Birth Plans

AmmyBelle · January 2016

So you hear a lot of talk about "making a birth plan" or "writing your birth plan" etc - and I was just wondering: how does one go about writing one up?

I looked online and there are tips of what to include, but the lawyer in me, is curious as to how you set up a birth plan, who you give it to, and how it's all supposed to look at the end. Anyone with any advice/experience? Thanks!

Dantzscher32 · January 2016

I found one online that listed all the possible questions you could be asked by the medical professionals. I put it in a Word document and researched to come up with the answers that suited me. I had it with me at the hospital, but I never gave it to anyone. It just prepared me to have answers ready when asked, or if something was about to be done and the professionals didn't ask, I was aware that I had a choice.

countrygrl5533 · January 2016

When we did our hospital tour, they gave us a paper with questions to fill out that was a birth plan to bring with us when I was in labor to give to the nurse. I filled it out then didn't bother bringing it. Detailed plans just don't seem to make sense to me with birth. I prefer a general idea of how I want things to go but be open to the fact that things change pretty fast. You really don't know what you want until you are living it.

LadySamLady · January 2016

H and I have an info session/intro meeting at our hospital this month and they explained that a big part of it is creating a birth plan. Maybe your hospital/OB offer something similar?

kbrands7 · January 2016

I agree with @countrygrl5533 that detailed, concrete plans don't go very well with the birthing process. It's good to have a idea of your preferences, and to communicate those, but things may not go as planned. Our hospital had a list of questions at check-in about our preferences and asked for a bunch of information from DH and me that was helpful to have written down.

Things that we included were (in no particular order):
Labor preferences (able to walk around if possible, etc.)
Delivery preferences (skin to skin, time before visitors allowed, DH in, delayed cord clamping if possible, etc.)
Most recent positioning of baby (DS was frank breech which was important because it necessitated a c-section if he was in the same position...he was)
My known allergies or reactions to medicines
Medical conditions
Most recent weight
Time of water break/contractions beginning
Religion
Circumcision preferences
Room-in or nursery preferences
PCP for me, Pediatrician for DS
Breastfeeding preferences

I'm probably forgetting some things, but it was helpful to have it written down since the maternity ward nurse did rapid-fire questions to plug information into their computer system while I was in labor. I probably would have forgotten some things had I not written them down ahead of time.

laurenmdrn16 · January 2016

I think, as PPs have said, just having a basic idea of what you want and don't want is more practical than a detailed birth plan. Obviously, it could all go out the window, but knowing and letting the hospital staff know if there are certain procedures (episiotomy, vacuum suction, continuous fetal monitoring, IV/saline lock etc) or medications (Pitocin, Cervadil, epidural, spinal block) that you definitely want or DON'T want can be helpful. Also, make sure your SO, mother, sister, friend, or whoever is in the room with you knows as well. Some treatments/meds may be unavoidable, but having an idea of what you would elect to have is wise. I think the Bump actually had one that was like a checklist (you could also list certain people you want in the room, if you want to BF immediately, etc) that I filled out for my first pregnancy, but things didn't go quite as planned...

swflJD · January 2016

@AmmyBelleThere is a link on TB for a sample birth plan: https://www.thebump.com/a/tool-birth-plan. As a fellow lawyer, I thought I had covered my bases by drafting Advance Directive, Healthcare Surrogate, and HIPPA Release forms in the event that something went wrong during the birth and I became incapacitated. But, as I read through the sample birth plan I realized that I need to do more research into some of the options and scenarios I had not yet considered. I found this sample plan on TB the be a good starting point.

AmmyBelle · January 2016

Thanks guys!

@kbrands7
- That's so helpful! And yeah - I always forget things when people ask me questions quickly and I bet I will be worse when in pain/stress.

