The Birth Plan: Helpful or Troublesome? by Marie Fellenstein Hale A birth plan can take many forms, but it is primarily a statement of your wishes for how birth will take place. When a birth plan is well constructed, it is an important tool for communication. However, if it becomes too rigid, any deviation from the plan can be seen as a failure — either by you or by your caregivers. The goal, then, is to create a birth plan that guides you and your caregivers to better communication and respect.

Many people view writing a birth plan as an important step in preparing for childbirth. Your childbirth educator may guide you or you can find ideas in many books (see resources section for suggestions). Writing a birth plan can be>a wonderful guide to self-discovery. The process may help you discover more about your wishes and feelings about birth, and if shared with your support people, you may all understand each other better and be able to work together during birth.

Learn About the Typical Care in Your Birth Setting
Begin working on your birth plan by finding out how birthing women are routinely cared for in your birth setting (hospital, birth center, or home). This will greatly influence what you write in your birth plan. For example, if women are routinely hooked up to an external fetal monitor throughout labor, and if no exceptions to this rule are allowed, then it may be pointless to ask for no monitoring during labor—it may even cause friction with the staff to ask for something that goes against the customary care given. If you discover that an issue is important to you, and the typical care in your birth setting does not allow it, then you may want to explore other places to give birth.

By exploring the typical care, you will also discover areas that you do not need to mention in your birth plan. Perhaps you have been reading a childbirth book that is 20 or 30 years old that says you should mention that you want no enemas and shaving for normal birth. When you talk to your caregiver or call your hospital, you will probably discover that enemas and shaving are no longer routinely done to all women in most hospitals, therefore, you don't need to waste space mentioning them in your birth plan.

When you're done here, come look at our customizable online birth planner. Make your plan now, or just get a head start learning about some options you might want to consider.

Use a Birth Plan as a Communication Tool
Having a support team who has discussed your birth plan with you will be your best help—they will work with you toward a birth that is satisfying. In writing your birth plan, focus on your basic view of birth and your preferences.

Schedule a time to discuss your preferences with your medical provider, birth partner, and other support people. Find out where you agree and disagree. For example, if your caregiver routinely does episiotomies and does not have experience in avoiding episiotomies, then it may be unrealistic to ask to avoid an episiotomy. However, if you express a wish to protect the perineum and your caregiver is willing to help you toward this goal, then you can work cooperatively. You may want to ask what you can do to prepare and how the situation will be handled if your doctor or midwife cannot be at your birth and a backup will attend you.

After a discussion about your birth plan, you should have a good idea if your wishes will be respected or not. A birth plan is not a contract designed to guarantee you the birth you want—it is an expression of preferences and must take into account special circumstances. The goal is to have a birth plan that is simple and clear. Strive to keep your plan to one page—there is not always time for everyone to read a longer plan. Also, if you have discussed your preferences with your caregiver and support people, the birth plan can be seen as a simple reminder.

You may want to make several copies of your birth plan: for your chart, your medical provider, the hospital staff, your support people, and for yourself to bring in your labor bag. Bringing a few extra copies is a good idea in case there is a backup medical provider, a change in nursing staff, or a backup doula (professional labor support person).

Work Cooperatively with Hospital Staff Sometimes a birth plan can be seen as a challenge to hospital staff — some people write their birth plan as a list of demands. Often the staff may feel the birthing woman is just setting herself up for disappointment. You may want to keep in mind these ways to keep your birth plan more open and adaptable: For some hospital staff, the term "birth plan" is associated with rigid elements. Perhaps you want to call it by some other name, such as "Birth Preferences" or "Our Wishes for Childbirth." Take time to add flexibility and cooperation into your plan. For example, adding clauses like "as long as birth progresses normally" or "unless there is an emergency" shows you recognize that what is appropriate for one situation may not be appropriate in every case.

Take time to add flexibility and cooperation into your plan. For example, adding clauses like "as long as birth progresses normally" or "unless there is an emergency" shows you recognize that what is appropriate for one situation may not be appropriate in every case.

You may consider going to the Labor and Delivery unit of your hospital to introduce yourself. It is a good idea to call ahead to find a time when the unit is as quiet as possible, because naturally the staff's primary job is to take care of the women currently in labor. If they seem open to it, you might show them a copy of your birth plan and ask them for feedback, such as "Did I phrase this correctly?" or "Is this clear and simple or too long?" If you disagree about something, it's not necessary to get defensive—simply reply "That's interesting" or "I didn't realize that." If the staff seems busy and unable to talk but the unit is not too crowded, you might ask to go see one of the birthing or labor rooms for a few minutes. This will give you a chance to evaluate what you might want to bring with you to the hospital, such as a tape player for music, extra pillows, or images to look at during birth.

