Birth Plans- Put It In Writing!

Many women have a fear of birthing in a hospital because they fear that their doctor or the hospital staff will pressure them into interventions that they do not want. Others are torn between wanting a natural birth and wanting the security of the controlled hospital setting. I want to tell you that you can have a natural birth in the hospital and not be pressured into interventions you don’t want. I did it and I will share with you how.

What we are really talking about here is patient self-advocacy. Many patients don’t know that they have options, and more importantly, rights when it comes to deciding medical treatment. Your first step in having the birth you want, is to be informed of your rights as a patient.
The most basic right of any patient is the right to consent. No doctor, nurse, lab tech, etc can touch you without your consent. (The exception is if you are unconscious. In this case, medical personnel can assume consent to life saving measures.) In your right to consent you have the right to be informed of all risks related to any treatment that is purposed, any alternative treatment options, and the risks of refusing treatment. You also have the right to seek advice from additional professionals or sources before providing consent. You also have the right to revoke consent at any time. Consent is given in writing with the exception of emergent situations. 
As the patient you also have the right, and I would say the responsibility, to be directly involved in deciding your treatment plan. This is where a written birth plan becomes so important. (We’ll talk about why it needs to be in writing in a moment.) In making your birth plan, you need to be informed on the decisions you are making and need to discuss all of your options with your health care provider. You need to feel comfortable talking with  your health care provider and discussing both your ideal birth situation and emergent care policies. It doesn’t matter if you are using a midwife, an OB, or a talking frog, you have the right to be involved in these decisions. If your provider does not allow you to exercise that right, exercise your right to revoke consent.
After you have done your research and discussed any questions or preexisting conditions with your health care provider, put your birth plan in writing and then discuss it with your provider again. Then you can finalize your birth plan and have it ready for mommy and baby’s big day. In your delivery bag, you need to have your birth plan in writing, and at least a few extra copies. When you go to the hospital to be admitted, hand your nurse your written birth plan and ask for it to be put in your chart. If you change wards in the hospital (example going from labor and delivery to postpartum care), check that your new nurse has a copy of your plan as well. Here is why it is so important to have it in writing: If you put your wishes on paper, no one can claim they didn’t know. This is essential to making a birth plan work in a hospital. You will also need to be very clear in the wording of your birth plan. Do not leave room for guessing on issues that are important to you.
Next I will go over the main items you will want to cover in your birth plan and then I will include my birth plan for Alex. My plan isn’t perfect, but I did receive compliments from several of the nurses about the plan itself. I am going to assume that a natural vaginal delivery is the goal. If that is not your goal, feel free to tweak the plan to meet your needs. Even if you going in for a scheduled c-section, having a written birth plan is a great idea. Last, but most definitely not least, remember that every birth is different and unpredictable. Even if this is your tenth birth, you cannot predict how it will go. You and your plan need to be flexible to accommodate the ever-changing birth process.
Here are the main areas you will want to address in your birth plan and some questions to consider:
  • Visitors: Who should be allowed to visit and when? Who will be there for the delivery itself? How much privacy do you and your partner want? Remember ladies- this is a big day for dad as well. He might want a lot of friends and family around or he might want a more intimate experience.
  • Labor Preferences: Do you want to walk? Use a birth ball? Birth on a bed, on all fours, in a tub? (In a box, with a fox, in a house, with a mouse…)
  • Pain Management: Labor hurts. I hear that some people can birth and not feel the pain. I’m slightly convinced that they are aliens. What mechanisms do you plan to have available? You may want to be very specific in this area.
  • Interventions and C-sections: Here is where you should consider interventions that may be done during the labor process. What drugs or treatments are you comfortable with? Do you have any hard and fast rules regarding any of the possible interventions?
  • Birth: The big event! How do you want this to happen. Are you okay with an episiotomy or do you want to be allowed to tear naturally? What about forceps or a vacuum delivery?
  • Immediately After Birth: Who cuts the cord and when? Where should baby go first? Should they wash the baby before you hold him or her?
  • Infant Care: Include your preferences for vaccinations, medications, feeding, rooming, diapering and circumcision, particularly if you are opting out of vaccinations, breastfeeding, or have strong feelings regarding circumcision. As a new mom, you have just inherited the right and responsibility to give or deny consent on behalf of your child. 
Let me explain my thinking behind some of these areas and then show you how it all turned out. 
We knew that my family was planning to fly in for the birth. I very much wanted their support, but I also wanted the birth to be a very special and intimate time with Philip. We decided that we would welcome visitors during labor but it would just be us during the birth itself. I wanted the most natural labor possible and wanted the freedom to allow my body to work as it was intended in this process. This meant that I wanted intermittent monitoring. When talking to my OB beforehand he noted that he was uncomfortable with the mother being off the monitors once active labor was under way so I amended the plan to also state that I would like monitoring breaks when possible. (When I actually went into labor the OB on call let me do intermittent monitoring until my BP started to rise.)
Pain management was a big one for me. I was adamant that I not have an epidural, so much so that I did not sign the consent form. My OB and I discussed this for a little while. Being my first, he didn’t want me to rule out any options, but was respectful of my choice. We did also discuss what my options would be should I have a c-section as most c-sections are done with epidurals nowadays. I was less fervent about other interventions and wanted to leave my options a bit more open here. I wanted a natural, unassisted labor but also understood that there were interventions to help with specific situations and that some interventions can prevent larger problems. You will see I also left the episiotomy up to doctor discretion. There is a lot of debate on the episiotomy issue and my thought was that I won’t be able to see what’s going on down there to make that call myself.
For infant care, I wanted to exclusively breastfeed Alex and at the time of writing the plan wanted to use cloth diapers while we were in the hospital. We ended up using their disposables just for the convenience of it, but when we did our tour, the nurses and the nursery agreed to cloth if we wanted. We also wanted to be with him for as many procedures and exams as we could. Philip went with him for all of them except his circumcision and when they checked him for jaundice just before discharge.

