What's in a Birth Plan...

This is a post I have really wanted to write for moms (especially first time moms) who are planning to give birth in the hospital. A birth plan is a huge asset and a great way to communicate your wishes between you and your medical team. We all have wishes and desires for how we want things to go, and the best birth plans I have seen are ones that are well researched. When I was a first time mom writing my birth plan, I often saw things on other peoples' birth plans and said "I don't even know what that is...so it doesn't matter to me." After researching, I realized I had a definite opinion. I'm hoping I can give moms some pointers of things they may want to research, and things to definitely include in their birth plans.

It is important to remember that no matter how much you love your doctor, they seem to understand you or you believe you can advocate for yourself, that can all change in the blink of an eye. Labor is intense, and doctors who believe you are a risk (when you may not be) can be intense as well. I have witnessed first hand the scare tactics that can be used on a mother that they seemingly assume is uneducated. You cannot assume that just because you are in a baby friendly hospital, or you are assured everything will go fine, that it indeed will. This is where a birth plan comes in handy. Get it all in writing! Know what you stand for, and be able to explain yourself.

First off...I wanted to offer some basic pointers when writing your birth plan.

• Keep it short and sweet. Longer birth plan = more skimming done by doctors.
• Accept that it is a plan, and don't bond too much with it. 
• Bring MULTIPLE copies to the hospital (and tape to put it up on the door/wall)
• Go over your birth plan around 34 weeks to make sure it is agreed upon with your provider.
• Make sure your husband/doula knows your wishes and is willing to stick up for you.
• Be assertive with your wording in your plan..."I am planning" rather than "If it is ok"
• Make it personal...don't copy and paste or use a template. 
• Ask friends to read their birth plans to get ideas. 

I also decided, before writing this post, to ask some moms on social media what they wished they could do differently... I noticed a pattern of two most common things they wish they had been more assertive about. They were:

• Seeking and demanding more breastfeeding support (even if all was seemingly well)
• Wishing they had researched more about induction and what is necessary vs. not 

So now, given all that, I'd like to light some fires in the minds of the moms-to-be out there writing birth plans. I don't want to sway anyone in any direction, but simply give some questions to research and things to consider. I encourage you to research and consider ALL of these. You don't want to have to defend yourself on any of this during labor. A lot of this may be too much to include in a birth plan without making it lengthy, but be sure whatever you don't include, you have someone to advocate for you and know your wishes.

The Who

• Who do you want to be in the room with you when you give birth? 
• Do you have a doula? (Mention her name.) 
• Do you have a crazy mother in law who is not welcome? 
• Do you want minimal staff or are you okay with students? 
• Does your husband have specific needs? Is he a fainter? 
• Do you want medical staff to talk to hubby or your doula before they talk to you? 
• Anyone else who will be there? (massage therapist/acupuncturist/photographer/etc)

The What

• Are you planning a certain kind of birth? (ie hypnobirthing/bradley)
• Does your hospital have a tub? Shower? Do you want the option to use it?
• Do they have birthing balls, peanut balls, birth stools, rocking chairs, etc? 
• Do you want to request a birth/squatting bar?
• Are you planning to have your own music? (find out if they have cd/dvd players)
• Do you think essential oils may help you? (You will need to bring your own, and this isn't necessarily something to include in your birth plan, but good to know: there are oils that can relax you, speed labor and even help pain)
• Do you prefer a dimly lit environment? (known to help labor progress)

Admission

• Do you want the option to walk/go home if you are not far dilated?
• Do you want an IV with constant fluids or a hep lock for emergencies only?
• If you are GBS positive, do you want to constantly be attached to an IV? Or only when needed for antibiotics.
• Do you want to be attached to the monitors the whole time, or be free to move around after 20 minutes on the monitors?
• Do you want a wireless/waterproof monitor? (many hospitals are getting these)
• Do you want a catheter/enema or to toilet on your own? (note: epidural recipients receive a catheter)
• Do you want to wear the hospital gown or bring your own?
• Do you want to eat/drink? (Find out the hospital's policies on this)

