birth plan

The Birth Plan of ACTION!!

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.

If you want to learn more about birth planning, and get my downloadable birth planning templates, you can sign up for my Birth Connected Childbirth classes, with online learning and personal support, or just sign up for the Birth Planning module.

The Birth Plan of ACTION!! Read More »

Don’t plan your wedding!!!

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.”

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

“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 »

Venn diagram of the three kinds of birth doulas

There’s more than 1 kind of birth doula?

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 »

Review: Beautiful Birth Bundle DVDs

Julie Johnson is a friend of mine, and my very favorite lactation consultant to refer to. I’d heard for years that she had a video on the back burner, so when I recently heard it was done and on the market, I asked if I could have a copy for review!

The full Beautiful Birth Bundle consists of:

  • A set of three DVDs
  • A hospital birth planner
  • A relaxation CD
  • Some essential oils that can be useful during labor

All products are available individually or as a bundle of all of them. I am reviewing the DVD portion of the bundle only. Newsletter subscribers can enter to win a copy of the DVD set, so if you want one, sign up for my newsletter before June 7!

The DVDs come in a set of three, they are labeled A, B and C. None of them have any information on the length of the program, or which information is on which DVD. So let me set it out for you:

Disc A: Childbirth Education

1 hour, 2 minutes

  • What to pack
  • Doulas
  • Timing Contractions
  • Positions
  • Breathing
  • Labor Massage (featuring a licensed massage therapist specializing in pregnancy massage)
  • An OB discussing his views on birth
  • The phases of labor
  • Accupressure

This disc seemed a little disjointed and I would have rearranged the order to make it flow a little better and have the information build up better. I would recommend viewing the phases of labor and timing contractions first, then going back and watching the rest. This way you’ll know what transition is before you hear a discussion of how to breathe through it. I loved how Julie brought in experts in allied fields to teach areas of their expertise, and she had a real couple expecting their first baby there to learn. The couple’s questions and comments felt sincere and unscripted.

Disc B: More childbirth education

46 min

  • When to go to the hospital
  • Welcome to the hospital
  • Options
  • Natural Comfort Measures
  • Epidurals and the medical side
  • Medical Interventions
  • Back Labor
  • Cesareans
  • Pushing
  • Inspiration

I loved how so many of the segments here were filmed in an actual labor and delivery room with actual nurses, doctor and doula. This way, they were able to show how to do many of the techniques using the hospital bed, something often missed in videos on comfort measures.
Some of the included information may not accurately reflect regional differences. For example, when discussing narcotic pain medications, Julie said that there were three options: Stadol, Nubain and Demerol. She also recommended a half dose that would help the mom for approximately 2 hours. However, in my 14 years of doula experience, I have never seen any of the three drugs she listed given to a laboring mom. Almost exclusively, providers in my area prescribe Fentanyl. A half dose of Fentanyl does very little, and a full dose lasts only an hour. Since most of Julie’s doula experience was when she lives in California, and I know this is something that varies regionally, her experience with which narcotics are common is different than mine.
The video shows 2 options for pushing. Coached counted pushing and the tug of war. I enjoyed seeing the contrast between the two, but I would have liked to see others as well, or at least a mention of different pushing techniques that were not in a lithotomy or semi-sitting position.
I liked the inspiration section, where the doctor discussed what he loved about his job and there is a lovely slideshow of women laboring and birthing in a variety of settings.

Disc C: Birth stories

1 hour 9 minutes

  • Preparing for birth
  • Jennifer and Israel
  • Richard and Hope
  • Clint and Krista
  • Introducing Baby

This opens with interviews of couples about their birth stories. Initially I thought it would be only stories told through interviews, and not actually birth footage. Keep watching, there IS birth footage! Some of the audio in the birth footage is hard to hear, but the footage at births has occasional subtitles and some great tips. For example, at one point they are showing a woman laboring through transition, and they have subtitles “5 tips for helping mom through transition” Then, as the dad is providing labor support, subtitles describing what he is doing pop up. It would have been nice to better hear what he is saying when it points out “encourage her” but you see that he is very close, holding her and talking to her.
Earlier in the series, Julie had talked a lot about being in different positions and getting out of the bed, so I was a little disappointed that nearly all of the in-hospital footage was moms lying in the bed. I would have liked to see a lot more active laboring in the hospitals. I loved the last birth shown, where mom did quite a lot of labor at home and doing a lot of different things. The scene where the big sister is rubbing mommy’s back with the massager was so sweet!
All of the birth footage did a good job of showing the clock periodically to give a sense of the passage of time.

Some things I feel are important to a childbirth class that were not covered at all here are:
Everything that happens after the baby comes out. Even the delivery of the placenta was not addressed, and there is no information on skin-to-skin and breastfeeding. While this is not intended to be a breastfeeding course, a discussion of how and when to get the baby to the breast in the first few minutes of life is important.
Midwifery care was not addressed at all. This course is designed for those who are birthing in the hospital, but midwives can and do practice in the hospital setting as well, and are generally a fantastic option for moms planning a hospital birth.
A better discussion of HOW to make decisions in the birth setting. Several times Julie hinted that moms need to decide, that moms need to negotiate, etc. but there was no information on HOW they can do that. Parents need skills! I personally love this handout on that.

Overall, I think this is a great resource, but I don’t know that it is a good replacement for a well designed and facilitated *local* childbirth class. At the very least, it should be supplemented with a tour of the birth place and a list of pointed questions to ask about the way things are done in your area.

You can view a preview of the DVDs here:

Review: Beautiful Birth Bundle DVDs Read More »