Make the Decisions Yourself
Being involved in all decisions about your birth is often the key to feeling good about it. Even a birth with many interventions can be a very positive experience if the woman is able to participate in the decisions about those interventions. A birth plan should not be seen as a way to compel everyone around you to behave in a certain way. If you give up control during birth, you may feel disappointed. By taking responsibility for your decisions and asking to be fully informed, you remain as much in control as possible.

Naturally, circumstances come up where you can't make every decision. You will need to trust your caregivers to do what is best for you in an emergency situation, and remain flexible because each birth is unique. It is good to plan for the unexpected, as well as for the natural course of events. Consider using terms that distance yourself from problems. For example, instead of saying, "If I need a cesarean" you might say, "If a cesarean becomes necessary." That way, you don't imagine yourself in that situation, but you acknowledge it as a possibility. Once you are in labor, if you uncomfortable with interventions that are recommended, first find out if there is a medical emergency. If there isn't one, you might use phrases such as the following to have time to make a decision: "We need more information," "We need time to make this decision," "Are there any alternatives?" "We will consider that, "Thanks for explaining that option," "Can you check back with us in a little while about that?"

April Tutino, a labor support doula, suggests writing a list of everything you want at birth. Sort the list in order, from the most important to the least important. Then take the top five or six items and drop all the rest. These should be the items that you truly care about.

Focus on Your Priorities With so many issues in birth to consider, it is understandable that you want everything to go according to your preferences. But this is when you may end up with a birth plan that could go largely unread because of the length. That's when it's time to narrow your scope and focus on what you really care about. For instance, if you think it might be fun to have your friend or your mother at your birth, but it really isn't important to you, and your birth partner doesn't get along with that person, then it may be important to compromise. The more comfortable your birth partner is, the better he will be able to support you. However, perhaps you and your birth partner don't agree on how to provide pain relief during labor and this is an important issue to you. Then your birth partner should be flexible and respect your wishes. April Tutino, a labor support doula, suggests writing a list of everything you want at birth. Sort the list in order, from the most important to the least important. Then take the top five or six items and drop all the rest. These should be the items that you truly care about.

Keep It Positive
Try to have your birth plan focus on the positive, instead of giving a list of what you don't want. Use words like, "We hope to" or "We plan to" or "We anticipate." Try not to use phrases like, "We don't want" or "We want to avoid."

Here are some suggestions: "We realize that many pain medications exist — we'll ask for them if we need them." "I am hoping to protect the perineum. I am practicing ahead of time by squatting, doing Kegel exercises, and perineal massage. I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch." "I plan to keep the baby near me following birth and would appreciate if the evaluation of the baby can be done with the baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation."

Things to Consider
Here are some topics to consider in your birth plan: (See the books listed in the resource section for many other ideas and considerations.)

• Which support people do you want?
• Will there be siblings present?
• What activities or positions you plan to use? (walking, standing, squatting, hands and knees)
• How do you feel about interventions, such as fetal monitoring,
• medication, and episiotomy?
• How do you plan to keep hydrated? (sips of drinks, ice chips, IV)
• What will you do for pain relief? (Massage, hot and cold packs,
• positions, labor imagery, relaxation, breathing exercises, tub or
• Jacuzzi, medication)
• What are your preferences for baby care, feeding, and rooming in?

Imagine Your Perfect Birth
After considering your preferences, as well as how you will handle circumstances if events don't go smoothly, you may want to take time to imagine your perfect birth. You can do this mentally or you can write it out and then reread it as frequently as you wish. Imagine yourself in labor, dealing with your contractions, finding your own strength and working through labor. If you think of situations where you begin to get worried, do more reading on that topic or talk to supportive friends to find ways to deal with it better.

By thinking positively about your birth and imagining working through your labor well, you will be creating thought patterns that make it easier for you to follow this path during your actual labor.

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Resources
The following books have information on writing birth plans:

About the Author: Marie Fellenstein Hale is the mother of two and the author of The Childbirth Kit: Ideas and Images to Help You Through Labor. She also created the first pregnancy and childbirth area on Microsoft Network, where she works as an online Community Manager. The Childbirth Kit is available online via Pregnancy Today and Amazon.com, find it in bookstores or through Independent Publishers Group at (800) 888-4741.