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Plan A, B, C, D . . .

Tuesday, 10 June 2014 14:34
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Meaegan Dougherty Photography Meaegan Dougherty Photography

When I was working on my birth plan I had a discussion with a coworker about making a plan. Her argument was that you can't plan a birth because there are too many unknowns. I countered that that was the very reason every woman needed a plan.  

This is not a birth plan:

I will start labor on my due date at 9AM after ten hours of sleep and a well-balanced breakfast. After four hours of early labor, spent watching TV and receiving a back massage, we will have an uneventful trip to the hospital. Upon arrival at the hospital, I will consent to a vaginal exam determining I am 6 centimeters, 80% effaced, and 0 station. An epidural will be administered promptly because there is a readily available and unoccupied anesthesiologist waiting for me. After four hours I will begin pushing and have my 7 pound, 7 ounce perfect bundle of joy after a mere five pushes. The doctor who attended me throughout pregnancy will be there to deliver my baby. There will be no tearing. We will be discharged by the next morning, only staying a night so that I can have the assistance of the nurses so I can sleep and establish breastfeeding. Before discharge my milk is in and our latch is perfected. While we were at the hospital my mother cleaned my house and has lasagna in the oven.


Okay, I hope with all of my heart that every woman can have a birth like that - simple, easy, painless, textbook (whose textbook?!).


My birth plan included rules like don't eat near me, let me roam freely (I ended up spending about 24 hours laboring on my toilet because it felt like I was trying to poop a railroad tie past three feet of rebar) I only wanted one cervical check, and don't rupture my membranes. I made rules because I didn't want any interruptions - we forgot to unplug our house phone and it rang mid-contraction and now when it rings I am filled with the same rage I was that morning.

I planned a homebirth but had a hospital transfer plan, and a Cesarean Section plan. 

It was important to me to labor unmedicated but wanted an epidural in the event of a transfer to the hospital. When we transferred I was glad I had pre-planned an epidural otherwise my birth team and I would have been on different pages: they might have encouraged me to continue unmedicated, oblivious to my wishes. Quite the opposite, a mother might think to herself that she believes she can have all-natural childbirth but fails to let her partner and care provider know - at 3AM she might discover a needle in her back not because she was tired, but because her husband was. Afterwards, she might be left yearning for what she knew she was capable of. With every intervention comes risks and benefits: it is important for every woman to know where she stands prior to entering the delivery room, lest she be faced with a decision when her limbic system has taken over.


Some important items to consider in a birth plan:

What methods of pain relief would you like? A hot shower? Massage from your doula or partner? Epidural? Nitrous oxide? A TENS machine? Be sure to know and understand the risks and benefits of each.

If augmentation of labor is suggested, what will you do? How do you feel about synthetic oxytocin? Do you know and understand the risks?

Who would you like present in your labor?

Do you want to eat and drink freely?

Do you want an IV?

How frequently do you want your baby monitored in labor?

How frequently would you like to be checked for dilation?

Your doctor might offer to rupture your membranes, how will you respond?

Under what circumstances would you consent to a Cesarean? Vacuum or forceps delivery? Know and understand the reasons for each - some are genuine emergencies, sometimes it is simply impatience.

Would you like to be encouraged to labor and push in different positions?

When would you like the umbilical cord clamped and cut? Do you want immediate skin-to-skin?

Erythromycin is often put in the newborn's eyes - is it necessary for your baby?

Oral or injectable Vitamin K? When and where will the baby's first bath be?


Knowing how you feel and letting your birth team know ahead of time will ensure your wishes are known. Things can change in a second, and so can your plan. Planning ahead will help you be more flexible - augmentation may have been off the table, but when someone mentions an impending Cesarean you will be able to weigh the risks and benefits and alter your plan accordingly and with genuine informed consent.


Remember this is your birth, your baby, your body. You have the right to refuse and the right to request. You are the boss.



Read 6199 times Last modified on Thursday, 31 July 2014 08:59

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