Getting Ready to Leave the Hospital
This is the post that never ends! But here is our birth plan in its entirety. Please feel free to comment with any questions. You will notice that the language is very specific in some areas. Once again, these were my preferences. Feel free to use any of this you find helpful and adjust it to your needs.
The Campbell’s Are Coming!
How we would like to welcome baby Alexander into the world…
Overall Philosophy
Labor and birth are natural processes that the female body was designed to accomplish. The end goal is a healthy mom and baby. We would like to reach that goal in the most natural way possible.
Visitors
Friends and family are welcome to visit during the laboring process. We ask that only mother, father, and medical staff be present for the delivery itself, any checks or interventions, any procedures done on the baby, and any nursing sessions. Visitors may be asked to leave the room at mother or father’s request.
Labor
I would like to have freedom of movement and position for as long as possible during the laboring process. I would prefer intermittent fetal monitoring to help maintain freedom of movement for as long as possible with breaks in monitoring as often as possible.
Pain Management
Labor is an uncomfortable and painful process, however, please do not offer me pain medication of any sort. I do not want any drugs for pain unless surgical intervention is required. I have discussed this issue with my doctor and have made an informed decision on this matter.
Interventions
Please only offer interventions when needed for the safety of mother and baby, not for comfort. The most natural and least invasive interventions and methods should be exhausted before proceeding to more extensive, risky, or invasive options whenever possible.
C-Section: This should be reserved for emergencies, or when all other interventions have failed and there is risk to mother or baby to continue to attempt a vaginal delivery only.
Birth
I would like the option of birthing in the most comfortable position for me at the time. I prefer an unassisted vaginal birth if possible. An episiotomy should be done only if needed; to be decided at the doctor’s discretion.
Immediately After Birth
We would like skin-to-skin contact immediately after the birth. The father would like to cut the umbilical cord. Mother would like to attempt to nurse as soon as possible after the birth.
Infant Care
Vaccinations/Medications: Standard medication and vaccines should be given.
Feeding: I plan to exclusively breastfeed. Please do not offer Alex any bottles or pacifiers.
Rooming: We prefer for Alex to room with us.
Diapering: We prefer to use cloth diapers only. We will supply the diapers and containers for dirty diapers, and will be happy to discuss cloth diapering with any staff.
Mother or Father would like to be present for all infant exams or procedures as permitted.

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