Birth Plans, Like Due Dates, Are Not Binding

Why you should create a Plan A, a Plan B and a Plan C via alexandrasacksmd.com

@ohyesverynice

This month, our #motherhoodunfiltered post featured a very real comic by Jessica Zucker PhD published in the New York Times about when birth plans don’t go according to plan. Even with today’s alternative and medical options, none of us can control every detail around who, what, when, where, and why labor and delivery will unfold. And because every birth is different, many women tell us that it’s impossible to precisely imagine and prepare for the emotional ride beforehand, even if you’ve done it before.

Even with today’s alternative and medical options, none of us can control every detail…

First of all — it’s perfectly natural to worry about one of the biggest days of your life, especially because there’s so little you can control, but what you can do is to create and prepare your birth plan.

Before writing your birth plan, however, we recommend you take some time to educate yourself about the various options and consider reflecting on these decisions with your partner. You may want to begin by asking your provider about the range of possibilities at the facility where you’re delivering:

  • What are the reasons you might need to cancel your homebirth and head to a hospital? When will your home birthing provider arrive during labor and how long will they be available in the postpartum? Will you be able to get up and walk around during labor pains? Can you include a doula? Can you bring music or candles? How many people are allowed into the birthing room?
  • Do you want to use medications, and what are the various types to consider for pain and which are used for other reasons, like speeding up the process? Do you want an epidural, and when? What about other procedures like a C-section or episiotomy? Can your partner be directly involved in the delivery by cutting the umbilical cord or any other way? What are the options for immediate skin-to-skin contact with your baby? What about taking photos or video during the delivery?
  • What about the days in the hospital after the baby is born — can your partner stay over in your room? What are the visiting policies? Why do they need to take the baby to the nursery and what happens there? Will you be able to talk to your doctor while you’re recovering? What do you do if you have a physical or emotional difficulty with your own recovery or how the baby is being cared for during your hospital stay?
By writing down your goals and talking to your doctor or midwife, you can confirm they will do their best to help you achieve them.

By making your preferences and priorities clear, you’re clearly outlining how you would like to be treated around your child birthing experience, as well as taking some pressure off yourself and your partner to make on-the-spot decisions. By writing down your goals and talking to your doctor or midwife, you can confirm they will do their best to help you achieve them. If your practitioner is unable to make certain promises, ask her to clearly explain the rationale, and if that doesn’t work for you in any way, consider researching other professionals who may have different approaches that are better suited to you.

Once you’ve done all that work to clarify what you want, you will ultimately have to accept that birth plans, like due dates, are not binding, and getting too attached to either one can result in disappointment. Try to think of a birth plan more as a list of wishes or guidelines than a guaranteed blueprint of how your delivery will go. As one of my patients advised: “Write a birth plan, even if the first thing you do is throw it out when you get to the hospital. It helps you emotionally prepare for the crazy experience of childbirth. It can help focus your intention — an act that I think is worthwhile no matter how you end up delivering.”

You can also put a “Plan B” or even a “Plan C” in your birth plan. For example, if you’re planning on using breathing techniques instead of pain medication to get through the contractions, great. But, if breathing isn’t enough, you can include massage and hot/cold packs as Plan B, and leave medication as an option for Plan C.

Ask your partner in advance to explicitly remind you of the reasons for veering off-course

If you predict you might feel demoralized if your labor and delivery doesn’t go according to your ideal plan, you may want to ask your partner in advance to explicitly remind you of the reasons for veering off-course with a C-section or another intervention. This can serve to reinforce in real-time that you did the best you could to advocate for alternate approaches, but clear, medically necessary issues that are not your fault required things to take another direction.

And if you’re a “less is more” person, you may want to forgo a birth plan all together; you can give your practitioner some general pointers and otherwise just show up. Another option is to make some big-picture decisions but avoid worrying about the details, like one of my patients who explained “I told my doctor not to give me a C-section or contraction medications to speed things up — I only wanted those if medically necessary. My birth plan was to just come out with a healthy baby. Just do what you have to do to have a healthy baby. I didn’t want to get too focused on how I wanted it to go because it’s so much out of your control.”

Try practicing using language with yourself that is both assertive and flexible when thinking about your birth plan. Here are a few examples of how to move from black and white thinking to a more balanced point of view when considering what kind of birth you want.

For example:
Black and white: “A natural birth is best.”
Balanced: “I am going to do everything I can to prepare for a natural birth. I’m going to take classes on breathing, have a doula to help me with other techniques, and explain to my doctor that I don’t want an epidural. But if I end up asking for medication after trying all of the natural techniques to get through the pain, it may turn out that I needed it. I won’t be a failure, it will just be what I ended up needing.”

I recommend that everyone read this wise article by my friend and co-founder of Loom, Erica Chidi Cohen “I’m A Doula. Here’s Why I Don’t Use The Term ‘Natural Birth’.”

“When people share their birth stories without shame and without connotation, we really get a chance to see each other, meet each other, help each other, and move away from comparison. What informs how someone moves through their birth experience belongs to them and them alone, without being judged by anyone else… We’re in a time when we need to invent new language and invent new realities, so that’s why I feel that the term “natural birth” doesn’t really work anymore. It’s not an insensitivity to people who use it, but in 2018, it’s time for better language.”

I couldn’t agree more!

“When people share their birth stories without shame and without connotation, we really get a chance to see each other, meet each other, help each other, and move away from comparison.”

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