Until a few decades ago, birth was entrusted almost entirely to doctors and/or, midwives. These days, women are taking more of a stand in their birth choices and stating that their birth is different than the ‘average’. Just because one method works for one mother, doesn’t mean it should be applied across the board. This is where birth plans come in – a general guide to preferences during and after birth. Many people think that birth can’t be mapped out – and this is true. Many people see a birth guide as a straight road, when in fact a good birth plan is based around two major features:
- Preferences for situations, no matter what interventions are needed.
- A way to point out the most important things that parents want (some things you may not mind, while others may be of major importance to you, based on your history, beliefs and knowledge.)
So what’s so great about a birth plan?
- Being informed and making choices ahead of time will make it easier to deal with the unpredictable.
- Having a general guide means less time spent telling birth supporters and medical staff what you want, when you’re deep in labor land.
- A plan takes the stress off about remembering and reminding during the rush of birth and the emotions that follow. The less stress the better!
Did You Know?
Legally you can refuse any person, trainee or PROCEDURE that you don’t want during birth, ask for more information OR look for a compromise. Read more about your rights in childbirth.
Why Do I Need A Birth Plan Instead Of Going With The Flow?
“Going with the flow” can be a safe way of saying “I have no idea. I am scared stiff. All I hear are descriptions of excruciating pain, and watermelons coming out of places they shouldn’t. I am just going to put myself in the hands of the experts, and hope I am fine.”. Women may be inclined to turn to this approach as a form of default, not knowing any other way, and as an acknowledgement that childbirth is out of their control. An understandable justification…
…Birth DOES matter, because how we experience it can affect every single thing that occurs after it. For this reason, ‘just going with the flow’ can be risky, as it often entails ‘giving your birth over to the experts’, and following their flow, as they advise you throughout. What this process can fail to provide, for a woman and her partner, is the opportunity to ask questions, provide insights, and make decisions as part of a team. Being involved in decision-making is a key aspect of emerging empowered from birth. Even if you make the same decision as your health carer advises…it is still YOUR decision if made from a place of knowledge (due to having information) rather than fear.”
Consent or Preference
There are two commonly used wordings for birth plans. You can use whichever wording you feel comfortable with (and based on how good you think the medical staff will be in following your preferences) or you can compromise and use both or a completely different way of setting out your birth plan. It’s your birth plan – write it in the way you’re most comfortable with!
- We Consent/Do Not Consent To – If you’re worried that you may be pushed into something you don’t like, clearly stating what you agree to during birth is a good way of writing your birth plan. This can be a good choice if you’re not feeling listened to, or you’re not sure who your care providers will be.
- We Prefer That – This style is a little more passive but if you trust your care provider and have nothing you are not open to changing, this is a good choice.
How Long Should A Birth Plan Be?
Generally, it’s best to keep birth plans to one page so that medical carers can easily skim them, especially if they know nothing about you. If you do have a longer birth plan you can:
- Cut it into specific sections. For instance preferences for a drug free birth, birth with intervention and birth with c/section.
- Put major points in bold font for easy skimming.
What Should I Do With My Birth Plan?
It’s a good idea to discuss your birth plan with your care provider sometime after 30 weeks. In some cases, your preferences may go against hospital policy, so it’s a good idea to make sure that you can reach a compromise with staff and make your wishes clear before you’re in labor. Some hospitals request that the mother, or both the mother and the care provider sign off on the birth plan. It’s a good idea to also have a copy to take with you to hospital, as well as a spare for any care providers or support people present.
Active or Expectant Birth Management?
Ask your doctor if they use active or expectant management.
Active – Making labor progress to arbitrary guidelines which vary by hospital – then augmenting labor if it does not go by these guidelines (saying that labor needs to progress at 1cm per hour for example.)
Expectant – Only intervening if there is a medical reason that labor is not going well.
What Should I Put In My Birth Plan?
- Would you like to be given time alone with your partner to discuss any major decisions?
- Would you like any steps taken by medical staff to be explained to you so you’re aware of what’s happening?
- Would you like to request that unless there is an emergency, interventions be delayed as long as possible?
- Would you like to eat and drink freely? All evidence says that there are little or no risks to eating and drinking in labor. In fact, NOT eating and drinking can lead to low energy and blood sugar in the mother, exhaustion and more chance of intervention. Make sure you discuss this ahead of time with your doctor as some do not follow evidence based practice.
- Would you like any personal items with you, such as music, pillows, birth balls or reading material?
What type of monitoring does your doctor use. Research shows that continuous monitoring actually increases the risk of interventions and often is counterproductive and inaccurate. It also often confines the mother to a bed. Ask your doctor about intermittent or portable monitoring, instead. Here is a very good read from Evidence Based Birth on continuous monitoring in labor.
- Are there people you want present at your birth?
- Are there people you do not want present at your birth? You can refuse to have any person in the room, family member or medical carer alike.
- Do you have any preference about the number of medical staff present (outside emergencies) and if training staff are allowed to be present?
- Would you like a silent or quiet birth? This means that people attending the birth are asked to take unimportant conversations outside and keep verbal interruptions to a minimum. If you prefer to labor without distractions, this can be a good choice.
