Thursday, May 3, 2012

Writing a Birth Plan

A birth plan is one of those mysterious things you hear a lot about during your first pregnancy.  My birthing class gave us a form to fill out, but I never gave my birth plan for Natalie to my doctor and nurses because I didn't feel strongly about anything on it.  That is the key to a good birth plan: You have to know what about the birth is most important to you and communicate your wishes about those items clearly and succinctly. 

First of all, don't just copy something you see on line, in a book, or that a friend used.  Instead, really think about what is most important to you during the birth.  Be firm in your phrasing, but remember that labor is unpredictable and you might have to be flexible in the moment. Writing a plan is much easier the second time around since you know what you did and did not like about labor the first time. 

Things to include in your birth plan:
  • anything about pain medication, including if you don't think you'll want any
  • anything special you want to happen during the birth
  • any item you'd like available to help with your labor, such as a birthing bar or yoga ball
  • any fears or concerns you have about the labor at all - I saw a great example of a birth plan that had a fear about her husband's diabetes during the labor and informing the nurses to keep an eye on him in case he forgot to take care of himself in all the excitment. 
  • special instructions for just after the birth
  • special instructions for baby's care while you are at the hospital

For me the second time around, I knew my biggest fear was that I would be alone because Mike would be at home taking care of Natalie.  I was scared to go through it alone and also worried about how much it would depress me to not share the experience with Mike.  So, it was important to me to cover that in my plan.  Other than that, I used what I learned from my first labor.  I made a list of what I liked and what I didn't like, and then I turned that list into my plan. 

If you are writing a plan for your first birth, I would write two lists.  One list contain items about the labor you feel very strongly about.  The second list should be all your worries, fears, or concerns about the labor.  I would then work with that over the last few weeks or months of the pregnancy to make a plan. 

A few small tips:
  • keep your plan to one page in a reasonable sized font
  • print several copies so that there is always one available for any changes staffing
  • print copies early and put them in your suitcase in case you head to the hospital expectantly

Here is my plan for William's birth as an example:

Labor Concerns and Preferences:
  • I am concerned about my husband not being present for the labor and birth if labor moves very quickly or there are problems with our  child care plans for my daughter. 
  • I’d like to delay pitocin and having my water broken so that I can move and walk during the early part of the labor. 
  • I hurt my tailbone pretty badly during my daughter’s labor.  I’m open to suggestions for pushing positions that might put less pressure on my tail bone. 
  • If possible, I’d like to see and feel the baby crowning. 
  • I’d like coaching on when and how long to push, at least at the start of pushing, because I had difficulty knowing last time.  
  • Holding my breath several times in a row while pushing became difficult for me last time due to my asthma. 
  • I’d like to hold William as soon as possible, preferably skin-to-skin contact on my chest.  I’d like to allow him to move to the breast to nurse at this time if possible. 

Pain Medication:
  • I plan to get an epidural during labor, and I would like help determining when to get the epidural, especially since I know this labor could move faster this time. 
  • When the time comes, if the anesthesiologist is delayed, I’d like to use Nubain again to help me wait until the epidural can be administered. 

After the Birth:
  • I’d like to hold William as soon as possible, preferably skin-to-skin contact on my chest.  I’d like to allow him to move to the breast to nurse at this time if possible. 
  • We plan to exclusively breast feed.  Please no bottles or pacifiers without discussing it with us first. 
  • We would like to room in as much as possible. 
  • We plan to have William circumcised. 
  • We are concerned about jaundice, as it delayed our daughter’s discharge several days. 

  • In case I am alone for the birth, I would greatly appreciate help taking a couple pictures of the baby right away.  Also, in case I’m unable to get up yet and still alone, we’d like a picture of him being weighed for the first time. 

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