Did You Have a Birth Plan?

YES, I did use a birth plan! I think birth plans are very valuable tools. I gave birth nearly a year ago (June). And my plan was only two pages long (and even that because I used large font for easy reading).

I was interested in having the most non-invasive and natural birth I could in a hospital. Most hospitals and doctors are trained to "deliver" babies in a certain way. My birth plan helped easily describe what I wanted.

My husband and I created our birth plan and discussed it with our doctor and our doulas. It included every step of the birthing process and what I wanted: delayed cord clamping, no IVs, no Hep-Loc (which I had to sign a waiver), no pulling on the baby's head, no episiotomy. It also included what I wanted for my newborn: not to remove the vernix, to have my baby placed directly on my bare chest, to delay bathing and weighing until at least one hour after birth, to delay vaccinations, etc. etc. (I did choose to add a section containing food/number of people/music/lights/and the like because, as Heather mentioned, this hospital had 'rules' for those things. By talking to my doctor early - and getting her to SIGN my PLAN - she was agreeing to allow certain things to happen.) We also asked that no one offer me (or my husband, for that matter!) any drugs. :)

At the top of the plan, we also asked for our hospital team to include only people that were excited and comfortable with a natural birthing mama. This was a great help. We got a WONDERFUL nurse that actually CARRIED MY PLAN around in her pocket!! She was fantastic and really took to heart our wishes.

I think the most important part of the birth plan is to open up a converation with your care provider. If Nancy was comfortable with a verbal plan, that's great! It seems she wanted a fairly standard birth. Good for her.

I had certain things that I wanted to see happen during my baby's birth. The plan helped me make those wishes come true. I had a wonderful birth experience.

Heather, I'm so glad that you are writing a birth plan! I think having a vision of your ultimate birth is important to achieving it. TIP: Give your plan to the hospital staff with a plate of BROWNIES!!! Then everyone will read it!

I understand why some women think birth plans are silly. They think the doctor will do only what is best and needed. Hopefully this is the case, but some have been delivering babies one way and one way only for years and might need a written reminder of your wishes. (This is where a doula is SO VALUABLE!! She can be insistant about your plan while you and your husband/partner can focus on the birth at hand!)

Also, for anyone else out there planning a natural birth, be "gentle" with your words. These days so many women seeking a natural birth are thrown into the category of "freak" or "granola" or whatever... I actually heard one of the other nurses say "Oh, it's gonna be a long night." because I chose to walk to my birthing room (instead of in a wheelchair). (She did not attend our birth.) But being pleasant, polite, and POSITIVE (as well as assertive) with your choices can take you far!

Mon, 2009-05-11 06:22

I didn't have a written birth plan. I had a loose version in my head that I wanted to follow, but it didn't work out that way at all. After going into labor, I wasn't progressing as quickly as the hospital staff would have liked, so they suggested giving me Pitocin to speed the process along. I didn't want the Pitocin, but felt very pressured by the nurses. I was told that it was dangerous to be in labor for too long after your water broke and "We really need to get this process going." After being frightened and made to feel like I was making the wrong decision, I agreed to the Pitocin and, all hell broke loose.

I was contracting so hard that it was sending my son's heart rate into distress. My blood pressure kept dipping dangerously low every time they would give me more Pitocin. At one point, my BP dropped to 80/30. After a few very stressful and scary hours of the Pitocin and bad reactions from both me and baby, I still was only dilated to 5 after being in labor for 12 hours. My Dr decided at that point that I would need a c-section b/c of my son's heart rate. The surgery went well, but I didn't get to hold my son for almost 3 hours b/c of the fluid in his lungs that didn't get pushed out since he was delivered by section and didn't travel through the birth canal.

To say the least, I was disappointed with how it turned out. Of course, I can't help but think that if I had stuck to my guns and wasn't bullied into getting the Pitocin, things would have gone differently. Shortly after my son was born, I watch Rikki Lake's documentary, The Business of Being Born, and just cried my eyes out b/c they described my experience exactly. I felt pressured by the staff to make choices I didn't want to make and in turn, it had a negative effect on myself and my baby.

