I'll just admit it. I am a doula and I had no birth plan for either of my births. I was giving birth at home and I just assumed that "Home Birth" inherently covered all the things I wanted in a birth. I toyed around with a document with birth preferences, but it was just for the people I imagined would be there ("I have no idea what I'll want or who I'll want around me. If I ask you to go see a movie please, it isn't that I don't love you!"), and to please not tell me what time it was or how long I had been at it. I assumed that if I needed to go to the hospital, it would only be because I needed this intervention or that one. It may have been naive, but it all worked out fine.
But I am in the minority. The vast majority of women birth in the hospital and if these women want a natural birth, a birth plan is not just a good idea, but essential to making sure they are on the same page as their caregivers.
So what does the doula who has never written a birth plan have to say about writing birth plans? My recommendations to my clients for birth plans are based on the words of the L&D nurse who attended my doula training workshop. She said (and I quote): "Oh, I usually read them. I definitely read the first page, then depending on what's happening on the floor, I'll scan the second page. If there's any more than that, I just don't generally have time for it." She also said (and I paraphrase) that she hates the birth plans that have all the little checks of I don't want this or I don't want that, and there is one important point no one ever puts in that she would tell all her doula clients to add. More on that later.
Keep in mind, this is from a nurse who was at a doula training workshop so she could be as supportive of natural birth as she could.
So let's deconstruct her statement.
"I usually read them."
Note the word usually. That means, of course, that sometimes she doesn't. Is it because she doesn't care? She doesn't want to make sure you get the birth you want? Of course not - remember, she was at the doula training to learn how to be more supportive of the natural birth process. Moving on:
"I definitely read the first page, then depending on what's happening on the floor, I'll scan the second page. If there's any more than that, I just don't generally have time for it."
So this shouldn't come as a shock, but hospitals are often sadly understaffed. And in the DC area, we have a lot of baby-factory hospitals churning out babies by the hundreds every month. There is a lot going on at any given time and one nurse will often monitor 3 or 4 mamas at once. She doesn't have time to read a 20 page birth plan.
So based on her statement, this is what I suggest. And of course, all of this is predicated on the health of the baby and the mother. I can't emphasize strongly enough that your caregiver must be on board with your plan. If s/he is not, you may consider switching providers to one more supportive of your choices
Keep it Simple.
There are things that are worth fighting for. Waiting for labor to begin naturally is a biggie. It is one of the best ways for you to ensure that you get your natural birth. But other little details may not be worth fighting about. This L&D nurse said that a mom agreeing to have a heparin lock in place is viewed as a mom willing to compromise on the little things, and so some of the harder-line nurses are more willing to work with her on the big things. (This is just an example - if not having a hep lock IS deeply important to you, by all means, mention it). So keep it simple. Narrow it down to the things that are really truly deeply important to you. And see if you can get it all on one page.
Keep it Positive
This goes back to getting the nurses on your side. In a perfect world, we would have "sides" when it comes to birth. But sadly, mamas wanting a natural birth in a hospital setting often have to fight the hospital powers that be to get it. So instead of handing a group of over-worked nurses a list of "I don't wants", try using positive phrases, such as "I know there are pain medications available. I will ask for them if I need them" instead of "I don't want an epidural." Or "I would like to use the position that feels most comfortable to me during the pushing stage" instead of "I don't want to push on my back." I sort of equate this to talking to my kids. If you use all negatives - Don't run, don't hit, don't throw your brother down the stairs - all they hear is the "don't" and the "no" and miss the actual message. Make your plan an expansion of the statement "this is what I want from my birth experience" instead of relying so heavily on "This is what I don't want".
Get Attached
This is from NATURAL HOSPITAL BIRTH by Cynthia Gabriel (and GREAT book that I cannot recommend enough!). Get attached to your plan. Be willing to fight for it. Yes, birth is unpredictable, and you have to be willing to shift gears if something goes awry, but be committed to it. Be dedicated to getting your natural birth. It is the same in life. You are not going to get that which you don't set your heart on. Obviously, if an emergency comes up, you will go with it. No one - not even us dirty hippie home-birthers - is putting the birth experience ahead of a healthy baby. But in the absence of an emergency, you need to be attached to the idea of natural birth. Otherwise it is too easy to be swayed by the "this" and the "that" that the staff could do to make things "easier". Get attached. Be passionate. Be informed.
The One Important Point
This L&D nurse told us at my training that if you are started on Pitocin to help with progress during labor, the nurses will routinely up the level of the drip at regular intervals - REGARDLESS OF HOW YOUR LABOR IS NOW PROGRESSING. Pitocin makes contractions hard. I mean HARD. She said that if the patient requests it, they will not do that. So consider adding a line that says something to the effect of "If I need Pitocin to augment my labor, please do not routinely increase the level after it has been administered unless absolutely necessary," or "If Pitocin is needed to augment my labor, I would prefer that the initial dose not be raised unless absolutely necessary and only with my knowledge and consent."
So that is my simple guide to a simple birth plan. Here are some suggestions of what to include:
* A short message to your care provider/nurses a la "I'm really committed to and excited about a natural birth. Anything you can do to help me achieve this would be greatly appreciated!"
* Preferences about letting labor begin on its own
* Who you want in the room
* Whether and/or when you want to be offered pain medication
* Being able to move freely and eat/drink throughout labor
* Avoiding vaginal exams
* Pushing positions
* Preferences on coached pushing
* Whether and how long you want to delay postpartum and newborn procedures (cord clamping, vitamin K shot, eye ointment, weigh/measure, bath, etc) while you bond with the baby
* If you plan on breastfeeding
Heidi Thaden-Pierce (a doula in Texas) has a wonderful resource called Things to Consider. It is a pretty comprehensive list of things to think about while formulating your birth plan.
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