Birth Plan Tips

We were so happy our resident midwife & acupuncturist, Elizabeth Bachner was able to answer your family’s questions about birth plans. Here are the questions you asked and answers below.

What is the point of a birth plan?

Gone are the days around the thinking that a birth plan is something you write up to tell your care provider what you want to magically happen at your birth. A birth plan is an exploration, a journey into understanding who you are as parents. It encourages a conversation with your care provider so you can find out if you are both be on the same page, what his/her boundaries are and whether or not he/she is practicing evidence based medicine. It is a flexible list of ideals in a low risk situation, your informed consent or refusal of state mandated vaccinations and tests, a list of who will be in the room and their role, as well as any other important information you wish to communicate to the birth staff. See the full thread and related questions and answers here.

How important is a birth plan?

A birth plan is a very important step in discovering who you are as parents. By going over the question you will learn where you are philisophically.. are you the family that wants to do every intervention there is and have the doctor tell you want to do? Or do you research everything and tend to choose choices that fall outside of western medicine, like herbal remedies and homeopathics as solutions to promblems? A birth plan can be a very important step in advocating for your rights within a medicalized system that does not practice evidence based medicine and if you have never met the nurse, midwife or doctor who will be attending your baby’s birth. If you are birthing at a hospital, I would say it is very important to have a birth plan. If you are birthing at a free standing birth center where they practice evidence based medicine, you have discussed how they assess risk and they have presented you with informed consent on all tests and newborn procedures but they do not spend 30-60 minutes at every prenatal getting to know you and asking mental, emotional and spiritual questions, I would say it is a very good idea to have a birth plan. If you are with a out of hospital midwife who you have established trust with, have discussed how they assess risk, determined that they practice medicine in a way that resonates with you, know they are wanting to honor your journey, they have presented you with informed consent on all tests and newborn procedures, they have good relationship with the transport hospital and will stay with you if you need to transport - then 9 times out of 10, you have developed one with your midwife as part of your care. The birth plan is very useful if you need to advocate for yourself in a hospital setting. I might be an idealist... but I would love to see hospitals change how they work with pregnant families and know that most of the mamas are not "sick" and are "low risk" and "healthy". We have a wonderful example of a hospital in Los Angeles that respects birth plans, Cedars-Sinai Medical Center. They are doing great things in changing how women in labor at seen and heard. See the full thread and related questions and answers here.

Why is evidence based care so important in a birth plan?

The fact is that we live in a medicalized society when it comes to childbirth. Evidence based care is just that, care that is supported by scientific studies as evidence. It is a common language that can be used as a staring off point for a conversation with your care provider as to why you do or do not want a certain procedure and why your unique body or unique situation will or will not work with the evidence. All medically board licensed professional practice evidence based care. Even if you are more of an “earth mama” than a “science mama”, do your research and you might find that evidence based care actually supports your personal choices and becomes another tool for supporting your body and your choice. One of my favorite sites for information in understandable language is Evidence Based Birth. A wonderful thing that is starting to happen is we are now getting evidence around low risk births. MANA and AABC are two organizations that are working hard to accumulate data to support the safety of low risk births, out of hospital births and water births. See the full thread and related questions and answers here.

What are some things that my care providers do not need to know?

Your care providers does not need to know if you will be wanting battery operated candles at your birth or which essential oils you want sprayed when. If you have a trusting relationship with your care provider you will not need to write down every detail what you want done in case your birth switches from low risk to high risk, because you know that they when they call for an intervention it is being done because it is necessary. Things that are good to discuss with your care provider before you go into labor are: What position can I labor in? What position can I push in? How soon after my water breaks will you want to induce me? There are quite a few things that forms need to be filled out if you decline a procedure, like Vit K, Erythromicin or Hep B. Make sure you let them know this when you arrive so they can have the forms ready and they don't just do the interventions "routinely." If you live in a city where they still do episiotomies routinely (so hard to image that this still happens... but it does.. and it is not evidence based care...) PLEASE discuss this with your care provider before you go into labor and put it in bold on the birth plan. That was in labor, when the doctor gets the scissors out, your partner, your doula, your mother, your friend can say, "Hey, there is nothing high risk going on and the birth plan says NO Episiotomy!" If you live in NYC, PLEASE add this to your birth plan, as episiotomies are routine still in the city!! See the full thread and related questions and answers here.

