You know what they say about “best laid plans…”. That being said, plans are still a good idea. You might not stick to one – nature or other forces may have their way with your plan – but the act of creating the plan is often the most important of the process because they produce a clarity of purpose, intention and vision.
Creating a birth plan and keeping it flexible
The same is true for birth plans. Your labor and delivery may go as planned or it might veer off a little here and there depending on what Mother Nature has in store. Regardless, birth plans are a good way for you and your delivery partner to “practice” what might be needed when, to come up with strategies to stall interventions if a natural birth is important to you, to create a “tool kit” of relaxation, breathing and pain relief techniques, and so on.
Step One: Speak with your healthcare provider
Some care providers are more dedicated to the idea of a birth plan than others. It’s worth asking about this when searching for the right OB for your labor and delivery. This is why we’re so supportive of midwives and doulas in the delivery room – they serve as the mother’s advocate throughout the childbirth experience, and can keep the birth plan and intentions on track when mama is in the hardest stages of labor.
Step Two: Start talking to the mothers in your life
Have conversations with a variety of women in your life about their birth plans. Were they successful? Did it help? What do they wish they’d done differently or accounted for? The thing is, you never really know what you’ll want in labor. First time mothers think they know what they want – but envisioning labor and being in labor are two very different things. Second and third-time moms are often surprised to find that each labor/delivery is different, and what worked with one doesn’t work with the other.
For this reason, create as specific plan, but one that is open to the fact that things might change when you’re actually in labor.
Step Three: Create a birth plan with a Plan A and Plan B
Of course, Step 3 has multiple parts – so here’s how to get started:
- Keep it all on one page – but create two pages. One page is all any care provider will be able to review in the heat of the moment but your birth partner will know every step in detail so the plan will serve as a guide. It’s best to create two separate pages – Page 1 – the uncomplicated birth plan(vaginal birth) version and Page 2 – the birth plan that accommodates for complications (cesarean section or complications with baby).
- Learn about policies and procedures. Part of preparing for childbirth is taking a tour of the space where you’ll give birth and learning about the hospital or birthing center’s policies and procedures. If there is anything that raises a red flag for you, check in about it earlier rather than later. If you can come to an agreement, have your doctor sign something saying your adaptation of the policy is granted as long as mother/baby seem healthy.
- Start from the beginning. Consider everything about the space you labor in, who should be there, who shouldn’t, what’s your code word or signal if you need a break from people in the room, and so on. What kind of lighting do you want? Do you plan to have some kind of sound in the background, etc.
- Medical interventions. What interventions, if any, do you want for pain? Or to speed your labor along? If you want a natural birth – it’s best to ask the staff not to ask you about induction meds, epidural or pain meds AT ALL. Period. That way you aren’t fielding unnecessary questions. Then, your birth partner, doula and/or midwife can make a request if you change your mind midstream. Sometimes we hear that women were asked so repeatedly about a specific intervention they finally said, “alright, already…” and then wished they had stuck to their guns. The less you have to defend or deliberate during labor, the better.
- Pain relief. While medication is an option, plenty of women are able to weather the discomfort and associated with labor because they know it’s temporary. Things like massage, pressure, ice/hot packs, showers, soak or Jacuzzi tubs, position changes, mobility, visualization, breathing techniques – all are available to you and your labor coach can help you run through the gamut of options since what you want may shift from moment to moment.
- What positions are available to me? Freedom to move and change positions can make a tremendous difference in how your labor progresses – and how you and baby feel through it all. It’s always best to work with providers who are flexible, and supportive of you changing positions , getting up to walk around or sit on a yoga ball, and who don’t consider detaching and reattaching the fetal monitor a major inconvenience. Do you really need the fetal monitor or will they agree to using a Doppler? That’s another potential adaptation/plan.
- How do you feel about episiotomy? While it’s still a mainstay in some hospitals, studies have shown that proper perennial support, massage, position changes and mother-led pushing can all eliminate the need for episiotomies. Similarly, there is ample evidence that a mother’s natural tearing heals better than episiotomies when all is said and done. According to a systematic review published by JAMA, “Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.”
- What’s your immediate post-partum plan? Do you want to delay the cord cutting? Do you want immediate vital signs taken while baby is skin-to-skin on your chest? Excluding a complicated labor or dramatic signs that something is amiss with baby, almost everything we do to check on baby’s well-being can be done in while baby is resting in your arms or on your chest. Some things (weighing, for example) can even wait for a little while- until you’ve had time to enjoy each other’s company, breathe in each other scent, feel each other’s’ heartbeat outside, and even until baby has had his/her first latch and breastfeeding. This is all assuming your baby is breathing well and shows no signs of distress or unusual complications.
- If you need a C-section, do you have any special requests? There is no doubt that vaginal birth trumps C-sections, but about 10 – 19% of the time – surgical intervention is necessary. This is Plan B for most women, but there should still be a plan in place. If the baby is not in any serious distress, skin-to-skin contact is still possible immediately after delivery. If the baby (or mama) requires immediate medical attention whisked away, your partner should be able to stay right with the baby, touching him/her (even if it’s just holding a food or hand) and talking to her (the voice will be recognized). Knowing dad, partner or another loved one is with baby makes the mother feel much more at ease during what is bound to be a stressful situation – the baby will be in constant contact with someone who loves him/her as must as possible. We recommend checking out this “real life” family-centered cesarean birth plan for more ideas.
- Breastfeeding. We hope you’re planning to breastfeed your baby but, if not, please do dedicate at least the first day or two (if not longer) to breastfeeding or pumping. Your breasts are producing colostrum and breastmilk that is custom-designed for your baby. It will optimize the health of your babies gut, immune system and overall, physical development. Seek assistance from the hospital’s lactation consultant(s) as much as you need it – that’s what they’re there for. If one doesn’t resonate with you, ask for another one or have your partner get in touch with a local La Leche League The sooner you have the right assistance the better for both you and baby.
Looking for a labor and delivery team that will prioritize your birth plan? Contact us here at Overlake and schedule a consultation. Our amazing team of physicians and midwives do our very best to put our patients’ best interests first.