What is a Birth Plan?
A Birth Plan is a written or typed document prepared during pregnancy with instructions and preferences for care providers during labor and immediate postpartum. Templates abound on the internet, usually covering common hospital procedures and prohibitions such as I.V.s, eating and drinking, mobility, offering of pain medications, avoiding cesareans, and newborn procedures that include circumcision for boys, Vitamin K, prophylactic antibiotics for their eyes, Hepatitis B vaccine and offering artificial nipples.
What a Birth Plan is Not
A Birth Plan is not a binding contract. It does not obligate any of your care providers in any way.
Conversations with Nurses
I have asked many nurses over the years how they feel about birth plans and was surprised to find very few that see them as the valuable communication tool that they are intended to be. Most nurses I’ve spoken with view birth plans as being rigid and a potential set up for cesareans. Of course, this depends on the nurse and the facility, and correlation (birth plan) does not equal causation (cesarean).
The nurses that see birth plans as a set up for cesareans seem to be making immediate judgements on the person handing them the document as being unrealistic about the unpredictability of childbirth and inflexible about protocols to address any unexpected events during labor. Is this victim blaming? Are these judgments leading to providing care in a manner that potentially leads toward cesareans? Is it possible that the intention during written requests get misunderstood much like communication by text does?
How do you say what you need when your provider may not value the research you put into your written birth plan preferences.
Say What You Need
We live in a digital age where we no longer have to have in person contact for everyday practices. We pay at the pump instead of sitting in our car while someone pumps our gas, washes our windshield, checks our oil and takes our money to the cashier for us. We go through self check out or buy online instead of getting to know our favorite cashier. Technological advances have benefitted us is many ways by making things easier and faster. However, we are becoming accustomed to not need conversation outside our social circles. Having a baby is not an everyday practice. You will need to talk to your provider to communicate your needs and preferences.
Instead of… Do This
Instead of your birth plan stating “Do not offer pain medication,” say “I’m trying to have an unmedicated labor. When it get really tough, can you give my support person some tips to help me cope?”
Instead of your birth plan stating “No IV,” say “My OB said they would authorize a saline lock.” Of course, this conversation needs to have actually taken place with your OB. The same goes for continuous fetal heart monitoring.
Instead of your birth plan stating “Cesarean only when absolutely necessary,” say “I need to do everything I can to avoid a cesarean. Please give advice during my labor that will minimize the risks of having a cesarean, even if it goes against my wishes for or against another procedure.”
Instead of your birth plan stating [insert any ambient setting such as dim lighting, soft music, aromatherapy here] simply adjust the lights and bring your playlist.
Instead of your birth plan stating you want “ability to move,” you should already have it without saying by having intermittent fetal heart monitoring.
Instead of your birth plan stating [insert any newborn procedure here], consent or decline as they are being offered to you. You will have to sign a consent form for any procedure anyway.
Don’t Ditch the Birth Plan
Depending on where you plan to deliver, a birth plan may or may not be the best means of communicating with your providers during labor. However, it is still useful educational tool for you to research many of the procedure that you can expect. Bring it with you in your birth bag to remind you of your preferences and to help your support person know how to advocate for you.