The Birth Plan

A birth plan is a few things. Firstly it is a written record of what our ideal is and what we will strive for. Secondly, it is a way of communicating to your care givers what your goals and wishes for the birth are. Thirdly it is a contingency plan which deals with all the ‘what if’s’ for when things don’t go the way we hoped

Can we really ‘plan’ our birth experiences? Well, we certainly cannot predict how long it will take, what it will feel like or guess at any other number of variables which our own individual birth experience may present us with. Labour and birth is, by its very nature, unpredictable so what does writing a birth plan actually mean and why does it help to have one?

A birth plan is a few things. Firstly it is a written record of what our ideal is and what we will strive for. Secondly, it is a way of communicating to your care givers what your goals and wishes for the birth are. Thirdly, it is a contingency plan which deals with all the ‘what if’s’ for when things don’t go the way we hoped.

A birth plan helps in a number of ways. It is a great way of preparing yourself for the task at hand. A written visualisation of how you would like the birth to be is a powerful tool in terms of mental preparation. On the other hand, dealing with the ‘what if’s', which are often the things we fear most, can help us to see that however our birth unfolds, we have the ability to deal with things as and when they arise and that we also have our ideals if facing one of these scenarios.

A birth plan is a great communication tool for working with your carer’s and a sign that you’ve educated yourself and expect to be part of any decisions that are made. A birth plan can communicate what you want when it may be difficult for you to do so. It also acts as a written reminder for you and your support person to refer to should scenarios arise which cause confusion.

Writing Your Birth Plan

A birth plan does not have to be long-winded or overly explanatory. Given that in a hospital or birth centre setting, there may be more than a few members of staff that you may want to have read it, it is probably best to be as straightforward as possible. Or if you are having a homebirth the birth plan is still very much an important reference for you and your caregiver. Things you may want to consider when writing your birth plan are:

First Stage of Labour

• I do not wish to be offered drugs
• Natural methods of pain relief I would like to use are hydrotherapy, acu-pressure, massage, aromatherapy, movement, heat packs, compresses, darkness etc)
• If I ask for drugs, I wish to be  encouraged to continue to labour naturally for as long as possible
• I wish to move about freely and eat and drink during labour
• I only want intermittent monitoring of the baby and minimal vaginal examinations
• I would like to be left as undisturbed as possible.
• People apart from my carer or support team should ask permission to enter the room. I do not wish medical students to be admitted into my room

2nd stage of labour

• I want to adopt the birthing position that feels right to me and not be made to move
• I do not wish to be told when to push or not push, I wish to birth my baby instinctively
• I wish to give birth in water
• If necessary I do not want an episiotomy, I would rather tear naturally
• If instrumental delivery is required I would prefer Ventouse/forceps
• I want the baby to be directly placed on me after birth, skin to skin
• I want minimal noise and maximum privacy after my baby is born
• I want to discover the baby’s sex for myself
• I want the lights dimmed
• I do not want the cord clamped until it has stopped pulsating/ I do not want the cord cut at all (lotus birth)

3rd Stage

It is worth noting that standard hospital practise is to medically manage the  third stage of labour (birthing the placenta) even if you have just given birth naturally. This involves injecting the mother with synthetic oxytocin to bring on contractions in order to expel the placenta. Birthing the placenta naturally will not take much longer than the managed 3rd stage and can be sped up by the baby suckling at the breast (this is natures way of helping th uterus to contract) The classic medical approach is to ‘tidy up’ as quickly as possible after the birth but there is no reason to just go with the flow if you want to do things your way. Things to consider when writing your plan for the third stage are:

• I wish to deliver the placenta naturally
• I wish to keep the placenta
• If I need to let go of the baby to birth the placenta I wish the baby to be skin to skin with my support person

More things to consider

There are an array of procedures that hospitals routinely perform after the birth along with weighing and measuring your darling baby. These practices vary country to country and hospital to hospital so inform yourself as to what your care providers practices are. Remember these protocols are not compulsory and it is down to you to make the decisions as to what is right for you and your child. Things that you should investigate and decide upon are:

• Vitamin K injection (colostrum is high in vit K)
• Hepatitis B injection (Hep B is transmitted the same way as HIV and only should be given to babies who’s mothers carry the virus)
• Treating the eyes with antibiotic ointment
• Washing the baby (removing the protective vernix)
• Heel prick test

Breastfeeding

Care providers are often more of a hindrance than a help when it comes to establishing breastfeeding. Often institutions will not ‘check out’ a mother and baby until the baby has regained a certain amount of weight. In their hurry to tick boxes, institutions often encourage mothers to give their babies formula to speed up this process. Mothers often comply as they are made to feel worried about the babies weight gain. This practice is hugely unhelpful to establish breastfeeding (more about that later) It may be worth writing in your birth plan:

• Do not give my baby any formula
• If formula must be given I wish the baby to take it from a cup and not a bottle

The contingency plan

It is a good idea to write a birth plan for, well if things don’t go to plan. Better to think about how you would deal with these situations should they arise rather than be reeling from the shock of it at  the time. Episiotomy vs tearing, forceps vs Ventouse have already been mentioned so finally here are some things you may want to consider writing should a c-section delivery be required:

• I would like my partner/ doula/private midwife with me
• I would prefer (type of anaesthesia)
• I would like the lights to be as dim as possible and the room quiet as my baby is born
• If it is not possible for me to be skin to skin with my baby then I wish my partner to be skin to skin with the baby until I can be
• I wish to delay cord clamping/ not clamp

This may seem a lot if things to consider but the reality is that we live in a highly medicalised society, one that interferes greatly with the natural process of giving birth. You can have the birth you want but within this modern day system of care you will need to get informed and get pro-active to get what you know is your right as a woman.