Creating a Birth Plan: How? Why?

Visual Birth Plan:

Why write a birth plan?

Birth plans can be very beneficial for a labor and delivery OR they can be a total waste. This is because they are what you make them. One of my main recommendations is that you DON'T use a pre-made birth plan from anywhere! Even our hospital birthing class offers one up with check boxes and fill in the blanks, the problem is this isn't always full of what matters to you (there will be more on there than you want and things you do want that aren't included).

When writing our birth plan I had nurses, teachers, and our OB all talk about the benefit of a quick picture format! Mama Natural has some great sources (https://www.mamanatural.com/visual-birth-plan/) but if you even just go to google images there are lots of options under "Visual Birth Plans." I created ours from different visual pieces I wanted to include and editing them on PowerPoint.

So here is the final image of our birth plan that I created (Note we have a header section that first says our names, baby's name, doula's name, due date, & photographer). We did not include any of my medical history including my allergies as that is all on my echart that they pull up upon arrival.

Key to note first is that we are having a 100% natural delivery. Why? So many people have said more power to us & I have even been asked if I think I am trying to be "better than others." Okay those are not the reasons people choose natural labors. So, with all the thoughts on it here are the main reasons we both wanted to have a completely natural labor:

1) Biological History: We don't know my biological familial history including medications, potential history of complications, history of premature babies, etc. Due to this we also don't know how my body would react to all the medications that they consider using that I have literally never had in my life before.

2) Mobility: I want to not have to be connected to machines, IV, and have constant monitoring. Laboring and creating progression with different positions and things like a shower is possible with our natural labor plan and not once you accept an epidural (read the waterfall effect below)!

3) Benefits to baby: Research via ACOG shows that babies born without an epidural are: less drowsy, more responsive, latch quicker and easier because the medicines you choose to take are not just getting to you but also to your baby.

4) Avoid Men: Thankfully my hospital has been very understanding of my trauma history and has been working with me to ensure the safest easiest delivery. If I use pain medications I would have to allow a man in my room to administer (and if you read my previous post from the Meltdown Monday it is just not something I can handle) so it has been very off the table ever since.

5) The last reason, and probably the least impactful but if I am sharing all of the "pros for not doing an epidural" I want to be open and honest with you all, is that an epidural just doesn't sound fun! It can be painful, it numbs you from the waist down and causes you to not feel the baby coming out which increases the chances of tearing, and a loss of control of your lower body.

Also here is the Waterfall Effect of Epidurals:

You get an epidural because of the pain which can increase your blood pressure. Because of this you are now required to be put on a constant IV and continuous monitoring. Epidurals also can decrease contractions as the hormone has been decreased in your blood stream which now means you will need Pitocin to up those contractions and continue labor. Because you are hooked up to everything and required to have continuous monitoring you are now forced to stay in the bed and unable to have free movement. You staying in the bed means that you will spend most of your time laying on your back, this position promotes an increase chance of back labor and if baby doesn't rotate increases the pushing time and chances of a c-section. If pushing time is increased there is an increased chance that they will have to use equipment intervention during your vaginal delivery (i.e. forceps/vacuum) to help get your baby out. If you have to have a c-section there is an increased risk your baby will need to go to the NICU even just for a few hours due to breathing too fast (more common in c-section babies since they don't get that push out that is so beneficial) which can impact breastfeeding as well.

Okay so here are the things we included AND why! I also think it is very helpful to the nurses if you have it separated by timing, so we have it divided by during and after delivery.

During Delivery:

1) No pain medications, please do not offer. If you don't state this on the birth plan then they will likely ask you hourly if you would like to have pain medicine or the epidural (even letting you know the last chance you can get the epidural). This may be something you are okay but it is something I want to keep out of my mind, it is completely off the table!

2) No Pitocin. Pitocin is a hormone used (administered through your IV) to induce labor and to create/strengthen contractions. If for some reason my contractions slow or I need some assistance we will be trying different positions, shower, and at worst case before meds we will have our water broken.

3) Vaginal delivery preferred: This is on our birth plan but potentially not necessary as that is most people's goal. However, it is there just to be clear.

