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How to Design a Birth Plan

…and then Deconstruct it

(An easy but essential 12-step birth plan process.)

You’re pregnant. Congratulations! Do you know yet if it’s a boy or a girl? What color will the nursery be? You have a design in mind, don’t you? Yeah, you probably had something in mind all along. Have you designed your birth yet? *Yes, designed.* Do you have a plan? Do you know what you want? Where will you find it? What will it cost you? Is it even available?

Let me tell you, you need a plan! Don’t show up expecting someone else to have chosen the right options for you. You have great friends, but they won’t live with this birth, this baby, for the rest of their lives. You will. And you have choices, just like you do in your beautiful baby’s room. I can help with that. Here’s your design guide:

First Draft: First trimester (or even when you are TTC)

Step One:   Begin a document titled “The way too long list”

Step Two:   Create 4 sections:

  1.  Labor
  2.  Pushing & Birth
  3.  Special Circumstances
  4.  Newborn Care

Step Three:   Under each of these headings, list anything and everything that is important to you about your birth experience.  At this stage, online birth plan creation tools can be helpful in offering suggestions of what you might want on your list.

Now what?  Based upon your list, consider whether or not your care provider and birth place will be supportive of such requests.  If you know this without a doubt, then you can readily move forward to Step Four.  If you are unsure or are just guessing they will be because they have been nice during your GYN visits or are popular among friends, it is crucial to ask around the natural birth community and ask your care provider directly about how they handle natural births. 

These answers will give you an indication of whether or not you need to act now to change care providers or birth place.  Be certain of this, as your care provider’s protocols will have a direct and strong influence over your birth experience.  (It’s also critical to ask whether their partners/backups practice in the same manner.)

Of all the choices you will make in your birth planning, you have the greatest amount of control over where you give birth and who your care provider will be.  These two factors alone will have the most impact on your birth experience.  Choose wisely!

Step Four:   Choose a couple of your most important items and discuss them with your care provider at your next appointment.  A friendly approach is best.  “How do you feel about intermittent monitoring?” goes over much better than “I refuse to be monitored during my labor.”  This dialogue will give you an idea of where your care provider stands. A natural birth advocate will likely answer many of your unspoken questions within the first conversation.  Resistance to your questions merits follow-up, but often is your first clue to seek care elsewhere.  (Note: For newborn care, follow this same process with pediatricians.)

It is here that I must interject that there is a time and a place for every practice, from the most natural to the most medical.  It is your responsibility to educate yourself by researching and asking questions so that you can determine this reasonably and responsibly in the context of your own labor and birth circumstances.  This is the essence of informed consent or refusal.

Step Five:   Review your list and note answers where you have received them and highlight questions that have now come to the top of the list.  You will want to continue your research until your questions are answered.  However, you may be able to seek this information from other sources within the birth community who are familiar with your care provider and place of birth, such as doulas or childbirth educators.

Second Draft: After you’ve done your first draft homework

Step Six:   Sort through your first draft and transfer items to a new list only if they:

a) Require further discussion with your provider / birth place / support team or
b) You have come to a compromise with your care provider that is outside of their routine practice and needs to be noted for future reference or
c) It is a special personal request that may be forgotten if there is no reminder.

Step Seven:   Research a bit deeper on each of these items to consider the options available to you, as well as their benefits and risks.

You will always have options.  They become fewer when an emergency arises, but labor and birth does not often involve true emergencies (i.e., life or death).  Your first question in a moment of choice should be, “Is this an emergency?”  If the answer is no, then proceed with standard questions:

  • What are my options?
  • What are their benefits/risks, advantages/disadvantages?
  • What if we wait a certain period of time (30 minutes, 2 hours, etc.)? 
  • What if we do nothing at all? 

Gather the information, then privately discuss what you’ve learned and come to a conclusion.

Step Eight:   Take a hard look at your list.  Have you asked all the questions you need to ask? Are you satisfied with the answers?  Do you need to revisit anything?

Step Nine:    Consider what preparation YOU need to make in order for your birth preferences to become real – additional support, classes, tools, etc.

Final Draft: Last few weeks before birth

Step Ten:   Review your previous draft and see if anything can be marked off that you feel confident is well-understood between you and your care provider.

Step Eleven:   Transfer only those items that the nursing staff will need to be aware of when you are checking in at your place of birth.  This should be short and to the point, friendly and easy to read.  Anything requiring more than a minute to read will likely not be read at all.

Step Twelve:   Make 3 or 4 copies of this single page birth plan to share with your care provider prenatally, the nursing staff upon check-in during labor, to post on the wall/have on hand in your L&D room and to give to the newborn care staff.

If you’ve done your homework, your final plan should be a simple reminder of the understanding you’ve come to with your care provider and not much of a surprise to the hospital staff.  How they respond to it can certainly vary, but that’s a discussion for another day.

Want help in preparing your birth plan?  Contact me to schedule an interview for doula services or to hire me for professional birth plan consultation.

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