My 18 year old daughter is currently 21 weeks pregnant and at her next antenatal appointment she will begin to design a birth plan.
She is booked to give delivery in the birth centre of our local hospital. The birth centre is part of the hospital birthing unit and has the same access to emergency facilities as the rest of the unit. Each birth unit room has a double bed, a spa, and a double shower. Other than that, they are not substantially different than the normal L&D rooms, except that they do not have a CTG. Nitrous oxide and morphine are the pain relief methods available in the birth centre and there is no drama if a patient decides that she'd rather have an epidural after all or if intervention becomes medically necessary - she's simply transferred across the hall (literally about 15 feet) from the birth centre to a standard L&D room.
The birth centre policy seems to be no eating during labour (we really need to clarify this, as when we asked the question the midwife sort of side-stepped it, responding that most women don't want to eat during labour and that "if you eat, you'll be sick - I ate all through my last labour and didn't even suffer any nausea, let alone vomit).
My daughter has a rough outline of how she'd like her labour and delivery to be managed, and I'm encouraging her to build in flexibility and articulate what she would like to happen if "Plan A" is not viable (in my experience, women with rigid birth plans often haven't thought about what choices they'll make if deviation from the plan becomes necessary and feel that control has been taken away from them if their original plan cannot be strictly adhered to for any reason).
My daughter's basic vision at this stage is an active labour with minimal chemical pain relief - preferably nitrous alone. I will be her major support person during labour, and the level of involvement of the midwife is pretty much up to my daughter.
I'd really appreciate suggestions of things to consider putting in the birth plan which we might otherwise overlook.
Jul 10, '04
I had a baby in March and did something similar so I can give you some tips.
First of all, I called mine a "birth preferences sheet". I know it is just a change of one word, but it is a big change. You can not PLAN labor, but you can most certainly have preferences on how you would like to go, and what kind of interventions you would prefer to avoid.
Second, I work in the labor unit, so I knew exactly what I needed down--things that might not be considered the norm at my hospital. One of the big problems with plan is that they contain WAY too much info--most of the things being interventions that are commonly done anymore. Nurses I think get overwhelmed with all the info--when there may be only 2 or 3 things they really need to know. As the prenatal class teacher, I have encouraged mothers who want a birth preference sheet to call our director or discuss with their doctor to find out which of their preferences they should have down. Things like enemas, are not routinely done much--so including that may be unnecessary, but if she wants to deliver in a different position, she may want that down.
She absoluetly should get her preferences okayed by her doctor. If her doctor doesn't go for it, she either needs to get a new doc or rethink her preferences. And her doc will then be able to advocate for her.
I think it is wonderful that she is individualizing her birth experience. try to keep her birth preferences down to 1 page only if possible. And remind her that birth can not be planned! A great book is "birthing from within" It taught me so much about birth and how your attitude and beliefs affect it. I would highly recommend it!
Jul 10, '04
I should probably have mentioned that the birth centre is fully midwife managed. Assuming my daughter's pregnancy progresses normally, she will see an obstetrician at 34 weeks, but otherwise all of her remaining antenatal care and her labor and delivery will be managed by midwives (this is equally true of the antenatal care for women using the standard delivery suites unless they choose to have a private physician attend their delivery or the pregnancy is high risk).
The only "given" in the birth centre is intermittent foetal monitoring using a doppler. Shaving, enemas, IVs and constant foetal monitoring are not standard for any delivery here - neither are internal exams during labour. To the extent that mobility or birth positions are restricted in the normal delivery rooms, it is usually as the result of an intervention (such as the mother requesting an epidural) or medical necessity rather than "hospital policy". The primary reason for having a birth plan for the birth centre is really in case intervention (and therefore transfer to the normal delivery rooms) does become medically necessary.
My favourite book during my last two pregnancies was Active Birth.
Jul 11, '04
Sorry--I forgot to say midwife instead of doctor. I believe it should apply to a midwife as well.
Jul 12, '04
Zhlake has some great suggestions. I agree with her - don't download a 7 pg birthplan off the net and mark what you do and do not want. The staff doesn't have time to read it, and most of the time some of the measures are outdated (routine shaves and enemas).
Condense what's REALLY important to you in half a page, or a page tops. If it doesn't differ from the routines at the hospital, don't write it down. Everything relevant to labor and delivery should be on this sheet. Plans relevant to PP should go on another sheet or should be shared verbally.
Also, address it something like Zhlake said - "preferences or wishes". "Plan" sounds hard and fast. Be sure you know that things may not go according to plan and be sure to prepare for them (don't dwell on them, be prepared for the unexpected).
It's interesting the way they do things in other countries. Freestanding birth centers in the states usually don't allow anything for pain (nothing IV or inhaled), and they do allow you to eat and drink as you wish. I just find that rather interesting.
BTW, I really enjoyed the program on TLC called "Birth Day". It had shown birth from around the world. Very fascinating program. I'd love to see more programs like it.
Jul 12, '04
..............or, hire a doula. that in itself can be so useful in empowering you in labor and delivery .This person is one who can communicate what you need to your staff and also tend to the needs of your significant other while you are birthing. That is my best advice. And I agree, a CONCISE and CLEAR birth plan is well-received. Be sure to tour your labor/delivery suite and department, meet the staff, and find out what is "routine" and what is not. Then, go from there! Don't forget to discuss your wishes thoroughly with your care provider.
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