The Birth Plan

Having a birth plan is becoming much more common for women preparing to give birth.  At the very least, women have probably read about writing one in magazines or pregnancy related books.  I’m not sure when the idea for writing a birth plan came into being, I suppose it was sometime in the five years between when I was labor support for my sister during the birth of my nephew in 2000, and when I gave birth for the first time in 2005.  Around the 7th month of my first pregnancy, I was flipping through a magazine that I had gotten for free in the mail, and an article within those pages introduced me to the idea.  I wrote one, printed it out on some nice paper, and presented it to one of the OBs in the practice where I was being seen.  Since writing that birth plan, I have thought much on the reasons why having one is a great idea, along with some reasons as to why there are times when they might not be so useful. 

What is a birth plan? 

A birth plan is a written document outlining the way a woman would like to experience the birth of her baby, and her preferences for the care she would like or would not like to receive along with preferences for the care of her newborn.  It is typically recommended that the woman share this plan with her doctor or midwife, as well as any persons who will be supporting her through labor.  It might also be useful to share the birth plan with the doctor who will oversee the care of your newborn in the hospital.  This opens the door for communication between the woman and her care provider, allowing information to flow freely before either the woman or her care provider is in the middle of her birth.  Birth plans can take a variety of forms from very detailed documents to simple one page statements.  There are a variety of templates to be found on the internet.  In the next Birth True Blog post, I will highlight some different styles of birth plans.

What a birth plan is not?

While the birth plan is a great communication tool, there are many things it is not, and should not be relied upon to do for the birthing woman.

• Birth plans may or may not be a legal document.  If you Google, is a birth plan a legal document, you will find reliable sources stating that it is and that it is not.  So, with many up in the air about a birth plan’s ability to bind anyone to anything, we cannot rely on it to be a legal document.  You can, however, request that the birth plan be made part of your medical records and that your doctor or midwife sign the birth plan after thorough discussion of its contents.  Doing this will clearly show that your wishes were made clear.
• Birth plans are not set in stone.  There are things about birth that in most cases are predictable.  However, we never know when our situation during the birthing process might change, and compromises might need to be made for a safe outcome.  For example, a mother who planned a natural birth might find herself in a labor that is progressing slowly and she has become exhausted.  In some of those cases, it might be in the mother’s best interest to accept an epidural or narcotic for rest so as to have the stamina needed to complete labor and vaginal delivery.  Another example would be a mother who planned an epidural as soon as it could be provided to her, but when she reached active labor, she progressed really fast and became near to completely dilated before an epidural could be given.  I tell Birth True clients to not be married to their birth plan.  Take it seriously, but more importantly understand the science and information behind the choices that you have made, so that if you do need medical procedures that are not in your plan it will not be a process that will make you fearful or confused.
• Birth plans do not take the place of quality childbirth education.  You can create a nice looking document whether on your own or from the internet, but if you have not educated yourself thoroughly about the options you are considering, it isn’t likely that your birth plan will mean all that much to you during the birth of your baby.  For example, if you thought you’d like to try natural birth, but you have not learned or practiced any of the natural comfort techniques available to you, you might find labor difficult and ask for medication.  If you planned to be induced, but did not learn about the requirements of inducing labor and the medications used, you might find yourself confined to bed when you had hoped to walk and be mobile during the first hours of labor.  More important than creating a document stating things that you would like to happen, is to become educated so that you can create a useful birth plan that is fluid and can be adapted as the need might arise, but still within a context that you are okay with.
• Birth plans do not replace a good relationship with a supportive care provider.  An expecting woman should not expect her birth plan to be the first time her care provider is made aware of her wishes.  From the first prenatal visit, a woman should be able to freely discuss her concerns and hopes for her birth process.  Together the care provider and woman should develop an idea of how to best offer the laboring woman the care she needs and would find satisfactory.  If at any time, you do not feel like your care provider is listening, supportive, or if you feel like they are rushed, it is probably best to change care providers to someone who is more willing/able to offer you the care you are looking for.  Mother’s Advocate has information on choosing/changing care providers.  I have also written on the topic here.
• A birth plan is not likely to do much to change hospital policy.  If you have chosen to give birth in a hospital, it is more important for you to discuss the policies of the hospital with your care provider or hospital administration before writing your birth plan.  This way, you can create a realistic document that will reflect the options available to you within your birthing facility.  If you cannot have the birth you desire in the facility you have chosen, it might be best that you change to another hospital or care provider.  For example, questions like can I eat and drink in labor, or will my baby be able to room-in with me are important questions to ask.  Check to see if your hospital/care provider is mother-friendly and baby-friendly.  If they are, you will have an easier time making a birth plan that both you, your care provider, and hospital staff will be able to use.

Before Writing Your Birth Plan

A birth plan should be an organic document where there is room for growth and room for cutting back as the laboring mother sees fit.  Before creating your birth plan, make sure you have chosen a care provider you are comfortable and open with.  Your care provider should not make you feel like your choices are less important than his/her recommendations.  Check into the facility where your provider attends birthing mothers.  Are they generally supportive of the options you have chosen for your birth?  Take a childbirth class from a qualified educator, and do all you can to become fully informed on the options you have and the risks and benefits of those options.

For hospital births, a written birth plan is a good idea.  During the laboring process you will be cared for by a variety of people, some of which you will have just met on the day you give birth.  If you have discussed your birth plan with your care provider and made it part of your medical record, it will help those who provide you care in the hospital to provide it to your satisfaction.  For homebirth, a written birth plan might be less necessary.  Visits with homebirth care providers are generally much longer with ample time for thorough discussion.  Talk with your care provider on the necessity of a written birth plan for your homebirth.  A written birth plan might help you ensure that you have discussed all your desires and options with your doctor or midwife.

In the next post, we will take a look at the various types of birth plans and the advantages and drawbacks of those plans, so you can find a style that works for you and your situation.  In the meantime, take a look at this article from The Journal of Perinatal Education on The Similarities Between Birth Plans and Living Wills by Nayna C. Philipsen, JD, PhD, RN, LCCE, FACCE and Dorothy R. Haynes, JD, RN.

Are you currently writing a birth plan?  Did you find a birth plan useful in your birth experience?  Comment and tell us your birth plan story!

Many happy days to you and yours,

Kelli