HOW MANY OF YOU HATE BIRTH PLANS?
I asked this to a room full of doctors I was presenting to. Only a few raised their hands, timidly. “Well, I hate birth plans!” I said. The room sighed and the number of hands up multiplied.
But I’m a doula! How can I hate birth plans? Well, because we don’t get to plan birth like we can plan a vacation or a wedding or a work schedule. We don’t get the same kind of control. Typically, Birth Plans seem to bring with them an air of rigidity, inflexibility, and a combative tone.
Yet hospital staff, increasingly, are prepared to receive such a document. Often, they ask for it. So there’s an opportunity. As you set the stage and prepare for birth, you can use the platform of a "Birth Plan" to share your hopes, desires, and preferences. It can serve to introduce yourself as an individual, as a conscientious healthcare consumer, as a unique person having a personal, life-changing event. It is also a means to set the communication stage with the staff and to optimize your care. This can actually be a fun and engaging document!
SO, HERE’S WHERE I GET TO SEMANTICS.
I actually think calling this document a "Birth Plan" is a misnomer. It’s important to remember that we can't control birth. And yet, you can put focus towards an ideal, and approach whatever comes in a way that feels solid to you. So this is why terms like "Birth Approach", "Birth Preferences", or "Birth Wishes" more accurately capture the nature of this document, and of participating in how it goes. Don’t shy away from a creative title of your own making--like “Labor Guide for a Shame-Free Birth,” or, “A Helpful Guideline for How Things Might Go.” Or, simply, "Birth Stuff". Choose something that suits you.
The aim with this is to communicate about you as an individual. This will help you get tailored support that will aid you in coping and meeting this day with the energy and vibe you envision. It will also enable your support people to remind staff of your wishes--which clarifies that you are the center of this experience and have put thought, attention, and intention into how you’ll move through.
NUTS AND BOLTS
Aim for a roughly one-page document that will cue the staff (who you may not have met) in to who you are and what you think you might like. Hopefully this will minimize questions they would need to ask you in labor and let them know how they can best help you get what you want. Think of this as introducing yourself (yourselves) and giving an overview of key points. Like a “Beyonce and Jay-Z 101”, if you will. Don't worry about formal language--the aim is for it to come out sounding like an individual wrote it.
Quite possibly the most important part is the introductory paragraph. It's where you set the tone and get the reader excited and interested in helping you. Maybe you can break them out of day-to-day job habits by cueing them in to how unique and awesome you are--caring for you is going to be collaborative and great. And you're making them better equipped to do an awesome job for you. Consider including some personal tidbits, like what your hobbies are, your job, how you and your partner met, a funny nickname you’ve had for baby during pregnancy, pets you have a home...something that gives a sense of you as a whole person.
Try to avoid a demanding, do/don't tone. This initiates a defensive relationship; it can make someone feel set up to fail for you if things don’t go exactly according to “plan”.
However, bullet points are great. Use subject headings like “In Labor”, “When Baby is Born”, and “After Birth”. This can aid the reader in finding what’s relevant to the moment. Perhaps you’re in the hospital in early labor, and knowing how you’d like your environment to feel is something they can help with. Perhaps you show up nearly ready to push, and they want to find out your preferences for the first postpartum hour. A reader-friendly layout is nice.
BEYOND YOUR IDEAL
Approaching birth with openness and fluidity often sets you up for an easier experience. However, it also asks of you to consider scenarios that aren’t your top-choice. It is wise to include a section in your Birth Document about induction or cesarean, or other situations that you’re hoping not to encounter. For some, that might be “If a male doctor is on call”.
Even when birth goes in ways you’re hoping it doesn’t, you often still have choices, and often still have ways to make that version of birth better for you. For example, options in cesareans are growing--such as playing your own music, delaying cord clamping, and having baby skin-to-skin in the operating room. Here is a sample cesarean requests to offer you some ideas.
PLANNING A HOME OR BIRTH-CENTER BIRTH?
