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Best Laid Plans: Creating a Birth Plan

I often have to remind myself that not everyone views birth the same way I do. For me, giving birth is an awe-inspiring act my body is designed to do on its own. I believe in the wisdom of women coming together and supporting one another through birth: be it at home, birth center, or hospital. Sadly these days, with the rise in medical interventions, birth seems like it’s being treated more like an emergency than a natural occurrence. Women’s bodies are often considered flawed; therefore, rather than giving women time to naturally progress, labor is frequently timed and scrutinized. When I became pregnant with my first child I desired a hospital birth. I wanted the security I felt a hospital provided if there truly was a life-threatening emergency. I also wanted a natural childbirth with a sense of control and dignity, so writing a birth plan became very important to me.    
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I realize some people view my desire for control and dignity during a hospital birth as…a joke. 
 
This was evident by some of the responses to a poll I posted on my Plus Mommy Facebook page about birth plans. I asked, “Did you write a birth plan?” I was troubled by some of the responses like, “Why bother? Nurses and OB’s just use it as scrap paper anyway.” 13 women had selected this as their response. I wondered if their wishes weren’t respected during their birth or if this was just their perspective of birth plans in general. 
 
Was I just naive and had my experience with a birth plan being honored been some kind of anomaly?     
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My doula was very open with my husband and me about how births don’t always go as planned. She had us write not only a birth plan but also a c-section birth plan. Whitney even handed us a piece of paper that went over our options if we had a stillbirth. I’ll always be grateful for her open and honest approach. She empowered us by making us aware of our options. 
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I believe that’s the power of a birth plan: not the plan itself but the act of creating one.

the power of a birth plan isn't the actual plan, it's the process of becoming educated about all of your options

 
The time spent thinking about and even researching your options is powerful. Before completing my birth plan I ask my midwife numerous questions about my selected hospital’s policies around labor and delivery. After reviewing my completed birth plan with her I knew we had selected not only the best medical provider but also the right hospital for us.
 
I believe medical providers who discourage women from writing birth plans aren’t going to be as amendable to their wishes during birth.
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I knew the moment I arrived at the hospital, birth plan in hand, that my wishes weren’t going to be the number one concern of my care providers. Hospitals have their own guidelines and safeguards and there was only so much I could do to insure my birth plan was followed. I was at peace with that knowledge but grateful my doula, husband and mother were there to advocate for me.
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Below you’ll see my one page, easy to read birth plan with comments about what actually occurred in blue.
 
 
McLellan Birth Plan
Objective – To have a natural childbirth with no medication.  We are completely aware that everything may not go according to our plan but hope you'll support our desire to have as close to a natural birth as possible.  
 
People Present
  • Jennifer McLellan (Mother)
  • Christopher McLellan (Father and Medical Proxy for Jennifer)
  • Whitney Nichols-Dewey (Doula)
  • Kathryn Rue (Jennifer’s Mother)
Labor and Birth 
  • Spontaneous or only natural induction methods (I'd be open to a Foley Bulb if I'm not progressing). 
  • During labor I’d like the freedom to enhance my labor by walking, change positions, nipple stimulation, use of shower or tub, and /or natural labor enhancers.  I do not want pitocin.
  • During labor I’d like to have the ability to eat, drink, and go to the bathroom as desired.
  • I don’t want to be continuously connected to a fetal heart rate monitor.
  • Please don’t ask me if I want any pain medication or what my pain scale is.
  • I’d prefer minimal vaginal exams. 
  • When it comes to pushing, I’d like to follow the direction my body gives me and not be directed on how to push unless I need help.
  • Warm compresses would be appreciated on my perineum without any numbing medications. 
Immediately After Birth 
  • Chris to catch baby if possible and then have the baby immediately placed on my chest without being cleaned. 
  • I would like to stimulate the baby and encourage the baby to expel its own mucous with coughing.
  • It is very important to me that I have skin to skin contact with the baby at all times.  My son required medical attention that superseded my birth plan, therefore, from this point on my birth plan wasn’t completely followed.  
  • I would like to spontaneously deliver my placenta, encouraged with breast stimulation, and then have Chris cut the cord after the placenta has been delivered.  I’m fine with routine pitocin if I start bleeding too much.  The cord was cut before I delivered my placenta.  A nurse started to administer routine pitocin but my midwife advocated for my birth plan and stopped her.  After I delivered my placenta my midwife recommended pitocin because I was bleeding heavily.  At that point I was comfortable with the use of pitocin and gave my consent.   
  • We also plan to keep the placenta and will have a cooler at the birth.  (I had my placenta encapsulated)  
  • Following the delivery of the placenta, Chris and I would like an hour alone to bond with our son.  No extended family members or guests will visit until this bonding time is complete.  This did not occur due to my son’s need for additional care. 
Treatments for the Baby
  • Vitamin K shot  (not until after breastfeeding and bonding has occurred)
  • NO Eye Care (we will sign a release if necessary)
  • NO Hepatitis B Vaccine (we will sign a release if necessary) 
  • We don’t plan to circumcise our son    
  • My husband and I researched and had long talks about the treatments listed above. Everything we wrote out was respected besides the time when our son was given the Vitamin K shot.
Thank you so much for your support
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So was I just naive and had my experience with a birth plan being honored been some kind of anomaly?  Absolutely not! 

