Monday, February 07, 2011

More on birth plans

I'm on a birth plan kick, if you hadn't noticed already.

First, I wanted to share this post about birth plans from Stephanie Soderblom's blog Vita Mutari. Stephanie is a CPM in Arizona. I met her once at a birth conference in Mesa, and a good friend of mine attends births with her. Stephanie's post actually inspired me to write up my own birth plan, especially the wording in the first part of the hospital version. Here are some excerpts:
I have heard some argue that a birth plan is trying to control the uncontrollable (the birth)…that it is almost guaranteeing that you will have problems because you are trying to dictate the way the birth will go.

First off…I can not disagree strongly enough...To me, a birth plan has nothing to do with controlling the birth or how the birth will unfold…it is ONLY about how you are treated throughout this journey. I haven’t read a birth plan yet that addressed the BIRTH (“I want to be in labor less than 10 hours” “I will feel it only in my hips and cervix, not in my thighs or back.” “My contractions shall not become closer than 5 minutes apart”)…..NO! The birth plan is addressing the choices and actions of those around you!

Most birth plans can be summarized thusly: “You will treat me with respect at all times and I will maintain the autonomy that I had before entering your hospital. Before you touch me or intervene in the normal course of my labor/delivery, you will discuss it with me and obtain informed consent.

**stands back and looks at the birth plan**

Yep…that’s pretty much it in a nutshell. This in no way states anything about how the birth will unfold or trying to control events – it’s about how you are treated and the respect you are given in the process as an adult autonomous human with rights and freedoms....

My favorite birth plan I have ever been given was hand-written on an index card and said simply, “Don’t F*** with me!” I happily signed this birth plan, hole-punched it and put it front and center in her chart.
I also added birth plans to the "topics of interest" on the left sidebar. If you click on it, you'll open this window, which has links to all of my posts on that subject.


  1. Rixa, I love your previous Birth Plan post where you have four items on the list in the first version~I linked to it because it made me laugh so hard. It's so freaking true, and it's all I want in a nutshell.

    Having had 2 hospital births and having another (insulin dependant diabetic) in a few weeks, I have a few thoughts on birth plans! Things in my part of Canada are different from some parts of the U.S. (for instance, hospital policy may state whatever it wants but legally the woman has the final say~we have less litigation I guess? I dunno, different culture), but I have found it useful to have a birth plan to state the who/what/why of things that I want that are significantly different from a normal hospital birth. For example, I bring all my kids and they're there for the birth of their sibling. That's one of those things hospital staff hear about but rarely if ever actually SEE~so it's good for me to explain my kids' presence. Not justify, but mention it.

    Also, as a VBAC, hospital policy is CEFM but I always refuse it. So I state that I refuse, that I choose intermittant doppler checks instead, and say why (my risk of rupture after multiple VBACs is only 0.2% and I want to be free to move around in labour, evidence shows the effectiveness of intermittent dop checks).

    I think this can be helpful in helping staff to understand where I'm coming from so they understand that these decisions are informed, and they understand why each decision was made. I don't have to explain while in labourland, ykwim? I've never had to explain away or justify any of my *weird* (in their eyes) ideas or choices, and I credit my midwives and my birth plan.

    A birth plan isn't a plan so much as an explanation of who/what/why, IMO. It's not a rigid dictation, but a 'meet me and get to know what's important to me' type of paper intro.

    A nurse might not be on the same page as me, but at least she'll understand the basics about me.

    Anyways. That's my essay on the topic. =0)

  2. After writing a birthplan and ending up with a c-section for my first my second birth plan said "Do not have a c-section." Then it went on to talk about a few highlights for my preferences re: interventions and chord clamping, wanting to help deliver the baby, etc.

    For me it was best to move away from focusing on every detail and move towards the big picture, which was a successful VBAC by any means necessary.

  3. Wonderful!! I love the summary. I think you hit it right on the nail.

    And I love that last Birth plan. Four words, simple and to the point.

  4. Love this post! My post today was also about birth plans- or just the fact that I decided to write one this time around. I think it was more for the husband and I- to make sure we were on the same page, than anything!

