The Birth Plan: Bringing It All Together.

Finally… putting all those plans and preferences together; getting your dreams, desires and demands clearly stated on paper!

On one hand… the Birth Plan can be a useful tool for you in clarifying your wishes. It’s also handy for others – any attendants, assistants, doula, midwife, doctor. This is your tool for organizing your own thoughts and understanding the birthing process; and sharing with others who may attend or assist at this birth your personal preferences. Think this out well and specify clearly. Things may change, of course, but start with a plan, and let everyone/anyone know so they are in full support of you and your wishes. This birth is YOURS.

On the other hand… I have been honored to witness birth without plans. And few things in this world will ever be as amazing. Birth happens. And more often than not, normally, naturally, and beautifully. All the planning in the world won’t change that. So… give this your all, or take it with a grain of salt, or be willing to step into the great wild unknown without a plan. No matter what your choices now, belief in your self and the nature of birth holds greater value than a well written plan.

Well, assuming (after all this work!) you may wish to put your plan together:

For home birth or unassisted birth, a plan is simply the clarifications and reminders of your how you intend for the birth to unfold, and the necessary preparations to best ensure a safe and wonderful experience. Taking the time to write a plan out may help the process become more clear and understandable. It also give you’re the opportunity to consider things again and again. Cover your bases: Did you forget anything? Is there something else you’d like to include? Is there something else you should plan for? Is there anything else you might want on hand?

For birthing center or hospital birth, a birth plan clarifies your desires and intentions for general conditions and any possible specific procedures that you may be presented with. The tendency for medical interference is of course greater for those choosing birth in hospital, yet the comfort this allows certain women is your decision. As a self directed mother, it is also your responsibility to know what procedures may take place and what your preferences would be in handling these situations. Specify what you will and will not allow, and how you want things done. More and more, we are seeing some hospitals being considerate to a woman’s birthing plan. Have it in writing and have it with you.

The birth plan is composed of your choices that we’ve been discussing over the last few posts, and whatever else you’d like to consider. Of course a plan is just that; a plan. Things change. Likewise, those choices you are making now may change as you learn, expand, explore in pregnancy, and as your birth unfolds. Thus your plan too may change. Be open and have fun!

Remember, others (including myself) may make recommendations. Take them with a grain of salt. Chances are very likely that the “advice” is well meaning, even when it is inappropriate. Some people just can’t help but want to help when it comes to pregnancy and birth! Ultimately I want you to believe in yourself first and foremost, and whatever care giver you choose second.  Remember this: no one will know your unique experience, body and birth as well as you. This is yours.

Your plan is your own blue print. Putting this on paper may help you emotionally. A birth plan and backup plan, in writing can be empowering – and save confusion.

You may want to spend some time brainstorming or daydreaming in your Sacred Journal. Write down as many thoughts and ideas for the upcoming birth as you can. Consider all kinds of details. Music, lights, food, what you want to wear… Why not? This is a sacred event. Make the most of it! Make it yours! Your journal may help you establish priorities and provide a list of ideas to help you create a birth plan.

The Birth Plan that you share with others may be best kept short, clear, specific. Perhaps a simple one-page statement of your preferences for the birth of your child. Providing a copy of the plan for anyone directly involved in the birth will help them better understand your desires, and can also serve as an effective tool for opening discussions ahead of time on important details with anyone involved in supporting and caring for you.

 The Back Up Plan

 So, in addition to your plan, you may consider having some sort of backup plan in writing should emergency situations arise. If you’re having a home or unassisted birth, it’s a comfort to know you have knowledgeable skillful support nearby if need be, and a plan for reliable medical intervention if necessary. As always, your plan will clarify your intentions as well as your desire to lessen interference and intervention. A plan in writing may minimize or eliminate/prevent medications and medical procedures unless absolutely necessary. Trust your body and baby to act naturally and birth to unfold naturally. At the same time, you can be responsible and respectful with a plan should intervention deem necessary. Don’t count on it, but know it is there for you if need be.

This is an optional choice. As per our discussion on the Nocebo effect, considering the backup plan may raise undue fears and concerns. So please keep this in perspective. This is like learning to read, but knowing you don’t have to sit down any time soon and conquer War and Peace. On the other hand, this is an interesting exercise to more fully educate yourself and handle any potential “what if” situations that may arise during labor responsibly. Once again, the more work you do ahead of time, the more you may be setting yourselves up for success. And the more preparation you do in advance, the more you may be able to let go and flow when the time comes. That’s what doing your homework is all about.

The following is a list of pointers you can discuss and plan for relating to choices in handling birth, aware that if complications do arise they will be handled as you have requested. You may want to cover everything from undisturbed contact the moment baby is born, newborn exam, placenta birthing and cord cutting, breastfeeding, etc. That’s up to you. It’s a lot of work, but may bring you a peace of mind in considering all your choices further. If rather than bringing you peace of mind this creates upset, you may let it go, as the likelihood for serious complications is so small. Or just skim through and make a short list of the most important things that matter to you.