My husband and I, following the guidance of our doula, spent time finding the right care provider and medical facility that would support our desire to have a natural childbirth. We asked a lot of questions and educated ourselves about not only the options but also the risks associated with giving birth. We were as prepared as two individuals without a medical background can be. 
 
Women need to empower themselves by researching options; not only for where to give birth and by whom, but also how. Vocalize wishes by preparing a birth plan and reviewing it with a selected medical provider.
 
 
Resources for writing your own birth plan:

The Bump Birth Plan, The Bump
Checklist: How to Write a Birth Plan, Parents Magazine
Creating Your Birth Plan, American Pregnancy Association
 

 
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Mother of Ambition

Friday 3rd of June 2011

More power to you! Sounds like you did your research and, overall, your wishes were respected. Ours, not so much, but I'm so glad that you had such a natural experience!

Natasha Maia

Friday 3rd of June 2011

You are a great writer, Mama!!!

Kel

Thursday 2nd of June 2011

I actually never shared my paper birth plan with the doctors or nurses, but they did ask lots of questions and take mine, so I got to cover everything (and all my worries were addressed, which was good). BUT I am incredibly glad that I took the time to write one.

I ended up being induced because I developed preeclampsia (but I was at 41 weeks, 3 cm and 75%, and contracting regularly without feeling anything, so it was more like augmentation than true induction!). I was told at my morning OB appointment that I needed to go directly to the hospital for further monitoring and possible induction (I'd done this two weeks prior, as well), and I refused the "immediate" part. I cried all the way home, ate lunch, finished packing my bags, and rewrote my birth plan. It would obviously need to change if the first line was "I don't want an IV," and I was going to be induced. That fifteen minutes I spent rewriting my birth plan helped to remind me of all of the things that could still go how I wanted, and it helped me to come to grips with what was going to change, rather than just experiencing it as it happened. When I went to the hospital, I felt like I was going of my own free will rather than being sent there by the doctor, and I had been able to take the time to replan and be willing to accept the necessity of the induction.

So in a nutshell, I think it's super important to write birth plans, and even if you know in advance that you can't follow it, reworking it is an important thought process to go through. I got to feel like *I* changed the plan rather than the plan being changed by circumstance, if that makes sense.

(Sorry that's so wordy. I really enjoy your blog, and your courage and candor in sharing!)

kissyface_98

Wednesday 1st of June 2011

I completely agree! I think that no matter what your birth plan is- drugs, no drugs, hospital birth or home birth its important to have decided before hand what you would PREFER to happen. Of coarse not everything goes according to plan but as a mother who chose no birth plan with my first delivery, I planned to be disappointed because I didn't educate myself and had no idea what to expect so everything was scary. Thanks again for another awesome post!