When you know all of your care providers ahead of time, writing a Birth Document might not be as essential. Still, I’ve seen people take the opportunity to write down support strategies they anticipate finding helpful. Things like “mantras I like”, “places I like to be touched”, “things it might be helpful for me to hear”.
And, because there is always the possibility of needing to transport to a hospital, writing a "Transport Document" could prove useful in orienting a new care team to who you are and what might be helpful. The tone I’ve seen be successful is along the lines of, “So, if you’re reading this, we’re on Plan B. When I wrote this, I wasn’t sure what might be bringing me to the hospital, or at what point in labor I might be in. So! Here’s some general things to know about me and my preferences; let’s see what might be relevant.”
This might feel like a project that needs to be done by the pregnant person. But, Birth Partner, I'd encourage you to write out at least a portion of this document. Or perhaps even tackle the first draft. Your desires, preferences, and needs are important here too! And you likely have insight about the person doing the birthing that they might not think to include.
Hopefully, this can be an enjoyable process of self-exploration, an empowering experience of influencing the care you’ll receive, and a connecting process with those helping to care for and support you.
SOME GEMS TO DRAW FROM
Read on if you’d like some fodder for what you might say or include. Not every point you make do you need to offer explanation for. Some requests you write will be simple and straight-forward. Some preferences, however, might benefit from added insight, context, or humor. Here are some ideas to get you thinking about how to personalize what you communicate.
EXPRESS WHAT YOU’RE EXCITED ABOUT! SHARING YOUR JOY IS OXYTOCIN-PROMOTING.
“We are a family that loves to laugh; anything you can do to help keep spirits high would be welcomed and encouraged. We DO NOT take ourselves seriously and believe that joy is the best medicine. (Dad will probably make some bad jokes and we ask that you only laugh if it genuinely funny; we don’t want to encourage his terrible joke telling.)”
“At the beginning of my pregnancy, I was so scared that I thought I’d want a cesarean. I’m totally shocked that I’m here now, feeling really curious and excited about a vaginal birth!”
“We’ve worked for this baby for over 4 years. I can’t believe I’m really here!”
"I have been talking to the baby, asking for her help for a mutually beneficial birth, so baby knows I expect both of us to get down to business and get ‘er done! As much as I'm eager to meet her, I'm even more eager for her to meet her older brother. He's been calling her Muchkin...but it actually sounds more like Mushin!"
CONSIDER SHARING YOUR FEARS. KNOWING SPECIFIC TRIGGERS FOR YOU REALLY HELPS YOUR TEAM UNDERSTAND HOW TO CARE FOR YOU.
“Please be brief with fetal monitoring and keep the volume low or off. I have seen my thoughts spiral towards panic when presented with blips and beeps; I am a moth to the flame. Even worse, I jump to amateur conclusions about what is happening. I would be so comforted if you could put any readings into context. I always find it reassuring to be told that me and baby are doing well.”
“I’m very much afraid of tearing at the moment of birth, so any distractions, affirmations, or techniques you could offer would be much appreciated.”
“During my last labor the staff did some whispering in the corner on several occasions. This freaked me and my husband out! Please refrain from whispering, we WANT to hear what you are saying; please include us.”
“I have more fear of having things done to me and feeling like I don’t know what is happening to my body than I do of pain. Please ask/tell me when you do things, even small things like if you are turning up Pitocin.”
“I have a hard time with vaginal exams. Suggesting I need an exam might make me really nervous and tense. I hope to feel like I can say yes or no or that I’d like to wait.”
CONSIDER OFFERING INSIGHT AS TO WHY YOU MAKING A CERTAIN CHOICE OR REQUEST IF IT HAS SIGNIFICANT PERSONAL MEANING. THIS PROVIDES YOUR TEAM WITH MORE OF A PERSONAL CONNECTION AND UNDERSTANDING OF YOU.
“Hospital gowns remind me of when I had an emergency appendectomy. I don’t want to remind myself of that while I’m birthing!”