The next time around, I will most certainly have a birth plan. I know for sure that I don't want Pitocin anywhere near my veins.

Mon, 2009-05-11 07:54

From the perspective of a labor and delivery nurse, I think that birth plans can be a positive and reassuring addition to a woman's experience with childbirth.
It is true that there are a lot of nurses who will roll their eyes when they see the pages of 'plans' come into triage with the, immediately labeled, 'granola' moms-to-be. This is certainly not the right attitude to take towards a birth plan, but I understand why some nurses feel this way.

Some women come in so determined to have what's in their plan carried out, that if any part of the plan veers down another path, then we become the evil and invasive medical staff that ruined everything. The problem is that some people come in without understanding that there are some situations that make what they planned unsafe or not possible.

When I have a patient who brings in a birth plan, I will always sit down and read it with them. If they have taken the time to think through what they would like, then it is my duty to take the time to understand and respect their wishes. I also do my best to carry out their wishes. Every nurse/doctor should. I can see how one may feel a loss of control over their experience once they enter the hospital delivery room. It is YOUR child and YOUR body and so you have every right to want to have a say regarding how you would like things to go.

However, I also read the birth plan with the family to bring a dose of reality to the situation. No, not all people need this 'reality-check', but some do. So as to not encourage false hope that the birth will go exactly as planned, I go through each request. I reassure them that I will do my best to carry out their wishes or remind the doctor to do so, but then I also say "Here are some situations where this may not be possible for the safety of you or your child......" Despite this, I also say that, ultimately, this is your body and your choice.

If you are the type of person that finds a birth plan reassuring, then by all means, make one. If you have a doctor who is willing to take the time to go through it with you, then take the opportunity! This will help you to know and be prepared for the things on your plan that might need changing during the birth. If not, as soon as you get to the hospital, show your nurse and ask them to go through it with you and discuss each request. The point is, don't be too inflexible with it. Labor and delivery can be so unpredictable and every single situation is different with every pregnancy. So have a plan, but be open too!

From my experiences, I have seen so many come in with their birth planned to the hilt, only to be devastatingly disappointed when things just couldn't go their way. That's even after telling them many times that we had to change the plan in order to have a positive outcome. I feel sad for these women.

When I have a baby, this will be my birth plan (based on 7 years of witnessing births):
1. Let me labor and support me as long as I can handle it, but when I say 'Epidural' get me one stat!-Please!
2. I would like a vaginal delivery, if possible. However, if there is any indication that my child is in distress, may get stuck in the birth canal or rip me to shreds coming out from below, I would like a c-section. -Please!
3. Episiotomy- No thanks! But if it looks like, upon crowning, that my kid's head is going to rip me from clitoris to anus, I would like a right-medial lateral cut. -Please!
4. I want to avoid an instrumental delivery at all costs! I would prefer a c-section over a vacuum and a vacuum over forceps. However, if in the last moments of the delivery my baby needs to come out STAT, then do whatever you need to do-safely- to get them out. -Please!
5. Skin-to-skin and leaving the cord uncut for one minute are things I would really like, however, if my baby comes out limp and blue, do not waste a moment. Help them, STAT! -Please!
The rest - music, lighting, labial massage, etc., are mere details. Details that, if you want them, then you should be allowed to have them- so long as they don't interfere with the safe delivery of your precious little baby or with keeping mom as healthy and intact as possible.

Mon, 2009-05-11 08:07

I would guess that you'd *know* if you wanted/needed a birth plan. For example, I wanted to try to go without an epidural, but I did want somebody to tell me if the window of opportunity for using one was about to close, as I've heard people deciding "ok, no more!" and being told it's too late. Similarly, I wanted to be allowed to tear, rather than have an episiotomy, because it's supposed to heal better, etc., so I made sure to specify that.

As for the other silliness on the form, I think it's more to give you things to think about that you might not have (like the music) rather than actually guide your doctor. But it would be helpful if they broke those out -- here's a worksheet for you, and here's a page for things you want to tell your doctor on The Day. Dooce's final points about checking on hospital policies are also apropos, but again, I suspect that most people have little or no plan, and thus don't really worry about coming into conflict -- the default in this country is more passive (I'll do what the doctors tell me to do) than individualistic...

