By Ali Weatherford
Birth plans can be a surprisingly controversial topic. A lot of people think they are a great idea and even essential. I sometimes work on birth plans individually with families and have had people tell me that their doctors have even required that they bring a birth plan to their next prenatal appointment!
Other care providers don’t like them. They might argue that birth is unpredictable and it doesn’t make sense to set up unrealistic expectations with a birth plan. The intention behind this advice is to avoid making a birth plan so people can avoid disappointment if things don’t go as planned. Others might say that a birth plan is an indication that a person is less concerned about health and safety and overly concerned about having a particular kind of birth “experience”.
Some of that makes sense, although I think it leaves some things out. First, I’ve worked with dozens of families in making birth plans, and I know for sure that none of them were more concerned about having a certain kind of experience over their health and safety or their baby’s. Everyone’s first priority is health and safety, but it’s also important to recognize that that is just a baseline. We should have the expectation of health and safety when we choose a good location and provider and because birth is inherently normal and safe. Birth is not, in essence, a medical emergency. It’s a healthy person experiencing a normal function of their body.
It’s more than OK to aspire to more than just surviving birth. I would even argue that it should be a high priority of care providers and facilities to aspire for more. Of course mothers and babies should survive the birth, but we can also help them have a positive experience and thrive.
Family Centered Care
An important piece toward that goal is providing family-centered care. That puts the family in the central decision-making role, with their care providers offering guidance and support toward their goals. For a family to be able to make decisions, they need to be informed, that’s true. But there are other considerations too. A person’s upbringing, culture, religion, values, and past traumas all have to factor into their decisions. That’s the only way to know what their true preferences might be, and how they might be able to have a healthy AND positive experience.
So, I think that, YES, you should make a birth plan! I encourage you to think of it more as a list of birth preferences. When I talk to classes and individuals about the birth plan making process, the leading thought is “As long as all is going well and everyone is healthy and safe, here are my preferences.”
How are Birth Plans Helpful?
The following list shows how to make a birth plan, but also how birth plans are beneficial.
STEP 1: I recommend that people start by taking a birth preparation class of some kind, or finding another way to learn the basics of birth.
STEP 2: As you are learning more about the birth process, you might start to develop some ideas about what it might look like for you. The next step to making a birth plan is to develop your birth vision. You might just talk it through with a trusted person, or you might write it down, draw it, or even just imagine it. Once you have a solid vision, you can start making your birth plan. The process of developing your birth vision is one of the things that makes birth planning so valuable! A lot of people never do this, and they go into labor without a clear vision. That can definitely make things feel more out of control and scary. When things feel out of control, if you are faced with a decision, you may decide not to participate. Birth can feel traumatic when you believe that everything is outside of your control, and when you don’t decide on or understand what is happening to you.
So, even if you stop here with your birth plan, you’ve done something positive for yourself. But I encourage you to take the next step!
STEP 3: Once you have a rough draft of your birth plan completed, the next step is to take it with you to prenatal appointments with your care provider. Most people have the experience of going in and out of those appointments very quickly. You do the basic assessments, and then your provider likely asks if you have any questions. So often we leave without asking anything, only to remember later that we did have questions! So next time, go in with your birth plan. It can be a great communication tool. You can go over it with your provider and ask any questions that it might bring up. They can even help you refine your birth plan since they know a lot about the facility where you’ll be giving birth and your medical history.
STEP 4: Once you have a final draft, you can take it with you at birth time. I recommend having several copies since there could be staffing changes while you’re there. You might even want to tape one to the door of your room. This is for all the people who haven’t met you yet. There may be nurses, doctors, midwives, or even interns visiting with you, and it can be helpful to give them some guidance for helping you.
Birth Plans and Breastfeeding
Of course I couldn’t complete this article without mentioning the importance of birth plans for breastfeeding success. There are some birth practices that can make breastfeeding more or less difficult. If your goal is to get started with breastfeeding most quickly and easily, and then continue to breastfeed, it’s important to learn about some of those things and incorporate them into your birth plan. Some examples include:
- Recognizing the potential impact of IV fluids on breastfeeding or avoiding IV fluids except when necessary for safety. A lot of fluid can cause issues with swelling and engorgement which can interfere with breastfeeding. It’s good to recognize that if you do get IV fluids during labor, it’s possible that your baby’s weight will be a little higher due to the excess fluid. Some recommend using a day-two weight instead of the birth weight as a comparison point when assessing weight loss or gain.
- Avoiding early induction when possible so that the baby is born fully developed with a coordinated suck-swallow-breathe pattern.
- Refrain from certain medications during labor that can cause sedation in the newborn, preventing early breastfeeding.
- Epidural anesthesia itself is not likely to cause a problem, but has shown to increase the risk of forceps or vacuum assisted deliveries which can lead to an interference with early breastfeeding if the baby experiences some distress and needs time to recover.
- Encouraging immediate skin-to-skin contact with mother. This provides closeness and some physiological cues to the baby and to the mother’s body that can increase breastfeeding success.
- Aim for little to no interruption of skin-to-skin contact. That usually means delaying procedures and keeping the baby on the birthing parent’s body even through delivery of the placenta. It’s best to delay an interruption until at least after the baby has had a successful first feed.
- Encourage early initiation of breastfeeding. When the immediate skin-to-skin contact time is uninterrupted, it’s likely that the baby’s first hunger cues will be recognized and acted on immediately, ensuring the best outcomes.
- Avoiding cesareans when possible, because surgery can make breastfeeding more complicated. But there are some things you can do to make things go as smoothly as possible including:
- Immediate skin-to-skin contact in the operating room.
- No mother/baby separation and help with early initiation of breastfeeding in the operating room.
- A gentle or family-centered approach can offer a less stressful environment for families, making breastfeeding easier.
If you’d like assistance making your birth plan, we offer a class to help you put your wishes for your special day into words. Check out How to Make a Birth Plan!
Resources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868283/
https://evidencebasedbirth.com/iv-fluids-during-labor/
https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0043-8
