Birth Plan
This is the number one hot topic with everyone when it comes to anything birth related; clients are either eager to work with me to hammer out their birth plan or they eager to tell me that they have seen/heard that birth plans never work out anyway so they don’t even want to make one because they’d rather just go with the flow.
I don’t think there’s much value in having a birth plan for a family if it’s just listing off things that are important to them, because that’s only half the exercise. The other half, and easily the most important piece of the exercise, is understanding exactly what it’s going to take in order to make those things come true. This is why, in my opinion, a lot of families are choosing to ‘go with the flow’ rather than creating their plan or list of preferences; birth seems so unpredictable, so uncontrollable, so random that it feels daunting to figure out everything they’d have to do in order to have the birth experience they want.
The biggest part of the birth plan that seems to trip birthers up is whether they’re going to do it unmedicated or with medical pain management. I hear over and over again that the thought of committing to do it without an epidural seems like too big of a promise, too much to expect of themselves, too impossible to know, when actually it is a lot easier than that.
Way before a birther chooses to opt for an epidural, they’ve made a slew of other choices. These may be medically-related, such as consenting to be tested for gestational diabetes or group B strep, consenting to stretch and sweeps or inductions at 41 weeks, consenting to ultrasounds to check for ‘big’ babies, and they also may be personally-related choices such as exercising or not exercising, watching birthing videos and practising the way a birther breathes, moves, finds a rhythm, whether or not a family takes a childbirth education class, and even if a family is willing to try birth without one, among lots of other factors.
Now, before I go any further, I want to make it very clear that I have zero feelings about the ‘rightness’ or ‘wrongness’ of someone’s birth plan or preferences; there is no one-size-fits-all and everyone comes from very different backgrounds and life experiences, so birth absolutely will always look and feel different for everyone. However, there are some patterns and decisions that can totally affect whether or not someone’s decisions and wants on their birth plans ‘come true’.
I think there are two essential parts to creating a birth plan.
The first is treating the birth plan as a flow chart, but in reverse chart. If a family wants to prioritize movement, then we need to follow the flow chart back up; this family would have to advocate for intermittent monitoring if they’ve gone into labour spontaneously, and they’d also need to avoid an induction that involves pitocin because that means they’re going to be attached to both an IV pole and the continuous monitoring system. Pitocin always increases the length, strength and frequency of contractions which often necessitates the use of medical pain management, aka an epidural, which is the ultimate restriction of movement during labour. If a birther who’s with an OB team really wants to avoid giving birth on their back, then they’re going to have to be prepared to advocate for themselves and get into positions themselves as sometimes alternative positions other than side-lying and back-lying aren’t suggested or encouraged by care providers. Another example is being tested for GBS; some families choose to opt out of the test and only treat with antibiotics if there are signs of an infection or they opt out because they understand that being positive might mean going to the hospital as soon as the water breaks and one of the important elements on their birth plan was to stay at home or not go to the hospital for as long as possible. Not consenting to the GBS test can be a scary thing to do if the care provider makes the parents feel guilty or irresponsible for doing so, so it’s important to feel and be educated before entering into a conversation that involves decision-making.
The mental birth prep is also a huge part of whether or not someone’s birth plan reflects their actual experience. Birth might not unfold in the way that someone wanted, but it can still *feel* the way that they wanted, which is the most important element of all. If someone is trying to birth without pain medication, then what kind of choices are they making beforehand? Are they practicing the breathing? Are they spending time every day to make sure baby’s in a good position? Are they saying ‘no’ when people around them are wanting or offering to share their scary birth stories? Are they actively involved in the decision-making when it comes to their care, or consenting because they feel like their care provider won’t ‘let’ them do anything else? Are they reading the literature on things like eating with an epidural, continuous fetal monitoring, the roles of different hormones in labour? At some point, especially with OB care, there tends to be a moment where a recommendation comes that is not what the birthing family had in mind. Take rupturing the membranes, or releasing the waters, for example. If a family has prioritized allowing labour to happen on its own, then they would want to avoid that. But after labouring for quite some time with slow, but realistic, healthy, normal progress, their care provider might offer to rupture their membranes to ‘speed things up’. And wow! What an amazing offer and quite enticing; faster labour? Who would say no? But the family will have done their research because they know what their priorities are and might decline, despite the shininess and temptation of what’s being offered, because it’s an intervention that they know might interfere with how they want their birth to feel or happen.
