The Motherhood Café Presents: HOW TO WRITE A BIRTH PLAN
Erin Baird: Mother of 4, Certified Nurse Midwife
Alisha Meador: Mother of two, Motherhood Collective Volunteer Staff
Kathleen Olinger: Mother of three, Motherhood Collective Volunteer Staff
Erica: We reference birth plans almost weekly in our small groups, so today we're excited to again devote an entire panel to writing them! We are pleased to welcome on of our wonderful CNMs. She will help define terminology, suggest ways to word birth preferences and give insight as to how birth plans are received by care providers. We also welcome two local mothers. They will be sharing their birth experiences and will chime in about the role birth plans played in their labor and delivery experiences.
This is an open discussion and I'm only serving as our facilitator this morning, so please jump in at any point with questions or comments. Lets begin with introductions.
Erica: What is a birth plan, why did they originate, why do we talk about them, and what’s the whole point?
Erin: A brief history of obstetrics in the United States… babies were originally delivered by midwives in their house or by their family practice doctor who came to their house and you would have an established relationship with that person, they would know you, you got to know them, you didn’t real have to plan things out because there weren’t a lot of options. Then there was a big push for women to be conscious and have options. Women started to write down their desires and bring them in form of a birth plan. They really took off in the 80s and 90s when there was a movement for less intervention. Now the pendulum is swinging again because people in the medical world are starting to do the changes that were asked for over and over and over again.
Kathleen: My first (birth) I didn’t know what a birth plan was. My second was a homebirth transfer. I had a plan for my birth but I was so confident I didn’t think I needed one. But now I’m reflecting that if you’re going to have a home birth still have a birth plan. Don’t get over confident and think that your birth is your plan. I think it would have been helpful to know what a birth plan was the first time.
Alisha: Its important to note my first was prior to the baby friendly designations of the hospital. I had a regular OB provider who listened but weren’t incredibly supportive. I went into the hospital experience assuming no one was going to care what I thought, so I wrote a really detailed birth plan, which is funny now because it was kind of pointless and was a very defensive posture. My birth went quickly and I almost accidentally had him at home. I realized after my first experience that I can attempt to control things, but with birth it can be a little bit crazy. I wrote out more of a wish list for what I wanted. And knowing that the hospital had a baby-friendly designation, I felt very supported by the midwives and talked to them throughout my care about what I wanted and how I wanted things to go. So I felt like going into it I didn’t need a plan, but we had a mutual understanding of what we wanted it to look like.
Erin: The baby-friendly designation is a World Health Organization designation that you have to apply for and is a challenging process to go through. It is to counter act what a lot of people use to write birth plans about. The idea behind it is that your baby is your baby and that is best served by being with you from birth until discharge. We support the preferred method of feeding your baby (breastfeeding) and that process if uncomplicated should not be disrupted unnecessarily by medical intervention by giving sugar water or formula. That’s the overarching umbrella, but how it plays out is that if everything is going according to plan, then the baby comes out of your body and goes to your chest and is there for the first hour of life. All newborn procedures and everything is done on your chest with your baby still with you. Then baby stays in your room for all procedures. The only time baby leaves the room is for a medical reason or if you would like your son circumcised. The baby-friendly movement is the answer to the desires of the mothers delivering now. If there is nothing wrong then don’t intervene.
Erica: Why didn’t you write a birth plan?
Erin: I didn’t write a birth plan because I was happy, I was a midwife, and I thought I could do it. I thought, “I’m a midwife, I work with the nurses who are going to deliver me, I’ll be fine. I’ve been doing this for years, I was a L&D nurse.” I thought, “I got this.” My first birth was a checklist. I didn’t write one with the second because I just wanted it to not be the first one. I thought anything would be better than the first. My third, I thought, “I got this.” My fourth one, I was on call. I didn’t feel like I needed to tell anyone because I really didn’t care about the things I had seen on the birth plans and I didn’t have the same preferences. And each of my births was a different situation.
Top 10 Do’s for Writing a Birth Plan
1) DO keep your birth plan short, simple and easy to understand (1-2 pages max)
2) DO keep the language of your birth plan assertive and clear.
3) DO use your birth plan as a starting point for doing your own personal research about your preferences or childbirth.
