If you have ever been pregnant, you remember the exact moment you had a positive pregnancy test. You probably remember that everything changed in that first deep breath. For most of us, emotions came rushing in….perhaps some surprise and anxiety but others full of hope, love and gratitude.
Regardless of the outcome, you felt an instantaneous connection and responsibility for every decision moving forward. You were potentially going to be someone’s Mom. In early pregnancy, we just have to get through the worry of the first trimester. We are making decisions on the options for bloodwork, genetic testing and sonograms. All of this while often suffering from feelings of nausea, fatigue and worry.
When we finally pause around mid pregnancy, we not only start to feel better but we really start to look forward and focus on the actual birth process. Many people begin to wonder, “Am I supposed to have a birth plan?” The answer is a resounding and definite…maybe? Birth plans originated as a way to have written documentation of your desires for decisions that may come up during the birth process. With the advances of science and medicine, labor and delivery has mostly transferred to a hospital setting. During this process women unfortunately lost some autonomy, but also gained safer maternal and fetal outcomes.
Nothing replaces good verbal communication. A birth plan is never a requirement and is never set in stone. The labor process can change suddenly without warning. The difficult question becomes, “how do I get all of the benefits of advanced medical care without the unnecessary interventions?”
When my patients ask me this question, I always refer back to our primary goal. In the end, we want to have the absolute best outcome possible. We want a perfect baby. At the same time, we want the least amount of stress and trauma to our moms both emotionally and physically. We know most everyone wishes for a nice natural vaginal delivery, but never at the risk of fetal compromise. It is critical that we know your baby is getting healthy, nourishing oxygen during labor. Of course, in reality, stress can enter the birth experience…even when moms and doctors do everything we can to make smart and healthy choices. Labor is a totally natural process and our bodies were made to do this. Most of the time labor and delivery can happen with very little intervention. The concern is that when something does go wrong, every minute matters. That is why you need a healthcare professional you trust to help navigate low intervention but still have access to a high level of emergent care when needed.
If you decide to create a birth plan, the good news is almost everything patients bring us is what we typically already do! The goal of your birth plan is to lay out your goals and expectations. It usually includes your wishes about when to get admitted for labor, managing your labor if it stalls or options of being induced if desired or recommended. It also addresses pain relief options and the events directly around delivery time. We want you to know what to expect during your labor, delivery and postpartum care.
Attached are copies of our two hospitals standard birth plans to help initiate thoughts and questions that may come up. A birth plan is not required, but can be a good tool to start up a conversation with your Doctor. After about 28 weeks, we are done with most of our screening and testing and your office visits may start to be directed towards your actual labor and delivery. That can be a good time to review it together. Things like setting the mood for your room and pain management are solely for you to decide. A nice calm environment is always best, so think about if you like the lights bright or dim, music playing, and make sure the people you allow to be present will actually contribute to the environment you desire.
When it comes to pain, I like to think about a “medicated or unmedicated” delivery. It is unfair to say it is a “natural or an unnatural” birth based on whether pain therapies are used. Labor is a painful process, even at its best. It helps to have realistic expectations. If your goal is to go unmedicated, we can pair you up with nurses who really focus on helping you with alternative therapies such as position changes, heat to your back, sitting on the ball, rocking in the chair, as well as meditation or prayer. I am totally in awe and amazed by those who go unmedicated. Women are warriors! But the truth is, it does not give you a healthier or better baby. It is unfair to be told that it is the “right way” to do it, and if we choose to get an epidural we have failed. We do not expect patients in any other medical situation to undergo severely painful experiences without treatment options. For example, if you had a kidney stone, we would not ask you to meditate or stare at a picture. We would give you options for medical treatment of course!
Alternatively, if someone does choose an epidural, it is not that you feel no pain at all, but it will decrease your pain dramatically. You can still have an absolutely natural birth…you are just choosing whether you want your pain fibers from the lower part of your body to send the message of pain back to your brain. It is not true that having an epidural would prevent you from being able to push or significantly increase your risk of a C-section. When you do choose an epidural, we will continuously reposition you with pillows and birthing balls that mimic the movements you would be doing if you were shifting around because of pain. Our L & D nurses are amazing and have so many strategies to mimic laboring positions. Both options are absolutely ok!
Other common birth plan topics surrounding delivery events are focused on effective pushing, decreasing tearing, and the moments right around birth. The short version is that we want to help you get into a position that allows you to push effectively. Often patients are exhausted at this stage of labor, so we want to be as effective with pushing as possible. Positions that create the greatest space from the anterior to posterior pelvis are most effective and we want to have access, of course, to this area to provide supportive care. This is why there are benefits to pushing with stirrups and opening up the hips/pelvis. Know that we will always provide lubrication, massage and support to the perineum to decrease the risks of tearing. If it is safe, we always try to deliver your baby right up onto your abdomen/chest. We always try for delayed cord clamping and ask partners if they want to cut the cord. We want our babies to have a natural skin to skin transition and gentle introduction to the world. If you have specific desires for the pediatric team you can include that in your plan as well.
We are all about breastfeeding but we also do not want to force it. The goal is to be nursing within the hour, but babies are doing a lot of work in the first few minutes of their life. We watch what babies show us. They will often let us know when they’ve safely transitioned their breathing and temperature control by starting to show signs of rooting, sucking and sticking out their tongues. The nursery teams are skilled and compassionate. They will be there to help you! These are just a few of many birth plan topics. Our doctors are all board-certified, and we follow American College of Ob/Gyn guidelines. If you have strong opinions, we want to make sure we are all on the same path so there are no disappointments. If you’re not sure of your opinions yet, that’s OK too! If you simply want your baby to have the healthiest start possible with the least amount of unnecessary intervention….then your birth plan is already in place.
At WCJC, we know it’s a big decision to choose your obstetrician. Our physicians have been delivering babies for a minimum of 10 to over 25 years. We have the passion, knowledge and experience to confidently partner with you while growing your family. One of the very biggest parts of the birth plan needs to be mutual trust. We promise to be good listeners, but we must be able to gain your trust so we can navigate through this journey together. Let us guide you on your childbirth experience!! We love growing happy families. Are you ready? Let’s go!
The Maternity Care Services Resources Guidebook
AdventHealth Birth Plan Check List