birth plan

The Birth Plan of ACTION!!

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You can find boatloads of information out there on birth plans. But most of them miss what I consider to be the most important part: Putting The Plan Into ACTION!

I consider there to be 4 steps in writing a birth plan:

  1. Researching your options
  2. Deciding what is important to you and what you want
  3. Writing the document
  4. Carrying out the plan

We will briefly go over the first three before discussing that fourth, often forgotten step.

STEP 1: Researching your options

There are the major choices like

  • Where to birth (home, birth center, hospital, WHICH birth center or hospital)
  • Who to hire as your care provider (Midwife, Family Physician, Obstetrician)
  • Hiring a doula
  • Whether to use pain medications or not

and more minor decisions like

  • Which music to listen to during labor
  • What to wear in labor
  • To tweet or not to tweet

Consider all your options and figure out the pros and cons of each.

STEP 2: Deciding what is important to you and what you want

Once all the facts are in, spend some time deciding what is most important to you and what you want. For some, birthing with a midwife might be more important than whether or not they hire a doula. For someone else, the doula might be more important than the place of birth. There is no one RIGHT answer to all of these options, only the right answer for YOU.

If there is something you do not have a strong opinion about, it does not need to be in your birth plan. Save the most important topics for your plan.

STEP 3: Writing the document

Does the thought of doing this make you cringe? That’s OK! You can totally skip this step if you want to! While having a written birth plan can be an excellent communication tool for the nursing staff, the document is not what birth planning is all about. Everyone has different planning styles. Some people like to just think about what they need to do that day when they shower in the morning. Some like to make a list on the back of an envelope (that’s me!) and some like to have color coded calendars. All are perfectly valid ways of planning.

If you want to just think about and discuss what you want, that’s plenty. And you can skip to step 4!

If you’re interested in a formal written birth plan, keep reading!

Some tips for a written birth plan:

  • Make it yours! Don’t do a checkoff plan from the internet. You are not ordering off a menu, and you want the written plan to accurately represent the time and consideration you’ve put into it.
  • Keep it to one page maximum! Bullet points are nice. This is where prioritizing is very important!
  • Keep it positive in your wording. Your aim is to enlist the staff’s help in achieving your goal, not to put off the staff with “NO this, NO that!” I like to suggest wording like “I plan to birth unmedicated and you can help me by encouraging me to stay active and suggesting techniques you think may help.” or “Since I am planning a HypnoBirth, I would appreciate it if you would chart “Patient declined” instead of asking me about my pain levels during labor.”
  • Address any non-birth related issues that you think might be helpful. I have had clients use the written birth plan to remind the nursing staff about Latex or iodine allergies, request a special diet, and inform the nurse how to best communicate with a client who was deaf and needed to lip read in order to understand the nurse.

Step 4: Carrying out the plan

THIS is where most birth plans fall apart, in my experience. Just like browsing Pinterest for 600 hours won’t get you the wedding of your dreams, writing the document without doing anything to make it happen won’t increase your chance of getting the birth that you want.

Some important things you can do to carry out your plan:

Laboring mom’s best friend providing great active support.
  • Choose a birth place that does births similar to what you want on a regular basis. I have had many friends and neighbors choose to go to the hospital close by, just because it is close. They plan for and want a natural birth, but they have chosen to birth in a place with very high induction, epidural and cesarean rates. And (not surprisingly) they have a very high chance of being induced, getting an epidural, or having a cesarean.
  • Choose a care provider who practices in the way that you hope to birth. A perfect example of this is episiotomy rates. I have yet to meet a pregnant woman who wants an episiotomy, so they often discuss it with their doctor or midwife. Invariably, they get the response “I only do them when necessary” so they feel good about that – but they don’t realize that everyone’s idea of “necessary” is very, very different. I’ve known providers who do 1-2 a year, and I once heard a doctor say that his idea of necessary was “every first time mom needs one, and every mom who had one before needs another one.” Dig deeper. Ask how often they do one, ask if they think you will need one, ask how they can help you not need one. But look closely at the care providers you are considering, and don’t be afraid to change in order to get care that is compatible with your values!
  • Take a GOOD childbirth class, actually go, and PRACTICE what you learn! I’ve had moms tell me they only went to 2 of the 5 classes, never practiced a thing, and then be disappointed that hypnosis “didn’t work” at all. Practice will help you to master the techniques before you need them.
  • Build a birth support team that will build you up and help you reach your goal. Choose carefully who will attend your birth. I hope you’ll choose to hire a professional doula (maybe even me? :)) and bring others who are supportive of your goal. If your mother thinks the natural birth you’ve planned is a stupid idea, you probably don’t want her fretting in the corner about how hard it is to watch you in pain (been there, seen that!). If your sister thinks epidurals are an anti-woman plot by the paternalistic misogynistic health care system, and you plan to use an epidural, maybe she should wait out in the waiting room. (Also been there, seen that!) You deserve to be surrounded by supportive, helpful people, not Debbie Downers!

