What’s In A Plan?
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Sweet Peas, Pods & Papas: All About Birth, B@@bs & Babies

What’s In A Plan?

     I attended the East Valley Birth Circle last night and the topic was comfort measures and birth plans.  There was some information and discussion related to birth plans that I was intrigued by since some were new ideas to me, and one offered a different perspective into something we talk to our students about.
     The group pretty much agreed on the basics:  Keep it concise and to the point, keep it positive, and fit your requests one page.  Replace phrases like “I refuse” and “I don’t want” with phases like “I prefer” and “I request that”.  Beyond that, there was some good discussion and here is the information that I want to pass along.  

Hospital Plan, Doula Plan
      One of the participants who has worked as a doula said that when she would meet with clients, she would help them evaluate their birth plan to pare it down to the most concise information that the care team needed to know to do their job.  For example, let’s look at these wishes:

  • Mom allowed juice and light snacks
  • Intermittent fetal monitoring to allow freedom of movement for walking, squatting, showers
  • Use of a heparin lock instead of continuous IV
  • Use of birthing ball/other labor aids
  • Personalize the environment with low lighting, music, pillows and blankets from home, socks from home
  • Use self-directed pain relief such as Massage, Yoga practice, Relaxation techniques

     Here are the things the hospital staff needs to know to do their job as long as mom and baby are doing well and labor progresses without complications:
-Mom allowed juice and light snacks – in most hospitals, they will restrict food intake unless otherwise directed by the doctor
-Intermittent fetal monitoring – the standard procedure is to have mom monitored continuously since epidurals are still the status quo in hospital births
-Heparin lock instead of continuous IV – again, this is a compromise in a hospital setting.  If you are not having an epidural, the doctors usually want a “just-in-case” entry point should there be an emergency.  The staff needs to know when you come in to set you up with a heparin lock instead of an IV line.  

     Her suggestion would be to move these things to the doula list:
-Use of birthing ball/other labor aids
-Personalizing the environment with low lighting, music, pillows and blankets from home, socks from home
-Using self-directed pain relief
-Freedom of movement means we want to try walking, squatting, showers  

      The editing made the list a lot shorter (3 lines instead of six) and easier for the hospital staff to determine what this family needs from them during labor.  However, the family’s desires and plan for a natural labor will still be met since they have a pain management plan designed by mom and coach. The doula and dad have a good working list to help mom manage her drug-free labor, and the hospital staff knows what they can do to help this family.  Everyone is happy!

