Writing Your Birth Plan

The other day I was asked by a 37 week pregnant client about writing a birth plan. I told her that she had already made her birth plan. She had chosen our practice with a philosophy toward natural birth and Morristown Memorial Hospital for delivery which allows women many more choices in labor than most New Jersey hospitals. I believe she has positioned herself well to achieve the birth that she desires.

What is a Birth Plan?

A birth plan is intended to be a written document for a woman to communicate with her care provider and the hospital staff about her preferences for the day her baby is born. A birth plan includes things like how she intends to approach labor, how she intends to deal with the discomfort, whether she wants an episiotomy or not, and how she wants the baby to be cared for.

Why is a Birth Plan Important?

Making decisions about your pregnancy, birth and postpartum is a very good idea. But the decision making needs to begin early in pregnancy because the biggest decision a woman makes is her care provider. And the second biggest is the place of birth. Within the parameters of the standard practice of the provider and the policies of the hospital, lies the ACTUAL choices a woman can make in her pregnancy, birth and postpartum. This woman may believe that she will labor in the tub, but if the hospital or provider never allows women in labor in the tub, SHE WILL NOT labor in the tub. If a woman does not want continuous fetal monitoring, but there is no system in place to provide intermittent auscultation of the fetal heartbeat, SHE WILL NOT labor without the monitor. If the provider, anesthesiologist and nursery staff have a policy that all babies born by cesarean section must go to the nursery instead of staying with her parents, SHE WILL NOT have a “natural” cesarean no matter how many times she asks or how much she wants it. If a woman wants her baby placed skin-to-skin after delivery and left there until after the baby has successfully breastfed as the American Academy of Pediatrics recommends, and the hospital policy is for the baby to be first evaluated on the warmer or if their provider hands the baby to the nurse instead of the mother, SHE WILL NOT have immediate skin-to-skin contact with her baby. Hospitals can decide in just one day to stop allowing certain comfort measures for birth like waterbirth. So no matter what the woman planned, no matter how well she cared for and educated herself and no matter how safe the waterbirth option has proven to be, SHE WILL NOT get a waterbirth. To have the best chance at achieving your birth plan, begin by seeking out a provider and hospital most likely to support your birth choices and that has even EVER provided those choices to ANY woman.

Most women in the state of New Jersey have epidurals, nearly 40% have surgical births, almost none labor free of an IV or a fetal monitor, very few are allowed to eat when they are hungry, many are not even allowed to get out of the bed to go to the bathroom and a bathtub for pain relief is laughable to most NJ obstetrical providers. Parents have very little say about the care of their baby while he is in the hospital due to the rigid policies that are followed.

How to Plan for a Natural Birth

If a more natural birth is your desire, if you would like to avoid an unnecessary cesarean birth and you would like to make decisions for your own children from the day they are conceived until the day they can support themselves, consider that alternate care providers and sites of birth are the best way to “plan” your birth. Plan a consultation meeting with your care provider early in your pregnancy if possible. Think about speaking with a midwife in addition to an obstetrician. Discuss your feelings and preferences for your birth and begin to get an idea of what choices you really have. Consider a birth center (Note: currently there are none in NJ) or a homebirth. Both settings are proven safe places for childbirth for a lower risk woman but have fewer rigid policies and allow the family more choices and more comfort. Don’t be afraid to drive an hour or two for the birth you desire. A safe birth of your choice is worth the drive!