Birth Plans

Birth Planning Basics

Know your options

The first step in writing a birth plan is to find out what your options are. Different doctors will give you different options for handling the same situation. Different hospitals will give you different options and have different policies. Differences in health between pregnancies can impact the options that are available.

Your first job is to find out what options are available to you. If you are not sure yet what possible options might be, review the Birth Plan Checksheet. It is an exhaustive list of options you might have. It is a good tool for beginning conversations with your caregiver too. Read through the list and determine what options appeal to you, and what options you don't think you want. Use this to find out what options your caregiver feels comfortable with.

Take the Birth Plan Checksheet on a hospital tour to find out how the policies may affect your options. If possible, make several copies and tour several hospitals. You may find that some hospitals appeal to you more based on the services they provide.

Find out what you want

Once you know what options are available to you, it is important to determine how you feel about the options. Some things will be very important, and others will seem small or unimportant. There is no right or wrong, it is simply a matter of understanding who you are and how you want things handled.

You may find that there are several options that you feel very strongly about. In this case, it might be necessary to try to decide how the options rank in importance to you. The Ideal Birth Worksheet can help you work through your feelings about the options.

Are your chioces available?

After you have decided what you want, you need to take a hard look at the reality of your situation. Are the choices you have made realistic given your health? Does your caregiver and hospital support your decisions? Do your birth partners (doulas, spouse, friend, family) support your decisions?

If you have made choices that are not possible you need to reevaluate your decisions. Do you need to change your plan, or do you need to change your care team. Can you increase the support for your choices by changing hospitals or midwives? Or would you prefer to change your decision about the options and stay with the practice, hospital and birth partners you've chosen. Only you can make that decision.

Start the Dialog

With your choices written out, talk with your doctor or midwife about what choices you have made and why. If your midwife has concerns about an option, find out what they are and where he or she recommends you go to do further study.

Be sure to be assertive, but not aggressive when discussing your options. Do not allow your caregiver to brush off your decisions or suggest that this is unimportant. At the same time, don't assume your caregiver will be hostile or uninterested in hearing what you have to say.

Talk first about how you want to handle a normal, uncomplicated labor. Then move on to your decisions in case of a complication. Be sure to let your midwife share thoughts and opinions about your decisions. Listen carefully to what is said. This will be your first real chance to determine if this is the midwife for you.

Using Your Birth Plan

Find the Right Support

As you begin to plan for your support team, your birth plan can help you determine the best ways for loved ones to be involved. Share your birth plan with the loved ones you want to invite to attend your birth, notice their reaction. Are these family members supportive of your decisions, or will they be a source of conflict as you make decisions during labor. Loved one's who may not be as supportive as you need during labor can be asked to provide other assistance - such as watching an older child, prepareing the home for your return, preparing meals and groceries for the first week home, or being central command to prevent unnecessary phone calls at the birth place.

Having a birth plan gives your loved one's the ability to support you according to your wishes. It becomes much easier to give suggestions when they know it was the type of help you wanted. Let’s face it, when a woman is in labor it can be hard for anyone who cares about her to want anything but relief for her. While family members may not be willing to suggest you not get medication because you wanted to go natural, they can use your birth plan to remind you with phrases such as, "In your birth plan you said you wanted to try the tub. Do you want to try that before asking for an epidural?"

Introduce Yourself

Your birth plan introduces your family to staff who may not know you. It lets them know what type of support you want or need, and how much assistance you would like if things happen as expected. This is important information that can help the staff, who doesn’t know by looking at you what type of person you are. Do you want medication as soon as it is possible or do you want medication not to be offered? Do you want to have your whole family with you, or do you want help making sure it is just you and one or two helpers? Do you have any specific concerns, allergies or other issues that might make your care different?

Your birth plan will achieve this purpose simply by being read. Have your midwife put a copy in your file, and take several copies with you if you plan to give birth outside the home. Have a family member give a copy to the nurse, thanking her for taking the time to read it.

Unexpected Situations

Your birth plan does not change because of an unexpected situation. One of the reasons birth plans are so valuable is because they can help you make decisions in unexpected situations. Not only does a birth plan let your birth team know what is most important to you, it can also let them know how you want to approach the unexpected. You cannot control the way staff respond to your labor, but you can use your birth plan while being part of the decision making.

Be sure to ask questions about the risks and benefits of moving along in your birth plan. For example, you may ask, “My birth plan says to try this first, do you feel it is no longer safe to try that way?” You may also find your family using your birth plan to help you make decisions. Your family can ask questions such as, “Your birth plan said if that didn’t work to try this, do you feel ready to move to this next step?” In all cases, the decision to move to the next step of your plan should be yours. Having the birth plan just helps others know what the next step is for you.

Some women get to do EVERYTHING on their birth plan. They get to try every position and pain relief technique and when complications arise, they get to have a cesarean done the way they wanted.

Other women get to do very LITTLE from their birth pan. The nurse keeps the right atmosphere, but labor moves so quickly she has no chance to try the tub and walk the halls.

Regardless of the circumstances of your labor, use your birth plan to help you determine how you will react to labor.