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Fruit of the Womb
Fruit of the Womb

Developing a "Birth Plan"

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A comment after my last post raised the question regarding “what constitutes a good birth plan” for a “first-time mother-to be.” I would love to answer this with a simple response that “a good birth plan” is whatever is right for YOU! And, even though that is true, anyone that would take the time to read through one of my longer posts deserves more of an answer than that alone.

I have mixed emotions about “birth plans.” Couples often develop birth plans based on what others tell them is best (that may or may not be based in reality) for themselves and their baby. The reason I know this is that most “birth plans” with which I am presented contain the same concerns, the same language (verbatim), and the same order of presentation. The script has been read and the blanks have been filled in. If you do not believe me, then go to any search engine, query “birth plans,” and see what comes up. If I am wrong, I will take it back! Indeed, there now are a number of websites that women can go to that will produce a written document based on a standard set of questions, concerns, strategies, and disclaimers. Unfortunately, this ‘quick fix’ and ease of preparation cannot replace frank inquiry and due diligence on the part of the individual. In fact, the ‘standard’ that results by such a process may produce a set of unrealistic expectations that can put a damper on the true importance of the whole ‘birth experience’ if it cannot be lived up to.

So, what do I suggest? The first step in the process is to identify your goals, the ones that are right for you, for the pregnancy, labor, and delivery. This step seems to be often overlooked when folks jump to specifics of ‘the plan’ before doing their homework (and there is nothing more certain to turn a provider off). I am suggesting that you think in general terms at this point, not in the details. Go ahead, start with a list. Sit down with your partner and free associate and focus on the positives: “I want a healthy baby.” I want this to be the happiest moment of my life.” “I want to feel I did all that I could to give my baby the best possible start in life.” “I want my partner and me to share the moment and be brought closer by the experience.” “I want to challenge myself and find out what my limits are.” “I want to feel safe and secure even if I am frightened.” “I want to be alert, aware, and focused so that I can enjoy and remember the experience.” “I want to participate in nonemergent decisions regarding my care.” “I want to be kept informed, be told what is going on and what my options are.” “I want to feel free to ask questions without being dismissed.” “I want to understand when it is appropriate to exert some control, and when I should relinquish control.” “I want to feel confident that my provider and her/his staff have my interests at heart and will do everything in their power to make my experience safe and worth remembering in a favorable light.” “I want to come out of this feeling proud about what I have accomplished.” I could go on, but that is the general idea. By the way, consider substituting “we” and “our” for “I” and “my” and this approach takes on a whole new dimension.

Then, I think the birth plan should be developed in conjunction with your provider. Present the “wants” developed in your list and ask how they might best be accomplished. Most providers do not want to be told what to do, but if you remain positive, nonconfrontational or demanding, and focused on the general goals, you are more likely to develop a true bond and get more buy in to what you would like to accomplish. Maintaining open lines of communication and flexibility are the keys here. Becoming educated is essential to success. Attend birth classes. Explore the internet with an open and critical mind. In discussions with your provider and their staff, nurses at the birth facility, other professionals such as certified midwives and doulas, and friends who have had babies before, find out what options are possible, what options are actually available and practical at the birth facility, and what can be done within the constraints of your provider’s practice, experience, and comfort level. ASK QUESTIONS AND REQUEST EXPLANATIONS ABOUT THINGS YOU DO NOT UNDERSTAND.

In the end, develop your birth plan. Be realistic. If something doesn’t feel right, it may well NOT be right for you. Realize that a ‘plan’ is not something that happens all at once, it evolves over time, and it may have to be modified to suit the current status of the pregnancy and your own changing expectations. Prioritize your desires and concerns. KEEP IT SHORT (bulleted points are more likely to be acknowledged). Be clear and precise. Different folks come to the moment with different backgrounds, innate resources, and coping mechanisms. Different individuals may also have very different ideas about what a word or phrase means and your provider cannot read your mind. I have had some patients tell me that their birth plan was that they wanted a “natural childbirth.” To one woman that might simply mean being conscious at the time of delivery; to another it might mean withholding pain medication “even when I beg for it, my head turns completely around on my neck, and I vomit green fluid and profane expletives on everyone in the room.”

Once you have drafted a plan, review it with your provider and ask who else might need to review it (e.g., other providers in the group, L&D staff, hospital administration, The National Enquirer). Remember, the “plan” is not the be all and end all. And also remember, if the birth plan cannot be adhered to entirely or, even at all, in the end because of unanticipated complications for you or your baby, you are NOT a failure. The work you have put into the process reflects the extraordinary motivation and dedication to a new life that only begins with the delivery itself. In my next post, I would tell you what I would consider putting into a birth plan of my own…
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