creating the perfect birth plan for you
Creating a birth plan with clients is one of my very favorite things to do! It’s a great way to discover my client’s values and get to know them better. And I love finding ways to get creative and support their (inevitably) very unique needs and wants. And for my clients, it’s a fun way to get informed on birthing choices and preferences.
Birth plans get a bad rap in the medical community. I have heard of providers who say, “show me a woman with a birth plan, and I’ll show you a woman who will have a cesarean.” While this is a deplorable attitude and one that is not founded in patient-centered care, I have seen birth plans which could easily inspire such a perspective. However, birth plans are not all created equal! Truly effective birth plans are ones that your care provider doesn’t need more than a couple minutes to read, apply specifically to your unique care and circumstances (including birthing place and care provider), and are focused on your specific values and needs.
As part of the process of creating a birth plan, I enjoy taking the time to inform my clients of their options and the evidence behind each choice or intervention. My very favorite resource of all time is Evidence Based Birth. Evidence Based Birth is a company that strives to keep up-to-date on all of the latest research on birth, pregnancy, and post-partum. They also have an incredible podcast in which they interpret the research, as well as discuss the possible biases or flaw behind studies, and they extrapolate that evidence to demonstrate what it means to birthing families. That podcast (EBBirth) is available on itunes, Spotify, Stitcher, Google podcasts, and most other podcast platforms. They’re great at explaining what evidence can be applied in which circumstances. One of my very favorite things about Evidence Based Birth, however, is their focus on equity of care for birthing people- they offer scholarships for Bipoc people, they present unbiased information on the current inequities of care in our communities, and they offer mentorship and continuing education for birth workers (I’m a professional member of Evidence Based Birth for that last reason).
After we’ve spent some time educating ourselves, I recommend using my very favorite method of creating a birth plan, which I learned from Angela Horn from Tuscon Doulas. She’s also a co-host of one of my favorite podcasts, Doulas of the Roundtable (another great resource for evidence-based information. Angela taught my Doula Masterclass that I took through ProDoula, when I became a certified VBAC Specialist. She described her method on Doulas of the Roundtable, and I have loved it ever since.
Angela’s method involves writing down all of your preferences, one by one, on separate pieces of paper, and listing them in order of importance. Then, I present a possible scenario that might cause you to reevaluate the importance of some of those preferences. For instance, being presented with the possibility of an induction may cause you to place more importance on “no/minimal pitocin, after discussion” than “no IVs.” (Side note, on the subject of induction, check out my blog post on your options during induction.) I will slowly present more and more scenarios in which you lose one or more of your options, until you’ve whittled down your list to three or four of the most vital portions of your plan. Write these down on a neon-colored index card that can be taped to your door, to the nurse’s computer screen, or wherever else you want to tape it!
This does not mean that you should not expect to receive all of those preferences that are not spelled out in the plan. And if you have a doula, s/he should definitely be informed of all of those preferences so they can advocate for those as needed. BUT this enables you to determine your key values and keep your critical priorities front and center for your nurse/midwife/physician. I discourage my clients from listing things like, “no hospital gown,” “no IVs,” or “eating and drinking as desired during labor” from the plans they share with their provider, despite how important they may be to your own plans. If you’re delivering in hospital, where hospital gowns, IVs, and fasting throughout labor are often routine, you may be expected to comply with those- but they each require your consent. It’s an easy thing to decline in person, and generally speaking, don’t concern your physician as much as your nurse. It’s easy to just not change out of your own clothes, or bring your own food and drink to your birthing place. I guarantee that you are completely within your rights to eat and drink as you desire, and nobody can legally enforce fasting. Also, if you decline an IV (as simple as saying, “no thank you” in many cases) nobody can slip pitocin into your IV without your express permission. For many hospitals, things like “delayed cord clamping” and “immediate skin to skin” are more routine than in the past, unless you or baby experience complications. For that reason, I ask clients to focus mainly on the things their providers will need to know up front- “intermittent monitoring only,” “no episiotomy,” and “epidural before transition” are all great examples of things to include on your plan.
Finally, on the other side of the neon index card, repeat the same process and create a baby care plans for after the baby is born. Things like, “absolutely no pacifiers,” “vitamin K shot after golden hour,” and “parent always accompanies child” are great things to include on baby care plans.
Remember, if you’re not interested in having a doula present at your birth, but you would like help creating a birth plan or communicating your plan to your providers, many doulas (including me) offer those services on an “as needed” basis. Hit me up if you’d like to schedule a session for these services!
