Not Your Typical Birth Plan

Not Your Typical Birth Plan

I have never written a birth plan. How can you even do such a thing when birth is so unpredictable!? I mean, even when I HAD a plan, things never went the way I expected them to, so I always kind of felt that moms who wrote birth plans and passed them out as they were wheeled into the L&D just felt the need to have control over every. little. thing.

But now I’m writing one.

Why a change of heart? Well, after four very different births, none of them anything like what I had envisioned, I am tired of feeling out of control when I’m wheeled into the L&D.  So, to those moms who have a binder of requests, I feel you. I feel you so much.

From My Perspective

I knew a regular old “Do you want to have an epidural?” birth plan wasn’t going to work for me. I needed a plan that took into consideration both my sex-positive, feminist perspective and my mental health as a domestic violence and sexual assault survivor. Plus, ya know, all the other important labor “stuff”.

Where to Start

I started by finding a general, but detailed, birth plan. It gave me a good starting point, but since this one was a printable fill-out form there was no way to really customize it for our circumstances. I read it over and filled it out, making notes for what to change or add to my own plan.

What is the Goal?

Obviously, the end goal is to have a happy birth, a healthy mom and a healthy baby, but what is the specific goal of your birth plan? Is it to avoid all the things you’re afraid of? Is it to minimize the chance of something bad happening? Or is it to help the staff understand your needs?

I spent some time away from planning until I realized what I really wanted was for the L&D staff to understand where I was coming from and respect my labor decisions. The nurses and doctors have no way of differentiating YOU from any of the other 10 laboring moms except your medical chart. They don’t really know if you have a low pain tolerance, if you hate having the lights turned off and on because of vision issues or that during your last birth you panicked when they held your legs down while you were pushing.  I needed the staff to know.

What are My Options?

I spoke with my OB about the options I had available at their hospital and over the years I’ve done A LOT of reading and research about my rights as a  person in labor. My only advice on the matter is to do your own research, be informed about your options and make decisions that make sense for you; not just what is easiest for your doctor, hospital or anyone else. Remember, your hospital might have preferences, but you do still have the option of opting out of certain procedures, asking for privacy, being able to eat or drink and even being able to move around the labor room while in labor.

Forming the Plan

First I searched a ton of different birth plans that had specific angles I identified with: VBAC birth plans, trauma birth plans, narrative birth plans, bulleted birth plans, birth plan tips from nurses, birth plan tips from midwives, etc

I found a VBAC birth plan that was split up into different sections like “Augmentation”, “Monitoring”, etc instead of just a Q&A format. I decided to split my own plan into the sections I felt I wanted to focus on: General Information, Interventions, Labor, Active Labor and Post-Birth. Baby Center also has an article that gave me additional suggestions.

But the article that helped me the most was Top Ten DOs for Writing Your Birth Plan: Tips from an L&D Nurse, PART 2. Part One is definitely worth reading as well, especially if you still have reservations about writing a birth plan. This article was important because I didn’t want to spend my time creating a birth plan if no one at my hospital was going to read it or take it seriously, so having the perspective of an L&D nurse was very helpful.

Putting My Thoughts Together

I decided to put my birth plan in a bullet format rather than a narrative. I began by putting my name at the top and the baby’s name below mine (and our nicknames for him). Then I began with my General Information. I included who was going to be in the room, when and what preferences we had or those people had. For example: Our kids weren’t sure if they wanted to stay during labor, but we wanted them to make that decision and didn’t want anyone else suggesting that they leave or stay. I also noted that I had anxiety, the importance of my requests being honored and my high tolerance for pain. If there is something important you think might impact your overall experience, this is a good place to note it.

General Information:
-My doula is here to advocate my wishes and provide me with labor support.
-My mother and my husband will be present during labor.
-My sister will be photographing during labor.
-Our children may or may not be present during active labor. My nephew may or may not be present during active labor as well. We may choose to have them step out with a family member if need be. Please do not remove our children from the room, or suggest that they leave, without our permission.
-Keep me informed and please ask before giving me any medications, IVs or performing other standard procedures.
-I have General Anxiety Disorder and may have a panic attack. If this happens, please give me space and allow me to cope.
-Please respect my wishes during my stay here. If I make a request or speak up regarding my care, please take these requests seriously. I kindly ask that you do not second guess my needs.
-I have a high tolerance for pain. A 1-10 scale is not a sufficient form of measurement for me. During labor I am generally quiet and calm.

