Is it possible to plan your birth?

Does creating a birth plan lead to disappointment and feelings of failure if your birth doesn’t go the way you had intended?

What happens if everything changes during labor?

We all know that unexpected things happen in labor, right? And most people agree that “healthy mom, healthy baby” is the goal! So, trying to make a detailed plan for labor seems like setting ourselves up for failure. Isn’t it a better idea to enter labor with an open mind so you’re not disappointed if things change along the way?

Birth plans have come in and out of fashion a number of times over the years. The argument against them tends to go as written above. It seems to make sense, right?

I’m going to encourage you to look at birth plans in a slightly different light! Let’s break down some of the statements above.

Can you plan your birth?

Perhaps we can blame the commonly used name “Birth PLAN” for this particular misunderstanding! If you write a birth plan in order to determine how your labor will unfold, then you may very well encounter disappointment. Thankfully, this is NOT the intended use of a birth plan. When studies look at birth plans and their relation to birth outcomes, they find that having a plan does not guarantee an improved outcome (shock!). However, studies that look at women who used a birth plan as a communication and education tool show that both the women and their birth attendants found the plans to be very valuable.

Education Tool

So, there are two purposes for creating a birth plan. First, the act of creating the plan causes the parents to search out, discover and think through all of the options that are available to them with their care provider and at their birthing location. In order to write a narrowed down list, they will need to sort through which choices are the most important for the mom and for her baby. In the professional world, this is called “value clarification”. When preparing for birth, there can be an overwhelming amount of options! The exercise of creating a birth plan forces parents to sit down and think through what are the most important choices for their unique family in their unique situation.

Communication Tool

Second, a birth plan acts as a communication tool. As the mother and her labor partner/team discuss what she wants to include in her plan, it ensures that everyone is on the same page and hopefully all on board! If not, this can be a good opportunity to talk through any disagreements BEFORE you get into the delivery room! Once written, the birth plan should be taken to a prenatal appointment to look over with the care provider. He or she can look at each option and let you know whether that is something that is available and/or possible. You can also find out which of the items on your list are already standard practice at your hospital or birth center.

If some of the items on your list are standard practice, that may give you the chance to whittle things down a bit more! In the end, you will only need to include things that are both possible and not standard practice. The final list is an excellent communication tool with the nurses and other staff who will be assisting you during your labor and birth. They can see in black and white what your goals are for your birth, and everyone can keep referring back to it as labor continues.

What happens if everything changes during labor?

Labor is unpredictable. You may plan to have an natural birth, a water birth, or a birth center birth, but due to unforeseen circumstances, you find yourself with pitocin, an epidural or even a c-section. There is a real chance of feeling disappointed with your outcome. This can lead to increased stress, tension in close relationships and an increased risk of postpartum depression. Still, the answer is NOT to avoid making a plan! Since we’ve just learned that the purpose of a birth plan is education and communication, here is where you can really increase your benefit. I encourage all of my students and clients to make a Birth Plan B. Once you find the ideal choices for your birth, take the time to think through how those choices would change if you needed the above interventions – especially a c-section. Entering an OR to have your baby does not mean you no longer have any options!

Having a plan means that you can continue to be an active participant in making decisions for yourself and your baby. As doulas, we are taught to protect a mother’s memory of her birth. To safe guard it whenever we can. Because we know that a mother’s view of her birth – how she felt she was treated, whether or not she felt listened to, and how much she participated in the decision making processes during her labor – are nearly always more important than the actual twists and turns that the labor takes.

The mothers who struggle the most are the ones who feel like all of their choices were taken away. When things feel out of control, when the mother feels disrespected or forced into a decision, that is when the stress, tension and increased risks of postpartum mood disorders come into the picture. If your first plan goes out the window, knowing that you have already thought through your options keeps you from trying to create a plan b in the middle of plan b!

Healthy Mom, Healthy Baby

This is a phrase that many people use. Many teachers teach it. Many families adopt it. There is some obvious truth to this statement. But what about the moms who come out of their labor healthy, they have a healthy baby, but they still find themselves feeling traumatized from their birth experience? Should we tell them not to feel that way because they achieved the Healthy Mom, Healthy Baby goal?? (Of course not!) What about the moms who have a baby who is not perfectly healthy? Do they have cause to believe they failed in some way?? (Of course not!)

As you can see, there is a lot more to this issue. It can’t be summarized in a catchy phrase. There are so many layers to this process we call childbirth. Many pieces to the puzzle. To try to oversimplify it discounts or dismisses many families’ experiences. While a birth plan cannot guarantee a smooth, satisfying birth outcome, it can be one piece of the puzzle that helps to prepare mothers to make choices and navigate the waters of labor and beyond.

So, where do we begin?

