In the happy haze of early
pregnancy
, you're probably already thinking of baby names and planning
to shop for baby clothes. The reality of labor and birth may seem
extremely far off - which makes this the perfect time to start
planning for the arrival of your baby by creating a birth plan that
details your wishes.
What's a Birth Plan?
The term birth plan can actually be misleading - it's less
an exact plan than a list of preferences. In fact, the goal
of a birth plan isn't for you and your partner to
determine exactly how the birth of your child will occur - because
labor involves so many variables, you can't predict exactly
what will happen. A birth plan does, however, help you to realize
what's most important to you in the birth of your baby.
While completing a birth plan, you'll be learning about,
exploring, and understanding your labor and birthing options well
before the birth of your child. Not only will this improve your
communication with the people who'll be helping during your
delivery, it also means you won't have to explain your
preferences right at the moment when you're least in the mood
for conversation - during labor itself.
A birth plan isn't a binding agreement - it's just a
guideline. Your doctor or health care provider may know, from
having seen you throughout the pregnancy, what you do and don't
want. Also, if you go into labor when there's an on-call doctor
who you don't know well, a well thought-out birth plan can help
you communicate your goals and wishes to the people helping you
with the labor and delivery.
What Questions Does a Birth Plan Answer?
A birth plan typically covers three major areas:
1. What are your wishes during a normal labor and
delivery?
These range from how you want to handle pain relief to
enemas and fetal monitoring. Think about the environment in which
you want to have your baby, who you want to have there, and what
birthing positions you plan to use.
2. How are you hoping for your baby to be treated immediately
after and for the first few days after birth?
Do you want the baby's cord to be cut by your partner? If
possible, do you want your baby placed on your stomach immediately
after birth? Do you want to
feed the baby
immediately? Will you
breastfeed or bottle-feed
? Where will the baby
sleep
- next to you or in the nursery? Hospitals have widely varying
policies for the care of newborns - if you choose to have your baby
in a hospital, you'll want to know what these are and how they
match what you're looking for.
3. What do you want to happen in the case of unexpected
events?
No one wants to think about something going wrong, but if it
does, it's better to have thought about your options in
advance. Since some women need
cesarean sections (C-sections)
, your birth plan should probably cover your wishes in the event
that your labor takes an unexpected turn. You might also want to
think about other possible complications, such as
premature birth
.
Factors to Consider
Before you make decisions about each of your birthing options,
you'll want to talk with your health care provider and tour the
hospital or birthing center
where you plan to have your baby.
You may find that your obstetrician,
nurse-midwife
, or the facility where they admit patients already has birth-plan
forms that you can fill out. If this is the case, you can use the
form as a guideline for asking questions about how women in their
care are routinely treated. If their responses are not what
you're hoping for, you might want to look for a health provider
or facility that better matches your goals.
And it's important to be flexible - if you know one aspect
of your birthing plan won't be met, be sure to weigh that
aspect against your other wishes. If your options are limited
because of insurance, cost, or geography, focus on one or two areas
that are really important to you. In the areas where your thinking
doesn't agree with that of your doctor or nurse-midwife, ask
why he or she usually does things a certain way and listen to the
answers before you make up your mind. There may be important
reasons why a doctor believes some birth options are better
than others.
Finally, you should find out if there are things about your
pregnancy that might prevent certain choices. For example, if your
pregnancy is considered high risk because of your age, health, or
problems during previous pregnancies, your health care provider may
advise against some of your birthing wishes. You'll want to
discuss, and consider, this information when thinking about your
options.
What Are Your Birthing Options?
In creating your plan, you're likely to have choices in the
following areas:
Where to have the baby.
Most women still give birth in the hospital. However, most are no
longer confined to a cold, sterile maternity ward. Find out if your
hospital practices family-centered care. This usually means the
patient rooms will have a door, furnishings, a private bathroom,
and enough space to accommodate a family, including the baby's
crib and supplies.
Additionally, many hospitals now offer birthing rooms that allow
a woman to stay in the same bed for labor, delivery, and sometimes,
postpartum care (care after the birth). These rooms are fully
equipped for uncomplicated deliveries. They're often attractive
and have gentle lighting.
But some women believe that the most comfortable environment is
their own home. Advocates of home birth believe that labor and
delivery can and should occur at home, but they also stress that a
certified nurse-midwife or doctor should attend the birth. An
important thing to remember about home birth is that if something
goes wrong, you don't have the amenities and technology of a
hospital. It can take a while to get to the hospital, and during a
complicated birth those minutes can be invaluable.
For women with low-risk pregnancies who want something in
between the hospital and home, birthing centers are a good option.
These provide a more homey, relaxed environment with some of the
medical amenities of a hospital. Some birthing centers are
associated with hospitals and can transfer patients if
necessary.
Who will assist at the birth.
Most women choose an obstetrician (OB/GYN), a specialist who's
trained to handle pregnancies (including those with complications),
labor, and delivery. If your pregnancy is considered high risk, you
may be referred to an obstetrician who subspecializes in
maternal-fetal medicine. These doctors have specialized training to
care for pregnant women with medical conditions or complications,
as well as their fetuses.
Another medical choice is a family practitioner who has had
training and has maintained expertise in managing non-high-risk
pregnancies and deliveries. In some areas of the United States,
especially rural areas where obstetricians are less available,
family practitioners handle most of the deliveries. As your family
doctor, a family practitioner can continue to treat both you and
your baby after birth.
