How to Create a Birth Plan
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 those involved in your care can read and consult it. The portion that pertains to the care of your baby (the baby care plan) can be placed in the baby's chart, which is separate from your own.A birth plan has many advantages. Simply preparing a birth plan helps you focus your preparation on the various options (for example, natural versus medicated childbirth, circumcision versus no circumcision, breast- versus bottle-feeding). It encourages you and your partner to discuss your worries and expectations, and to come to 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.
 ©2006 Publications International, Ltd. Developing a birth plan can help you feel more relaxed when the big day comes. |
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 communication and lets them 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.
Components of the Birth Plan
A birth plan helps you communicate your wishes to your caregivers 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 they can offer you maximum support in that effort.
If avoidance of pain is a high priority, let them know. Inform the staff if you have religious preferences, impaired hearing or vision, or if this has been a difficult pregnancy. Knowledge of these conditions will help the staff meet your needs. You might simply 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 items 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 caregiver will give you the needed information.
If your labor is prolonged or 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. It should reflect a recognition that these events can occur and you are flexible enough to accept changes in the plan if they are necessary for your sake or your baby's.
Sometimes a cesarean birth becomes necessary for any of a number of reasons. It helps if you acknowledge the possibility of a cesarean birth in your birth plan, and indicate your preferences if it becomes necessary. 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.
The Newborn Care Plan
Your birth plan should also include a newborn care plan. Many mothers wish to hold their baby skin-to-skin immediately after birth. Skin-to-skin contact provides warmth for the baby and satisfaction for the mother. Some parents want their baby to have a relaxing float in a Leboyer bath soon after birth. The baby might be placed in a heated unit in the nursery if the mother prefers or if the baby is chilled.
What about feeding your baby? Do you prefer to breast-feed or bottle-feed? Do you want to provide all the feedings for your baby (which would mean that the baby should receive no water or glucose water from a bottle)? Do you want to feed on demand (that is, whenever and for as long as the baby seems to want to nurse)? Many nurseries restrict demand feedings unless the mother states that demand feeding is her preference.
How much contact do you want with your baby? Some hospitals provide a private postpartum room, allowing the baby to stay with you and even allowing the father to rent a cot and stay all night. This enables you to begin caring for your baby immediately.
When you feel you need a brief respite from caring for the baby, staff will take the baby to the nursery for a few hours to allow you to rest. Other options are to have the baby with you during the day only or for feedings only. State in your birth plan if you want to feed the baby yourself and if you want to spend as much time as possible with your baby.
Remember, the amount of time you spend with your baby depends on several factors. The most important of these are your health and the health of your baby. For example, it may be medically necessary for a premature infant to be placed in the hospital nursery, where the baby's condition can be carefully and continually monitored.
What about circumcision of your baby boy? This surgical procedure involves removing the foreskin of the penis. Since the procedure is optional, it deserves your consideration.
When will you and your baby leave the hospital? Depending on your health and your insurance coverage, you may stay from a few hours to a few days after the birth. An early discharge, or short stay, means that you leave within 6 to 24 hours after the birth. One obvious advantage is the financial savings involved. Hospitalization costs are calculated by the day or fraction of a day; obviously, the longer you spend in the hospital, the more it costs. Find out how the billing is done so you won't inadvertently stay longer than you can afford.
Other considerations besides costs, however, are your need for rest, your need for medical care, and your desire for instruction in care for your baby and medical supervision for the first couple of days. Find out if your hospital sends a nurse to visit all women who have had a short stay, or if they at least make a phone call to check on them. Is instruction available for those wishing a short stay, so you know what observations to make to be sure everything is going well for both of you?
Another factor in your decision is whether you will have help at home. Sometimes the father can take time off from work, or a relative or friend can come in and help extensively; sometimes parents hire helpers to come in daily for a week or two after the birth. In the absence of any help, you might prefer to spend a couple of days in the hospital before going home to all that responsibility.
A baby who is premature or ill and needs extensive medical care either stays in the nursery or is transferred to a different hospital with more sophisticated facilities for newborns. Time with the baby and breast-feeding may be postponed until the baby recovers or becomes strong enough to suckle.
Unexpected Loss of a Baby
One of the greatest difficulties we face is the possibility that the baby may not live. Every prospective parent worries at times about losing a child. Although it is uncommon, some babies die. This very sad ending to the pregnancy leaves the parents stunned, grieving, depressed, and angry. After losing a child, parents are in no state to make important decisions. If you have thought through how you would want a newborn death handled, then, should a death occur, such decisions will have already been made by you at a time when you were calm.
Many counselors recommend that couples have private time together with their baby who died. Seeing or holding the child gives the parents a chance to say good-bye to the baby. In addition, pictures, footprints of the baby, and perhaps a lock of hair are mementos that mean a great deal later.
Having a memorial service or a funeral for the baby allows friends and relatives to also acknowledge the baby's life and death. Formal ceremonies can often give family and friends a way to express their grief and their support for the parents.
The question of an autopsy often comes up. If the cause of death is unclear, sometimes an autopsy is beneficial, both in answering questions and in possibly preventing the death of another baby in the future. It would be worthwhile to think through in advance whether you would consent to an autopsy in such a case.
The Value of a Birth Plan
A birth plan represents your thinking regarding normal labor, postpartum, and newborn care. It also includes your preferences if the process does not follow a normal course. Because you prepare it when you are calm and rational, it reflects what you really desire. It becomes a valuable guide for you and for your caregivers during a stressful period when you might not be thinking clearly.
Choosing Freely
As prospective parents, you must make many choices regarding maternity care. These choices require thought and discussion and careful planning. They can make a great difference in your ultimate sense of satisfaction and fulfillment in giving birth. The emotional and physical quality of the experience will impact you and your family for a very long time to come.
Your choices regarding the birth of your baby are numerous. And to date, no studies indicate conclusively that one place of birth or one type of caregiver has a better safety record than another as long as women are well cared for throughout pregnancy and have access to hospital facilities and obstetric care when needed. That still leaves a lot of room for parents to freely choose the type of care that seems best for them. It is well worth the time and trouble to choose carefully.
ABOUT THE CONSULTANT:
Dr. Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.
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