I Have The Secret To The Best Birth Plan Ever!

Birth plans are all the rage in pregnancy in the last five to seven years. Every app, every mommy website, every natural birth instructional anything contains mention of and often a template for a birth plan. In this post I will answer the following questions:

1. What is a birth plan?
2. What are some common misconceptions between doctor and patient?
3. What are things that you, the mother, can do to increase chances for a vaginal delivery?
4. What factors are unpredictable, so that you won’t be shocked if you encounter them?
5. What items SHOULD be on EVERY PARENT’S birth plan?

Wait, you’ve haven’t heard of a birth plan?

Well, a birth plan is essentially a written guide crafted by the mother that lists her requests for her labor management and delivery. Sometimes it contains lists of medications that are requested and ones to avoid. Sometimes it contains requests for who will participate in the labor and delivery- Attending physician versus midwife versus resident versus medical student etc. Sometimes it contains statements like this:

I do not want a C-section.

Why do people create birth plans?

The answer is simply two words: Vaginal Delivery. A birth plan is like a recipe for the best Thanksgiving dinner delivery. Most people want their baby to come out of their vagina as healthy as possible. At the end of the day, they want an uneventful vaginal delivery. If you get the ingredients just right, that baked macaroni and cheese delivery will be amazing. Right? 

It is a delicate line to walk as a physician.

BIRTH PLAN FOR MY PERFECT DELIVERY

No induction.

No pain medication.

No IV fluids.

No Pitocin.

No breaking the bag of water.

No C-section. No C-section. No C-section.

GLOWING VAGINAL DELIVERY

These are common components of birth plans, large and small. It is technology’s fault that vaginal deliveries don’t always happen. It is because we doctors want to rush ladies through the labor process and have a baby before our own dinner time. If we doctors would let labor happen on its own, with minimal intervention, there would be less C-sections. Right? Wrong. I have no incentive to rush your labor. I am not motivated during your labor by any other goal than to get you and baby through labor and delivery unscathed.

I want to tackle a few facts.

• 99% of OB/GYNs want you to have a vaginal delivery as much as you do.
• There are things you can do to increase your chances for having a vaginal delivery, and I will share those.
• There are factors that are out of both the doctor’s and patients control that can lead to a c-section, birth plan or no birth plan. I will give some examples.

Picture this: You need to get from one end of the country to the other. You have never traveled outside in the elements before. You can’t drive and the only map you have is one drawn by a friend or acquaintance who once traveled a long distance on foot in the past. The only difference is that they started from a different place and had a different destination than you. Some had luggage, some didn’t. Some exercised, some didn’t. Some traveled in the summer. Some traveled in the winter. Some traveled over mountains. Some over flat land. Some traveled 2 miles, and some traveled 20 miles.

Oh and one friend had a brand new prosthetic leg when she made the trek.

In my analogy, the distance represents the labor course. I’ve cared for women who were in labor for 5 hours and women who were in labor for 5 days. The luggage represents not only the woman’s weight, which can matter in labor, but also the size and shape of her pelvis. How easy or hard is it for this baby to make it through the pelvis? The season and weather can represent the baby’s well being, which is very unpredictable, variable and can change in an instant without warning. The prosthetic leg represents the different circumstances that make us each unique. Maybe this woman has fibroids. Another woman has had surgery on her cervix. Another has severe back pain resulting from a slipped disc. They are all different, and because of this, the labor course is unlikely to be the same.

Where do I, the OB/GYN, fit into the mix of this analogy? Well, rather than being guided by a person or people who have traveled a hand full of times over limited terrain and have drawn you a picture, consider me an in-person hiking guide who has made thousands of trips over variable terrain in every season in every storm. Who do you want as your guide?

Technology is not the enemy.