And doctors aren't the only health care providers a pregnant
woman can choose to deliver her baby. You might decide that you
want your delivery to be performed by a certified nurse-midwife, a
health professional who's medically trained and licensed to
handle low-risk births and whose philosophy emphasizes educating
expectant parents about the natural aspects of childbirth.
Increasing numbers of women are choosing to have a doula, or
birth assistant, present in addition to the medical personnel. This
is someone who's trained in childbirth and is there to provide
support to the mother. The doula can meet with the mother
before the birth and can help communicate her wishes to the medical
staff, should it be necessary.
Your birth plan can also indicate who else you'd like to
have with you before, during, and immediately after the birth. In a
routine birth, this may be your partner, your other children, a
friend, or other family member. You can also make it clear at what
points you want no one to be there but your partner.
Atmosphere during labor and delivery.
Many hospitals and birthing centers now allow women to make some
choices about the atmosphere in which they give birth. Do you want
music and low lighting? How about the freedom to walk around during
labor? Is a hot tub something you'd like access to? If
possible, would you like to eat or drink during labor? You might be
able to request things that may make you the most comfortable -
from what clothes you'll wear to whether you'll have a VCR
or DVD player in your room.
Procedures during labor.
Hospitals used to perform the same procedures on all women in
labor, but many now show increased flexibility in how they handle
their patients. Some examples include:
-
enemas.
Used to clean out the bowels, enemas used to be routinely
administered when women were admitted. Now, you may choose to
give yourself an enema or to skip it entirely.
-
induction of labor.
At times, labor may need to be induced or sped up for medical
reasons. But sometimes, practitioners will give women the option
of getting some help to move things along, or giving labor a
little more time to progress on its own.
-
shaving the pubic area.
Once routine, shaving is no longer done unless a woman requests
it.
Other procedures that you can include in your birth plan are
requests about fetal monitoring, extra birthing equipment you'd
like in the room, and how often you have internal exams during
labor.
Pain management.
This is important for most women and is certainly something you
have a lot of control over. It's also something you'll want
to discuss carefully with your health care provider. Some women
change their minds about
pain relief
during labor only to discover that they're too far along in
their labor to use certain methods, such as an epidural. You'll
also want to be aware of the alternative forms of pain relief,
including massage, relaxation, breathing, and hot tubs. Know your
options and make your wishes known to your health provider.
Position during delivery.
You can try a variety of positions during labor, including the
classic semi-recline with the feet in stirrups that you've seen
in the movies. Other choices include lying on your side, squatting,
standing, or simply using whatever stance feels right at the
time.
Episiotomies.
When necessary, doctors perform episiotomies (when the perineum -
the area of skin between the vagina and the anus - is partially cut
to ease the delivery). You may have one if you risk tearing or in
the case of a medical emergency, but if there is an option, you can
discuss your preference with your provider.
Assisted birth.
If the baby becomes stuck in the birth canal, an assisted birth
(i.e., using forceps or vacuum extraction) may be necessary.
Cesarean section (C-section).
You might not want to think about this, but if you have to have a
cesarean, you'll need to consider a few things. Do you want
your partner to be present, if possible? If you have a choice,
would you like to be conscious or unconscious? What about viewing
the birth - do you want to see the baby coming out?
Post-birth.
Decisions to be made about the time immediately after birth
include:
- Would your partner like to cut the umbilical cord?
- Does your partner want to hold the baby when the baby
emerges?
- Do you want immediate contact with the baby, or would you
like the baby to be cleaned off first?
- How would you like to handle the delivery of the placenta?
Would you like to keep the placenta?
- Do you want to feed the baby right away?
Communicating Your Wishes
Birth plans are relatively new inventions, and your doctor or
nurse-midwife may not be completely comfortable with them. For this
reason, make sure you communicate clearly that you intend to create
a birth plan.
Give your health care provider your reasons for doing so - not
because you don't trust him or her, but to help ensure
cooperation and to cover the possibilities if something should go
wrong. If your caregiver seems offended or is resistant to the idea
of a birth plan, you might want to reconsider whether this is the
right caregiver for you.
Also, think about the language of your plan. You can use many
online resources to create one or you can make one yourself. Here
are some tips:
- Make your birth plan read like a list of requests or
best-case scenarios, not like a set of demands. Phrases such as
"I would prefer" and "if medically necessary"
will help your health care provider and caregivers know that you
understand that they might have to alter the plan.
- Think about the other personnel who'll be using it -
hospital staffers might feel more comfortable if you call it your
"birth preferences" rather than your "birth
plan," which could seem as though you're trying to tell
them how to do their jobs.
- Try to be positive ("we hope to") as opposed to
negative ("under no circumstances").
Once you've made your birth plan, schedule a time to go over
it with your doctor or nurse-midwife. Find out and discuss where
you agree or disagree. During your pregnancy, review the birth plan
with your partner periodically to make sure that it's still in
line with both of your wishes.
Strive to keep the plan as simple as possible - preferably less
than two pages - and list them in order of importance. Focusing on
your priorities will help ensure that the most important of your
wishes are met.
You may also want to make several copies of the plan: one for
you, one for your chart, one for your doctor or nurse-midwife, and
one for your birthing coach or partner. And bringing a few extra
copies in your labor bag is a good idea, especially if your doctor
ends up not being on call when your baby is born.
Although you might not be able to control everything that
happens to you during your baby's birth, you
can
play a role in the decisions that are made about your body and your
baby. A well thought-out birth plan can help you to do that.
Reviewed by:
Larissa Hirsch, MD
Date reviewed: February 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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