Erin: Someone who is arriving who is very active… you are asking them to know you quickly, so short and sweet is important. There is a fine line between assertive and defensive.
Alisha: I think you’re choosing that because you trust them to take care of you. Make sure your language is respectful. Doing your own personal research.
4) DO include your fears, concerns, and helpful things for the nurses to know.
5) DO review your birth plan with your birth attendant and ask him/her to sing off that he/she read and understands it.
6) DO make your birth plan personal (don’t just copy and paste) and make sure that you understand everything on it.
Kathleen: I went to the hospital for an induction because there was no fluid. All though my pregnancy with my homebirth midwife I interviewed her everyday. So with Erin when I got there (hospital) I was I was trying to come to terms with my risk level because I needed medical intervention… they (the hospital) were so respectful of everything.
Erin: You’re feeling out the person you asked to take care of you. You’re playing a little bit of a tennis match with your provider. Part of what you’re doing is establishing your final confidence in your birth provider.
7) DO look at examples of birth plans online to get some ideas.
8) DO run through scenarios (how long labor could go, etc.)
9) DO try to treat research a birth plan as fun and exciting, not a chore.
10) DO remember to take your birth plan with you to the hospital!
Alisha: Bring it (birth plan) to your care provider’s office beforehand, so you can talk through it. You can ask questions. They can ask questions. They also put it in my chart, so anyone at the hospital was able to look at it and see it. So in the middle of labor you weren’t trying to converse with someone about it because it was already there.
Erica: You can never have too many copies of the birth plan.
Maria: I didn’t print out my birth plan, but they were able to email it and print it at the hospital for us. They were very accommodating.
Erin: If you’re having a home birth, have a plan for transfer and how you would like it to go at the hospital if you transfer. It’s not just you and me who have opinions, but babies have opinions too and have to be put into what you think. When you’re going through those scenarios you need to think through what do I do if I show up and the hospital and baby is in distress, etc. Bring in those scenarios.
Sexual Abuse or Traumatic Birth
Erin: Any history of trauma (in birth or in your life) is going to rear its ugly head in pregnancy, labor, and motherhood. And not addressing it and bringing up the muck from the bottom and bringing it to the surface means that people don’t know. And as a person, midwife, and mother, I feel an overwhelming desire to get around the wounded person. Most care providers are the same way. If you have a history of any sort of trauma (birth, childhood, sexuality, etc.) it is important for your care providers to know about that. There is nothing more violating on planet earth as prenatal care and birth can be. Nowhere else do you expose yourself and become that vulnerable. The minute you’re pregnant you are vulnerable. The minute you are in labor, it is a vulnerable position. So if you have history, we need to know, your nurses need to know, everyone needs to know. We don’t have to talk about it, but I need to know that this is going to be one of those things that we make a process and do on your terms. It’s important for us to know. And sexual trauma and birth trauma can become a roadblock in your labor. Anything can rear its ugly head… say in transition… there is a vulnerable state there. We can let you know that you are safe and we’ve got you. That has to be on a birth plan. I can’t help you if there’s something I don’t know you need help with.
Facebook live question: Is a birth plan somewhere I should put my fear of needs or an explanation of a bad epidural experience?
Erin: Nobody knows what your body is going to do with an epidural. You can’t really give a lighter epidural that tends to result in an unhappy patient. In my experience, laboring women when they’ve made the decision that they want an epidural they want it about 45 minutes ago. Being able to feel more makes them displeased. What every anesthesiologist goal is for you to be able to move your legs, feel pressure, but feel no pain. That’s what they shoot for. But every human being, labor, etc. is different. But every time you get something a little different.
Yes, on your birth plan put: doesn’t like needles, prefers no male providers, talk me through vaginal exams, or don’t tell me what and when you’re doing something that freaks me out, etc.
Is it important for your birth partner to know what’s on your plan?
Erin: Labor support people can totally sabotage your birth plan. Having a discussion with your partner, doula, etc… everyone needs to be in on the plan. You deserve a certain level of focus, but you can’t blame them for things if you haven’t told them.
Erica: Have you ever been offended by a birth plan?
