Wednesday, May 6, 2015

Should I write a Birth Plan?

Image credit: Birth Boot Camp
I hear this question often. As with any topic, there are differing opinions as to whether or not a woman should draft a birth plan. One of the most frequently repeated answers from those in the "No" camp is, "Birth never goes according to plan. There's no point." Or any variation of that statement. You know those statements. "I know that when a woman hands me a birth plan, she is headed straight for a c-section."

I like birth plans. I think they are a great tool. I understand that when people give me a copy of their birth plan, they are not handing me a contract. They realize that birth doesn't always go according to plan. I understand that these women are intelligent enough to deviate from the "plan" if the need should arise. I don't need to undermine or belittle their wishes by telling them that "birth doesn't always go according to plan." I understand this. They understand this. I think everyone understands this. I also think some people just feel like being a jerk for a minute when they say something like that.

So to appease those that like to maintain that birth doesn't always go according to plan, (we all get it, okay?) many people in the birth community have started calling them "Birth Preferences" or "Birth Visions." For the purposes of this article, I'll continue to refer to them as Birth Plans.

If anyone asks me if they should come up with a birth plan, I say yes. I think it's a great exercise in figuring out what options are available to a birthing woman. Many women do not know what options are available in their communities. Some women do not know what an episiotomy is. Some women don't realize that episiotomies aren't the routine anymore. Some women do not realize that VBAC is available to them in their communities. Some women still believe, "Once a Cesarean, always a Cesarean." Some women don't realize that they do not have to consent to an induction at 41 weeks just because it is "hospital policy." Some women do not know that it is routine to administer pitocin during the third stage of labor unless you request otherwise. (I didn't.) Some women do not realize that you can have a midwife attend your hospital birth. Some women do not realize that you don't have to have an epidural if you don't want to. (I didn't for a long time.) Some women do not know there is a such thing as natural childbirth, birth centers, or home birth. (I had absolutely no idea natural childbirth still existed for a long time.)

When drafting a birth plan, a woman can discover all of the options available to her. The earlier she does this in her childbearing years, the more options are available to her. For example, let's say Mama A starts reading some articles about natural childbirth toward the end of her pregnancy. The more she reads, the more she realizes that she wants a midwife to attend her birth. She still wants to have her baby in a hospital because it's her first baby, and she's worried about the "what ifs." She feels safest in a hospital setting. She really loves her OB, but now she's decided that having a midwife attend her birth would suit her better. She discovers that there is a group of amazing hospital based midwives in her city, but now that she is so far along in her pregnancy, they aren't able to accept her. She no longer has the option to birth with that set of midwives.

The earlier a woman starts drafting a birth plan, the sooner she can start asking her care provider questions about the way s/he practices. She can ask what the rate of episiotomy is for first time mothers. She can ask if she can labor in the tub. She can ask about intermittent vs. continuous monitoring. She can ask under what circumstances that provider would suggest induction of labor. She can ask if that provider attends VBAC births. If she starts to find that her care provider isn't quite on board with the birth that she would like to have, she may be able to switch to one that is more agreeable to helping her achieve the birth that she wants. The earlier in her pregnancy she is, the more options are available to her. However, it is never too late. I know plenty of women who have switched providers during labor.

Image credit: morgueFile
Not all care providers practice the same way. Not all care providers agree on what is the best way to give birth. Not all care providers are willing to help a woman achieve her ideal birth as much as others are. Some care providers truly bend over backwards to help a woman achieve her desired birth, and no, they are not just midwives. There are some really amazing OBs out there too. Some providers take a team approach to birth, and some don't. And I truly believe that a woman's choice in care provider is crucial in determining her odds of achieving the birth that she wants. And no, a woman doesn't have to have her baby by herself out in the woods somewhere to have an "ideal birth." Unless that's what she wants. There are plenty of women who have wonderful, healing births in the hospital. And no, that doesn't always mean a natural birth. Or even a vaginal birth. There are plenty of women who have elected to have a repeat Cesarean who have said that it was a healing birth. Birth can be amazing or it can be a complete nightmare, and a huge portion of that depends on a woman's healthcare provider.

A birth plan isn't always just about the birth, and there is still plenty on a birth plan that is in a woman's control. Will she dim the lights or not? Will she request an episiotomy or will she request to tear naturally. Does she want someone to offer pain meds at the first sign of discomfort or does she want everyone to keep quiet about it until, or if, she asks for pain meds? Will she want to labor in the tub or shower? (Some hospitals don't have tubs in every room, so if you want a tub, you have to request a room with a tub.) What position(s) will she want to try during the pushing stage, and will her care provider accommodate those wishes? Does she have the option of intermittent monitoring or is continuous her only option? Does she want immediate skin-to-skin after the birth? Does she want complete silence as the baby is born? Does her partner want to cut the cord? Does she want the nurses to give her baby a bath, or does she want to do it herself? (See? It's not JUST about the birth.) Does she want the baby to have the Hepatitis B shot in the hospital? Does she want her baby boy circumcised or not? These are not decisions you want to be surprised with the day you have your baby. My husband and I had no idea that babies get vaccines in the hospital after they are born. We never researched that. Although these questions would be more appropriately labeled, "Newborn Preferences" or "Postpartum Preferences," they are still considered part of the "Birth plan."

Or whatever you want to call it. It is the thing that helps you know your options so that you can achieve your best birth possible.

I'll just stick with calling it a Birth Plan.