The Importance of a Birth Plan

So you've discovered you're pregnant... Congratulations!!! Now you are faced with some options. The first one that comes up is the issue of care provider. Should you go with a doctor or a midwife? Well, if you have underlying health issues, including, but not limited to, high blood pressure, a history of high risk pregnancies, a history of premature births, a history of high blood pressure during pregnancy, a history of diabetes, a history of diabetes during pregnancy, etc, you will need to choose a doctor. However, if you do not have any underlying issues, you have the option of choosing a midwife instead.

So you've made your choice of care provider. If you chose a midwife, you also have the option to chose where you will give birth. Many women choose to give birth at home or at a birthing center, while many others chose to give birth in the hospital with a midwife attendant. Whichever you chose should be what you feel most comfortable with.

If you chose a doctor, your only choice for birth is at the hospital. Here is where it gets tricky. Many doctors do not see birth as natural, only as something needing to be fixed. As such, doctors are much more apt to use unnecessary interventions. It is important to know what your choices are regarding your child's birth, and to be able to get your doctor to acknowledge your choices. It is great if you can talk to your doctor about what you want to happen at your birth, but when it comes down to it, they don't have to listen to anything you said at prenatal visits, and they can take your choices from you. You can keep this from happening by writing up a birth plan, and having your doctor or nurse put it in your file. This puts in place a written plan, that your doctors and nurses are expected to follow. It is also important to have a support person who is familiar with your birth plan, so that they can answer in your stead if you are unable to speak through the contractions, and who will stand up for you if a choice is being made without your permission.

In an emergency, such as if the baby is in dire destress, most of your choices will be taken from you, regardless of a birth plan, and it is important to know at this point that this is just a fact of life. You can still have some say though, in what happens. Do you want your spouse to be with you in the operating room? Do you want pictures, videos? Do you want to watch them take the baby out, or would you prefer to be completely covered. It's important to know that even in an emergency, you still have choices.

If you chose midwives, you are more likely to have your wishes followed, even based soley on spoken conversations, since midwives are there for the express purpose of supporting the mother through her childbirth. However, it is still good to have a written plan in place, in case something was missed during prenatal visits regarding your wishes.

A birth plan can be simple or very extensive. It should cover your plan for a normal healthy birth, as well as your plan in an emergency. It can cover only the birth, or can include what happens with the baby after the birth, including emergencies. Whatever your desire, make sure you have educated yourself thoroughly about all of your options, instead of simply handing yourself over to your care provider. Remember, noone knows your body like you do, and noone can tell you when you've had enough except you.

I've included a few links at the end of this post to help you get started. You can use one of these as a template, or write one of your own.

If you do not have a birth plan, and you are having your baby at the hospital, prepare to not have your thoughts considered while you are in labor. Unless your spouse or other support person know your wishes and are able to stand up and say yes or no to the doctor, the doctor will do whatever he or she feel needs to be done. Remember, doctors are people who fix problems. Most see labor as a problem needing to be fixed, rather than a natural, everyday occurance. They see a woman in pain, they give her something to stop the pain. They see a labor not progresing according to the doctor's wishes, they give the woman something to speed it up. Every intervention available is there for a reason - to fix a very real problem. When needed, they should absolutely be used. However, there is a sickeningly high rate of problems caused by unnecessary intervention, and often, one intervention leads to another. Look at this particular slippery slope. A women is overdue by a week, and the doctor decides she's gone on long enough and it's time for the baby to be born. (Only after 2 weeks does this really become an issue... before then, it is possible for dates to be wrong, and 9.999 times out of 10 the baby just isn't ready to be born yet.) An induction usually involves an IV of pitocin. Pitocin causes extreme pain, which the woman finds she is unable to handle. An epidural is then put into place. The epidural can slow contractions, and more pitocin is needed. The epidural can also cause fever in the mother, as well as other side effects, but many times the mother doesn't have any complications. Because the mother is unable to feel when to push, and because her body is numb, the baby takes forever in getting pushed out, so the doctor uses forceps or a vacuum to get the baby out. With forceps, an episiotomy is also used to widen the birth canal. Now the baby is here, but he's a little early because he wasn't ready to come yet, so a little underweight, and maybe even has a little difficulty breathing right off the bat, so oxygen is needed to be given.
How many interventions was that? As many as 7, all because the doctor wanted things to run on his or her timetable instead of allowing the baby to naturally decide when to be born.

It is extremely important that women know what the interventions are, and their purpose, and whether or not they truly need them. If you arm yourself with this knowledge, noone can push you around when you are in labor.

Don't forget, labor is hard, but the wonderful joyous occasion of finally being able to hold your baby in your arms makes it all worth it. I wish all of you new mommys-to be the best of luck on your journey through pregnancy, labor, and birth.

http://www.birthplan.com/
http://www.childbirth.org/interactive/ibirthplan.html
http://www.amazingpregnancy.com/birthplan/enter_birthplan.php?post_type=new&PHPSESSID=
http://www.americanpregnancy.org/labornbirth/birthplan.htm
These are just a few of the great resources out there. There are a great number more. Look around, take what you like, throw out what you don't. Have fun making your birth plan, and remember to share it with those you want to have at your birth, so that they can familiarize themselves with your wishes.

ETA: Something that was pointed out to me is that while a birth plan is important, it is also to make sure that you make it flexible... what things are you willing to give up first? How long do you want to try something before changing to something else? Make it a list that goes from most willing to try to least willing to try. If you go in with a birth plan that is rigid and does not make allowances for labor that goes off track, the nurses will simply get frustrated and may not even take your choices into account, because they think you are too rigid. So... know what you want, but know that sometimes things happen, and make allowances for those.