@LadySamLady
- We have ours scheduled for a month from now, I am just trying to stay ahead of the curve on things so I am not overwhelmed

AmmyBelle · January 2016

@swflJD
- Right? The more I read the more I need to read ... it's like law school all over again

finnybooboo · January 2016

Several nurse friends I know who work in the L&D ward have often said the ones who come in with the detailed, written out, laminated birth plans are the ones who end up having birth experiences completely opposite that

You and your partner should discuss what you'd prefer to happen and not happen in terms of the labor and delivery, but ultimately, the baby is in control and healthy mom and baby are priority #1. Our hospital had sample questions for us to think about regarding how we envisioned things to go, preferences, etc. It's always best to be prepared and educated, but also be prepared that it could go completely differently!

JennyS86 · January 2016

I didn't write a birth plan last time around, but I used to work at a hospital (so this advise goes for hospital deliveries). As much as it helps to discuss your plan with your OB/provider, it is also important to have an ongoing conversation with your nurses. Honestly, birth plans generally are not being read during/after labor, so you will need to speak up on you/baby's behalf to get what you want. Maybe think of your birth plan as a list of talking points that you might have to bring up should the need arise. For example, if you don't want the erythromycin antibiotic put on baby's eye's, you're going to have to tell the nurse rather than assume she has read your birth plan.

Some points should be discussed with OB well in advance, such as, "Do you practice delayed cord clamping?" If that is important to you.

For my repeat c-section this time around, I have a short list of things that I want to do. Some are routine at the hospital, and some will be requests. I haven't worked there in 2 years, so I'm not sure if they are totally on board with skin to skin for the end of the surgery, but I will ask. I will also ask if I can remain skin to skin with newborn while we are wheeled to recovery rather than bundling baby and rolling in a bassinet. I just happen to know that this was a more recent policy change.

This isn't meant to be a comprehensive list, just a few points! Good Luck!

dsmith211 · January 2016

I have an idea of preferences I have but I've already come to terms with that whatever happens, happens. To try and stay optimistic I'm looking at some of the things I'd like for labor and delivery more as goals than absolute needs.

saraleigh2 · January 2016

A few things:
- "birth plans" often get a bad rap because many people put them in the form of a list of demands directed at the doctor and hospital staff, no one likes to be told how to do their job!
- things never go according to plan
- I do however think it's valuable educate yourself and to go over with your husband or whoever is going to be at your labor and delivery what your wishes and preferences are for you and your baby.

You do not want to be researching pitocin and having your water broken at the hospital while you are in labor... Do it NOW.
ex: do you want to be offered pain medication or would you prefer to ask for it when you're ready? are you comfortable being hooked up to an IV or prefer to have it placed but not hooked up? what type of fetal monitoring do you want what are the options? Labor augmentations, what are the side effects? Do you want them to bathe your baby or wait or do it yourself, cord clamping, vitamin k shots, breastfeeding, circumcision just to name a few...

- if there something important to you that comes up in your review I suggest you go over it w/your doctor, how do they feel? (in writing is optional) you can list it as your labor wishes or preferences (if writing it down) you may also like to bring a copy to the hospital and nicely alert the nursing staff that will be helping you.
-personally for me it's most important that myself my husband and my labor team are well-informed and on the same page writing it down is not as important...
-I do think having a postpartum plan is extremely valuable who's going to help with the baby? Who will let the dogs out while you're gone? Help w/ meals, laundry etc

Hope this is helpful!

doozer1345 · January 2016

There's several templates for online ones. I will just say that while making a tentative birth plan is good and fine but always be prepared to throw it out the window. Don't get to caught up with it that you aren't flexible. I had one with DD and pretty much had to throw it out the window. I'd be very vocal with your doctor about your preferences and discuss alternatives to your wishes in case they aren't feasible.

Pascal86 · January 2016

Birth plan:
1. Push
2. Ask for drugs it it hurts really bad
3. Cut me open if #1 doesn't work

I have it memorized! But thanks @saraleigh2 for reminding me to ask someone to watch the dogs while I'm gone. I feel like maybe I should make somewhat more of a plan... but I trust my hospital's doctors/midwives a lot, and I trust my husband and mom to call them out on anything that doesn't sound quite right. I could research for the next four months if I thought it would lead me to have strong opinions on anything in particular, but don't think it will make a big difference, so just going to see what happens!

