Every pregnant person is encouraged to write a birth plan, and for good reason. Preparing a birth plan motivates new parents to educate themselves about some of their childbirth options. In turn, the exercise of writing such a document encourages families to have important conversations with their birth attendants. And, of course, there is a sense of empowerment that comes from being prepared and well-supported.
That being said, it should come as no surprise that there is a 'good, better, best' approach to writing one. So, if you're giving birth in a hospital and feel ready to take your birth plan to the next level, read on!
Planning the Unpredictable
First, a disclaimer: Birth plans are about taking control of your birth experience, but childbirth is completely unpredictable. Striking the appropriate balance between opinion and flexibility will contribute to higher birth satisfaction. So, research away, and align yourself with a care provider that you trust -- and then when labor begins, remain calm and 'flow like a river,' baby.
Starting the Conversation
I recently watched a couple hand their birth plan to their labor & delivery nurse, expecting her to read it right then. In the bustle of preparing their hospital room, she didn't. Imagine their surprise when she wheeled over an IV pole and began prepping a bag, despite the fact that they had declined routine intravenous fluids in their birth plan.
Just because you have presented your preferences to your birth team does not guarantee that your wishes will be respected or enforced automatically. You will still need to advocate for yourself -- but fortunately, your earlier preparation will make it easier to have those conversations.
Ideally, honest communication should begin during pregnancy with your chosen birth attendant (midwife, nurse-midwife, obstetrician, family physician, etc.). Using your birth plan as a conversation starter, you can ensure that your care provider is of a similar birth philosophy. After all, what happens in your birth largely depends upon the birth facility or care provider you've chosen, as professional opinions vary between venues and birth attendants. Labor is no time to argue, but to relax! It's important to develop trust and rapport in advance.
I'd like to share some sample questions to jump start a discussion with your care provider during pregnancy. You may be able to think of others.
My partner and I have worked hard to prepare for an unmedicated vaginal birth. What is your experience supporting physiologic birth? (If you're intent on having a more physiologic birth, but your care provider has little to no experience supporting unmedicated births, you may not receive the appropriate care to support your objectives.)
What percentage of your patients give birth via Cesarean section? In your practice, what is the most frequent cause for surgical birth? (Comparing your doctor's surgery rate with the national average - or even the World Health Organization's recommendations - will help you determine your doctor's views on surgical birth. Learning the reason for their Cesarean rate is also informative.)
How can you support me with these goals I've outlined? Are there any goals that you will not or cannot support? (It's important to know in advance if your midwife or doctor isn't on board with your preferences; someone else might be a better fit for you.)
What is your protocol for overdue patients? What procedures will be recommended at 41 weeks? 42 weeks? (If you're a believer that babies are born when they're ready in most healthy pregnancies, then it's important to find a care provider who supports labor beginning spontaneously. If your care provider routinely induces at 39 weeks, you'll know that they're not practicing evidence-based care.)
Will you support me eating and drinking during labor? (The American Society of Anesthesiologists has confirmed that women can eat and drink during labor. Is your care provider up to date on best practices?)
Will you put time limits on my labor, even if baby and mom are healthy? If I have energy, how long may I push in 2nd stage? (Knowing that there's no such thing as a textbook labor, would you prefer a patient care provider, or one who is quicker to intervene?)
Will you support my preference for intermittent fetal monitoring? What do you consider 'intermittent'? Do you offer support using doppler during labor? (We'll dissect this one later.)
Discovering Birth Philosophy
Obviously, in order for such a conversation to be meaningful, it's necessary to be educated about your childbirth options. Think about it. How can you ask informed questions without being well informed?
Here's the thing... there are many different ways to give birth, and there are pros and cons to each of those choices. Sometimes, birth can seem like a one-size-fits-all process, but deciding how to have your baby can and should be a very personal decision. (Taking a comprehensive childbirth class can help you wade through the research. So can a brilliant website called Evidence Based Birth.)
Your birth philosophy will fall somewhere on a spectrum between medical and holistic. The more that your care provider's birth philosophy mirrors your own, the more satisfied you'll be with your birth experience. As part of the birth planning process, don't hesitate to shop around for your doctor or midwife.