Family Plan
     This suggestion was brought up by one of the certified nurse midwives (CNM) in attendance.  She says she doesn’t care to see all the items listed in the above plan.  She feels since her clients have already signed up for midwifery care, that is part of the package.  What she does like to see written her patients plan are directions that specifically address how they want their birth to proceed:  Who do they want there?  When are they going to go to the hospital?  How are they going to notify people?
     Her feeling was that the biggest hindrance in labor is the emotional aspect.  (BTW - I couldn’t agree more!)  She relayed anecdotes of mothers whose cell phones were ringing every five minutes with people wanting to know how things were going, or a mom who had people there that were making her uncomfortable, i.e., her mom, a sister, a mother-in-law, who were not comfortable with seeing the laboring mom uncomfortable or they didn’t believe in the natural process and started to push the family to make choices that they didn’t want to make or deal with.
     When having her patients think about and prepare the plan well ahead of the birth, she suggests that they share this information at the baby shower.  This way it is shared at a “happy time” and not during the labor.  Labor is for “laboring” when all mom needs to be focusing on is tuning in to her baby and her body, not the distractions around her that are keeping her labor from progressing.
To Sign or Not To Sign
     One very experienced mother (7 births) who is also a doula and a childbirth educator commented that she tells her clients if they feel the need to have their birth plan signed by their care provider, she has found that there is an underlying trust issue and that they should think about finding a care provider that they trust completely.  For narrative purposes, let’s call her Tracy.
     RED FLAG! RED FLAG!  That was my first reaction.  What???  As a person who has had three hospital births, I wanted my birth plan signed by my doctor to ensure that the hospital staff knew that my doctor and I had discussed our options and we were all on the same page.
     The more I listened to her perspective, the more I began to understand where she was coming from.  There were other people who were pro-signing who added to the discussion, and Tracy kept going back to the illustration that if you are in such a large practice that you need to have your care provider sign to ensure the other care providers respect your wishes, could that mean that you might be going into labor with some fears?  From this perspective, I could see where Tracy was coming from.  Fear is another one of the speed bumps in a normal, progressive labor.  If switching to a practice where there are fewer care providers and all of them are on board with natural labor and birth, then yes, that would eliminate one of the pressures that a mom might have going in to her labor.
     Here is how we dealt with that situation with our mega-practice.  There are 14 care providers, and of those, nine are doctors who attend hospital deliveries.  We put our birth plan in our file early so that every one knows that we do not do in-office vaginal exams.  At the monthly doctor meeting that occurs before our due date, our primary OB care provider takes our file and our birth history with her and tells them our case history, and asks that whoever is on call when we go to the hospital respect our wishes.  She reassures them that we are there to take advantage of their medical knowledge if we need it, but until then, they can leave us alone.  So far, it has worked with good results.  Since this is not the case for all practices or doctors, nor is it the standard if you are a first-time mom, then Tracy’s recommendations make more sense.
     In the pro-signing camp, it was generally agreed that having a signed document from your care provider is an asset when working with the hospital staff, especially if there are requests such as the three things we pulled out from the wish list in the example above.  I suggest to our students that of there is anything out of the ordinary as far as the hospital staff is concerned, have your care provider sign off on it so that the staff knows they “have permission” to break their protocol.  Nurses like to do their job, and they like to do it well.   Understandably, they do not want to “get in trouble” or do anything that would endanger their patients.  If these requests are new to them, then you are more likely to have your wishes respected if your doctor gives them permission to break with their normal routine.
     I really enjoyed last night’s session, and I hope that this information on birth plans helps you clarify your format when you start to prepare yours.  As far as what to put in it, there is so much information out there, and there are many variations in what “standards” of care are according to the practice or the hospital.  Here are some questions to ask of your care provider and of the hospital or birth center when you go on your tour:
1.  What can I expect to happen when I get to the hospital or birth center?
2.  What is your normal routine with a low-risk patient?
3.  Is there anything that you absolutely don’t allow?
4.  What are some things that you have seen on birth plans in the past that are a cause for concern?
5.  What are some things that you have seen that work well?
     If you get any red flags with any of these questions, or you don’t feel like there is room for them to hear your wishes, then it may be time to consider a change in care provider or birth place.
     The CNM in attendance last night offered an observation that I found interesting: doctors in the U.S. have a tough job (she is from the UK).  They are highly skilled surgeons making life-and-death decisions in one minute, and the next one, they turn around and all they have to do is catch a normal, low-risk baby.  She said it is tough to turn the switch on and off in an instant.  Having heard this, I say even more emphatically: it is our responsibility as parents to know what our care provider and birthplace are comfortable with.  It is not realistic to expect them to change just because you have done your research and want to do something that is outside of their comfort zone. 
     To use another great analogy from last night, someone offered the metaphor of finding a mate.  You will be happier with your outcome if you find the care provider and birth place with whom you “feel the love” instead of continuing to “date” someone who is nice, but just doesn’t feel right to you.  They may be the right person for someone else you know, but until you “feel the love” you will continue to be disappointed in your interactions. 
     The birth of your child is a special and momentous event.  Prepare for it, plan for it, and surround yourself with the team that will joyfully welcome your child with you.
Disclaimer:  The material included in this blog and/or website is for informational purposes only.  It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog and/or website contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained in this blog and/orwebsite do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

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