So you’ve gone through all four steps, and your Birth Day is finally here! Will it all go exactly as planned? Not too likely. Keep in mind that life rarely goes exactly as planned, and birth is no different. If things do happen and you have to adapt your plan, that’s OK. It does not mean you need to give up EVERY aspect of your plan, it just means you have to improvise a little. Writing a birth plan is not writing a script, but rather a process to help you get the birth you wanted. Staying in the game as an active decision maker is an important part of having a birth experience you can remember as a good experience, and that is possible in just about any type of birth experience.

The Birth Plan of ACTION!! Read More »

Don’t plan your wedding!!!

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Don't Plan BirthI’ve really gotten tired of it. Pregnant women who are planning for a specific kind of birth are told things like:

“You know what is so cute? You – when you’re pregnant and think you actually control how things go in the delivery room.” -ScaryMommy

“I encourage my clients to create “birth preferences” rather than a “birth plan.” In this case, semantics are important. By writing your preferences instead of a plan, you maintain the understanding that circumstances beyond your control may change and you’ll need to adapt your preferences accordingly.” -Fit Pregnancy

“Since you can’t plan how your labor and birth will unfold, I prefer to talk about your birth wishes or birth preferences than your birth plan.” -Motherscircle.net

“If my births and every single birth story I’ve ever heard is any indication, birth follows anything but a plan.” AnHonestMom.wordpress.com

“The word “plan” in reference to normal, unmedicated birth is pretty silly, actually.” – Facebook post

Why is it that when it comes to birth, women are shamed and told they should not expect to have any control? Birth is life. Life is unpredictable, in any given day you may have “circumstances beyond your control may change and you’ll need to adapt” – but no one says that we should not take time to plan out our day to make things run smoothly and we don’t miss anything we need to do! When I am teaching about birth plans in my classes, I ask for a show of hands who in the class had some plan for their day when they woke up this morning. Nearly everyone raises their hand. I ask how many had their day go exactly as planned – and most (if not all) of the hands go down. And yet somehow, in pretty much every class, someone talks about how the plan helped them adapt and/or prioritize when things went wrong.

Think about another significant event in the growth of a family: A Wedding.

Would it ever be OK to tell a prospective bride something like:

“The word ‘plan’ in reference to a wedding is pretty silly actually. After all, things go wrong at weddings all the time!”

“If my wedding horror story, or the ones I’ve read online are any indication, weddings follow anything but a plan!”

“Since you can’t control the weather or the behavior of your guests, I think it’s better to think of it as ‘wedding wishes’ or ‘wedding preferences’ rather than a plan for your wedding.”

“As a wedding planner, I encourage brides to create ‘wedding preferences’ rather than a ‘wedding plan.’ In this case, semantics are important. By writing your preferences instead of a plan, you maintain the understanding that circumstances beyond your control may change how your wedding day will go and you’ll need to adapt your preferences accordingly”

“You know what is so cute? You – when you’re engaged and think you actually control how things go on your wedding day.”

PinterestWeddingI sincerely doubt anyone would dare tell a bride any of that. And yet, things go wrong at weddings all the time!

Instead brides are advised things like this:

Unexpected Wedding Disasters and How to Handle Them

Wedding Planner Disaster Stories – and How to Avoid Them

Top Wedding Disasters and How to Plan for Them

Not a single story I read on weddings mentioned avoiding planning as a way to make the day run smoothly. Huh.