I have a history of sexual abuse and I don’t know which doctor in the practice will show up. I’m scared to give birth. Is there anything I can do with my birth plan to help me?

Firstly, I am so grateful you had the courage to ask this questions, as this is something that I hear over and over again, yet know one wants to talk about it. Did you know that birth is 85% emotional? And that our cells have memory?? If you don’t let the person in the room know you have a history of trauma, and a stranger tries to do a vaginal exam on you, your body will probably retract and withdraw to protect itself (it is that wise!). I want to encourage you to have a conversation with your care provider to let them know and then on your birth plan put at the top: “I have a history of PTSD. When there is no emergency, please explain the procedure you would like to do and then ask for my permission.” It is that simple. Remember, nurses, doctors and midwives are healers in their heart and they have all been trained in how to work with people who have PTSD. You don’t need to go into detail and they will show up to respect your choice. See the full thread and related questions and answers here.

Can I move and eat during labor?

Many progressive and modern hospital are now recognizing that if a mom’s labor is considered “low risk” she can not only walk around during labor with intermittent monitoring; but she can also eat. When you are in labor you will not desire a roast beef diner! The body is wise!! You will crave the foods that are easily digestible and filled with nutrients you need for “running the marathon" like scrambled eggs, bites of a protein bar or watermelon. And if you throw up, well, at least you have thrown up food and not bile! (and as we like to say, when you throw up that’s another half a centimeter in dilation! yeah!) Discuss this with your care provider first to make sure you are both on the same page and find out what situations would present themselves where you would not be able to eat and you would need to be monitored 24/7 while lying on the bed. If you are birthing at home or a birthing center you are considered "low risk", so you will be monitored with a doppler intermittently. There are many hospitals that now do this too! Ask if your hospital will use a doppler so you can move around the room, get into any position you want and even labor in a tub or shower! See the full thread and related questions and answers here.

Can my baby go skin to skin with me as soon as he/she is born?

Again, most modern hospitals, freestanding birth center and home birth midwifery practices understand the scientific benefit of skin to skin and want baby to be with mom getting all that good bacteria, integrating and being near the breast to start breastfeeding. If there is no medical urgency for knowing baby’s weight and length, then you can ask for “delayed weighing and measuring of the baby”. (If you think about it, why do you need to know baby’s weight right away? Does it make a difference in how you will love this child if you do it an hour after he/she is born?) This is called the “Golden Hour” and good hospitals know to respect that first hour of baby’s life as family bonding time. In general, most midwifery practice do not rush the post partum time and encourage skin to skin bonding as part of their protocol. See the full thread and related questions and answers here.

I’ve just asked my doctor/midwife all of my birth plan questions and I don’t like the answers. What do I do?

Switch to a new doctor or midwife!! Things will not change unless we, the consumer start demanding change! Speak the language that big corporate hospitals and insurance speak - money! If we work together and let them know that they are not practicing evidence based or kind care and that we will be taking our business elsewhere, perhaps change will start to happen. Join a FB chat group, ask a doula or find some moms who are the local good midwives and doctors and give those providers your insurance dollars. It is your body and you have a right as to what gets done to it. And remember, when everything is considered “low risk”, you have lots of choice. And if it should turn into a “high risk” situation, your choices do become limited. The key is to find a provider who you can trust to not do “unnecessary" intervention, so in a true emergency situation, when an intervention becomes “necessary”, you can trust the care provider to do her job well. See the full thread and related questions and answers here.