A Birth Plan vs. Planning for Birth

Birth Plan.

These two words have come to mean a lot these days. Women feel more and more empowered to have the kind of birth they desire, and writing this thing called a "Birth Plan" is meant to produce that result.

These words conjure up images of bullet lists detailing a perfect environment, exactly how each stage of labor should progress, and a slew of things NOT to do. Images of a laboring woman arriving at a hospital and handing over pages and pages to the nurses on duty, expecting that they be meticulously read and followed. Images of these overworked and under-appreciated nurses inwardly sighing and bracing themselves to deal with yet another one of THOSE women.

Now, it's already sounding like I have something against birth plans, and let me quickly say that I am VERY pro-birth plan. Let me explain.

To me, a "Birth Plan" is so much more than a document typed up and handed over to hospital staff. If a woman or a couple truly wants to have a plan for the birth of their child, shouldn't it include all of the things surrounding the event? The people involved? The place of the birth? The steps that should be taken? Their ideal situations?

I have read my fair share of articles and blog posts on the etiquette of writing this document that has come to be called a Birth Plan, and yet I've found very little on the rest of the process of planning your birth. After working through this process myself for the last 9 months (and longer, since I began imagining how I'd like to have children a few years ago), I've come to some simple conclusions.

Putting together a Birth Plan requires a lot more work than simply typing up a document. 

Doing this work makes said document short, easy, and almost unnecessary. 

So how does this work?

Even more than the written document, there are a few components that are essential for a thoughtful and well-rounded Birth Plan. They are:

1. YOUR HEALTHCARE PROVIDER

A few caveats right as we get started. First, I'm not here to advocate one type of provider over another. Second, I understand that issues like insurance and covered networks/providers can create limitations and challenges. And third, I've lived in extremely rural areas before and I understand that sometimes your choices are simply non-existent.

All of that being said, I truly believe that the large majority of the work of planning your birth can be done by choosing a healthcare provider who fits your needs. If you know what you want (and consequently know what you DON'T want), you can quickly establish whether or not a provider will work well with your desires. And I've had multiple friends switch providers during their pregnancies because they felt ignored, steamrolled, or unimportant to their first provider. They have all told me how much better they instantly felt about their impending births once with a provider who made them feel safe and secure and listened to.

So, how do you find a provider like this?

Ask women whose desires are similar to yours.
This is one of the easiest ways to find a good provider. If you know for sure that you're going to want to try for a VBAC, then the best way to find a good provider is to ask a woman who actually HAD a VBAC who she doctored with. The same goes for things like home birth, water birth, pain management, interventions, staff, and temperaments during checkups. Are you someone who brings lists of questions to every appointment? Ask a woman who is similar how that was received by her doctor (and the nurses!). Do you really want someone who will lead you and guide you through this pregnancy rather than sit across from you, smiling and not offering tests and services, expecting that you will pipe up if you want something done? Ask around!

Ask all questions as SOON as you have them.
Your doctor or midwife's job is to monitor your health (and baby's) AND address your concerns when you go in for an appointment. Questions are an essential way to express those concerns. If you're made to feel that there's no time for your questions or that your questions are intrusive and/or foolish, then you can almost certainly bank on your wishes for childbirth being viewed the same way. Sometimes one of your wishes for childbirth simply isn't what's in your (or baby's) best interest, but you want a practitioner who will listen, understand, explain, and then work with you to find a comfortable solution while still keeping your health as top priority.

Do a little bit of research about birth ahead of time.
It's all too often the case that a woman doesn't realize just how complicated the birthing process in America has become until she's well into a pregnancy. Using a reputable source (and most blogs, including this one, are NOT reputable, medical sources), learn about the pros and cons of various tests and procedures while pregnant. If you decline a test early in pregnancy (because you've educated yourself well and you're not high-risk) and your practitioner fusses at you or makes you feel bad about that decision that's not a one-time incident. That will likely happen throughout your pregnancy, and you want a doctor/midwife who will not make you feel like a weirdo for turning down a non-standard test. My favorite reputable source is the American Pregnancy Association's website.

2. YOUR BIRTHING LOCATION

A hospital? A birthing center? A home birth? Where do you plan on having your child?

It's usually the stereotype that women who choose to birth at home or at a birthing center not connected to a hospital are more "crunchy" or "granola" than women who choose to birth at hospitals. While there may be some truth to this, it's entirely possible to give birth at a hospital and retain your "crunchy" status. It all comes down to knowledge and research.

A lot of women don't realize that even the most trusted and well-loved doctor/midwife can be overruled by hospital procedures and policies. Their hands are often tied by these things, and those who choose to birth in a hospital should know what they are ahead of time. Especially since the large majority of labor is spent with hospital nurses. To find them out:

Listen to the birthing stories of women you know.
Are their stories filled with praises and warmth when it comes to the nurses? Do they regale you with tale after tale of a nurse who ignored their wishes or made them feel stupid? These things have nothing to do with their doctors/midwives and everything to do with the hospital itself.

Get a tour of your potential hospital's labor and delivery unit.
Come prepared with a lot of the same questions you asked your doctor/midwife. If your hospital offers childbirth classes they often come with a tour of the hospital. These are excellent resources when it comes to feeling out the hospital and the nurses. Plus, they're designed for you to bombard them with questions. Do it!

