just having a list of what’s-not, but a plan that will bring a little more clarity to what you’re about to go through, and a place for you and your provider to come to a common understanding of what you want to happen.

Here Jada tells us how to get your plan (or lack thereof) on track.

How do you decide what kind of birth you’d like to have?

The most important decisions, in our opinion, are who is going to deliver your baby and where you want to give birth. Some of what you are hoping for should influence who you hire as your birth team and where you plan to give birth. So consider whether you would like to use pain medication or not during your birth. Consider how much freedom of movement you would like to have. Do you want to have the option to give birth in a tub? Do you want to be able to bring lots of support people with you? Do you hope to avoid a cesarean unless absolutely medically necessary? All these factors will dictate your choices. The mom who hopes to give birth in the water is not going to choose Labor and Delivery in a hospital. The mom who definitely wants to use an epidural early in her labor is not going to give birth in a birthing center. The mom who truly hopes to avoid an unnecessary cesarean will not work with a doctor who has a 50% c-section rate.

Do you need a birth plan to achieve it?

You don’t need a birth plan to move toward the kind of birth you’d like to have. In fact, if you hire a midwife or doctor who you know espouses your birth philosophy ahead of time and supports your choices and options, as long as they are safe, then you seldom need a physical birth plan. If you are birthing in an environment that does not typically support what you are hoping for during your birth, it can be nice to have this physical, easy-to-read record that will help communicate your wishes in a quick way.

There are two real benefits of writing a birth preferences sheet. 1. You can sit down, alone or with your partner, and really get clear on what is most important to you. The clear you are, the more effective you will be at communicating your hopes to your care provider. 2. You can take this document to your care provider well before you give birth to make sure you and your midwife or doctor are on the same page about giving birth. As hard as it is to switch care providers mid-pregnancy, it is much harder to find out during labor that they don’t support you!

Do doctors and nurses really read it, and what can you do to make sure they do? How long should it be?

Totally depends on the person. You should keep your birth plan to 1-2 pages max. Ideally one page. Resume-like. Clear and concise. And in a positive voice. The last thing anyone wants to receive is a long list of things they don’t want you to do to them. So for example, don’t write: Don’t give me an IV. Better: I would prefer to eat and drink to remain hydrated and nourished. Please offer me an IV only in the case that I am dehydrated or need specific medicines for my labor.

The best way to get a nurse to read your birth preferences is to take a moment to introduce yourself to her, and then kindly ask if she would mind reading through some of your preferences when she has a little time. Respect her time and her job and you will find you will have a lot easier time with some of the negotiable aspects of childbirth.

Note: If you are refusing all care that is standard where you plan to give birth, you may want to switch care providers or birth places.

Who should have a copy? Where should you put it?

Give a copy to your midwife or doctor, bring one for your nurse, give one to your doula, and have three extra copies. Keep it in a folder with other important documents in your birth bag.

What’s a good way to think about a birth plan? Is it a wish? A guideline? A concrete set of steps?

We generally recommend that you begin with a short paragraph directed to your care provider, in which you thank them for assisting you with the pregnancy and birth and tell them that the following are your wishes under ideal conditions. It helps to note that you are happy to have their medical expertise and that you love to be informed and hope that they will inform you about anything which needs to be done during their care. Then organize your birth plan by the stages of labor. You can also add in a bit about in case induction becomes necessary and in case of cesarean birth.

If you’re having a home birth would you draw up a birth plan?

It is definitely worth discussing with your midwife whether you want to actually write down your birth plan. In a home birth setting, you can be a bit more luxurious with your vision, including how you envision laboring, what kind of pain relief you imagine might help, and environmental factors that will help you. You should absolutely write an “In Case of Transfer Plan” though. This can be packed in your hospital bag which will only come out if your midwife determines you need to give birth at the hospital.

What happens if your birth does not go according to your plan?

Birth seldom goes according to your plan. You should plan that birth won’t go according to your plan! Going to a childbirth class that addresses issues like this and helps prepare women to meet whatever their labor asks of them can help. Talking with a therapist or close friends or your doctor or midwife can also help. If you find that in writing your birth plan, you are adamant about avoiding a procedure, try to talk with your care provider about how best to deal with the procedure if it becomes medically necessary. Your birth preferences are a general guideline. Ultimately, if medical necessity dictates changes in the labor, hopefully, you have chosen a care provider you trust! The best we can do for ourselves as birthing mothers is choose the best team of support and then step back and let labor unfold.


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