Merciel · January 2016

I feel like I plug it in every thread ever, but Emily Oster's Expecting Better was really helpful to me when I was trying to figure out what a "birth plan" was or what should be included in it.

She goes over the most common interventions and what, if anything, the studies show are the results of those interventions. If the results are ambiguous or the studies are not well designed, she points out the potential flaws so that you can make the most informed decision based on your own priorities and preferences.

Ultimately my semi-non-plan "plan" is just to review the common interventions well ahead of time, get a rough sense of what I'd prefer in an ideal situation, what I'd prefer to avoid if possible (but will accept if circumstances necessitate), and what goes in the OH HELL NO bucket. Then, hopefully, when we actually get faced with some of those decisions, I'll already know what my preferred options are and will be able to act accordingly.

araecasey · January 2016

Another vote for respectfully worded birth preferences. Instead of wording mine "I do not want/I will not have pitocin," I have mine written, "I prefer to labor without augmentation." Leaves the medical pros room to make tough calls if they need to be made. Another good rule of thumb is to keep is less than one page long. Nobody's wants to read a novel of a birth plan when they're in the thick of giving you the care you need. My doula was invaluable in helping me write my birth preferences last time. I also spent one of my prenatal visits talking over my birth plan with my midwife just so we were on the same page and if I had anything completely outlandish that we could talk through it and figure out an alternative we were both happy with.

kami09 · January 2016

I actually think having a detailed birth plan is great. Obviously every single thing you put on it could go out the window, but why not try your damndest to have the birth you want?

& I had talks with my doctors, wrote a birth plan...I thought we were all on the same page...until labor. It was horrible. But I stuck to my guns and, although everything flew out the window after a day and a half- I truly believe he would've ended up CS if we had stayed and did what the doctors wanted. It's your birth, your body. I wrote my plan as I would any other goals in my life. You want and try for things to work out a certain way...some do, some don't and that's fine.

JessicaB0627 · January 2016

kami09 said:
I actually think having a detailed birth plan is great. Obviously every single thing you put on it could go out the window, but why not try your damndest to have the birth you want?

In my personal experience with my first birth, nothing went the way I wanted it to. It wasn't anyone's fault, it was just the circumstances. The only thing I was able to do was avoid a c-section and that was only because of circumstance again. Afterwards I felt like a huge failure and like I was robbed of having the experience that I wanted.

In hindsight, DD and I both came out of it healthy and I realized that's really the only thing that matters. So I don't think it hurts to tell someone that although you may have an idea of how you want things to go, sometimes it's out of your control.

I trust my doctor and I trust that he wouldn't make any decisions without having mine and my baby's health as his #1 priority.

kami09 · January 2016

JessicaB0627 said:

kami09 said:
I actually think having a detailed birth plan is great. Obviously every single thing you put on it could go out the window, but why not try your damndest to have the birth you want?
In my personal experience with my first birth, nothing went the way I wanted it to. It wasn't anyone's fault, it was just the circumstances. The only thing I was able to do was avoid a c-section and that was only because of circumstance again. Afterwards I felt like a huge failure and like I was robbed of having the experience that I wanted.

In hindsight, DD and I both came out of it healthy and I realized that's really the only thing that matters. So I don't think it hurts to tell someone that although you may have an idea of how you want things to go, sometimes it's out of your control.

I trust my doctor and I trust that he wouldn't make any decisions without having mine and my baby's health as his #1 priority.

Yeah, I guess the point is that if you have a plan, you have to go into it knowing nothing may go to plan and not be disappointed if things change. Getting the baby out however it ends up happening is the win.

LondonToSavannah · January 2016

My birth plan with my first was to do what the nurses and my OB told me to do...best plan ever! Will copy that plan again.

