During my very first prenatal appointment with clients I give them the option of working with me to create a detailed birth plan. or birth preferences. The reason I offer this as a service is because I want it to be used to empower a couple and not to make them feel like it is a set plan. That if their birth does not follow that plan then they have failed or missed out on what they wanted, but a way to maintain control and navigate the uncharted territory that is their birth.
In pregnancy we use it as a tool.
An informational starting point to know everything that could possibly happen during their birth.
The purpose is to not overwhelm with information but to help be empowered by it.
It is a way new parents can know how they feel about every decision before they have to make it.
Birth is not the time to try to learn new information about things they had no idea could happen.
Each new path during your birth has new things that could potentially call for (or indicate that there is no need for) an intervention. There are protocols and tools your birthing team uses to help you have your baby.
Most of the time none of the things we discuss are needed, but the times when they are, the parents were able to make informed decisions because of the evidence based information they received through our sessions or their own research.
You hire your care provider to be able to trust that they have your best interests in mind, but your opinion and decisions still matter and will still shape and mold the birth that you have. Your doctor is meant to work with you, while you have your baby, and help you when things suggest the need. But it is still a huge team effort, based on your decisions and what is happening in the moment.
Just a few things that are covered in during our session:
- We talk about what laboring at home will look like. Why?
Because if you are getting a GBS (Group Beta strep) test, it will determine how soon you need to go to the hospital or birthing center in labor, or what questions in pregnancy may be a good idea to talk to your doctor about before making a decision on your preferences.
- Different types of monitoring
When in labor it is hospital protocol for the babies well being to be monitored frequently.
But how frequently is necessary and how will they be monitoring?
If labor is progressing normally, most doctors will allow for intermittent monitoring. Which means that you will be monitored for a certain amount of time and then allowed to come off the monitor for until the next time they need to check on the baby again.
There are a few different types of monitors that we discuss. external, internal and wireless.
- Postpartum pitocin
Each hospital has a different protocol for their administration of postpartum pitocin but most of them require it immediately following the birth of your placenta. Most of my clients that I talk to are completely unaware of this protocol. We talk about your ability to ask questions about the necessity of this, what they use it for and contradictions. It is different from its use it labor to stimulate labor contractions but is used to clamp down the uterus to stop bleed.
Whether or not some of the things we talk about are put in your birth plan really depends on who you have chosen as your doctor or practice.
For example: In most of the practices I work with, the doctors do not routinely cut episiotomies. They try to avoid it but will of course offer their medical opinion, in the moment if it is medically indicated or the health of the baby is at risk.
As such, it may not be important to include in your birth plan that you do not want one.
If you are birthing outside of the hospital it may not be necessary to include at all.
We discuss it during our session, why doctors do it and go over the importance of having the conversation with your doctor in pregnancy and make sure every doctor in their practice feels the same. If there is any question as to if they will try to do it or not, then it can be included on the birth plan.
It is important to maintain open communication with your doctor during your pregnancy. Having a birth plan can start a dialog to make sure your doctor is okay with what you want and a great way to learn more about the way they practice that you may not have known before.
Here I am including a example of someones birth plan that we wrote together.
Birth Plan for Molly
We wanted to go ahead and thank everyone who is helping us to have our baby. We appreciate everything you are doing for us and appreciate the help! I trust that my midwife will seek out my opinion concerning all of the issues directly affecting my birth before deviating from this plan.
I would like my husband to catch the baby I would like immediate skin to skin with the baby I would like to delay cord clamping I would like my husband to cut the cord I do want the vitamin k shot I DO NOT want the eye ointment
I am keeping my placenta
In case of a transport or Hospital Induction ----------------------------------------------------- I would like a saline lock if possible I would like to reduce vaginal exams as much as possible
I would like intermittent monitoring if possible and a telemetry unit if bed rest is not indicated.
I would like immediate skin to skin I would like to Delay cord clamping
I am keeping my placenta
I DO NOT want the eye ointment for my baby I do want the vitamin k shot for my baby I would like to delay the Hep B shot I would like to delay bathing the baby
In case of a C section ----------------------------------------------------- I would like a family centered c section where my husband and my doula are present. I would like skin to skin and to breastfeed in the OR I would like my husband to get to do skin to skin while I am being sutured I would like to recover in the L&D Room instead of the recovery ward I would like to reduce the amount of pain medication given during surgery and would like to talk to the anesthesiologist beforehand. I would like to swab my baby's microbiome and would like help in doing so
Thank you for taking the time to read this!
Birth plans are very personal. Knowing how you feel about your birth will help you to better navigate the important decisions. It also helps your doula to know how you feel about things as well. She can remind you while you are in labor why your decisions were important to you, why you wanted or did not want them or the reasoning behind why you wanted to avoid them and sometimes why it may be a good idea to use the tools at hand based on your preferences.