Pain Relief

• Are you planning on an epidural? Hoping to not have an epidural? Completely against an epidural?
• If you get an epidural, would you like to have your position changed often and use a peanut ball? (find out if your hospital does this) Can the medical staff do table turns?
• Do you want pain relief offered to you or do you want to ask yourself?
• Are you comfortable rating your pain on a scale of 1-10 or will it hinder your focus?
• Do you want the discussion of pain to be avoided?
• Are you open to narcotic/IV medication?
• If you experience back labor, would you like to try saline shots? (find out if your hospital can do them)

Interventions

• If your labor stalls, would you like pitocin, or do you prefer to change positions, walk, try nipple stimulation, use other natural measures. (some hospitals offer acupuncture/reflexology)
• How do you feel about having your membranes ruptured? 
• Do you want to get your membranes stripped? (again happens early on so may not need to be included in the birth plan...but something to research) 
• If doctors offer you an episiotomy would you like to try perineal massage or position changes instead? Do you know what this is? Can you access a nurse to do perineal massage?
• In what situations are you okay with pitocin? (note: don't focus so much on when you are not in labor yet, as you can advocate and talk then)
• If doctors want to induce, have you considered trying a foley bulb first? Cervadil? Cytotech? Do you know the benefits/risks of these?

Birth

• Would you like to be told when to push, or push on your own? (research purple pushing) (also know if you have an epidural, pushing on your own may not be an option)
• Do you know the sex of your baby? Do you want the doctor to tell you? Do you want your husband to tell you? Do you want to look for yourself? 
• Do you want your husband to catch the baby? (Many hospitals will allow this, under the supervision of the OB/midwife, of course!) 

After Birth

• Do you want the cord cut immediately or would you like to delay this so the baby can get all the blood from the placenta?
• Is there someone who you want to cut the cord? 
• Would you like to have skin to skin time with baby (assuming he is not in distress) before the doctors poke around? How long? Do you want baby to stay skin to skin with you while assessment and testing is done?
• Do you want baby to have a bath? Do you want Daddy to do it? Would you prefer to leave the vernix on baby and not do a bath? (the benefits of vernix is a great topic to research!)
• Are you breastfeeding? Would you like immediate assistance with nursing? 
• Do you want eye gel? (Yes, this IS optional)
• Do you want vitamin K? (Note: there is an oral and injectible vitamin K...which does your hospital offer?)
• If breastfeeding, do you want to make sure your baby does not receive any pacifiers or bottles during your stay so as to avoid nipple confusion?
• If there is an emergency and baby needs to go to the NICU, who will go with baby and who will stay with you? (not necessary in the birth plan but good to know)
• If baby has to go to the NICU would you like access to a breast pump? 
• Do you want to see a lactation consultant? 
• If your baby is a boy, will you circumcise? (Note from personal experience: Regardless of how you feel, or if your partner is circumcised or not, I highly encourage parents to research this. Dr. Momma is a website that has lots of information. My husband and I disagreed on this, and I really thought I knew what I wanted to do with this, but after researching, I came to a different conclusion. This is your child's body, and circumcision is surgery, so please just be sure that whatever you do, you have evidence to support why you did or didn't do it.)
• Do you want your baby to have a Hepatitis B vaccine, normally administered at birth? Do you want to delay until a couple days later? Do you want to delay until a month?
• Do you want to take home your placenta? (Note: ask in advance about what kind of additional testing you will need in order for this to happen. Most hospitals require a Hep C test on file)

These are my big pointers I feel strongly about moms having a stance on. I again want to reiterate how important it is to research all of this, talk to friends, talk to your doctors and figure out what is best for you. You want to educate yourself and be confident talking about why you want the things you want, or else the medical staff advocating for you may not feel confident about doing so. There is seriously so much to think about during a birth, it can seem overwhelming, but I promise if you research all of this and know where you stand on these issues, it will be a lot easier.

I pray that those reading this and writing their birth plans have a great birth that goes exactly as planned, but please know if your birth plan doesn't hold up completely, it's okay. Mine did not, but I savored as much of it as I could. I still had a wonderful and very memorable birth, and I know as long as you are well researched, positive and remain flexible, you will as well. Happy Birth-Plan Writing!

[If you have any questions, feel free to comment or ask me privately. I would be happy to assist moms in finding the research they need.]