Education Tool

With our education goal in mind, we begin with some research. You will need to find out what options are available to you with your current care provider and at your place of birth. You don’t want to get your heart set on a water birth if your hospital has no bathtubs! These are great questions to ask in your childbirth classes. Your doula is also a wonderful resource. In addition, there are many places online that have sample lists and questions for building birth plans. Here are a few ideas to get you started:

TO START OR SPEED UP LABOR

Nothing/Waiting
Natural induction methods (eg. nipple stimulation, herbs/essential oils)
Sweeping membranes
Cook catheter
Cytotec/Cervadil
Pitocin
Breaking of Water

MONITORING & IV

Continuous monitoring
Intermittent monitoring
Handheld doppler
IV with fluids
IV placed and capped off (Saline lock)
No IV

PAIN RELIEF/COMFORT

Epidural
IV Narcotics
“Please don’t offer medication unless I ask.”
Own clothing
Hospital gown
Lights and Music
Water and/or Ice Chips
Snack food/Fruit (more than just a clear liquid diet)
Breathing techniques
Imagery or Visualization
Hot/Cold Packs
Water – Shower, Tub, Hot or Cold Compresses
Massage
Aromatherapy
Doula Support
Movement and Positions
Birth Ball
Peanut Ball

PUSHING

Spontaneous
Directed (by nurse or partner)
How long?
Try various positions
In water
Use a mirror
Perineal massage
Warm compresses
Risk a tear rather than receive episiotomy

FOR BABY

Baby directly to mother’s chest after birth
Immediate breastfeeding or within first hour
Breast crawl
Delay newborn procedures 1 hr
Accept or decline: Eye Ointment, Vitamin K, Hepatitis B
Delayed cord clamping (mom or partner cut the cord?)
Yes/no to: bottles, pacifiers, formula, breastmilk (pumped if necessary)
Alternative to bottle, if necessary: finger feeding, spoon, cup, syringe
Circumcision

CESAREAN

Watch this fantastic video on Family Centered Cesareans to find a list of ideas to include in your Plan B Birth Plan.

Narrowing It Down

Once you have compiled a master list, go ahead and cross out any options that you know you are not interested in or are not available for your birth. Then, take a minute to imagine what your ideal birth would look like. You can close your eyes and picture it in your mind, or you may want to draw a picture. Now, look at your list and circle all of the options you would want to include in your ideal labor and birth.

Now, in this imaginary birth, let’s pretend that some things have changed in the course of your labor, and you need to cross off half of the things on your circled list. Go ahead and begin crossing off the options that you would be most willing to let go.

If you are down to only a handful of options, you can stop at this point. If you still have a very long list, try cutting it in half again. (I know you’re not happy with me right now!!) This exercise will help you determine which things are of the utmost importance to you. In my classes, I have the moms and their partners do this activity separately. They compare their final lists when they are finished. It can be fascinating to see the similarities and differences in each person’s priorities for the labor!

Communication Tool

Now, you can take your lists that you have made and begin to write out your plan. I recommend making a bullet point list or using one of the visual birth plan tools that are available online.

Remember that you do not need to include options that are assumed or are standard practice at your place of birth. For example, in most places no one will bat an eye if you wish to wear your own clothing, turn down lights or play music during your labor. Including these things tends to clutter up your plan and makes it more difficult for the important things to stand out. Remember: nurses may only have a brief moment to skim your list as they come into the room.

Take your birth plan to your prenatal appointment and discuss it with your doctor or midwife. Be sure to take note of which items they tell you are standard practice. You can remove those from your list before your birth to clean up even more space.

Be sure to pack a copy in the bag you will be taking with you to the hospital. You may wish to have a second copy stashed somewhere else in case the bag gets left in the car! If you have a doula, email her a copy, as well, so that she can keep bring it in her file. It never hurts to have too many copies!

As a final note, since “Birth Plans” sometimes have a bad rap, you may wish to consider a different title. Some have used “Birth Wishes” or “Birth Desires”. Some prefer to reflect the educational value of their plans with titles like “Birth Choices” or “Birth Preferences”. I’ve even seen “My Personal Birth Preferences Based on my Evidence-Based Education”! It may be a bit wordy, but I love the informed confidence that it conveys!

We put hours of research and planning into buying a car, moving to a new area, or starting a new job. Our babies deserve just as much investment of our time and efforts! With a well-researched, well-written birth plan, you can be prepared to make informed decisions for yourself and your baby regardless of any surprises that come along. Get your thoughts on paper and get your labor support team all on the same page. You’re not in this alone! Everyone at your labor wants what’s best for you. But you know yourself and your baby the best. Take a proactive role in planning for your labor and birth! You can do it!!

For more information about what options you have in pregnancy, labor and postpartum – as well as the opportunity to dive more deeply into addressing anxiety, creating a birth plan and finding your way to calm and confidence – check out this $20 mini childbirth course: Birthing with Calm and Confidence.