They all mentioned planning well, carefully evaluating the people who you hire, having backup plans, and thoroughly evaluating your options.

Sounds like a Birth Plan of Action to me….

Go ahead and plan for your birth. Yes, PLAN. Not “Wishes” or “Preferences” but actually plan for and put your plan into action. No, it’s not a script or a guarantee, but it does significantly increase the chances of having the birth you want.

Don’t plan your wedding!!! Read More »

There’s more than 1 kind of birth doula?

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Venn diagram of the three kinds of birth doulasIt’s been at least a decade since I first heard of the concept of birth doulas with different ways of looking at the job, and it has been an interesting concept to consider as I’ve come to know other doulas and mentor new doulas just starting it. I feel it can be a useful concept for parents considering which doula can best help them meet their goals as well.

At some point in the first 2-3 years of being a birth doula, I took a little quiz that categorized doulas into three types:

Birth focused – These doulas were focused on helping moms have the kind of birth that they felt was the best. They are the ones who are advocating for all low risk women to birth at home, for midwifery to be the standard of care unless higher level care is needed, and who have in mind an ideal birth they’d like to help their clients achieve. They tend to be huge fans of birth plans and often align themselves with specific methods of childbirth. Some doulas who have this philosophy will work only with out of hospital birth, and many go on to become home birth midwives.

Baby focused – These are the doulas who view everything about birth through the lens of the impact on the baby. They tend to be attracted to the work of APPPAH, to encourage mothers to talk to their babies and to be huge proponents of skin to skin bonding and breastfeeding. Many doulas who philosophically fall in this area tend to be very much against circumcision, routine newborn procedures, and formula. They can be passionate and valuable advocates and supporters of moms who have similar philosophies.

Woman focused – These are doulas who are most concerned with mothers feeling supported in their decisions and having the power and right to make decisions for themselves. They have an easier time supporting moms who make decisions that they may not have made for themselves. They tend to work in homes, hospitals and birth centers somewhat equally, and can support women planning everything from a planned cesarean birth to an induction with epidural to a home waterbirth or lotus birth.

Now these three types of philosophies are not at all mutually exclusive, nor are they unchanging and constant. As doulas learn, grow, and see more births, their thinking often changes. I would say that when I started out, I was definitely more birth focused, but over time I have become more woman focused, though I still do have quite a bit of overlap between the two with some baby focus thrown in there for balance. I feel pretty passionately that there is not any ONE way of giving birth that is “correct” for everyone, and I firmly believe parents have the right – and should be trusted – to choose what is best for their family.

Want to take the quiz for yourself? You can find it here: What Kind of Advocate Are You?

I don’t think that any one focus of a doula is necessarily any better than any other, but I do think it is important for parents to consider if the doula they are interviewing has a focus that is a good match for them. Most doulas will (like me) have quite a bit of overlap, but often there is one area that is more passionate for them, and it sure comes out when doulas talk about what drives their work and motivates them to do this job. You’ll hear it in their tone of voice, in the fire in their eyes, and in the power of their words.

One thing to watch out for is the doula that ProDoula founder Randy Patterson calls the “Birth Avenger” style of doula work. I’ve seen many times that new doulas come to this job because they had a horrible birth experience and they want to “save others from what happened to them” – this can create a really difficult situation when the doula has not processed and resolved her difficult birth experience. I’ve heard from a doula that she had to leave in the middle of a client’s birth because “she was going down the same road I did and I could not stick around for the train wreck” that she believed was coming. It was her last birth as a doula, she dropped all her remaining clients and left the field. I’m sure the client felt abandoned at a vulnerable time as well.

I’ve counseled doulas who were retraumatized by attending births at the hospital where they delivered – even if all went well.

Let me be clear here: Having experienced birth trauma does not mean a woman can never be a doula. It does mean she should do whatever it takes to process and heal from her birth trauma before attending other women’s birth. It may mean she sets boundaries such as not working with a specific place of birth or provider, too.

Being aware of what drives a doula philosophically is an important thing when practicing as a doula or when choosing which doula to hire. Not all doulas are alike, and find a good match in style, philosophy and personality is crucial for a good working relationship with your doula.

There’s more than 1 kind of birth doula? Read More »