JoMunson · January 2016

I think a "plan" is good if you have strong feelings about interventions for you and your baby. It's okay to let your preferences be known- for example I'm going to resist any IV placement because it becomes that much easier to give me pitocin, which I don't want, were delaying first bath until the baby has had a chance to absorb some of those vital fluids still on his body, I'm open to a discussion about episiotomy but I don't want it done without a discussion, we don't want the eye ointment or hep b shots, and were delaying cord clamping. Of course, if something starts to go seriously wrong and one of those things needs to change, I'm not gunna pitch a fit. Doctors, midwives, anyone who helps you give birth has a patient template they use- first we do this, then this, then this. If you don't want to be that patient you have to tell them.

laurenmdrn16 · January 2016

Another reason to have a clear idea of what you want is because sometimes the doctors/midwives/nurses disagree and if you can be part of the conversation, it can help make some decisions go the way you feel they should. I am a huge proponent of listening to the medical professionals, but from experience I also know that you need to trust your body because only you know what is really happening. When I was first admitted, I knew something was terribly wrong, but all the tests were coming back WNL (within normal limits) so the midwives chose to prepare me for a vaginal birth. When the OB came in, he noticed my hyper-reflexia, lack of dilation, and that my son wasn't even in station and immediately suggested a CS. There was back and forth between the OB and midwives and I wish that I had more clearly made known my wishes/priorities because (even though I was unable to speak) MH or mom could have clearly advocated that a vaginal birth was not a huge priority and I would rather take the risks associated with a CS (I had already had a consult with the head of anesthesiology and drafted a surgical plan) to limit the amount of IV mag sulfate my son was getting in utero. I get that the midwives pride themselves in having a low CS rate and wanted to try vaginal first, but for me I knew that was not meant to be and would've preferred a more proactive surgical approach to decrease the risk of respiratory issues for my son. He still has some minor RAD due to the delay in getting him out of there while I was still on lots of pain meds and anti-epileptics.

ETA: words are hard.

AmmyBelle · January 2016

To be more clear: I am aware that "plans may go out the window". I don't think you can be pregnant and on the internet without being hit over the head (time and time again) with the "plans will go out the window" shtick. My Birth Plan details things I want to avoid and answers to questions that may be asked of me where I am not in a position to answer those questions. It is also a written document that I can point to and say "Please respect my wishes where you can" since, in my profession, I see a lot of people refusing to acknowledge verbal agreements/decisions/wishes, etc.

This is not about not trusting my doctor: I trust my doctor to pull my baby out safely and to make sure I am ok throughout the process, that was never an issue, or I would have switched doctors. This is more about articulating the things I want based on the information I have gathered and research I have done into the birthing process in America.

I just wanted to know what to include and how it ought to look - so thanks to those who helped out, it means a lot to me that you shared your experiences

LemmyRN · January 2016

laurenmdrn16 said:
Another reason to have a clear idea of what you want is because sometimes the doctors/midwives/nurses disagree and if you can be part of the conversation, it can help make some decisions go the way you feel they should. I am a huge proponent of listening to the medical professionals, but from experience I also know that you need to trust your body because only you know what is really happening. When I was first admitted, I knew something was terribly wrong, but all the tests were coming back WNL (within normal limits) so the midwives chose to prepare me for a vaginal birth. When the OB came in, he noticed my hyper-reflexia, lack of dilation, and that my son wasn't even in station and immediately suggested a CS. There was back and forth between the OB and midwives and I wish that I had more clearly made known my wishes/priorities because (even though I was unable to speak) MH or mom could have clearly advocated that a vaginal birth was not a huge priority and I would rather take the risks associated with a CS (I had already had a consult with the head of anesthesiology and drafted a surgical plan) to limit the amount of IV mag sulfate my son was getting in utero. I get that the midwives pride themselves in having a low CS rate and wanted to try vaginal first, but for me I knew that was not meant to be and would've preferred a more proactive surgical approach to decrease the risk of respiratory issues for my son. He still has some minor RAD due to the delay in getting him out of there while I was still on lots of pain meds and anti-epileptics.