Mon, 2009-05-11 08:32

I have two perspectives.

As a birthing woman, I think birth plans perhaps are most useful as a tool to understand, educate yourself, and consider all of your options. It helps you to think through the birth experience you wish for. It is ALWAYS understood that it is simply a plan. And plans may deviate. That said, I doesn't hurt to fill one out as a reminder to yourself, your support partner, and the staff.

As a doula, I recommend birth plans for my clients for the above reasons but mostly as a tool for ME. As their doula, I never speak on behalf of my client's wishes but can refer to the birth plan as a way to respectfully remind staff of their wishes. It is a low-stress way to communicate between my client and the hospital staff. That way, I'm not speaking for them nor overstepping boundaries. :)

What's most important in your plan, in my opinion? Strong, educated, loving support people. Your birth team. Get those on board early, develop deep trust, and know you are all on the same page.

Mon, 2009-05-11 09:30

I had a birth plan too, but only parts of it went as planned:).

I was lucky to have both a midwife and an OBGYN present. My midwife was my epidural...without her, I would have had one STAT! The hospital was wonderful about doing their best to honor whatever they could about the short plan we had (little to no intervention if possible/natural/no epidural/no c-section unless needed/no med students). My husband and I went into it hoping for a smooth delivery, but planning for the worst. That way, if the birth plan was shot to hell, no hearts would be broken. Truly, we just wanted a happy and healthy baby. That was the primary objective! Even though I had to be induced due to sky-high blood pressure, and ended up taking some minor pain-meds, I can't say that I'd change anything about the experience.

What I will say is that in the years since having given birth, I've reconnected with a friend from high school who is an OBGYN resident. Her comments on her facebook account about birth planning moms are always cutting and sarcastic. (as are the replies from other residents) They seem to indicate that the medical profession wants us to simply surrender our bodies to them without question. Now don't get me wrong, had my midwife and OBGYN said either myself or my son were in danger and I needed a c-section, I would have done it without fail. But mothers in labor are not idiots either! I find it highly insulting when we are treated as such. I am just glad that the kind nurses and doctors at the hospital where I delivered treated me with nothing but dignity and respect. I can only hope that the other women out there don't happen to run into doctors like the person whom I know from high school. I can only say that I think her feelings on it will change dramatically once she has children herself.

Mon, 2009-05-11 10:49

I had a pretty detailed birth plan. It didn't include my music selections, but my doctor and I discussed things like when I would want medication or who I would want with me during which stages of labor. I was so excited because it gave me this sense of control over my birth. My son, apparently, had other plans.

My doctor came in after I'd been in labor for ten hours and decided to break my water. We'd talked about the potential for this and I was already five centimeters so it seemed like a fine idea. Well, she didn't tell me that the real reason they were breaking my water wasn't to speed up my labor, it was to insert and internal fetal monitor since my baby's heart rate was sporadically dropping from 150 to 70. After the first monitor was removed and another was put in because it "wasn't reading right", my doctor looks at me and tells me we're going to deliver the baby now. Twelve minutes later, my son was delivered via cesarean.

When it comes to birth plans, the plan is to get that baby out safely. I still wish I could have delivered naturally, but in those twelve minutes, my only concern was him. Definitely the scariest experience of my life.

Downfall of the emergency c-section: my hospital doesn't allow VBAC. I will have to schedule another c-section next time around, or find another hospital. Hopefully, I'll have another two years to worry about that.

I will say that the c-section rate is scary. The hospital we delivered in has a 40% rate of cesarean delivery. 40%! I had three friends who felt completely robbed of their birthing experience. As far as I'm concerned, unless it's medically necessary and the baby is compromised, there is no reason to not allow a woman to deliver her baby. It should be criminal.

Mon, 2009-05-11 11:49

I think knowing the hospital's policies and standards greatly inform your need for a birth plan. Our hospital is very progressive and "What do YOU want" about things, so in general I wasn't too worried about being forced into something I wasn't interested in. If our hospital weren't so progressive I might have been much more proactive about voicing my desires for minimal interventions.

