Birth Dreams vs. Reality: Birth Plans?

Do you need a birth plan? I think it is important to think about and discuss with those who plan to support you in birth, about your birth ideals. But, I think it is not only misleading but unreasonable to even begin to think that a woman can really plan her birth. I believe that we need to think in terms of planning our births in a different way.

Take the online birth plans that are out there on the internet today… considering the ideas that they make will help you to begin to consider your options. How should you consider their usage? The ideas suggested are great if you use it for facilitating communication between you and your birth team prior to labor beginning. But expecting the nursing staff to read a three or four page document prior to supporting you in labor is not something that I believe is reasonable. The ideas you may have for your birth should have been discussed a long time prior to you arriving at the location for your birth. Your doctor or midwife can write orders for you based on your ideals after this conversation occurs. Their written orders have much more clout than a document you bring to the hospital.

Since so many practices have multiple doctors or midwives within the practice, having a birth plan that is approved by one provider does not insure that the next provider will agree. Many women think that if their primary provider signs the document it insures them of their wishes being taken seriously. I hate to say, this does not.

Women should consider leaving their options really open in the area of birth ideals. Since a woman has no firm idea on what will happen or what she will need in labor prior to it occurring, it is difficult to make a plan to hold to later. Who has never made a vacation travel plan only to make a change when some location or scenario makes you deviate? Perhaps this opportunity was not something that you had known about prior to driving by it or picking up a brochure at a rest stop. Does it make your vacation more difficult or not the vacation of dreams? No just different than the one you planned originally.

Pam England in her book, Birthing From Within, teaches doing the Next Best Thing. As your labor unfolds, you are able to make good informed decisions based on what is right for you in that moment. I teach using the acronym of BRAIN. A couple needs to consider the benefits, risks, alternatives, their intuition and what will happen next depending on their decision prior to having a procedure done.

A woman may want to think about her birth ideals like a dream. What does she hope will happen in her labor? I encourage them to think about their birth plan being written in pencil and a large eraser should be packed. When a woman thinks her birth is able to be planned and controlled, when things change, she feels like she somehow failed. A birth ideal is just that. It is something that should be hoped for and worked toward. But being flexible is the key.

If you do desire to have a birth plan of sorts, I would suggest keeping it really short and to the point. Keeping it positive and simple are good ideas. Don’t ask for things that don’t need to be asked for and only put things that are really important to you personally in it. If you want to be seen as an individual, then keep your birth ideals personal and individualized. Let’s look specifically at some of the questions that arel on the online type birth plans. (Pregnancy Today’s plan)

I would prefer to avoid an enema and/or shaving of pubic hair. (Note – this is no longer standard procedure at many hospitals.) They do not even offer this as an option unless the enema is to augment a slow labor or the mom is having difficulty with constipation and desires it.

I would like to be free to walk around during labor. Why would you need to ask to walk around in labor? I am a big proponent of not asking permission but forgiveness. Unless you are being monitored without telemetry, you should have freedom unless you make a decision otherwise- like choosing an epidural.

I wish to be able to move around and change position at will throughout labor. Ditto- see above.

I would like to be able to have fluids by mouth throughout the first stage of labor. Why would you even be in the hospital during the first stage? Ideally the studies show eating and drinking should be controlled by the mom as needed and desired. Again, don’t ask permission- eat and drink unless you decide on medication that may increase the chance of a surgical birth.

I will be bringing my own music to play during labor. Why would they care if you brought your own music? Of course you should do so- you don’t need their permission to do so.

I would like the environment to be kept as quiet as possible. Isn’t it a shame that you need to even make this statement? You should be able to control the environment by lighting and mood by creating it yourself and having them respect your desires.

I would like the lights in the room to be kept low during my labor. See above.

I would prefer to keep the number of vaginal exams to a minimum. You know I have this little rule- stay out of the bed and keep your panties on and vaginal exams won’t occur unless you decide otherwise. Use the BRAIN acronym to help decide when to take your panties off.

I do not want an IV unless I become dehydrated. But wait a minute- if you are eating and drinking as you need to, you will not become dehydrated, unless nausea becomes a problem. Again using BRAIN is a good tool here as well. But there are other reasons for an IV to be used. Being GBS+ and needing antibiotics or desiring medication is a reason to desire an IV.

I would like to wear contact lenses or glasses at all times when conscious. Again, is this a reasonable thing to expect- hmm- I want to be able to see well- so keep your glasses on or contacts in.

I won’t be going through the rest of the birth plan. I think you understand the message I am trying to convey. Think about what you really want. Discuss it with your care provider when you are still dressed, not in labor and not feeling that in labor vulnerability. Use the format of these online type birth plans to help you begin to understand your options. Please realize that you need to make a birth ideal sheet that is just for you. But use is sparingly, understanding that labor is unpredictable. Create a dream for what you want to have happen, but keep your options open.