Birth Plans--Are they worth it?

I’ve heard different takes on birth plans. I know some mamas are all about them–have them written out during the first trimester and want their doctor to sign and seal them with blood! On the other hand, I hear from some nurses that no one even pays attention to them. I tend to fall somewhere in the middle. I mean, having your doctor sign your birth plan does not in any way INSURE that you will have the birth that you planned! Any sort of a complication can arise that would mean a different turn from your plan–especially in a hospital with an OB. Let’s face it, a “complication” to an OB is not necessarily the same as a complication to a midwife. But that’s a different post…. Now, I also tend to disagree with the belief that no one pays attention to them at all. I think it makes a statement just in the fact that you have one. If you care enough to sit and think about what your desires and requests are in your labor and delivery and put them down on paper, then you should certainly be commended and recognized for that. Even if no one read it (which most certainly someone will) they would at least know that you have an idea about what you want out of your birth experience. That speaks volumes. That lets the OB and nurses know that you aren’t just going to passively sit or lie by and let them make all the decisions for you and your baby.

So, I do think it’s a good idea to have one. That being said, I think there are some guidelines you should follow.

1. Keep it short! Limit your plan to one page! Too many pages, and it’s more than likely that it will just get dropped in the trash and you will be labeled one of those high maintenance moms, and sadly, some nurses might try to see to it that you learn that things don’t always go as you planned. A one page birth plan is very reasonable, and most nurses will be happy to read through it and, as I said above, realize that you are taking an active role in your labor.
2. Only focus on the things that are truly the most important to you!Make sure that you think about THE most important thing to you and make that #1 on your list!! After that, go down in descending order of what’s important. You may have to give a little on certain things so make sure you think about the things that you truly don’t want to give on.
3. Keep it positive! Don’t start your sentences with “I won’t do ….” Try to state it positively. For example, “If my labor stalls, I would like to try natural ways to help it along and would like to discuss any use of synthetics before they are administered” instead of “I do not want pitocin!”
4. Take it into your appt. with your OB (around 37-38 weeks) and have him/her sign it! No, it still doesn’t insure that it will all happen exactly like that, but at least you’ll be able to show your nurse when you go in during labor that your doctor has seen it and agreed to it. It’s also a way for your partner to hold your OB accountable if things start to get a little crazier than your comfortable with.
5. Be Flexible!! This is the most important part when you are birthing in a hospital! When you decided on your OB, you decided to play on their turf. Yes, you certainly still have rights. I’m not saying that!! But there will be some things that may not work exactly as planned or go as smoothly. That’s okay. If you go into it knowing this–and knowing that you did as much as you could to get the birth experience you wanted–you should still be relatively satisfied with your time there.

Now, here are some examples of things that you might want to include in your birth plan. This is certainly not an exhaustive list nor do you need to put everyone of these things on there!! Some of these might be very important to you–others not so much. These are in no order of relevance to anything! You need to think about what you really want and then decide how to put your own plan together. I did not take the time to make these all in a “positive” statement here.  Just giving you ideas to think about.

• Intermittent monitoring (instead of continual fetal monitoring)–once you are on a continual monitor, you are very constrained to a certain area and unable to do a lot of moving around which is what we want to do in labor!!
• Allowance to get in the bath/shower (this will depend on the facility and OB)
• Eating during labor It’s crazy to think that we should go through one of the hardest physical activities of our lives with no nutrition (even if it lasts 24+ hours) but that’s exactly what OBs expect. Get some facts and talk to yours!
• Using natural ways to boost a “stalled” labor Nipple stimulation (whether manually, by a partner, or with a breast pump) is one of the best way to boost your natural oxytocin levels.
• No pitocin or labor inducing drugs
• No epidural or medicated pain relief
• Limited (or no) vaginal exams
• No episiotomy
• Allowance of a birthing ball (during labor) and a birthing bar (while pushing)
• Allowance to push in whatever position feels “right”
• No “purple pushing” (Pushing while holding your breath to the count of 10–can burst blood vessels and really wears you out. Ask to push as your body tells you–I promise, IT WILL!!)
• Wait until cord stops pulsing to clamp
• Do not pull the placenta–wait for it to detach on it’s own
• Allow skin to skin contact immediately with baby
• Allow nursing as soon as mom and baby want after birth (This also helps uterus tighten up and prevents hemorrhaging)
• Do not take baby right away to weigh, clean up, etc.
• No Vitamin K shot; no Hep B shot (baby)
• No erythromycin in the eyes (baby)
• Do not clean vernix off of baby’s skin (This is the white, protective coating that baby has had on his/her skin in utero to keep the skin protected from being in water for nine months. Keeping it on for up to a day after birth has been shown to continue to protect from new outside things as well. Plus, it helps keep their skin very soft. It’s helpful to just softly rub it into baby’s skin over the first day.)
• Rooming-in only!
• No bottles or pacifiers

Like I said, this list is not exhaustive. If you can think of something else that’s been important to you in birth, please share it in the comments and I’ll include it in the list!