I also think that while you may not need to write out a specific birth plan, it's good to know what the different options are that are available and different things that may happen so that you can think through how and when you might need them. Had it not been for reading about birth plans and attending our hospital's tour I might never have thought to ask if I could be on a telemetry monitor and labor in the tub. And dear god, the tub was the only thing that got me through transition.

As it was, our hospital actually has a white board in each room in which the encourage you to write what "Excellent care means to you" so that the staff can work to achieve that. Whether it's: GIVE ME THE DAMN DRUGS or Leave me alone and let me do my own thing or Holy Crap breastfeeding is hard, PLEASE HELP.

Thus, our birth plan was: "We're aiming for as few interventions as possible and no drugs unless requested. Mom and Dad deal with stress through humor and sarcasm." That last little bit was so that they didn't take us seriously when we started making snide comments.

And without a birth plan I was able to have an all-natural drug-free birth and the only thing I'd change about the experience was to request a different overnight nurse than that Nurse Ratchett that insisted on being a Chatty Cathy at 4:30 in the freaking morning.

Mon, 2009-05-11 13:00

I discussed my desires with my doctor prior to my delivery. Things like wanting to avoid a c-section if possible, who I wanted in the room with me and how I felt about having an epidural. I didn't feel like it was necessary to write anything down.

Like most deliveries, mine was nothing like I had planned. I passed a massive kidney stone (the size of the end of my pinkie finger) two days prior to my son's birth. It did so much damage that I was put on a Morphine pump after 4 shots of Demerol were deemed useless. I stayed on the morphine pump for 24 hours. When they tried to wean me off the Morphine, I was still in so much pain that my doctor had me switched to a surgical grade epidural. After another 24 hours, my doctor decided that I had had enough and that it was time to have the baby. She put me on Pitocin (I was only dilated to 1/2 cm) and broke my water. My son was born 5 hours later. I never felt a single labor pain.

Would I have liked things to go differently? Yes. I could have definitely done without the kidney stone. The pain was unbelievable. Another thing I would have changed was the insane amount of narcotics I had before my son's birth. As a rule, I try to avoid taking medication if it's at all possible. In the moment, I was thrilled with the Morphine pump.

If I am ever blessed with another child, I will feel like it's my first delivery all over again. I don't think that I will ever write out a massive birth plan. I know enough to know that the best laid plans don't always turn out the way we want.

Mon, 2009-05-11 16:23

I think if you have a five-page birth plan, you need to reexamine your priorities in life. They're doctors, they're trained professionals there to help you, not part of some evil government conspiracy paid off by the drug companies. If the baby comes out healthy and you live, isn't that what matters?

Mon, 2009-05-11 17:43

Man plans, god laughs. And I aint religious.

I didn't plan to have The Kid in the UK where it's a battle between the midwives and the docs. The midwives will do just about anything to avoid any intervention of any kind: drugs, tools, cuts, docs...near the end of delivery, the midwives kept shouting at me, "the Drs are standing outside, don't let them come in here. PUSH."

Midwife-led care meant I never had an internal exam or many of the "normal" US things, but it did mean they came to my house to check on me. Which went about like this, "You look well. See you next week." Very, very hands off.

Delivery in the midwife-led unit went like this: stay home, stay home, go home, stay home, oops you need to push, come in I guess. If you want. Knew I'd never get an epi even when I asked in time.

Never wanted my MIL there (but glad she was in the end), didn't plan to cut my bangs without a mirror in the kitchen during labor (not so glad about that). But also didn't plan to recover in a double bed with purple-flowered sheets in a delicate, floral-iron-headboarded bed like at grandma's house circa 1952, where my husband also slept with me the first night in the hospital. That was nice. Didn't plan to have midwives come to my house as often as I wanted for as long as I wanted after I had The Kid. Sunday, 8am, after desperate 6am phone call because I was so unwell, for example. And had we stayed in the UK, would have had 4 years of someone to come to the house to check on us if we needed.

All free. Zero cost. Not one penny. Now that's a plan I can get behind.

Mon, 2009-05-11 19:26