Fail to plan – plan to fail
So do you really need a birth plan? If you are birthing in the privacy of your own home then probably not. The midwife is a visitor and should remember she is a guest. It’s good to talk through your desires with her and if you feel there would be any doubt write them down.
Ambigious planning can lead to unexpected results. Shock! Can you believe I did some of my midwifery training at this hospital.
If you are going to the hospital, then yes you definitely need a well thought out and documented plan. You can find many birth plan templates off the Internet and modify them to your requirements, however they tend to be way too formulaic and each has the failing of giving the hospital leeway to override or ignore.
So how do you avoid having your plan steamrollered? Quite simply make your plan short and sweet. Do not compromise anything and don’t put in get out clauses for your practitioners. If you have any points that are ambiguous they can often be used to facilitate the policy rather than enhance the plan.
For Example:
- Don’t say: No VEs (vaginal examination) unless clinically required. Every 4 hours could be seen as clinically required by the institution.
- Do say: No VEs. This way if you want one you can just ask and they have to discuss any issues they have if they feel one is necessary.
- Don’t say: No CTG (continious monitoring) unless there is an issue. They use CTGs on admission to exclude issues, even though we know it’s not clinically proven.
- Do say: No CTG, only intermittent monitoring (if you want that). If there is a real issue with the baby you will soon know and can then opt for continuous monitoring if you think necessary.
- Don’t say: I want to be mobile through out.
- Do say: Move the bed from the centre of the room because it is not suitable for my needs.
When you are considering your birth plan write down in dot point with your birth partner what is really important to you and then turn them into exactly how you can facilitate this.
Main points to cover:
First stage of labour – birth supporters,monitoring baby, VEs, IV infusion, mobility, environment, freedom, water.
Second stage of labour – natural pushing over coached pushing, positions for birthing, listening to baby before birth, catching baby, water.
Immediately after birth – environment, skin to skin, cord clamping.
Third stage of labour – physiological management, active management, lotus birth, keeping the placenta, prints, weighing, measuring, bathing. (All things which can wait while you get to know your baby)
It’s important to spend time researching the above points. They are the main considerations for your birth and then convey them as literally as you can. I birthed with a woman who has diabetes in a prearranged hospital birth, her birth plan read like this:
- No VEs.
- No routine IV insertion.
- Do not ask me if I want pain relief.
- I will manage my own diabetes.
- All things go through my midwife.
This a pretty simplistic attitude but EVERYONE at the unit knew her wishes. We took the time to mail the birth plan in advance and then I followed it up with a visit to the unit to talk to the head midwife about how this could be facilitated. The staff on the day may not have agreed but stood by the plan. Mailing the plan into labour ward on coloured paper means the hospital have your information in advance. They always read it and if you put your phone number on there it is common for a follow up phone call from the labour ward.
Lots of women I birth with are HBAC and often chose to have a back up hospital. We use this system of posting the plan as a way of preparing. Write the plan send it off, then birth at home!
Should you make a ceasarian section plan?
It is possible to add in the event of an emergency what you would require. Things to think about are: who will be with you, skin to skin, blood tests, antibiotics, lotus birth.
You may never have thought of these things before, but in the event of your birth not being in your control you’ll want to be certain that your wishes are followed. Skin to skin contact is vital after a section. If your baby is in a good condition at birth everything else they may want to do can wait. Being with your baby is the MOST IMPORTANT thing of all.
As with a normal birth research the options so you do not have nasty surprises sprung on you and you are ready with what you want. Especially with blood tests and antibiotics, research the local policy and what is evidence based before you decide what you want in your plan.
Finally
Let me finish with another proverb.
“A lack of planning on your behalf, does not constitute an emergency on my behalf“.
Don’t let that one get rewritten as: “A lack of planning on your behalf, will constitute an emergency section on my behalf“.
Remember, chances are you have paid directly or indirectly for your birth. You wouldn’t employ an architect to design your house, only for him to go and build some varient for his convenience. Don’t let your birth be any different.
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That hospital sign is hilarious! I wonder how long it was up before anyone noticed. Is it still there now I wonder?
Great post BTW.
Another thing about writing a birth plan is that it crystallises what the woman wants and doesn’t want with her partner. Make sure he reads it and you discuss it. Best to keep it brief and to the point. Use bullet points in the style of breasts if his attention is seriously lacking!
You know I think a lot of husbands end up not fully supporting their wives during a birth because they think their wives are delirious. They’re screaming in agony and at the same time shouting they don’t want pain relief. A very confusing signal to a man. When the Ob swaggers into the room and rationally suggests an epidural, who is the husband going to side with? Crazy wife who’s yabbering like a drunken idiot or the calm Ob that offers such a rational approach to this confusing dilemma.
Honestly, he’s genuinely thinking he’s doing you a favor by siding with the Ob. You’ll be thanking him afterwards – not.
Write a birth plan and everyone can sing off the same song sheet. Your husband will thank you and support you when he realises all those birth endorphins have not suddenly turned you into a fruit cake.
Love it. sucinct and to the point.
I have just written my birth plan (5th baby, home birth natch). it says: to let my body get on and do it and to be supported to listen to my body and enjoy this amazing event in our family.
I do then go on to some more detail – such as no VEs, will have birth pool up, may give birth in it, but intend to use the whole house to labour in and will see where I actually end up. I want a natural third stage. I appreciate the vigilance and support of a mw – consent to intermitant monitoring of baby and me, want to pick up baby myself, no plastic cord clamp-i’ll provide cord tie, no vit K. etc.
I may know the midwife I get but I may not so I have also put in that I have some knowledge of birth and run support groups so expect to be fully informed.
I’ve been an L&D RNC for 25 years and with all due respect for the philosophy and viewpoints presented here, I can tell you hospital policy and procedure trump any and all birth plans. The docs practice defensive medicine and they all ascribe to standards of care as set out my American College of OB/Gyn (ACOG)…BECAUSE they are ALL afraid of being sued. If your doc practices Joint Commission accredited facility that does obstetrics, they may politely take your birth plan and put it in your chart, but everybody gets essentially the same treatment: Continuous fetal monitoring, scalp electrodes, rupture of membranes and pit drips if you don’t progress. Lots of epidurals too. That’s the way it works in these places. Period. Sorry to be the bearer of bad news, but it’s the truth. PS “Move the bed, because it doesn’t suit your needs” Y’all the staff won’t move that bed out of it’s docking station. No way. Too many wires and cables that they have to use.
That’s why I am having a home birth. I’m in the UK. By law we can decline any treatment – unless a court decides we are clinically of unsound mind. Of course in hospital it can be hard – especially when emotional blackmail is used. My one hospital birth included a cervical sweep without my consent (therefore assault) during an internal despite just having read my plan which said I did not want my labour speeded up in any way.
I am very very very glad I do not live in the US. It does amaze me that so much is known about what helps and hinders labour and then the medical establishment ignores it and wonders why the cs rate is soaring.