Birth Plans and Birth Options

A birth plan is not a binding agreement but is a guideline. Your health care provider should know, from having seen you throughout the pregnancy, what you do and do not want. But a well thought-out birth plan is your best guarantee that the delivery of your child will go according to your wishes. Birth plans are relatively new and your doctor or nurse-midwife may not be completely familiar or comfortable with them. For this reason, make sure you communicate firmly and clearly that you intend to create a birth plan.

Once you've made your birth plan, schedule a time to go over it with your doctor or nurse-midwife. Find out and discuss where you agree or disagree. You may also want to make several copies of the plan: one for you, one for your chart, one for your doctor or nurse-midwife, and one for your birthing coach or partner. And bringing a few extra copies in your labor bag is a good idea, especially if your doctor ends up not being on call when your baby is born.

Although you may not be able to control everything that happens to you during your baby's birth, you can play a role in the decisions that are made about your body and your baby. A well thought-out birth plan can help you to do that.

1) What are your wishes during a normal labor and delivery?
These range from how you'll handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.

2) How do you want your baby to be treated immediately after and for the first few days after birth?
Do you want the baby's cord to be cut by your partner? Do you want to store the cord blood? Should your baby be placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breast feed or bottle-feed? Where will the baby sleep - next to you or in the nursery?

3) What do you want to happen in the case of unexpected events?
No one wants to think about something going wrong, but if it does, it's better to be prepared than to have to make snap decisions when you're upset. Given the number of women who have cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.

Before you make final decisions about each of your birthing options, you should talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.

You may find that your obstetrician, nurse-midwife, or the hospital or birth center where they admit patients already has birth-plan forms that you can fill out. If this is the case, you can use the form as a guideline for asking questions about how women in their care are routinely treated. If their responses don't meet your expectations of how you'd like to be treated, you may want to switch health care providers, if at all possible.

Finally, you should find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high risk because of your age, health, or problems during previous pregnancies, your health care provider may advise against some of your birthing wishes. You'll want to discuss, and consider, this information when thinking about your options.

Most women still give birth in the hospital but more and more women are choosing birth centers. However, most women are no longer confined to a cold, sterile maternity ward. Find out if your hospital practices family-centered care. This usually means the patient rooms will have a door, furnishings, a private bathroom, and enough space to accommodate a family, including the baby's crib and supplies.

Additionally, many hospitals now offer birthing rooms that allow a woman to stay in the same bed for labor, delivery, and sometimes, postpartum care (care after the birth). These rooms are fully equipped for uncomplicated deliveries. They're often attractive and have gentle lighting.

But some women believe that the most comfortable environment is their own home. Advocates of home birth believe that labor and delivery can and should occur at home, but they also stress that a certified nurse-midwife or doctor should attend the birth. An important thing to remember about home birth is that if something goes wrong, you don't have the amenities and technology of a hospital.

For women with low-risk pregnancies who want something in between the hospital and home, birthing centers are a good option. These provide a more homey, relaxed environment with many of the medical amenities of a hospital. The birth centers are also very willing to have a doula assist the delivering woman.

Who will Assist at the Birth?

Most women choose an obstetrician (OB/GYN), a specialist who's trained to handle pregnancies (including those with complications), labor, and delivery. If your pregnancy is considered high risk, you may be referred to an obstetrician who sub specializes in perinatology (the care and treatment of the expectant mother and baby 5 months before and 1 month after the birth).

Another medical choice is a family practitioner who has had training and has maintained expertise in managing non-high-risk pregnancies and deliveries. In some areas of the United States, especially rural areas where obstetricians are less available, family practitioners handle most of the deliveries. One special benefit of choosing a family practitioner is that, as your family doctor, he or she can continue to treat both you and your baby after birth.

And doctors aren't the only health care providers a pregnant woman can choose to deliver her baby. You might decide that you want your delivery to be performed by a certified nurse-midwife, a health professional who's medically trained and licensed to handle low-risk births and whose philosophy emphasizes educating expectant parents about the natural aspects of childbirth.

Increasing numbers of women are choosing to have a doula, or birth assistant, present in addition to the medical personnel. This is someone who's trained in childbirth and is there to provide support to the mother. The doula meets with the mother before the birth and also helps to communicate her wishes to the medical staff, should it be necessary.

Your birth plan can also indicate who else you'd like to have with you before, during, and immediately after the birth. In a routine birth, this may be your partner, your other children, a friend, or other family member. You can also make it clear at what points you want no one to be there but your partner.

Many hospitals and birthing centers now allow women to make some choices about the atmosphere in which they give birth. Do you want music and low lighting? How about the freedom to walk around during labor? Is a hot tub something you'd like access to? Do you plan to eat or drink during labor? You might be able to request things that may make you the most comfortable - from what clothes you'll wear to whether you'll have a VCR or DVD player in your room.

Hospitals used to perform the same procedures on all women in labor, but many now show increased flexibility in how they handle their patients. Some examples include:

enemas. Used to clean out the bowels, enemas used to be routinely administered when women were admitted. Now, you may choose to give yourself an enema or to skip it entirely.
induction of labor. Years ago, some doctors routinely induced labor. This is no longer done, unless there's a true medical need for it. Labor is allowed to take its natural course, with less medical intervention, in most hospital settings today.
shaving the pubic area. Once routine, shaving is no longer done unless a woman requests it.

Other procedures that you can include in your birth plan are requests about fetal monitoring, what types of birthing equipment you'd like in the room, and whether you have internal exams during labor.

Pain management

This is important for most women and is certainly something you have a lot of control over. It's also something you'll want to discuss carefully with your health care provider. Many women change their minds about pain relief during labor only to discover that they're too far along in their labor to do anything about it. You'll also want to be aware of the alternate forms of pain relief, including massage, relaxation, breathing, hot tubs, sedatives, and tranquilizers. Know your options and make your wishes known to your health provider.

Position During Delivery

There are a variety of positions you can try during labor, including the classic semi-recline with the feet in stirrups that you've seen in the movies. Other choices include lying on your side, squatting, standing, or simply using whatever stance feels right at the time.

Episiotomies.

When necessary, doctors perform episiotomies (when the perineum - the area of skin between the vagina and the anus - is cut to ease the delivery). You may have one if you risk tearing or in the case of a medical emergency.

Assisted Birth

If the baby becomes stuck in the birth canal, an assisted birth (i.e., using forceps or vacuum extraction) may be necessary. Find out what your doctor is most experienced with - that's probably your best choice.

Cesarean Section(C-Section).

You may not want to think about this, but if you have to have a C-section (cesarean), you'll need to consider a few things. Do you want your partner to be present, if possible? If you have a choice, would you like to be conscious or unconscious? What about viewing the birth - do you want to see the baby coming out?

Post-Birth

There are many decisions to make about the time immediately after birth, including:

Would your partner like to cut the umbilical cord?
Does your partner want to hold the baby when the baby emerges?
Do you want immediate contact with the baby, or would you like the baby to be cleaned off first?
How would you like to handle the delivery of the placenta? Would you like to keep the placenta?
Do you want to feed the baby right away?

Birth Plans and Birth Options

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