A birth plan and/or backup can help you prepare ahead of time to create the birth you want, and in birth, help you maintain your focus and stay calm even if unexpected events occur. As I remind you often:  there is no right way, only your way. In looking the following list over, please keep in mind the due respect of personal privacy, beliefs and practices. Honor yourself and your family first.

  •  Who do you want to be present?
  • Do you want a doula?
  • Will there be children/siblings present?
  • Do you want mobility, or do you wish to stay in bed?
  • What activities or positions do you plan to use? (walking, standing, squatting, hands and knees)
  • Do you prefer a certain position to give birth?
  • What will you do for pain relief? (massage, hot and cold packs, positions, labor imagery, relaxation, breathing exercises, tub or Jacuzzi, medication)
  • How do you feel about fetal monitoring?
  • How do you plan to stay hydrated? (sips of drinks, ice chips, IV)
  • How do you feel about pain medications? Do you have a preference for certain pain medications?
  • How do you feel about episiotomy?
  • Are there certain measures you want to use to avoid one?
  • What are your preferences for your baby’s care? (immediate skin to skin, when to feed, where to sleep)
  • Do you want a routine IV, a heparin/saline block, or neither?
  • Do you want to wear your own clothing?
  • Do you want to listen to music and have focal points?
  • Do you want to use the tub or shower?
  • For home and birth center births, what are your plans for hospital transport in case of emergency?
  • If you need a cesarean, do you have any special requests?

The following can be helpful to use or look over. Use it if you wish, change it as you wish. This is from the wellnessmama.com site and is just an example of a possible written plan to give you some ideas. I personally think this is interesting to look over. Even if you are planning a home birth, if you do find yourself in a hospital, you can still work within your personal preferences for those things which matter most.  Yes, a healthy birth is always our number one goal. But birth is – and can be – so much more than that. For those that see birth as a Sacred Transformation, why not make the most of this great awakening?

Birth Preferences

Name:

Estimated Due Date:

Doctor/Midwife’s Name(s):

Others attending birth:

Labor

-I prefer to labor and deliver without an medication or drugs unless medically indicated

-I prefer not to be offered any pain relief by the nurses.

-I will use natural measures like meditation, massage, breathing and heat/cold to help cope

-I prefer to have no IV but will consent to a Hep lock if necessary

-I prefer to have no medication to augment labor

-I prefer not to have my water broken before I am pushing

-I prefer not to be directed in pushing but to allow my body to direct itself naturally

-I would prefer to eat and drink as needed during labor

-If labor augmentation becomes necessary, I would like to try natural methods first including: nipple stimulation, walking, herbs, etc

-I prefer only external monitoring when needed (not continuous)

-I prefer no internal exams except to establish active labor (if needed) and to check for complete dilation before pushing (again, only if needed)

– I prefer to move around freely during labor with lights dim and music on

– I prefer to push in whatever position feels most comfortable at the time

– I prefer no episiotomy unless absolutely required for baby’s safety and would like perineal support, massage or hot compresses to help avoid a tear if needed

– I prefer that no vacuum or forceps are used

– I prefer to try all a natural options before considering a c-section and will only consent to c-section for imminent medical reason

Birth Preferences

-Please place baby immediately on my chest if supine, or allow baby to rest on the ground before me if squatting, and leave baby there

-Please do not cut the cord for at least 15 minutes or until it stops pulsing

-Please clean/check baby on my chest and do not separate me from baby

-Should a cesarean become necessary, I would like my partner to remain with me at all times and be conscious during the surgery if possible. I would also like to have skin to skin with baby while being stitched and breastfeed as soon as possible.

Newborn procedures:

We have chosen to decline:

  • Eye Ointment
  • Hep B Vaccine
  • Vitamin K Shot
  • Circumcision

We will consent to:

  • PKU test
  • Hearing test
  • Necessary emergency treatment

After Birth:

-Baby will be exclusively breastfed, please do not offer pacifier, sugar water or formula

-I wish for baby to remain in my room 24/7 and will accompany baby to any testing

-I do not wish to receive any pain medication post labor and will cope with after pains naturally – please do not offer medications or stool softener

-I would prefer to leave the hospital as soon as possible after birth

-Should a transfer be necessary for baby, please allow me to accompany baby

Now it’s your turn if you wish for writing the Birth Plan and backup plan. Explore, discover, discuss, expand, open; consider the creative, the spiritual, the whole you. Most of all, have fun with this. If it starts to feel like filing taxes, I’d say drop it. It’s not worth that! But for those of you who love organizing and feel empowered “covering the bases,” creating a personal Birth Plan or Preferences is a wonderful tool. Use it as you like!