Interventions

I have a lot of opinions about the interventions used during labor. I think many of them are overused and have become standard procedure even for women who do not need them, so there is an entire section of my birth plan devoted to “Interventions”. It was really important to me that I put this section in my birth plan separate from the labor sections so they wouldn’t be overlooked, but I don’t suggest that every person giving birth include this section or even refuse interventions right off the bat. Discuss with your Doctor what is common for your hospital to perform, do research and then decide.

Interventions:
-Continuous monitoring, IV and a heplock have been agreed to. However, if at anytime I feel the monitors are interrupting my labor or adding unneeded stress, I may remove them. After I spoke with my Doctor and my doula I agreed to be monitored, to have an IV and a heplock, with the agreement that I can adjust and/or remove them if I feel it is needed.
-I absolutely will not have an epidural, but may request tylenol if needed.
-An initial internal exam may be performed upon arrival to establish progress. Additional, vaginal exams will not be performed unless at my request.
-If augmentation is necessary, I would like to try non-pharmacological methods before resorting to medications. If I agree that pitocin is required, I request that the it be administered following the low dose protocol and increased in intervals no closer than every 30 minutes, allowing my body an appropriate amount of time to adjust and react to each dose increase.
-I do not consent to an episiotemy, under any circumstances.
-If a Cesarean delivery is necessary, I would like to be fully informed and to participate in the decision-making process. I do not consent to having my arms or hands strapped down unless I am unable to control them. I understand the necessity of maintaining a sterile surgical field. So I can view the birth, I would like the screen lowered just before delivery. My husband should accompany me in the delivery room at all times.

Labor and Mental Health

In the Labor and Active Labor sections I made sure to speak up about being touched as well as my need to walk around and not be hooked up to electronic monitoring. During previous births I’ve had people hold me down, move my arms, position me and jab me with needles without getting permission to touch me first. As an abuse survivor, this was a huge problem for me and the staff normally aren’t informed in how to deal with mental health issues properly.

If you have a mental health issue, it’s always a good idea to discuss this with your doctor so they can either put it in your file or work with you on a plan. I know I have issues with anxiety and depression. I’m already on medication, but I also use alternative methods to help cope when I have an attack, which could be anytime, anywhere for any reason. During my last hospital birth, the nurses started immediately suggesting I take a sleeping pill when I had an attack and I accepted it because it was easier at the time (in the middle of an attack) than arguing with them again. This time, I noted in the very beginning of my birth plan that this could happen and to let me cope with my own techniques if it does occur.

Labor:
-This will be a VBAC (or TOLAC) birth.
-I would like to be able to move around, eat, drink and use the restroom as needed.
-I may chose to shower, walk, dance, etc during labor.
-Please keep lighting and noise to a minimum. Do not increase the lighting or noise level without permission.
-Please allow us privacy during labor. This includes nurse check-ins. We understand this birth has some special circumstances, so please keep us informed about who and when staff may be entering the room. I do not want staff coming in and out.

Active Labor:
-Do not touch me without permission. I do not want anyone grabbing my legs, positioning me, suggesting positions, etc.
-I do not consent to being confined to a bed during labour. If the birth is happening away from the bed, I do not wish to be moved from this position.
-Please do not direct my pushing with verbal commands or counting.

Post-Birth/Recovery

My post-birth section focuses mainly on our son, who has gastrochisis. Normally, this section would include things like whether you plan to breastfeed, if you want your child to receive Vitamin K, etc. But for me, it’s more about staying informed about our son’s status once he’s transported and out of surgery.

You can also include in this section if there is anything in particular you need during recovery (medication, food, clean clothes, etc), if you’d like anyone particular in or out of the room or if you’d like the baby to stay with you or in the nursery.

Post-Birth:
-I understand that since he has gastrochisis my interaction with him after birth will be limited. I do, however, request that I be allowed as much time with him as possible and the ability to hold his hand, love on him, etc before he is moved.
-My mother, husband and/or my sister will be accompanying Arthur to Cardinal Glennon.
-Please keep us updated about Arthur’s arrival and condition while I am in recovery.
-Please allow me privacy during recovery. If I need assistance or medications I will ask.

The End!

Remember that writing a birth plan is about your ideal birth. It isn’t going to go 100% how you envision it. It might not even go 20% how you envision it, but having a birth plan can help avoid unnecessary stress during labor, sort out issues and help make decisions so you’re not put on the spot.

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