Alright, Let's Do It!
If you're giving birth at a hospital, you may have received a 'check the box' birth plan. While that approach might eliminate some of your work, those forms are not ideal. If you want to present yourself as an informed consumer with concrete objectives, you'd be better served by a unique document of your own.
(In fact, I'm going to recommend that you write three separate birth plans.)
Document One: Conversation Starter
Looks Like: Multiple pages of birth preferences, in whatever format you prefer!
Purpose: Motivate your research, encourage discussion with your labor partner, start a conversation with your care provider (and help you shop around). Note: You may need to schedule a longer appointment, so call ahead!
Where to Keep: After using this document at your prenatal appointment, put it in your labor bag! It will remind your partner and/or doula of your preferences, and they will use that information to help you advocate for your wishes. (You could also drop a copy at the nurses' station.)
Wording Help: What you WANT + What you'll DO
Check out the difference between these possible statements:
We decline IV fluids.
No IV fluids, please. We are prepared to hydrate with fluids between contractions.
Please help us protect the perineum by applying warm washcloths, encouraging squatting, etc.
Do not mention drugs!
Please do not offer medication for pain relief. We have practiced a variety of physical and mental coping techniques. Please do not mistake phrases like "I can't do this" or "This hurts!" as a request for medication. I will use a "safe word" if I need medication for pain relief.
In the section of this document where you state your preferences for labor, try following up a request with a plan of action (whenever appropriate). Your care provider will appreciate your thoughtful preparation.
Wording Help: Confusing Statements
1. "We elect to have a natural birth."
To some medical personnel, 'natural birth' means 'vaginal birth' - medicated or otherwise. If you are working toward an epidural-free birth, the term 'unmedicated vaginal birth' will convey your objectives more clearly.
2. "No induction or Pitocin, please."
This statement requires some clarification. If you wish to decline induction of labor - cervical ripening, Pitocin, foley bulb catheter, amniotomy (artificial rupture of amniotic sac membranes), membrane stripping, etc. - you might say, "I would like to let labor begin on its own." If you intend to decline Pitocin during a long, stalled labor, you'd be covered by saying, ''We prefer a 'no rush’ approach to labor progressing and pushing."
3. "No frequent [fetal monitoring, vaginal exams], unless necessary."
In making a statement like this, you first need to consider what is meant by the word 'necessary.' I have attended hospital births where perfectly healthy laboring women were attached to fetal monitors around the clock because the doctor on call considered it necessary. Another birth team would have likely disagreed.
Second, the word 'frequent' is hardly clear, much like 'intermittent.' What do those words mean to you? You might be tempted to use words like 'frequent' and 'if necessary' several times throughout your birth plan, so watch out! Be clear with your preferences.
Document Two: "This is Me" At-A-Glance
Looks Like: One piece of paper, HUGE FONT, very little text.
Purpose: Introduce your birth preferences to your birth team as quickly as possible.
Where to Keep: Taped to the wall and outside of your door, or next to the computer monitor in your room.
Keep this birth plan brief, brief, brief.
Bullet points are great. Visual birth plans with pictures can be useful. You may feel tempted to write down every little preference that you have, but try to pick the most essential words or images to introduce your birth philosophy.
Try writing this simple kind of birth plan, and try reading it in ten seconds. Think about how you can you make it more more easily digestible.
Document Three: The Cesarean Plan
One More Tip for Success...
Looks Like: One piece of paper, bullet points.
Purpose: Ensure that your birth philosophy and preferences are respected in case of surgical birth, and reduce fear and anxiety.
Where to Keep: Tucked away in your labor bag.
For your piece of mind, you might appreciate having a separate document for emergency situations. If a Cesearean section is necessary for mother or baby's safety and health, you'll feel greater ownership over your birth experience if you're able to personalize your experience.
I love helping birthing people prepare for an empowering birth. Would you like some help with your research, or would you like someone to take a preliminary glance at your birth plans? Reach out.
Do you have any additional tips to share? Leave them in the comments below!
Megan Hamzawi is a certified educator and birth doula. Her class is ideal for birthing people and partners who prioritize individualized healthcare, informed consent, health-promoting nutritional choices, and active participation in the birth process.