I recently met with a couple for a private childbirth education class. When we started to talk about birth plans, the mama-to-be told me her doctor didn’t want her to write one. I asked why and she said that her doctor didn’t want all the details of her birth mapped out in case things didn’t go the way she hoped. In some ways, I completely agree with her doctor. It is important not to get too attached to one specific way of birthing and be open to the possibility of unplanned events. However, I do think it is necessary to go over your “birth preferences” with you doctor so that there is a general understanding of what you want. (I am going to go ahead and say “doctor” because most of these points are a given when working with a midwife.)
I suggest making two birth plans: one for you and your partner and one for your doctor. The one for you and your partner may include things like what type of pain management techniques you want to try (i.e., massage, counterpressure, getting in the bathtub or shower, visualization, and aromatherapy) and the different laboring positions you may like to use. (Usually, your doctor will not really care what positions you want to labor in as long as the fetal monitors can pick up your baby’s heart rate.) Your plan may also touch on whether you want music playing, or pictures you find inspiring you’d like placed around the room. Another topic to discuss is who you want in the room with you. In teaching hospitals, there may be students that would like to observe, but you are free to choose not to have them there. I would also suggest including in your personal plan whether you would like standard newborn procedures delayed (especially if you are planning to breastfeed) and if you would like to room with your baby. None of these things are of all that much concern to your doctor, but would be ideal for you to have considered head of time.
In the birth plan for your doctor, you may want to address:
When to head to the hospital or birth center.
If you are not planning on using pain medication, your doctor will likely advise you to come when you are in a very steady, active labor pattern. To identify if you are in active labor, your doctor may refer to the “3-1-1 rule”–meaning your contractions are three minutes apart, lasting a minute, and this pattern has been going on for one hour. If you are planning on pain medication or you are high risk, you may be asked to come in at 4-1-1 or even 5-1-1.
What kind of freedom of movement is to be expected?
If you are hoping to be able to pace the halls or get into the bath or shower at the hospital, is you doctor on board with intermittent monitoring? Or should you expect full-time monitoring, which will limit your freedom of movement?
Food and drink.
Some doctors are fine with you continuing to nibble lightly or at least drink clear fluids. Others have a strict “ice chips only” rule. Find out ahead of time what your doctor’s protocol is. Keep in mind that while you are at home and in transit, you can eat and drink whatever you like! And you should continue to nourish yourself.
Epidural and other pain medications.
You may find your doctor to be a good advocate in helping you achieve a natural birth should you opt for one. I was once at a birth where the mother had chosen a drug-free birth and as she was saying how hard the contractions were, her doctor rubbed her back and said, “This is what you said you wanted, and I am here to help you.” I still remember being moved by the doctor’s commitment and compassion toward her patient.
Labor augmentation.
There are many ways to naturally move labor along: nipple stimulation, sex, acupuncture, and castor oil, to name a few. If you are facing an induction date, check with your doctor to see if these are options. It is also helpful to know if your doctor regularly uses pitocin. You can discuss with your doctor if you would like to avoid artificial augmentation and find out what their comfort level is with you incorporating some of the natural methods just mentioned.
Overall schedule.
It is important to get a general sense of your doctor’s expectations for what kind of schedule you will be on before and during labor. Some questions are:
-How far past your due date can you go before being induced?
-If your water breaks before the onset of labor, how long can you expect to labor at home before your doctor wants to intervene with pitocin?
-Once in labor (assuming mom and baby are doing fine) are you expected to progress at a certain rate?
-How long can you push for?
Positions for second stage of labor (pushing).
There is a wide spectrum in terms of how each doctor approaches pushing positions. A lot of doctors allow you to push in any position you find beneficial, but when it is time for the baby to actually crown, they want you on your back. Others, as long as they can see the baby emerging, don’t care what position you are in. While still others prefer you to be on your back or side the whole time. At one birth, I witnessed a woman asking (pleading) to push on all fours, but the doctor insisted she be on her back. During labor is not the time to find out how your doctor prefers to deliver your child. If you have strong feelings one way or another, speak with your doctor ahead of time
There are other topics I usually include on my “birth preference” worksheets but, honestly, I don’t think doctors pays too much attention to these. In situations where they may come up, usually the doctor is going to go with their interpretation of the situation to make a final decision. These topics are: episiotomy (most OB/GYNs do not regularly perform this unless they need to use a vacuum or forceps to aid in the birth or immediately need to get the baby out), using instrumental assistance such as a forceps or vacuum (even if you said you did not want this, if the doctor thinks this is necessary, your preference is really not going to matter). A lot of women bring up their desire to avoid a C-section if possible. But unless a C-section is medically necessary, avoiding it is usually the doctors preference as well.
I would also suggest making a list of your top three priorities for your birth, and making this list known to your doctor. To help you better understand all your options and start to carve out a personal birth plan, check out another blog post of mine, Educate Yourself, Know Your Birth Options.
Debra Flashenberg is the founder of the Prenatal Yoga Center. After spending much of her life in musical theater, she was introduced to yoga in 1997 and has since become a certified doula, Lamaze coach, midwife, and certified vinyasa yoga instructor. She is continuously in awe of the beauty and brilliance of birth and is the proud mother of baby boy Shay.