The second part of the birth plan, in my opinion, is deciding that baby’s health is the obvious and number one priority, and to set it aside as not being the first marker for decision-making. Birthers who end up having the birth experience they want focused on what *they* wanted first, and then made sure it aligned with the health and safety of baby second. Why? Because families are often encouraged or even pressured to make decisions for the ‘health and safety’ of the baby that make labour harder, involve more interventions, and then actually make things less safe for both the birther and baby. I encourage my clients to first focus on their needs and wants, and if there ever comes a clash between their need and want and what their care provider wants, then baby becomes the tiebreaker. For example, induction. If a family wants to avoid induction, they are often told at 41 weeks that they must have one for the safety of their baby. The family expresses their desire to not be induced, their care provider encourages them to consent. Thus the family asks, “Is the baby in any harm?” If the baby is currently in no harm and there are things that the family can do to ensure that the baby remain healthy and safe, then they decline the induction and continue to wait for labour to happen on its own. In this case, a family can either wait for labour to start, consent because they no longer want to wait, or consent to ultrasounds and non-stress tests to continuously check in on the health of baby. The family’s choice will *always* be for their baby to be healthy and safe so that’s why I encourage families to begin with their own preferences and double check their preference with, “Is baby well?” as that’s the ultimate and best reason for a family to deviate from their wants and needs, especially in comparison with deviating for your care provider’s convenience or preference.
Okay, so! Now down below you are going to see pieces of the birth plan made by the Bump that I really like! You can go through, fill them out, and use them as a guide when you’re asking questions at your childbirth ed class, while texting with me, with your care provider, as you get closer to your date so you have a good guide as to what you would like to consent to and what you will not consent to.
There’s also another pdf that has questions to ask yourself to verify whether your birth plan is complete. You can go over that on your own but I’ll be asking you these kinds of questions at our prenatal which will give you a chance to hash some things out with me if you’re still looking for more info or let me know what you’ve decided if you’re clear on what you want.
Of course, some families are totally okay with consenting to whatever their care provider suggests, which once again I have zero feelings about, and as long as a family fully understands their decision and is happy with it, excited about it, and feels good about it then I couldn’t ask for anything more.
Let me know if you have any questions as you review the links below, and we’ll hammer out your own personal birth plan by the end of our prenatals.
This is the number one hot topic with everyone when it comes to anything birth related; clients are either eager to work with me to hammer out their birth plan or they eager to tell me that they have seen/heard that birth plans never work out anyway so they don’t even want to make one because they’d rather just go with the flow.
I don’t think there’s much value in having a birth plan for a family if it’s just listing off things that are important to them, because that’s only half the exercise. The other half, and easily the most important piece of the exercise, is understanding exactly what it’s going to take in order to make those things come true. This is why, in my opinion, a lot of families are choosing to ‘go with the flow’ rather than creating their plan or list of preferences; birth seems so unpredictable, so uncontrollable, so random that it feels daunting to figure out everything they’d have to do in order to have the birth experience they want.
The biggest part of the birth plan that seems to trip birthers up is whether they’re going to do it unmedicated or with medical pain management. I hear over and over again that the thought of committing to do it without an epidural seems like too big of a promise, too much to expect of themselves, too impossible to know, when actually it is a lot easier than that.
Way before a birther chooses to opt for an epidural, they’ve made a slew of other choices. These may be medically-related, such as consenting to be tested for gestational diabetes or group B strep, consenting to stretch and sweeps or inductions at 41 weeks, consenting to ultrasounds to check for ‘big’ babies, and they also may be personally-related choices such as exercising or not exercising, watching birthing videos and practising the way a birther breathes, moves, finds a rhythm, whether or not a family takes a childbirth education class, and even if a family is willing to try birth without one, among lots of other factors.
Now, before I go any further, I want to make it very clear that I have zero feelings about the ‘rightness’ or ‘wrongness’ of someone’s birth plan or preferences; there is no one-size-fits-all and everyone comes from very different backgrounds and life experiences, so birth absolutely will always look and feel different for everyone. However, there are some patterns and decisions that can totally affect whether or not someone’s decisions and wants on their birth plans ‘come true’.
I think there are two essential parts to creating a birth plan.