4) No Males: This is on our birth plan with a separate note that says due to trauma history we can't have any men present. Please be true to you! When you think about your birthing plan consider adding no family members, only mom, only spouse, etc. To be very clear about who can be in the room.

5) No Students: Do you want to have residents in your birthing? That is totally up to you, I just know due to my history I want the least amount of people involved as possible with the best experience and so in our case I chose to not have any residents.

6) No Episiotomy: An episiotomy is a cut that the doctor performs during labor to aid in a vaginal delivery. It used to be standard practice however in most cases doctors don't perform routine episiotomies anymore. However, it is good to note that if you prefer not to do it so if they doctor is thinking of doing it they know they need to discuss it with you more.

7) Clear liquids/foods & intermittent IV if necessary: A hospital is not going to let you eat real food. (So eat a meal before you go in for sure) However, you have 2 options to consider at the hospital. A.) Attach to an IV and receive IV fluids only OR B.) Still receive the IV connection just to be safe, receive the IV as needed (the likelihood of you keeping up enough fluids during labor is pretty low honestly so consider this), and until they say it is needed you can stick to clear liquids and foods - jello, popsicles, ensure clear, and water!

8) Doula Support Services: I already have our doula listed at the top of our birth plan as one of my helpers but I decided it would be helpful to also include her listed under the during delivery process as she will be such an integral part of our process.

9) Free Movement/Intermittent Monitoring: These are 2 different but connected icons on our plan. A core part of natural birthing as discussed above I want to be able to move and try different positioning to get through labor which also means we need intermittent monitoring otherwise moving around would be very difficult.

10) Use of Aromatherapy: A benefit of having our doula is that she also specializes in aromatherapy. Know your triggers and use what helps you! We both know that Tomek's scent is very relaxing to me, that the use of aromatherapy has been very helpful for me when sleeping, or to relax at home. Therefore, we will also be using it in the hospital. Likely lavender, citrus, potentially vanilla, & of course having my husband close.

After Delivery:

1) Immediate skin to skin: Again this is a common practice for many hospitals as ACOG has produced quite a bit of literature on how beneficial it is for the baby! We of course put this on our plan to emphasize our need and desires to include it.

2) Partner to cut cord: I will admit this is something my husband wants to do but is also really nervous about as well. However we both agreed it is such a great moment for the dad and so we wanted to have him experience this.

3) Cord/Placenta Donated: Speaking of the cord we will be donating the remaining cord blood and placenta. Please note our hospital automatically does delayed cord clamping due to ACOGs research on how beneficial it can be. So we aren't depriving our baby of the extra red blood cells he can get, we will give him some and then donate the rest to potentially help other babies!

4) No pacifiers, formula, bottles: This is especially important to those who want to breastfeed as the potential for nipple confusion increases in babies who receive other types of nipples.

5) Breastfeeding ASAP: We know how important it is to breastfeed and so we want to attempt latching as soon as possible.

6) Please consult before EXTRA meds/foods: This doesn't mean we want to avoid medicines that are required and necessary! Standard procedures are: eye ointment, vitamin K shot, Hep shot, foot prick. All of these are necessary for baby and I am not opposed to them. The need for this icon was that beyond these elements and the standard testing I don't know what else is they may offer baby and I don't want them to do so until we can make an informed decision about it first.

7) Allow golden hour: So most hospitals have the idea of doing something like this anyway but don't always actually follow it as they are also trying to get all their boxes checked (which can wait!). Therefore, we put on here the need to have our golden hour between the two of us to bond with our baby!

8) Yes circumcision: This icon obviously only applies to if you are having a little boy. Do your own research to decide whether or not you want to have a circumcision performed on your baby. We chose to as it is more hygienic, has a decreased risk of UTI and STIs, is the same as his daddy, and if it became more difficult for him growing up the surgery to remove the foreskin as a teenager or adult is quite painful, while as a baby it is something that makes them cry but they are always okay right after, many have even reported that they have seen their little boys get it done and they stop crying right after.