ETA: words are hard.

I'm angry for you that the midwives wasted precious time by fighting for their personal preferences over what the patient's needs are. I'm not buying the "all tests were WNL," I'm sure you had protein in your urine at that point. Regardless, if action was taken sooner, your birth experience wouldn't have been as traumatic... Which I'd give a 10/10, your story is intense. Could you imagine if the midwives got their way? Scary!
Thank God you and Renzo made it out okay.

laurenmdrn16 · January 2016

Thank you @LemmyRN I go back and forth between blaming myself and being angry at the midwives, but overall the outcome was positive so I am just going into this birth with a more direct and concise plan. I can guarantee that my labs were not normal because I had demanded to see them a few days earlier and my platelets were trending down and my urine was packed with protein. I was admitted at 4am and my son wasn't born until almost 10pm! Doesn't sound like a lot to those mamas who have labored for 24+ hours (God bless you!), but that is a long time for a little munchin to be exposed to mag sulfate and morphine. This time, things will be different and I have made it very clear from the get-go that my #1 priority is reducing the risk of damage to my baby at all costs. If that means being more conservative in my treatment or more aggressive, so be it. Just get my girl out safely!

As a side note, for all my fellow DA fans, the conversation between the OB and midwives was almost identical to the scene between Dr. Clarkson and the village doctor when Sybil was in labor in season 2. Too close for comfort, honestly!

lest12 · January 2016

I think you'll learn a lot when you go on your hospital tour, or childbirth classes (if they're offered by your hospital, like mine were), or talking to your OB.

My hospital had pretty strict guidelines about what they were going to allow you to do, or not do - like, delayed cord clamping was just not an option for me.

I was comfortable with their guidelines but I know some people have different views. My advise is to think about what is really important to you, what will be flexible, and what could be a deal breaker, and be prepared to ask THEM a lot of questions about how things are handled, rather than the other way around.

jenl1681 · January 2016

Birth plan as in discussing your preferences with DH/Dr/Midwife before labor begins? Knowing the general practices/procedures of the hospital/Dr/Midwife? Absolutely!

Showing up at the hospital with a printed copy of your every wish/demand? Absolutely not. It's getting thrown in the trash

Image: https://us.v-cdn.net/5020794/uploads/editor/ji/nzpxw0rnemd1.jpg

PYLWhammy · January 2016

I'm going to go on a tour of the hospital and go from there. I think they talk a little about birth plans in that tour. Otherwise, I'm not too bothered. I'm one of those crazy people that believes the doctors and nurses know what's best. I just want a healthy baby.

araecasey · January 2016

jenl1681 said:

Birth plan as in discussing your preferences with DH/Dr/Midwife before labor begins? Knowing the general practices/procedures of the hospital/Dr/Midwife? Absolutely!

Showing up at the hospital with a printed copy of your every wish/demand? Absolutely not. It's getting thrown in the trash

I completely disagree. I will absolutely have my wishes written out so they are plain as day. So if something happens to me during my birth that I'm unable to verbalize my desires (which happened during DD's birth), they can be known anyway. If my care providers don't have time for that, then they can kiss my business goodbye.

araecasey · January 2016

Here's a copy of our birth preferences with personal info edited out. Every member of our care team read and respected this document. My nurses were excellent about referring to this when I was too out of it to make choices for myself and my husband wasn't thinking clearly either. We had to deviate from our "plan," but even in the midst of needing a bit of pitocin, our care team was excellent about honoring our preferences when they were able.

AmmyBelle · January 2016

araecasey said:

Here's a copy of our birth preferences with personal info edited out. Every member of our care team read and respected this document. My nurses were excellent about referring to this when I was too out of it to make choices for myself and my husband wasn't thinking clearly either. We had to deviate from our "plan," but even in the midst of needing a bit of pitocin, our care team was excellent about honoring our preferences when they were able.

Thanks so much!

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