Having a Plan
Your friends who are either expectant or new parents may have spoken to you about writing birth preferences or a birth plan with their ob/gyns, midwives or doulas (trained labor assistants). The purpose of a birth plan is to inform your obstetrical team of your wishes, based upon your preferences.
Communication with your birthing team is of the utmost importance to help achieve the kind of birth experience you desire. You can use the following guidelines to help you write your intentions in an outline or essay format, then give them to your provider in advance. Pack copies to take with you to the hospital/birthing center to share with those who will support and care for you during your labor and delivery. You can also use the guidelines for a discussion with your healthcare provider if you prefer not to have a written plan.
Writing Your Birth Plan
A birth plan should be one page, covering labor, delivery and just after delivery.
LABOR
Hospitals and birthing centers offer tours and answer questions regarding their standard protocol for obstetrics care. You might wish to labor and deliver in the same room; you may want to labor in subdued lighting with soothing music. A tour can help you see the options available. If you would prefer certain family members or friends present, inquire about the site’s policies for visitors and labor support. There may be limits on the number of people allowed in the labor room.
• Decide who will be with you during labor and delivery. Your partner, family member or a close friend may be all you want or need. You might be interested in having a doula, who can provide extra emotional, physical and informational support before, during and after delivery (see www.dona.org). Women who had doulas had significantly less epidural use and were more likely to rate their birth experience as positive, according to a study cited in Obstetrics & Gynecology (1999:93; 422-426).
• Discuss induction of labor and pain medications with your provider. If needed, oxytocin is used to induce labor when delivery is desirable and labor has not started on its own. It may also be used to stimulate labor when contractions are weak or ineffectual. Some women opt for natural pain relievers, such as warm compresses, massage and breathing techniques, while others prefer intravenous pain relief, or an epidural that blocks pain but does not sedate. Epidurals confine you to bed, which limits your laboring positions. If you opt for an epidural, intravenous fluid is standard procedure to keep you hydrated. You may wish to labor without pain medications but have the option of an epidural if the discomfort is making you lose control, detracting from your participation.
• Talk with your provider about external and internal electronic fetal monitoring. Monitoring may be continuous or intermittent, depending upon medical issues, the use of epidurals or the standard protocol of the labor and delivery unit. If those taking care of you have concerns about the fetal status during labor, monitoring is likely to be continuous. Your plan should remain flexible so that everyone can make the best decisions for the safety and health of you and your baby.
DELIVERY Consider these options:
• Would you like a mirror positioned so you can watch the birth?
• Will your partner cut the umbilical cord?
• If you’re having a C-section, would you like to be able to view the delivery?
• What are your thoughts on episiotomy (an incision made in the perineum to avoid tears while pushing)?
• Will you bank your baby’s cord blood?
AFTER DELIVERY State your preferences:
• Do you wish to hold your baby immediately after birth?
• Do you plan to breastfeed? Just after birth is the best time to start, when babies are most alert.
• Do you want your baby with you in your room, or do you plan to use the nursery?
• If you’re having a baby boy, will you have him circumsized?
• Have you chosen a pediatrician yet?
• Have you thought about birth-control?
When to Call Your Doctor
Alert your provider immediately if you experience heavy vaginal bleeding or discharge of fluids, abdominal pains, severe headache, dizziness or visual disturbance, swelling of your hands or face, fever or persistent nausea or vomiting. Obstetrics care providers want to honor your birth preferences, but cannot always follow them if you or your baby need urgent assistance for an unforeseen problem.
Partners in Birth
Note that your birth plan cannot forecast how labor will unfold. You must trust your delivery team and be flexible so that proper measures can be taken, when necessary, to ensure a healthy birth.
Adair R. Heyl, Ph.D., is an assistant professor, and Peter S. Heyl, M.D., is an associate professor, at the Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk.
