There are so many birth plan templates on Google. Some of them are pretty good, but they're all missing the most important piece: education.
A birth plan is most powerful when you understand the why behind it.
Our doula package includes childbirth ed, because we believe that knowledge is power. After class, your doula helps you craft your birth plan.
Three things we put on our birth plans that the templates are missing:
1. Are you ok with students, residents, or other trainees being at your birth?
In the Twin Cities, Regions hospital (St. Paul) and Riverside hospital (U of M - Minneapolis campus) are two of our local teaching hospitals where residents are almost guaranteed, but you might encounter trainees at any hospital! People who are new in their medical career tend to be open to trying anything, which can be a huge benefit. I've seen brand new doctors be more comfortable than more seasoned doctors when it comes to things like letting partners assist with catching babies, or the birther being in a hands-and-knees position as baby is delivered. Newer nurses are also usually energetic and excited about trying different positions in labor, or helping encourage a malpositioned baby to rotate.
However, students, residents, or other trainees often also slow things down. This can be a downfall when you're in active labor and needing an IV placed, or you're contracting hard and wanting an epidural ASAP.
It's your birth, and you get to decide who's in the room! You can always change your mind mid-labor too.
2. Do you want pain meds offered to you, or do you want to ask for them if/when you're ready?
I've seen many OBs, midwives, and nurses come into a labor room, observe one contraction, and immediately say "let us know when you'd like an epidural!" They mean well, and they're just trying to help. But if you're planning an unmedicated birth, or planning to delay an epidural until you're deeper into labor, this offer from your team can be really discouraging to hear, and hard to turn down. Many of our clients who had unmedicated births report that they tried to block the word epidural from their brains.
But if you're planning an epidural, it might be helpful to know your team thinks it's a good time!
Side note: it's almost never too late to get an epidural. The reasons why it might be too late: baby's head is crowning (about to be born), or the anesthesia team can't get to you fast enough. There are no rules about how far dilated you have to be in order to get an epidural. I've seen clients who are 1cm ask for one (more likely in a long induction situation), and clients who are 10cm ask for one!
3. Push and deliver in the position your body tells you to, or the position your provider recommends?
There's an important difference between pushing (baring down) and delivering (when baby's head is crowning/body being born). Pushing can take a few minutes or may take a few hours (most doctors will start evaluating for a c-section or vacuum delivery around the 3-4 hour mark, depending on the situation). Delivery is the final few pushes, and usually takes a minute or two.
Many local providers here in Minnesota are comfortable with pushing in any position, but then want the birther on their back (lithotomy position) for delivery once they can see baby's head.
If your provider prefers to catch babies in lithotomy position, I can almost guarantee that's the position you'll deliver in. You can always say no, or just refuse to move, when someone asks you to get on your back during labor, but it's a vulnerable time and most birthers find it difficult to advocate for themselves in the moment. As you're planning your birth, you'll need to decide if it's important to you to push and deliver in any position, or if you're ok following your provider's recommendations in the moment.
Instead of asking your provider: "can I push in any position?", try asking: "when was the last time you delivered a baby with the birther NOT on their back?" The answer will help you understand your provider's style!
Reminder: birthing on your back is not a bad thing if you choose it. But physiologically, it's not the most ideal position for birth, and most pregnant people won't instinctively get in that position unless someone tells them to. Also, I'm not talking about emergency situations here, like a shoulder dystocia. I'm talking about finding a provider who is supportive of the way you wish to birth.
These are just 3 things to consider...
While birth rarely goes according to plan, we still highly recommend creating a robust birth plan! The birth plan will help you consider the things that might happen to you during labor and birth, and prepare for any outcome. The plan also helps drive conversations with your provider team, and helps guide them to respect your wishes (most providers will respect what you want, if they know what you want!).
Once you create a solid draft, talk to your provider about it at a routine visit in your third trimester. Ask them if they have any concerns about the plan given 1) your medical history and 2) their standards. After that conversation you can decide if you want to tweak anything on the plan to match their recommendation, stick to the plan and know you'll need to advocate in labor, or try to find a more supportive provider. Ask your provider to put a copy in your chart, and bring paper copies with you in labor for your nurse team to easily reference.
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