The first is treating the birth plan as a flow chart, but in reverse chart. If a family wants to prioritize movement, then we need to follow the flow chart back up; this family would have to advocate for intermittent monitoring if they’ve gone into labour spontaneously, and they’d also need to avoid an induction that involves pitocin because that means they’re going to be attached to both an IV pole and the continuous monitoring system. Pitocin always increases the length, strength and frequency of contractions which often necessitates the use of medical pain management, aka an epidural, which is the ultimate restriction of movement during labour. If a birther who’s with an OB team really wants to avoid giving birth on their back, then they’re going to have to be prepared to advocate for themselves and get into positions themselves as sometimes alternative positions other than side-lying and back-lying aren’t suggested or encouraged by care providers. Another example is being tested for GBS; some families choose to opt out of the test and only treat with antibiotics if there are signs of an infection or they opt out because they understand that being positive might mean going to the hospital as soon as the water breaks and one of the important elements on their birth plan was to stay at home or not go to the hospital for as long as possible. Not consenting to the GBS test can be a scary thing to do if the care provider makes the parents feel guilty or irresponsible for doing so, so it’s important to feel and be educated before entering into a conversation that involves decision-making.
The mental birth prep is also a huge part of whether or not someone’s birth plan reflects their actual experience. Birth might not unfold in the way that someone wanted, but it can still *feel* the way that they wanted, which is the most important element of all. If someone is trying to birth without pain medication, then what kind of choices are they making beforehand? Are they practicing the breathing? Are they spending time every day to make sure baby’s in a good position? Are they saying ‘no’ when people around them are wanting or offering to share their scary birth stories? Are they actively involved in the decision-making when it comes to their care, or consenting because they feel like their care provider won’t ‘let’ them do anything else? Are they reading the literature on things like eating with an epidural, continuous fetal monitoring, the roles of different hormones in labour? At some point, especially with OB care, there tends to be a moment where a recommendation comes that is not what the birthing family had in mind. Take rupturing the membranes, or releasing the waters, for example. If a family has prioritized allowing labour to happen on its own, then they would want to avoid that. But after labouring for quite some time with slow, but realistic, healthy, normal progress, their care provider might offer to rupture their membranes to ‘speed things up’. And wow! What an amazing offer and quite enticing; faster labour? Who would say no? But the family will have done their research because they know what their priorities are and might decline, despite the shininess and temptation of what’s being offered, because it’s an intervention that they know might interfere with how they want their birth to feel or happen.
The second part of the birth plan, in my opinion, is deciding that baby’s health is the obvious and number one priority, and to set it aside as not being the first marker for decision-making. Birthers who end up having the birth experience they want focused on what *they* wanted first, and then made sure it aligned with the health and safety of baby second. Why? Because families are often encouraged or even pressured to make decisions for the ‘health and safety’ of the baby that make labour harder, involve more interventions, and then actually make things less safe for both the birther and baby. I encourage my clients to first focus on their needs and wants, and if there ever comes a clash between their need and want and what their care provider wants, then baby becomes the tiebreaker. For example, induction. If a family wants to avoid induction, they are often told at 41 weeks that they must have one for the safety of their baby. The family expresses their desire to not be induced, their care provider encourages them to consent. Thus the family asks, “Is the baby in any harm?” If the baby is currently in no harm and there are things that the family can do to ensure that the baby remain healthy and safe, then they decline the induction and continue to wait for labour to happen on its own. In this case, a family can either wait for labour to start, consent because they no longer want to wait, or consent to ultrasounds and non-stress tests to continuously check in on the health of baby. The family’s choice will *always* be for their baby to be healthy and safe so that’s why I encourage families to begin with their own preferences and double check their preference with, “Is baby well?” as that’s the ultimate and best reason for a family to deviate from their wants and needs, especially in comparison with deviating for your care provider’s convenience or preference.
Okay, so! Now down below you are going to see pieces of the birth plan made by the Bump that I really like! You can go through, fill them out, and use them as a guide when you’re asking questions at your childbirth ed class, while texting with me, with your care provider, as you get closer to your date so you have a good guide as to what you would like to consent to and what you will not consent to.
There’s also another pdf that has questions to ask yourself to verify whether your birth plan is complete. You can go over that on your own but I’ll be asking you these kinds of questions at our prenatal which will give you a chance to hash some things out with me if you’re still looking for more info or let me know what you’ve decided if you’re clear on what you want.
Of course, some families are totally okay with consenting to whatever their care provider suggests, which once again I have zero feelings about, and as long as a family fully understands their decision and is happy with it, excited about it, and feels good about it then I couldn’t ask for anything more.
Let me know if you have any questions as you review the links below, and we’ll hammer out your own personal birth plan by the end of our prenatals.