Birth Plan
When my sister-in-law was pregnant with her first baby, she asked her doctor what she thought of creating a birth plan spelling out the type of birthing experience she hoped to achieve. The doctor turned to her and said, "How would you feel if someone told you how to do your job?" I advised my sister-in law to high tail it out of there and find another doctor, one who was sympathetic to her concerns and would at least acknowledge her wishes.
Nowadays, many women have very specific ideas about how they want their labor to play out. In this day of large group practices and cross covering obstetricians, the birth plan is a good way to quickly and clearly communicate the things that you consider important. In developing a plan, you will also gain a better understanding as to why choosing a caring and competent doctor or midwife who listens and takes a patient's concerns seriously should be a top priority.
In addition, birth plans are a great way to clarify and communicate a couple's thoughts on a variety of interventions, including labor stimulation and induction, pain management, forceps and vacuum deliveries, episiotomies and care of your newborn baby. Birth plans can also cover the atmosphere the patient would like to create, including specifics such as lighting and mobility, as well as broader goals such as staying with the baby as much as possible once it is born.
Of course, some couples have unrealistic expectations that the birth of their child will occur in an orderly and predictable fashion. But once labor begins, things are often hard to predict. Some high-risk patients have easy, uneventful births, while healthy women who do everything they can to make their dreams come true may experience dramatic and even life threatening complications, which are beyond their control.
One cold winter's night a few years ago, an anesthesiologist walked onto the Labor and Delivery floor with his wife, who was obviously in labor. As a nurse shuffled by with the moaning patient, the husband calmly spoke to the staff at the nurse's station. "My wife is here in active labor, and she is having contractions every 2.5 minutes," he said. "Please notify the anesthesiologist on call that she will have her epidural now." A minute later, we heard a loud scream and the patient delivered a healthy boy. No one was more surprised than the husband, who was still standing at the desk. He did not even have time to take off his coat and hat.
Ideas about your birth experience are generally formulated over the course of the pregnancy after gathering information from books, web sites, classes and the experiences of other patients and health care practitioners. For first time parents, this may be hard. They have never actually been through the process before, and there are a lot of choices to make in terms of whom to listen to and trust. For women who have had children before, past experiences may help guide ideas on what they would have liked to do differently and or the same way as before. Choose good sources for information, and if something seems controversial, ask your doctor's opinion. Many patients, including my sister in law, end up switching doctors during the pregnancy or the second time around in part because they didn't think about or spell out their expectations the first time.
Ideally, a birth plan should be discussed with the person who will be delivering your baby, or who can at least represent the opinions of the team of doctors and or midwives whom might be involved with your care. It should be discussed during your prenatal care in a relaxed setting where a reasonable amount of time may be set aside to ask questions and discuss specific issues. Handing a doctor you have never met a plan when you are eight centimeters dilated is not ideal. I encourage patients to both discuss things all along the way, and or pick a visit where both patient and partner can be present together, to go over the plan in detail. In the end, building a trusting relationship with your caregivers and having your partner on the same page are of the utmost importance and should make you feel safe and secure.
Some women are motivated to draft a birth plan because they want to avoid a C-section, which is how 30% of all babies are born—although a birth plan does not guarantee a vaginal delivery. Your doctor's goal is usually fairly simple—to end the day with a healthy baby and a healthy mother. To achieve this, there are times where a C-section or an operative vaginal delivery using vacuum or forceps may be necessary. The physician or midwife delivering your baby will use their experience and knowledge of what is safe and effective to try their best to make sure everything turns out well. Even in the best of hands though, there are no guarantees, so try to be flexible so your birth plan doesn't set you up for disappointment. If they don't take your birth plan or your concerns seriously, it may be time to consider a different practice.
Think of your birth plan like a resume; just as employers are not going to read through pages of superfluous information, a busy labor and delivery nurse will not either. A short, concise document – no longer than one page – will be taken more seriously and get your important points across. In the end, the birth plan can truly help couples achieve the experience for which they had hoped. Mulling over the many issues involved may also help demystify the process and gain some sense of control over the situation. As a result some of the fear and anxiety over this exciting yet stressful situation may be alleviated. Lastly, don't forget to think about the really challenging and complicated part – what to do once that baby comes home with you.