Are you wanting a Bradley birth? Will you be using HypnoBirthing? Will you want a gentle cesarean? A labor and delivery nurse's response to these sort of questions can be very indicative of your potential experience at the hospital. Have they heard of these things? Are they interested in learning about these things? If your heart is truly set on using the Bradley method but a nurse brushes that off by saying, "Oh, they all say they want natural birth, but most will get epidurals by the end," then you've got a pretty clear indicator of the kind of support your wishes will receive.

Nurses will work to follow your birth plan at any hospital, but nurses who SUPPORT your birth plan ideas ahead of time will also SUPPORT you at a time when you need help staying strong.

Get to know your closest hospital even if you don't plan on using one.
When talking about birthing plans, healthcare providers will always say the same thing--birth is unpredictable. A healthy and uncomplicated pregnancy could still become difficult once active labor begins. There's no way to predict or plan for any number of complications, so know what your back-ups are.

3. YOUR BIG-PICTURE PRIORITIES

Sometimes it's hard to see the forest for the trees when it comes to childbirth. We get so caught up in what shots and tests we do and don't want. We obsess over how dim the lighting will be and what our birthing playlist contains (got mine ready!!). We dwell on this image of the perfect birth and ingrain it deeply into our brain. We do these things so much that when the actual event arrives the first deviation from that plan can ruin the entire experience.

It's important to remember that hospitals and doctors do not start out with the intention to ruin that experience for you. A hospital is just like a regular business in some ways. They have to have policies and rules--both for your protection and theirs. Some will naturally be a little behind the times, and I can guarantee that the hospital's policy of clamping the umbilical cord immediately after birth (which has growing evidence against it in the medical community) is not your nurse's fault. Her sour reaction to your request of delayed clamping is more likely because it's hard to change a routine she's been doing for hundreds of births rather than her thinking you're stupid or difficult.

This is not to say that you shouldn't advocate for the birth you want. You SHOULD! But how much easier will it be if you can find a practitioner and a location that already endorses many of your ideas?

In the end, that sort of security will make it easy for you to keep the most important thing in the forefront of your mind: a healthy baby and a healthy you. This is what everyone wants. If you know your team is all on the same page when it comes to your basic birthing desires, how much more will you be willing to trust them if a difficult arises and a change needs to be made? When you're presenting a five-page Birth Plan to your practitioner, you're telling them you don't trust them to make good choices for you. But when you know you can trust your doctor/midwife with every part of the process, and you feel confident about the support and care you'll receive at your birthing location, suddenly that Birth Plan document shrinks drastically.

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So, FINALLY, we arrive at . . .

4. YOUR BIRTH PREFERENCES DOCUMENT

Now, most blogs these days are encouraging women to call it "Birth Preferences" simply because, as I mentioned before, it's impossible to truly PLAN every part of something like birth. This part of the post will be short and sweet--just like the document should be! Here's how I created mine:

Start with a note of thanks.
Let the hospital staff know that you understand that things don't always go according to plan and that you're grateful for their expertise.

Organize, organize, organize!
A long list of STUFF is just hard to read through when you're on hour 10 of a 12-hour shift. Bullet points are good. Categories and sub-headings are GREAT. Keeping things in chronological order just makes SENSE. Here's how I laid out my Birth Plan categories:

1. Environment
2. Labor
3. Delivery
4. After Delivery
5. Recovery and Breastfeeding
6. Unplanned C-Section and/or Complications

Under each category are bullet points, and each point contains a single, simple statement. My longest section (After Delivery) has six bullet points. My shortest section (Unplanned C-Section) has only two. 

Write it early. 

Go over your first draft with your healthcare provider. You can learn a LOT about why hospitals and doctors make certain choices, and you can also learn quickly what you don't need to mention because it's not going to be an issue at your hospital. 

Edit, edit, edit! a.k.a. Keep it short and relevant. 

Honestly, things can change all the way up to birth itself. A new condition can develop. A bullet point can suddenly become obsolete. Your rough draft started at three pages long. Everyone out there says the same thing about a Birth Plan document--the documents that have the best chance of being read and supported are no more than ONE PAGE long. 

Cover your bases with a single statement.

Ours says, "If intervention becomes necessary, I ask that my husband and I be included in discussion and decision making as much as possible given the circumstances." 

This statement appears at the top of the document--right after the thank yous. This covers all of those "in case of" scenarios that can clog up a Birth Plan. 

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If anyone really wants me to post a copy of my Birth Preferences document, let me know, but I'm not going to post it right now. I truly believe that such a document is an afterthought once you feel good about the things listed above. 

And I definitely feel good about those things, which is crucial right now, considering that after I post this I'm going to have to make yet another change to my birth plan. 

I just found out that I tested positive for Group B Strep, meaning I'll have to have an IV during labor. That was something I asked NOT to have in my original birth plan, but I won't ask for that anymore. It's not a guarantee that Feisty will be affected by the bacteria, and I could choose to fight for no IV. But I trust my midwife completely, and I know that her views on birth match mine, so if she says that an IV is what we should do, then I'm willing to follow that. And follow it happily! My vision for the "ideal birth" has to change, but I'm not crying about it.

And if you are able to do this before your birth, you probably won't cry either when changes happen. 

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Keep it real, everyone!