In places and countries where interventions are not available, there may be less C-sections, but there are more complications. In the United States, one of the biggest risks for a woman in labor is hemorrhage or excessive blood loss. A working IV is essential to be able to give fluids during labor for baby’s safety, but also to slow the effects and allow intervention during hemorrhage. While a person is bleeding excessively, this is the WORST time to try to start an IV (the veins practically disappear) or to find out that an IV that does not have fluid flowing through it is not working or had clotted shut. In my hospital, you can still walk and be mobile with an IV. It is like a labor seatbelt.

Likewise, monitoring the baby’s heart beat ensures that you and baby are getting through labor safely. Some desire to not have their babies monitored because they don’t want interventions as a result of monitoring. Keep in mind, if the baby looks healthy and safe, interventions aren’t necessary. If the baby looks like they aren’t getting enough oxygen based on the heart rate, this may lead to intervention, but you would want that intervention. In that moment, the safety of you and baby is more important than the route you take on you cross-country trek.

If you are in a car accident, that is not the time to put on the seat belt. It is the time to use it. Allow the IV.

Pregnant trimesterSome things that a woman can do to increase her chance of having a vaginal delivery are to exercise before and during the pregnancy, to try to be at a healthy, non-obese body weight at the beginning of the pregnancy, to keep diabetes and high blood pressure under good control if present, and to deliver before 2 weeks past the due date. These are just a few examples.

Some factors that are relatively out of the mother and doctor’s control are the baby’s ability to tolerate labor, the size and shape of a woman’s pelvis, the size of the baby (sometimes it is just genetic) and the baby’s position. I am actually writing a post about some factors that may increase breech or head up positioning at term (the due date) and some ways to encourage normal positioning. Stay tuned for that.

Labor, unlike many other aspects of life, is very difficult to control.

Most people can walk a short distance. A few blocks or even a mile or two on foot on a mild spring day could literally be a walk in the park. But what if your destination is a little farther. What if you unexpectedly have two suitcases, you are wearing high heels, and your grandma who gets short of breath when she walks is with you? In a blizzard? How are you going to get to your destination in one piece with all of your stuff and your grandma? That’s what your guide is for.

So what SHOULD you put on your birth plan? At my hospital most of these items are automatic, but just in case, here are some suggestions for a term (not premature) pregnancy:

1. What kind of pain management am I interested in, if any.
2. I would like any labor interventions discussed with me for understanding and clarity.
3. I would like skin-to-skin with myself and baby if the baby is breathing well. Dry the baby first to maintain body temperature but then chest-to-chest contact with mom is important.
4. I would like delayed cord clamping for at least 30 seconds if there is no meconium and baby is breathing well.
5. I would like BLANK PERSON to cut the cord.
6. I would like to breastfeed if possible. It is the healthiest thing for baby if I am able. I understand that occasionally supplementation is necessary depending on the amount of baby’s weight loss and/or blood sugar measurements.
7. Do I want music playing? Who is bringing the play list.

While these are not the only items that can go on a birth plan, notice that these few suggestions do not include labor management. You have to trust that your doctor is making appropriate decisions with and for you and your baby’s safety. If you aren’t clear about the reasons things are happening during the management of your labor, ask for explanations from the nurse and/or doctor.

Informed consent and shared decision making…

… means that we – the doctor and the patient – discuss the management, including, risks, benefits and alternatives of the various options and together come to a mutually agreed upon decision. This will continue to foster trust and allow the labor process to take place with low risk for complications and with clear expectations.

My birth plan as your doctor: To get you and baby through your delivery as safely as possible, with as little intervention as is necessary, but as SAFELY AS POSSIBLE. Try this:

The OB/GYN Serenity Prayer

In pregnancy, grant me the SERENITY to accept the things I cannot change,

The KNOWLEDGE and MOTIVATION to change the things that can increase my chances for having my dream delivery,

The PEACE and UNDERSTANDING that my healthcare providers have the best interests of myself and my baby at heart,

And the WISDOM to know the DIFFERENCE between what can be changed and what cannot while understanding all associated risks, benefits and alternatives.

 

What do you think?

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This article was originally published on The Gyneco-(b)Logic