  5. I would also suggest that mother who have experienced abuse or physical trauma that birth might trigger for them, need to put that in bold print FRONT AND CENTER as the first thing read.

    I'm a rape survivor and put that at the very top of my birth plan. I do feel that it help tremendously in how they approached me. (ie: cautiously)

  6. I love this birth plan (the slightly longer one, although the 4 word one is good too!) I always encourage my clients to give me their "birth preferences", and "plan" as a word always bugged me a little.
    In my current practice, I have the luxury of having discussed clients preferences repeatedly during prenatal care, and having a small nursing staff who are dedicated to doing what clients want. Birth plans haven't been very important (I mean a written communication - the plans themselves are important) since clients could be assured of having their own doc, and nurses who were really accomodating.
    Since I'll be leaving that for a bigger academic center, and covering for other docs for the first time in my career, I'm going to have to think about how to encourage clients to write something out to communicate with staff and maybe even doctors they won't know. I love that simple 2 sentences that really sum up what people want. I might just add "No means no."

  7. Personally, I love that you're on a birth plan kick! :-)

    I love both birth plans and the only reason I wouldn't use the second one is because the nurses wouldn't know me and I'm dropping F bombs they might be put off by that. But if they DID know me? That would TOTALLY be my birth plan!

    I went to my OB yesterday and she's cool with birth plans and I told her that so far I've got 'Don't cut me open and be nice to me' on my birth plan. Also, 'if you're having a bad day, take it somewhere else.' But I seriously may borrow this first one and put it on an index card. Love it!

  8. “You will treat me with respect at all times and I will maintain the autonomy that I had before entering your hospital. Before you touch me or intervene in the normal course of my labor/delivery, you will discuss it with me and obtain informed consent.”

    Wow, that is so perfect. I wrote a birth plan just recently and these posts are really encouraging to me. I was kind of embarrassed showing it to the OB at first but I am so glad I got over my fear of being belittled. He was really nice about it and said it was completely reasonable.

  9. Oh I love the summary! And I love your idea of calling the L&D nurse and finding out what a hospital birth at that hospital is really like so you can write a plan that addresses what you're likely to find. I'm feeling motivated to actually get mine onto paper and present it to my Dr (of course it's very likely I'll get one of the other 7 Dr's on call-depends on the day which one you get).

  10. I had a 2 page laminated birth plan I handed out when I delivered my first baby with a midwife in a hospital. My second I delivered with midwives in a free standing birth center. The difference was amazing, no birth plan was needed because I knew my wishes would be followed.

  11. I ABSOLUTELY LOVE this birth plan and if I ever decide to get pregnant again I am going to use it for sure! I may even add at the bottom the other one, " Don't F*** with Me!" Great stuff and says it all! LOL

  12. As a trained birth doula, I have a lot of mixed feelings about "birth plans." I agree the name is problematic -- you can't plan birth, but I don't like calling them "wishes" or even "goals" and usually default to "preferences" but even that isn't ideal. I think that the most important function of a birth plan is for the mother-to-be (and preferably her partner) to fully research all their options and make sure her/their philosophy of birth matches that of their care provider and birth location. If a mother chooses a certain a CP/birth location -- usually a midwife at home or in a freestanding birth center -- no birth plan will be necessary. But for the majority of women who give birth in a hospital, a birth plan can give the nursing staff an idea of what she's expecting and basically how to approach her. It draws a line in the sand, for better or worse.

    On a personal note, I'm glad you're on this kick, because I'm pregnant, due in April, and I need to write a birth plan. But it's going to be really tricky. After having a hospital birth with my son (with a birth plan, CNM, very supportive husband, no doula but relatively supportive nurses), I planned a homebirth this time. Then at 27 weeks, we discovered that I'm having twins. Homebirth is out of the question, and I'm still trying to decide between 2 hospitals to give birth, but either way, I'm going to be with a large group of care providers (so absolutely no idea who will be on call when I deliver) and even if I have a perfectly ideal vaginal birth and am able to have a CNM present, an OB will be "in charge." I'm kinda freaking out about having to deal with the whole hospital experience, much less as a "high risk patient." I have a doula and a very supportive husband, but I feel very nervous about this birth.


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