Additional thoughts on birth plans

I've never written a birth plan. My first baby was a planned unassisted birth, so there wasn't any need to write a list of what I did or did not want to happen. I would just do it! With my second baby, I saw a nurse-midwife in a solo homebirth practice. Several times during my pregnancy, we discussed what I wanted her role to be at the birth. I'm seeing the same midwife this time; the only difference is she has added another CNM to her practice. They almost always attend births together, so my original midwife will likely be there. I've talked through my wishes with the other midwife, so she also knows what I expect her to do (basically, not much at all unless I ask for something or an urgent situation arises).

Some women planning out-of-hospital births write up a birth plan in case of a hospital transfer. Because my midwife is legally recognized, she can accompany me to a hospital with no fear of arrest or imprisonment. She knows what I want, and I figure between the two of us, we will be able to make my wishes known.

If we didn't have such a fragmented maternity care system, written birth plans would be largely unnecessary. When a woman knows her care provider well and has continuity of care through prenatal visits, labor, and birth, a birth plan is redundant. But this scenario exists mostly in out-of-hospital births, where the people attending the woman already know her and her desires. Most women give birth in hospitals, where nursing staff they have never met before provide most of the labor care. Hence the rise of the birth plan. Birth plans also exist because hospital routines vary so widely from one institution to another. If, for example, all hospitals were Baby-Friendly, then there would be no need to have a birth plan mentioning skin-to-skin contact or not giving pacifiers or sugar water to breastfed babies.

One of the best tools you can take with you to the hospital is getting BRAINS/BRAINED*. Go through these simple steps whenever you're facing a decision about a procedure, medication, or intervention. This is definitely something to print out for your birth partner!

BRAINED
Trying to make a decision? Get BRAINED!
Ask yourself, and your caregivers, these questions:

Benefits - How could the recommended course of action help me or my baby?
Risks - How could the recommended course of action harm me or my baby?
Alternatives - Are there any other courses of action I could consider?
Intuition - What are my gut feelings about this?
Nothing - What happens if I do nothing?
Evaluate - Can you give me some time to consider my choices? Then...
Decide - Now that I have the information I need, I'm ready to make a decision.

BRAINS

Benefits- How will this procedure benefit me and my baby?
Risks - What are the risks to me and my baby?
Alternatives - What are some other things we might try instead?
Instinct/Intuition - What is your gut telling you?
Now/Never/Nothing - What if we don't do the procedure right now? What if we never do it? What if we do nothing?
Safety/Satisfaction - Will this procedure increase the safety and satisfaction of the birth for me and my baby?

Additional reading on birth plans:
A physician speaks about doulas and birth plans
Kingsdale Gynecologic Associates: doula ban and birth plan
Ghouls and doulahs
Midwifery model of care

*The BRAINED acronym comes from a handout that someone gave me from "Lucina Birth Services." The BRAINS acronym was passed around on a doula list serve.