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Birth
Plans: Planning to Empower The birth plan is dead! Long live birth planning! The time has come when most maternity care providers greet birth plans with scorn. No busy professional wants to wade through a long document full of non-negotiable demands. Today, most obstetricians and hospitals at least pay lip service to the idea of treating each woman with respect and making an attempt to honor her requests. Let’s face it, doctors and hospitals are engaged in a keen competition for every health care dollar spent. Consequently, they are very interested in patient satisfaction. The necessity today is to communicate what an individual’s needs are for this specific birth. Presenting these plans in a non-threatening way guarantees more willing cooperation from the doctors and nurses involved. The best way to convey your needs and goals is still with a written document. It allows for a clear, permanent record of decisions that have been made by the birthing mother. The completed document is the final result of many conversations carried on with your care provider from the beginning of your pregnancy. So, begin discussing it right from the start and prepare your doctor or midwife to receive the final birth plan when it is ready. This is important because no care provider is going to appreciate having a list of demands sprung upon them without notice, a week before your due date “Clarifying Goals” Your first goal is to distill and clarify your personal vision for birth. Your doula can be very helpful in at this task. For instance, many women have strong ideas of what they want for their birth, but clarification is imperative. What are your most important issues? In an attempt to maintain control in the intimidating atmosphere of the hospital, the temptation is to show a preference regarding every possible situation. In reality, depending on the facility and the care provider, some choices are never offered, some are automatically presented and some are nonnegotiable facts. Your care provider and doula can help you learn what to expect at your birthplace. This will enable you to choose which of your goals need to be included in your birth plan and which are standard practice with your care providers and therefore do not need to be mentioned. “Practical Application” The next step is to settle in your own mind which specific aspects of your upcoming birth are most important to you. One very useful technique is to visualize having the baby. Close your eyes and concentrate. Then describe what you see to your doula or birth partner. Have them listen carefully and then together compare your narrative to the standard procedure where you plan to birth. Perhaps you see yourself walking a lot and giving birth in a supported squat. Chances are that one of your main issues is to remain mobile. If the facility you are using encourages mobility, great. If not, it will be an important issue for you to address with your care providers. If you see yourself holding and bathing and nursing your baby without interruption, perhaps your main issue is to avoid separation. Again, consider where you’ll be birthing. Do they routinely send the newborns to the nursery after a few minutes with Mom? Are exceptions ever made? Find out and then make your wishes known to those who have the ability to make the exceptions, if need be. The majority of women have at most only two or three very important issues. If these issues are addressed satisfactorily, you are likely to have very satisfying birth memories. Since too many demands tend to be threatening, an overloaded birth plan can create unnecessarily strained relations with the staff, without providing significantly better memories for you. Fiercely resist the temptation to adopt anyone else’s issues as your own. Don’t be afraid to recognize reality if needed. Some women inadvertently set themselves up for major dissatisfaction by demanding the impossible. One woman had been secretly hoping that she would stay in the whirlpool tub a little too long and "accidentally" have a water birth. Unknown to her, the reality was that the only whirlpool tub in the hospital was located four floors away in the physical therapy department, absolutely off limits to maternity patients. After learning the facts from her doula, she explored how important this vision was to her. The more she talked about it, the more she realized that at least being able to labor immersed in water was essential to her and eventually led to her choosing to switch to a birthing center attended by midwives. She did make extensive use of the tub during her labor but ended up delivering - by her choice - on a birth bed. Writing the Birth Plan The next step is to get these important issues down on paper so you can share them with your caregivers. Remember Mary Poppins’ advice: "A spoonful of sugar helps the medicine go down." Phrasing something pleasantly may mean the difference between kindness and hostility from the hospital staff. For instance, consider these two examples:
The second statement is much more likely to win the sympathy of the nursery nurse. Time is precious, so keeping written plans short and to the point is fundamental. You may want to use the form provided here. Keep in mind that although it is important for your doula and other support people to be aware of all the details of your needs, it is not essential for the hospital nurses. They need to be able to get right to the heart of how to personalize your care during this birth. If any of your issues are at all controversial, I strongly recommend that you discuss them ahead of time with the person in charge of dealing with those issues. That may prove to be the obstetrician, the head nurse, the anesthesiologist or the hospital administrator. After you have agreed on a course of action for your birth, have them initial the birth plan. Finally, make enough copies so that everyone involved may have a copy: you, your doula, your doctor, and the maternity nurses. If you find that your desires mesh very closely with standard procedure at the facility where you will be birthing, you may then make the valid decision not to pass out copies of these plans to all your prospective care providers. You will perhaps find that the birth plan has served its purpose for you by simply helping you to clarify your desires and focus more effectively on your upcoming birth. Most women’s satisfaction with their birth and the people involved in it is directly linked to her sense of control. It is well worth the time that it takes to clarify your most important issues. Following these guidelines will empower you, while maintaining a spirit of pleasant cooperation with your care providers. Careful birth planning and concise presentation will assure everyone’s satisfaction and ensure that you have the best birth possible. |
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