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4 Things to Know Before Writing a Birth Plan

“If you want to make God laugh, tell him your plans. If you want to make a midwife laugh, tell her your birth plan,” writes Mia Freedman, a journalist and mother writing for the Sydney Morning Herald. Her point — told via a personal story about *planning* for an epidural and not getting one — is that the more specific the birth plan, the higher the risk of disappointment. Or even PTSD, which she suffered to a mild degree when her best laid plans went awry.

Mia Freedman is absolutely right that having a very fixed idea of how the birth will unfold is asking for trouble. Though Ms. Freedman had always thought that birth plans “were about candles, Norah Jones CDs and breathing, and were sprinkled liberally with words like ‘natural’ and ‘active,’” she came to realize that expecting a straight-forward medicated birth has its pitfalls, too.

Recently I posted about a massive survey of labor and delivery nurses in California that showed the majority of nurses think birth plans are helpful in preparing women in labor — that the women who brought them in to the hospital tended to be more educated about birth and therefore less afraid and overwhelmed.

This obviously goes against the very reasonable logic of Ms. Freedman’s observations. I actually understand both points of view. I’ve thought a lot about whether  a woman should write a plan and, if so, what kinds of things it should specify. And I’d like to offer some suggestions to those of you nearing birth:

1. Think about the things you can control and then let go of what you can’t.

You have control over your care provider, birth location, labor support person and your own education about how birth works. You can’t control your due date, the way labor will start, the length of labor, and how your body and baby will respond to labor. Sure, we all have ideas about how we’d like birth to unfold, but preparation for childbirth includes trying to stay open and flexible.

2. If you write up a birth plan, keep it simple.

The reality is that care-providers (from a high-risk OB to a home birth midwife) may not read every word of your six page print-out or, if they do, they may forget the minutia anyway. So think of a few things that matter most and jot them down. Maybe you had a very bad experience with narcotics and would like to avoid an epidural at all costs. Maybe you want to be sure no random people — such as medical students — come in the room.

The people caring for you at each step should know about your preferences: Sometimes this means a conversation with all the doctors or midwives in your practice and then reminders to whomever is there on the day of the birth. Your labor support partner should also be prepared to debrief nurses and residents so that your priorities are clear if you’re birthing in a hospital or birth center.

3. Learn a lot of coping techniques no matter what your “plan” for labor might be.

Some techniques simply do not work for certain women or certain stages of labor, so you want options. Early labor is completely different from very active labor, which is different again from pushing; how you cope early on may be entirely different from what you do later.

I do a lot of work with women preparing for birth and often find that I’m addressing set expectations. Some women really want to avoid or are even actively afraid of medical interventions in birth. I often need to speak to them about how and when these procedures and possibilities are valuable. The hospital — though not always the most lovely place in the world — has much to offer.

On the other hand, I speak to women who feel very anxious about laboring without intense medical supervision and intervention. These people often need help getting more comfortable with the idea that birth is a normal physiological process. They need reassurance that the pain of contractions does not mean something is wrong, and to be given lots of tools for coping with those contractions. An epidural used very early in labor increases the risk of labor stalling, more medications being used, maternal fever and the chances of a C-section. This means that even those who’d love to have an epidural often try and hold out until about five centimeters dilation or when active labor — the part that usually hurts a lot — is well underway. So some level of coping without drugs can be necessary in all scenarios.

The point is that whatever your primary plan is, you need to think about back-up plans and avoid demonizing the “other choice” too much.

4. Don’t freak yourself out about pain, but be realistic about the fact that labor is hard.

I do hear, from time to time, a woman feeling pretty sure that because her attitude is so good and her yoga body so primed, birth will be euphoric, if not orgasmic. I hope this is the case for all women in labor, but I’m a realist. Being prepared for some hard work, no matter what happens, is important. It’s hard work recovering from a C-section. It’s hard work laboring without drugs. It’s hard work being hooked up to machines and monitored and given lots of drugs in labor. If birth is an absolute a breeze, you can call me up and tell me to shove off. I’ll take the hit.

Now of course, birth is also filled with unforgettable moments and extraordinary experiences — you have a baby, it’s profound, life-altering, moving beyond words. There’s often a ton of euphoria that comes with the pain — medicated or not. It’s a very heightened, amazing time. I can’t count the times I’ve heard dads, mouths agape, gush over the power of women in labor, and this is after all kinds of births. But! There’s the hard stuff, too.

It’s also important to be realistic about your birthing experience. You want to labor in a pool with baby dolphins? Don’t think that’s going to happen at a high-risk obstetric ward in a major New York City hospital! Some medical conditions make it so that you’ll need to be continually monitored. If you know this in advance, then drop the idea that you’ll be walking and moving around a ton in labor and think about other things you can try.

This brings us back to point number one: educate yourself, know what your choices might be and then go forward as open-minded as possible. Soon you’ll have a baby and I hope that you’ll be impressed with whatever it took to get you there. Because I know it will have taken lots of work. And remember, eliminating the idea of a “perfect birth,” automatically rids us of the “imperfect birth.”

photo: Daquella manera/Flickr

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