“I’d prefer touch to talking. I’m nervous that a ‘cheerleading’ vibe will remind me of how I hated high school sports.”
“When our baby is born, we would like our voices to be the first he hears. We understand and respect that all of you have been through this so many times, and this is our first time! It’s also what my parents seem to remember most about my birth.”
“I may not want a hat on her, because our family is placing bets on if she’ll have as long of locks as her cousin! And because the scent from her head, I imagine, will be a point of bonding for us.”
LET THE STAFF KNOW HOW YOU ANTICIPATE COPING. IF YOU HAVE A SENSE OF THINGS YOU’D RESPOND WELL TO, OR POORLY TO, LET THEM KNOW. THIS HELPS THEM KNOW HOW TO TAILOR WHAT THEY DO TO WHO YOU ARE.
"Please encourage me keep going, even if I mention an epidural. I might just need to say that I'm thinking about it. But please pull out all your tricks to get me into a new position do 5 more contractions. I’m hoping by then I’ll make it over the hump of doubt.”
“I want to be focused on the process of birthing and not the statistics. So please don’t give me any information about dilation, heart rates, etc. If I’m having trouble getting out of my head, my partner might cover the monitors for me.”
“I am a very active person and am planning an active birth. One of the best ways to support me is to encourage me to move around.”
“I've had a lot of conversations with my doula; please utilize her to help understand what I might like, and what agreements we've made as a team to support me.”
“I would like to use epidural anesthesia in late labor but plan to use self-help comfort measures including breathing, relaxation, and massage as long as I’m able to.”
“I respond well to verbal reassurance and support that is present-focused. Please tell me ‘You ARE doing it!’ instead of telling me that I CAN do it. The difference in the language is meaningful to me.”
“I also want to apologize in advance for my potty mouth. I fantasize that I will be focused, introspective, deep “om” chanting...but chances are my baser instincts will include many more expletives. In fact, I might find a fit of cursing quite the release. It may not be my proudest moment. I hope we can all laugh about it.”
“My belly is really sensitive (ticklish), especially on the sides. If you touch me there, please touch firmly, otherwise, I will tense up and it will be painful for me.”
“Chances of me needing to listen to terrible rap music are very high. #SorryNotSorry”
“She's a runner, so she's ready for a long haul. She is incredibly tough, though she thinks she isn't.”
“We are very connected to each other and also fairly private people. We are both good at asking for help when we need or want it. If you see us and we seem to be doing ok, please just leave us to it.”
“We are excited to have your hands-on support and encouragement!”
“I have prepped for and am committed to a natural birth. That being said, I am no masochist; my husband and doula are prepared to interpret the difference between complaints about pain and actually needing relief to move forward. Please don’t offer pain relief or reference the pain scale (I feel like those little faces are mocking me).”
PARTNER POINTS. YOUR NEEDS AND DESIRES MATTER TOO!
“I don’t want to be left out of any medical decisions.”
“I really want to ‘catch’ the baby and cut the umbilical cord, but reserve the right to freak out and decide against it at the last second.”
“I don’t want to feel ‘useless’; I want to be there for my wife.”
“Full water bottles = a deep love and appreciation for the nursing staff and a less “bear-like” Papa!”
“My husband is not a morning person, and may require a coffee before being capable of speech. We plan to pack some food for him too, as the ‘hangries’ aren’t any good either.”
“I want to be hands-on, but everything I learned will probably fly out the window in the heat of the moment. Please remind me what I can be doing to be good support!”
“I’ve been tasked with taking pictures. But I’m likely to forget. Feel free to pick up our camera on my behalf.”
“Thank you so much for reading, for helping, and for changing our lives!”
“Thanks for helping make this a wonderful experience!”
“First, thanks for taking the time to read through this. Second, thanks for being forever part of our memories of this day.”
AND if you still want more...or need comic relief, here is a roast of “Jamie & Jeff’s Birth Plan”.