Tuesday, March 10, 2009

Doula Digest - Writing a Birth Plan

Posted by Kim:

Birth Plans have become an important part of the birth experience. This is the time when you and your partner's most important wishes and concerns can be expressed to your doula, midwife, doctor, hospital staff and any family or friends who will be attending your birth. This document lets everyone know what you hope will or won't happen during your labor, birth and postpartum care. Be sure to give everyone a copy of your birth plan prior to your labor.

When writing your birth plan the two main points of advice that both Carri and I give our doula clients are

1) Write it in bullet point format
2) Try to make it no more than 5 main points.

I recommend that there can be 5 points in two different categories

1) Labor
2) Baby

Bullet points make it easier for everyone to read through your wishes quickly. If your birth plan is written in a long paragraph form it is difficult to get the gist of what your needs and wishes are and may not even be read, even if they have the best of intentions. Remember the staff and doctor may be caring for several laboring moms so you want to keep it easy and simple for the them. Plus this will also make it easier for your doula to quick reference your choices. The nurses really want to help you have the best birth experience as possible, but they are use to specific routines so they may do things out of this routine, not to go against your wishes. So having the easy bullet points helps to avoid confusion.

Items you may want to consider for your birth plan:

  • Support People - Who will be with you in during your birth names of your birth partner, doula, allowed guests, whether or not you will be accepting guests
  • What you would like to wear during your labor
  • Vaginal Exams - preference to have exams only upon request
  • IV - Preference to not have a continuous IV, but willingness to have a buff cap placed
  • Urinary Catheter and Enema
  • Induction - Use of pitocin during labor and delivery of the placenta
  • Breaking the bag of water
  • Pain medication - What methods of pain relief, if any would you consider? "Please do not recommend any method of pain relief unless I ask"
  • Fetal monitoring - Prefer intermittent fetal monitoring vs continuous monitoring, would like to avoid internal monitoring
  • Freedom to walk or eat and drink
  • Labor Positions - Preferred positions, laboring in the water
  • Labor Environment
  • Preference to labor down before pushing
  • Assisted Delivery - Preference to avoid the use of forceps or vacuum
  • Preferred Pushing position - Squatting, in the tub/birth pool
  • Partner to "catch" the baby
  • Episiotomy
  • Delay cord cutting until cord stops pulsating
  • Partner to (or not to) cut the cord
  • If stitching of perineum is required use of local anesthetic
  • Placenta - would you like to keep it or have it disposed of in a particular way
If a cesarean section is required
  • Partner present
  • Epidural anesthesia if possible
  • Breastfeeding in recovery room
  • Partner to hold baby in delivery/operating room
  • Baby to be placed on Mother's chest immediately after birth
  • Perform all newborn physical exams and procedures while baby is with mother
  • Baby to be rooming in with parents at all times
  • Breastfeeding - use of supplemental formula feeding and/or water
  • Preference regarding bottles, artificial nipples, pacifiers
  • Eye ointment, Vitamin K shot
  • Bath - do not remove vernix
  • Clothing
  • Vaccinations
  • Circumcision
  • Use of disposable vs cloth diapers
Ultimately your birth plan is your birth guide, a general outline of what your ideal birth scenario would be. But as we all know birth is a wonderful, beautiful, unpredictable experience and the need for everyone involved to be flexible is very important. However, in my opinion do not mistake flexibility with your ability to advocate for yourself and your baby. If at any time you feel pushed to make a decision before you feel comfortable with the results of that decision, don't be afraid to ask for time to consider your choices. It is your experience and ultimately your care and your baby's care should be a team approach between you and your care providers. That is why it is very important that you are well educated and you surround yourself with well educated birth partners so you can make informed decisions during your labor if questions arise.

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