The Win-Win Birth Plan

By Penny Simkin

A Win-Win birth plan states the parents’ personal preferences but does not compromise quality of care. Its tone is respectful and flexible.

Components of the Birth Plan

Your birth plan should contain an introduction, your most important issues, fears, or concerns; a general description of the approach to birth you prefer; and sections on normal labor and birth, care of the newborn, and unexpected events (a prolonged labor, cesarean birth, a premature or sick baby, even death of the baby).

Your caregiver, your guide on the hospital tour, childbirth educator and your doula may be helpful resources as you prepare your birth plan, especially if they are familiar with the options available in your community. Use your childbirth educator or doula as a consultant on local practices, choices available, wording to use, or any aspect of the birth plan with which you need help. Your birth plan, however, should reflect your preferences and your partner’s, and not those of your friends or advisors.

The Introduction

The introduction is a paragraph that tells the staff a little about your partner and yourself, why you chose your caregiver and place for birth, and explains why your birth plan is important to you. For example, you might want to tell the staff such things as: if your pregnancy has been pleasant and healthy; if you have had difficulties, such as infertility, previous miscarriage, emotional or physical problems during this or a previous pregnancy; if you have a fear of childbirth, hospitals, or medical procedures; if you have cultural or religious preferences or special needs; or if a natural or a medicated birth is extremely important to you. Also, provide helpful information about your partner or others who will be present. Who will accompany you? Do they have any physical or emotional problems that may influence their participation in your care? Will there be a unique combination of family members present (for example, adoptive parents, lesbian co-parents, children present), or stressful family dynamics? Are there people whom you do not want at the birth? Will you be accompanied by a doula? The nurses can help you more effectively if they have this kind of information. You might also state that you will appreciate the expertise, help, and support of the staff in carrying out your birth plan.

Important Issues, Fears and Concerns

This paragraph is optional; you may have no particular fears or concerns, but if you do, this is your opportunity to disclose these to the staff and, if possible, why you have these concerns.

For example, you may fear for your baby’s well-being; you may fear the hospital or its policies; you may be uncomfortable or distrustful of people whom you do not know who are in authority, such as nurses and doctors or midwives; you may worry about the pain of labor and how you may behave or cope; you may have issues with modesty; you may fear losing control; you may find vaginal exams, blood draws, or other procedures very stressful. Sometimes negative previous experiences play a role in these fears. Previous pregnancy losses or traumatic births, negative experiences with doctors or hospitals, growing up in a dysfunctional, abusive, or neglectful family—all these experiences and more may influence your feelings as you anticipate birth.

By disclosing such feelings and some of the reasons, you can help the staff provide sensitive care and take your special needs into account.

Normal Labor and Birth

When labor and birth proceed normally, few interventions are necessary for medical safety. Some interventions may be used, however, for other reasons. Sometimes, for example, caregivers induce labor or start giving intravenous fluids even when there is no problem, in the belief that it is better to use them before rather than after a problem arises. Other routine interventions, such as the back-lying position for birth, the use of stirrups, taking the baby from the mother for testing and observation, and changes of shifts of nurses and other staff, exist for the convenience of the staff or caregiver. Still others, such as antibiotics for the baby’s eyes, newborn screening for PKU, hypothyroidism, and other conditions, are preventive and required by state or provincial governments. Some practices, such as enemas, shaving the perineum, and draping the mother’s body and legs during birth are less common today, but continue in some areas of North America. They became routine at a time when they were believed to be beneficial, but now are known to be of little or no benefit or even harmful. Some routines, such as anesthesia and circumcision, may present an element of risk to mother or baby that may not be worth taking, depending on the beliefs of the parents and the benefits to be gained.

Others, such as feeding sugar water or formula to the baby, began at a time when breastfeeding was discouraged and were believed essential to the baby’s well-being. Some procedures, such as epidural, cesarean, and circumcision, require your informed consent — that is, only after your caregiver explains the procedure, its benefits and risks, and the risks and benefits of any alternatives (including not doing it) is your consent recorded in your chart.

Part of your preparation will be to find out which routines you are likely to encounter, along with the reasoning behind them. Childbirth classes, the hospital tour, and your caregiver can help you find out which routines are used. As you prepare this part of your birth plan, mention only the preferences that matter to you. You do not have to hold an opinion on everything. Or, better yet, you might summarize your preferences with a blanket statement, such as, “I prefer to avoid routine interventions and procedures, and want to discuss any that are being considered.” Or, “I am comfortable relying on my caregiver to make decisions about interventions and procedures, and do not wish to be consulted.”

Care of Your Newborn

This section describes how you want your baby cared for during the first few days. There are as many differences in the way healthy newborns are cared for as there are differences in every other aspect of maternity care. Generally, the healthy newborn needs little more than a warm environment, diapers, clothing, and access to her mother’s breast and parents’ arms. Particular observations, tests, and procedures are done routinely to discover serious congenital disorders or prevent potentially serious illnesses. In considering your options, balance concerns for your baby’s comfort and well- being with the potential benefits and risks of each procedure.

Unexpected Events

The section on the unexpected will be most helpful if something unforeseen arises. A birth plan for a cesarean birth can help you retain some of the priorities of your original birth plan. Though an unexpected cesarean can be a disappointment, you will feel better about the experience if you have thought about this possibility, learn about your options, and express your preferences.

Although almost all babies are born healthy, there is a slim possibility that something could go wrong or that your baby might have a problem. This possibility worries most expectant parents to some degree. You know that prematurity, illness, birth defects, or even death sometimes happens. It is helpful to consider in advance how you would want such misfortunes handled, because if they occur, many decisions have to be made when you are upset and unable to think clearly. Your birth plan can include such possibilities, so that the staff can care for you and your baby with knowledge of your preferences.

Once you have made your birth plan for the unexpected, put it aside and concentrate on a normal birth and a healthy baby. You will probably not need the plan for the unexpected, but if you do, you will have your own plans to follow at this extremely difficult time. This will mean a lot to you later.

Conclusion

As you can see, preparing a birth plan requires time, thought, and information gathering. You should get input from your caregiver before you prepare the final version. By the time you have finished, you should have a fairly complete picture of what you can expect in terms of your care during childbirth and immediately afterwards. Not only have you and your caregivers formed a trusting relationship and made a general plan for managing your uncomplicated, normal labor and birth, you will also know how unexpected variations and complications are likely to be handled. This Win-Win Birth Plan helps lay the groundwork for a satisfying birth experience.

Penny Simkinwww.pennysimkin.com

Penny Simkin, PT, is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates she has prepared over 13,000 women, couples, and siblings for childbirth. She has assisted hundreds of women and couples through childbirth as a doula. She is author or co-author of books for both parents and professionals, including The Labor Progress Handbook; Pregnancy, Childbirth, and the Newborn: The Complete Guide; When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women; The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions. She has developed teaching materials for birth classes and produced several videos for educators, doulas, and families , the latest of which is for siblings-to-be, There’s a Baby. She is co-founder of DONA International (formerly Doulas of North America) and PATTCh (Prevention and Treatment of Traumatic Childbirth).