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The Birth Plan

Published August 23, 2007        by Kim

One problem that keeps coming up in patient-physician relations is communication. Physicians are busy people and one of the most common complaints about them is that they are always rushed and do not have the time to answer and discuss questions. Sometimes the physician is not even present; the office nurse is the one who sees the woman if the physician is tied up at the hospital. Poor communications and misunderstandings lead to depersonalized and sometime unsatisfactory care. There are solutions to this problem. One is to seek a care-giver who is not so busy [physicians who are just starting a practice often have more time] or who schedules appointments long enough to get to know each woman. Midwives are such care-givers, but they are few in number. Some established physicians also plan more time for individual appointments. Another solution, which has many other advantages, is the birth plan. What is a birth plan and why is it worthwhile? A birth plan is simply a written description of your priorities and preferred options during labor and birth, and afterward. The plan may be placed in your chart, where it can be read and consulted by those involved in your care. The portion that pertains to your baby [the baby care plan] can be placed in the baby's chart and is separate from your own.

A birth plan has many advantages. Simply preparing a birth plan helps you focus your learning on the various options [for example, natural versus medicated childbirth, circumcision versus no circumcision, and breast versus bottle feeding]. It encourages you and your partner to discus your worries and expectations and to come to an agreement on what is important. During labor of course, the benefit of the birth plan is that you do not have to take the time and trouble to tell each staff member your wishes on every option as it comes up.

Birth plans also help your care-giver. If you prepare a rough draft and go over it with your care-giver, he or she will know you better and will know how to help you in labor. He or she can also help you modify options that may seem unwise or inappropriate. Potential misunderstandings can be detected in advance so that neither of you is caught by surprise when the stress of labor makes discussion difficult. Your care-giver may be willing to initial your plan, indicating to hospital staff that he or she agrees with it. It is not a legal agreement or a contract. It is simply a statement of your wishes.

For the nursing staff and other people who will be caring for you during labor, the birth plan makes you less of a stranger to them. It is a shortcut to communications and lets you know what is important to you and how they can help.

Your birth plan should be flexible, taking into account not only a normal, or "textbook" labor, but also the possibility of a difficult labor, complications, or other unexpected events.

Your birth plan might begin with a brief paragraph describing yourself and anything that you feel would help the staff understand you better and to understand your birth plan. For example, if you had a long period of infertility before your pregnancy, if you have had miscarriages in the past, or if you previously experienced a tragedy associated with childbirth, it will help for the staff to know that. If you have a fear of hospitals or medications, or if you have had unpleasant experiences in hospitals in the past, tell them. If a natural birth is extremely important to you, let them know so that they can offer you maximum support in that effort. If avoidance of pain is a high priority, let them know. If you have religious preferences, if yours is a blended family with other children, if you have impaired hearing or vision, if this has been a particularly difficult pregnancy-knowing these things will help the staff meet your needs. You might simply want to state that you will appreciate their help, advice, and expertise.

The next section of the birth plan is a straightforward list of your preferences for a normal labor and birth. Include only item that you care about. You do not have to hold an opinion on everything. At the moment, you may feel you do not have enough background to decide your preferences on these procedures. Childbirth classes and discussions with your care-giver will give you the needed information. It doesn't need to be so detailed that it states where to put an infant gift, but detailed enough that your desires are met.

If your labor is prolonged and more painful than expected, if the baby isn't tolerating labor, or if you develop complications that make intervention necessary, your ideal birth plan may have to change. Let it reflect a recognition that these things can happen and that you are flexible enough to be able to accept changes in the plan if they are necessary to your sake or your baby's.

Sometimes a cesarean birth becomes necessary for any number of reasons. It helps to acknowledge the possibility of a cesarean birth in your birth plan, and indicate your preferences if it does indeed happen to you. For example, you might state that you prefer to remain awake, to have your husband present, or to touch and nurse your baby as soon as possible after the surgery.