Erin: Yes, and I might be eye rolls from this. I know my body best and I know what’s best for my body. Then why did you come to me? I know you know your body best, but have you labored before, have you had a baby before, do you understand fetal monitoring, do you understand fetal oxygenation, do you understand hemorrhage? No, that’s what you pay me for; that’s my job. Anyone can catch a baby… but that’s the easy part. It’s getting to the catching of the baby and the getting you home afterwards portion that is the challenge. I know you know your body best, but if something is wrong that’s what you pay me for. I know WRONG best. I’ve studied and been educated in the processes of labor. If something goes wrong. I want to let you do everything you want to do… your care provider woke up that morning to take care of women. I did not wake up this morning to light your birth plan on fire. Our job is to inform and educate you through this process. I’ve been offended by birth plans that put me in the role of not being valued for my education and expertise and dedication that I give my patients because I do give 110% of myself, and I feel that we all do. I don’t think a birth plan should be a defensive stance.
Keri: Can you speak to the phrase, “the longer your birth plan the shorter the distance to the ER.”
Erin: If you have a 3-page birth plan you are holding on real tight to some control that you’re about to have to let go. Your job is to get that baby to labor as healthy as possible. Then your job is to take a mental step and get out of the way of your body. Your body is on a mission, so get out of the way of your body. When you are writing a 3-page birth plan on how you would like your contractions called, and how you would like to be addressed, and that you can come in but only at this time, and you can only do this and I will only be checked then, you’re holding on to tight. Underneath it all, we are all just mammals out in a field giving birth. You cannot control it; you just need to be there.
Kathleen: I thought the hospital I delivered at before was baby-friendly, and then I found out it wasn’t.
Other: I think writing a birth plan is awesome and amazing, but I also think it allows women to build up this idealistic experience. So when it doesn’t go their way in the actual labor and delivery, they feel like they failed. I think what really helps women understands is writing a birth plan is great but be flexible. Your body is going to do what its going to do and when baby’s healthy and mom is healthy, that’s a huge success! My heart breaks when women say, “oh I had a section and my life is over, I failed as a human being… I’m like, “no you didn’t, are you kidding me! You are so GOOD!” Being flexible is so important.
Alisha: If you’ve had a traumatic birth or felt like a failure, I think it’s important to work through that before hand with your next birth experience. Although I technically had the birth I wanted; I didn’t have the support that I need at the time. It was traumatic and I was fearful the second time. Working through that before having my second son, once I let go of those fears my body went into labor. Then six hours later I had him. Fear was a thing keeping it in control.
Erin: It’s very first world to plan out our routine birth. As a midwife I have expectations of myself, I’m going to bring another baby into the world and its going to be awesome. I think that had an open heart and open mind, and had I approached this with better planning and better forgiveness and r self love, then I probably would have had a better labor and it probably wouldn’t have been as dysfunctional. And I certainly think my depression would have been less because I think that when you go in with these plans and then you end up with a c-section or you third-degree laceration, or you endup with and epidural and your baby gets jaundice and has to be admitted or you have breastfeeding issues, all of the things that can go askew… you somehow take that into your heart as your fault. There is always a third player in the birth plan and they did not write a birth plan, and if they had a choice they would not birth at all because that’s really snuggly, and that’s why they all want to go back for the first few months after they come out.
Erin: Celebrating your awesome birth because you brought life into this world, YEAH YOU DID! Who cares how it had to come out, who cares what you had to do to get there. IVF, steroid injections, bed rest, drugs up the ying yang, section, meds afterwards, four day admission to the hospital, YOU BROUGHT LIFE FORTH INTO THIS WORLD and YOU ARE A MOTHER NOW! You should have a cape and a theme song.
Erin: If you can't celebrate it (your birth) then you need help and you need to be seen by your provider. If you can't move past it to celebrate the birth that you had, then someone needs to know!
AN OPEN HAND
Our executive directory, Lauren Barnes, has talked before about the importance of entering birth with an "open hand." I think writing birth plans is definitely one of the instances where that is helpful. There are so many variables, so many choices and wishes throughout labor - but ultimately, birth is unpredictable. A mothers wishes for labor may be ignored or changed for a number of reasons. And while there is comfort in researching and choosing what you want (or think you'll want, being comfortable with your care provider and trusting your support team prepares you to enter birth ready to accept whatever happens.