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| |    Five Steps to an Effective Birth Plan by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Why create a birth plan? The idea behind a birth plan--which I would rather call birth preferences--is to help you think ahead about what you want from your birth experience, and to improve communication with your OB team. One word to the wise here before we start: birth plans have a bad rep among many ob/gyns. I have even heard otherwise caring and respectful doctors say that the length of the birth plan is proportional to the length of the labor or to the chances of cesarean! This reflects a commonly held (if superstitious) belief that the more you try to control something, the less well it will go. While it is tempting to speculate as to the many reasons that doctors and nurses view birth plans negatively, I will focus here on how to specify your birth preferences in a way that will improve communication and trust between you and your OB team. Here are five steps to getting the birth experience that you are seeking: 1. Have a general sense of the kind of experience you want. Are you leaning towards natural childbirth? Do you want to have an epidural? Do you want to feel that you are being monitored medically for problems or allowed to be more on your own? These leanings can help you to decide on a practitioner and a place in which to give birth. Your choice of practitioner and site for birth may have more impact on your experience than any "birth plan" that you create. Note that many practitioners only deliver at one or two locations so these two decisions are closely related. 2. Educate yourself. There are many ways to have a baby. The next step is to learn about labor and birth and all of your options in greater detail. Read, talk to friends, and choose a childbirth preparation method that reflects your philosophy. 3. Get a feel for what it's like to have a baby at the site that you have chosen. Many hospitals provide tours of their labor and delivery units. Find out about routine procedures and policies of the birthing unit and of your OB's practice group. Ask questions during the tour, and check with your practitioner and with friends who have delivered there. For example, some hospitals have a limit on the number of people who can be with you in labor, or a policy on videotaping deliveries. Some units have birthing tubs or showers in the rooms to help you relax. Many practitioners feel that it is unsafe to eat during labor or to give birth without an intravenous line (IV) in case of an emergency. Is there a policy about how much cervical dilation is required before getting an epidural? Understanding these issues can help you to appreciate the choices that are open to you. 4. Your birth preferences. Now you are ready to determine the kind of birth experience that you are seeking. Think ahead about what you want, and choose coaches who can help you to achieve your personal goals. Remember that during labor you may not be thinking clearly and will need those around you to help implement your wishes. Planning makes you more likely to have the kind of experience that you have been wishing for. Instead of the traditional bullet point list, you may want to write your birth plan as a letter explaining the sort of experience that you are seeking. If you can keep it short and focus on your priorities, it will be easier for your practitioner to read, and less overwhelming. Be sure to state clearly that you trust the hospital team to do the right thing for you and your baby, and to make some decisions for you in case of emergency. For this step, see our article birth preferences. 5. Communicate with your team. Talk again with your doctor or midwife about what you are seeking. Ask her how realistic she thinks your goals are, given the location where you will deliver and how your pregnancy has been going. Not surprisingly, many practitioners aren't comfortable signing a birth plan as if it were a contract. Even if they support all your wishes, they can't promise that things will go as you want them to. When you begin your labor, you or your coach should let the nursing staff and the doctor or midwife know about your birth preferences. Be sure to explain that your purpose in listing your wishes was to clarify for yourself what you might want, and to encourage two-way communication with those who will be caring for you during this personal and memorable experience. Let them know that you understand that one of the beauties of childbirth is that no two births are exactly the same-and that you hope to be flexible and reasonable if confronted with the unexpected. You are most likely to be satisfied with your experience if you work together with your practitioner and the rest of the team to achieve the ultimate goal: a healthy mother and a healthy baby.
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