Birth: To Plan or Not to Plan?

That IS the question that seems to pop up time and again for expectant moms. If you want to see evidence, check out the latest posts about birth plans (and the multitude of comments) from NPR on The Baby Project — here, here and here.

To some, the idea of a “birth plan” sounds silly and unnecessary. “What is my birth plan? Well, I plan to birth a baby!”  Still other moms hinge every other thought in their third trimester on their birth plan. And what about maternity care professionals — how do they feel about a birth plan? Well, it depends. At the hospital where I plan to give birth, nurses, OBs and midwives alike encourage moms to submit a birth plan and bring a few extra copies for everyone attending their birth to review. But I’ve also heard of care providers who scoff at the idea, even calling women who bring in an overly detailed birth plan an “automatic section” (as in, cesarean).

So where’s the middle ground? My personal philosophy, which I was happy to learn aligns with Lamaze educators, is that writing a simple, informed and succint birth plan helps a woman (and her birth parter): consider and research the many choices available surrounding labor and birth; open a discussion with her care provider that can sometimes reveal surprising differences in their “vision” for birth; and provides useful information to a woman’s birth team.

While there’s no “right or wrong” for creating a birth plan, there are some things to consider that will help you get the most out of the process and make it more likely that your care providers will read your plan.

A Birth Plan is Not a Script — or a “Plan”

You can plan your wedding day, you can plan a vacation, you can even make plans to build a house. The idea that you can “plan” a physiological event like birth is a bit of a misnomer. You can’t plan — or predict — exactly how labor and birth will unfold, but you can request preferences for you and your baby’s care during birth. With that in mind, it’s important to understand as you create your birth plan that birth is unpredictable and flexiblity is key. While certain birth plan requests, like allowing the baby’s cord to stop pulsing before being cut or delaying (or refusing) the Heb B newborn vaccine, should be observed regardless of the birth situation, other preferences may have to be amended depending on the health of both mom and baby.

Rixa Freeze, MA, PhD, a well-known birth advocacy blogger at Stand and Deliver who has written at length about birth plans, has this to say:

“…planning for birth is like preparing proactively for breastfeeding. There are the individual choices you make and have control over during pregnancy, such as provider or place of birth. There are the institutional protocols and provider preferences that will influence what happens to you during labor and birth. And then there are the unpredictable, uncontrollable events that may throw you a curveball during labor. Birth plans are primarily for the second category of events–navigating institutional routines and employee protocols that may or may not be what you want, and may or not be beneficial for you or your baby.

Involve Your Partner and Your Provider

Writing your birth plan is not a one-woman-show, but rather a group effort. Talk to you care provider about your birth plan preferences — are they in line with your care provider’s philosophy or what she will even allow? Are they in line with typical hospital protocols? If your birth plan is chock full of requests that go against standard hospital protocols or ask for tools (bath tub, wireless fetal monitoring, birth stool, nitrous oxide) that aren’t available, you might be disappointed on the big day. Involving your providers in your birth planning process will help you understand alternative options to achieve the care you desire or perhaps, seek a different care provider or place of birth.

Write an Outline, Not an Essay

Remember the “succinct” part I mentioned above about about birth plans? There’s good reason to keep birth plans short and sweet. For one, your care providers and birth team have will have limited time, especially on the day of your birth. If they are presented with a two and-a-half page, text-heavy document to read, it will most likely not happen. Create a birth plan that is easy-to-read and as short-as-possible (one side of a one 8.5 x 11 page is great!), with bulleted text and only the necessary details. For example, I didn’t include on my birth plan that I will eat and drink as necessary — I just plan to do it, even though I know it is against routine hospital policy. Per Rixa’s advice:

“…don’t worry about including any of the little things that you shouldn’t even be asking permission for. The don’t ask, just do kind of things. Eating and drinking if you’re hungry, moving and changing positions, music, lighting, unhooking yourself from the monitors to move/go to the bathroom/etc (especially if, like most women, you have no specific reason to be on constant monitoring). Just do these things and don’t take any flak from the nursing staff. Make sure your birth partner knows about these things and can buffer you from the nursing staff if you deviate from their policies or routines.”

For more on birth plans, stay tuned for Monday’s post where I will share and discuss my birth plan for my third (and due in about a month!) baby.

What is your personal philosophy on birth plans? If you used one for a previous birth, how did it help you?