Induction/Augmentation of Labor
- Whether or not you are happy for labor to be started or sped up by breaking the amniotic sac [Risk info here].
- Whether or not you are happy for labor to be started or sped up with the paid of syntoconin/pitocin [Risk info here].
- Whether you’d like to refuse induction outside important medical reasons [More info on your rights, here]
- Would you like to avoid internal examinations unless medically necessary (such as when pain relief is given)? Would you prefer methods such as the purple line are used instead? The cervix is not a crystal ball – some women can be dilated weeks before labor, others may dilate from nothing to full dilation in less than an hour. Cervical checks increase the risk of infection and labor stalling. They are only needed in cases where a doctor plans to induce, generally.
- Are there interventions you’d like to avoid unless birth has truly stalled or there is an immediate emergency? Examples include: Breaking the amniotic sac, episiotomy.
- Would you prefer not to be checked when medical staff believe you are fully dilated? Coached pushing is more likely to result in complications or tearing in the mother. Unless in the case of a medical emergency, most women will naturally push their baby out and some can even breathe their baby out.
- Would you like to request that you do not receive an IV drip unless medically indicated? Generally, there is no need for one unless you have a high risk pregnancy or specific condition. If you do feel forced to have one, ask if you can simply have the cannula inserted but not have the drip. This way it’s there if needed, but you don’t need to worry about what you’re being given without consent.
- Would you like your care providers to try and distract you or encourage you not to have pharmaceutical pain relief if you request it?
- Are there any particular natural pain reliefs you’d like recommended to you when needed? For instance a hot shower/bath, moving around, changing to a certain position, using a birthing ball, a massage or something else?
- Do you have an order in which you’d like to try pharmaceutical pain relief? For instance gas/air, pethidine then an epidural if needed?
- Is there a specific pain relief you are very adamant about not receiving?
- Do you have a specific type of birth program you’d like to use, such as hypnobirthing?
- Would you like to stay off your back and in active positions as much as possible (when possible)? Laying on the back can lengthen labor and increase risks.
- In case of induction or other complications, would you like to request intermittent or portable monitoring so you can be upright?
- Do you have a preference for pain relief positions?
- Do you have a preference for birth positions?Examples include: Squatting, kneeling, on all fours, using a birthing stool, standing, in the shower, in the bath, holding a bar, laying on side, or whatever position you feel comfortable.
The Father (Or Birth Partner)
- Would you like the father to catch the baby upon delivery?
- Would you like the father to stay with the baby if mother and child need to be separated for any reason?
- Would you like a doula present during the birth? These birth coaches are employed by you to support any decision you make, explain medical jargon, give you evidence based information, help your partner support you and provide both mental and physical support. They provide continuity of care, during pregnancy, labor, birth and in the postpartum period. You may need to check ahead of time if yours will be allowed in the birthing suite.
- Do you have a preference between forceps or venthouse if the baby needs extra help during delivery?
- Which person would you prefer with you during the operation (often you’re only allowed one)?
- Would you prefer to be awake or asleep for the operation (where possible)?
- Would you like a maternally assisted birth or the option to see your baby being born (where possible)?
- Would you like to have skin-to-skin immediately after delivery OR in the event that the mother cannot, skin-to-skin immediately with the father?
- Would you like to have a natural c/section if possible?
- Would you prefer that baby not be given a dummy or formula without your consent?
- Would you prefer help with breastfeeding or to be left alone?
- Would you prefer the baby be allowed to do the natural crawl towards the breast?
- Would you like to be visited by a lactation consultant in the first 24 hours (medical staff only have a general knowledge of breastfeeding, so may not be able to give good advice if you’re experiencing issues)?
- Would you like to request baby is not bathed (the protective coating of vernix protects against infection and protects baby’s delicate new skin from drying out)?
- Would you like to request immediate skin-to-skin following birth?
- Would you like to request that baby is kept skin to skin for any/all shots and measurements/checks and that any non vital checks that require time away from the mother be done at a later time?
- Do you have a preference as to whether the baby receives vitamin K and hepatitis B shot? Do you have a preference how soon after these are given, if they are?
The Umbilical Cord and Placenta
- Would you like to delay clamping the cord until all blood has transferred to your baby?
- Do you have a preference who cuts the cord?
- Would you like to deliver the placenta naturally or have a ‘managed third stage’ where a syntoconin or pitocin needle is administered to speed up the process?
- Would you like to keep the placenta?
- If you don’t already know, would you prefer that you’re not told the gender of your baby and are allowed to find out yourselves?
- Would you prefer to be discharged as soon as all health checks are completed or would you prefer to stay in hospital longer?
- Have you done your research on circumcision? It’s a risky cosmetic procedure that can cause a range of issues and in some cases even death. Read 50 reasons it’s a bad idea. Make sure that medical staff know that they should NOT retract a foreskin, ever, even for a health check or catheter. The foreskin is attached and retraction can cause tearing and infection. Boys can be 10-15 years old before they can retract themselves naturally.