28 Weeks - My Birth Plan

Of course, I haven't written in FOREVER!

I am 28 weeks and 5 days today, and can't believe the time is already here - I've hit the 3rd trimester, and that means birth preparations! In other words, my Birth Plan.

~ Watch the video that goes along with this blog post here: https://www.youtube.com/watch?v=KvHeuROAta4 ~

I had a birth plan with my son, which I am very grateful for as I did end up having a hospital birth and I feel that my Birth Wishes helped my birth team be all on the same page and support me in the way that I needed. I absolutely needed to do another birth plan with this baby, as a few things have changed (including having a partner present this time), and being more knowledgeable on how I personally cope with birth & the usual practices at the hospital required some tweaking to make my birth plan as accurate as possible.

28 weeks is a great time to start thinking about your birth plan, as well as beginning putting together your hospital bag (whether you plan a homebirth like me, for the "just in case", or a hospital birth where a birth plan is definitely needed), as you are still small enough to comfortably get around to pack & clear headed enough to thoughtfully plan your birth experience.

Here are the top points of *my* birth plan writing process:

1. I don't call it a "Birth Plan"
   I call my wants for my birth my Birth Wishes, because really, our babies make the plans. The most we can do is educate ourselves on normal birth progression, the options available to us in the place we choose to give birth and our providers, and the methods we plan to cope with childbirth pain - whether that be via epidural, IV pain medication, laughing gas, or more natural pain relief like the use of water, massage, different positions, music, humming, etc.
   
   Birth Wishes express our preferences and how important these preferences are, as well as outlining anything that may be emotionally or physically trying for us in our labour/delivery/recovery so our birth team knows how to best support us for the birth experience we hope for.
2. Keep it respectful but firm in your wants & needs
   While sometimes doctors (and midwives, nurses, etc) can get things wrong, for the most part they are well educated, professional, well meaning individuals that deserve a certain level of respect. I am a big advocate of advocating for YOURSELF, especially with pushy (and sometimes poorly educated) caregivers, but give them the benefit of the doubt that they are looking out for you & your baby's best interest.
   
   Because of that, I think our birth plans (wishes) need to be laid out in a respectful way, so as to not seem like we are so stuck on the "things" (music, delayed cord clamping, etc) that we are unwittingly putting our babies in harms way - of course we'd never do that, but these caregivers have to see some really stubborn-to-the-point-of-recklessness patients, and we want to set ourselves apart from that. So a nice disclaimer that this is what we HOPE for, but understand they might not all be possible if ours or our baby's safety is at risk is a nice way to show while we know what we prefer, the most important thing is everyone's safety, and we respect that aspect of their job.
3. Keep it to one page if possibleHopefully you'll be putting this in your hospital file (whether planning a hospital or homebirth, it's a good idea to have this in your file "just in case"), and every shift change your nurses, etc will be reading your file to be up to date on your progress & your wishes, as expressed in your birth plan. This also means your nurses have to read EVERY patient on their rotations' file, so try to keep your birth plan short, sweet to the point so as not too overwhelm them or take up too much time from patient care.
4. Research, research, research
   The best thing you can go for your birth is research EVERYTHING! Read books on childbirth from your local library or bookstore, use sites like babycenter.ca and whattoexpect.com for parent-friendly info, and reference sites like your local health link, Mayo Clinic, the World Health Organization, Society of Obstetricians and Gynaecologists of Canada (Canada's version of The American Congress of Obstetricians and Gynecologists) and any provincial/state recommended reading/hand outs/etc to find out more about procedures you may or may not encounter/want for your birth. Links for my area (British Columbia, Canada) will be available at the end of this post, or google other organizations applicable to you.
   
   Along with research is communication, which means bring your birth plan in to your doctor or midwife, talk it over with specifics pertaining to your hospital policies and why your doctor/midwife may or may not agree with certain requests you've made to to come to a happy, well informed and reasonable set of birth expectations you can all be comfortable with.
   
   Knowledge is power, and I (being very Type A and wanting all the facts) felt a lot better about birth & what would happen should complications arise knowing just how my birth team would react & best support my baby's and my health while also respecting my wishes.
   
   In writing my birth plan, it was extremely helpful (and recommended by my midwife) to look up sample birth plans specific to my area to know what things are common and not so common in my province, so as not to include useless info (like not wanting an episiotomy, which is no longer routine or even recommended anymore unless in extreme emergency situations) and to make sure to include relevant into that may be necessary in my area (like the availability of birthing room showers, should I choose to utilize them). Also helpful are basic birth plan generators that help you sort through which items are most important to you and bring up topics you may not have thought about on your own. Some great websites for this are listed here:
   
   https://www.heartforbirth.com/birth-plan-creator/
   http://www.childbirth.org/interactive/ibirthplan.html
   http://www.justthefactsbaby.com/birthplan/edit
   http://www.pregnancyandbaby.com/calendars/articles/937331/birth-plan-creator
   http://www.justmommies.com/quizzes/birthplan.php
   
5. Get excited!!
   Birth is EXCITING!! It is also scary, going into something you expect to be painful and foreign to you (see above how research can ease some of that "not knowing" anxiety), but it can also be a beautiful, magical, empowering experience, if you plan for it and face it head on. The best thing I did to aid my natural, positive birth is watch positive natural birthing videos and read birth stories from moms that absolutely LOVED their births - it helped me understand the waves of emotions I may feel in labour, what has helped women before me (millions of women did this before I did, going through this amazing process can truly make you feel connected to this incredible circle of women, past and present), and that I wanted my birth to be a positive, loving place for my baby to be brought into the world.
   
   Some women (and men) will say "It doesn't matter how you birth, as long as you and the baby are safe" - to an extent, safety is the MOST important thing, no doubt. But, when everything is going well and safe, things like feeling respected, supported, loved and empowered are important too, and that is where birth plans come in - in normal, uncomplicated, healthy births, not only can you bring a healthy baby into the world, but ENJOY doing so, feel HONOURED by the process and EMPOWERED that yes, your body can do this, you can create life and bring it forth, just you and your body (and baby) working together, no drugs necessary (if you so choose).

So now, after all that rambling, here is my birth plan (formatted so you are free to copy, paste, edit and plagiarize to your heart's content) - enjoy!

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Birth Wishes

Name:                              CareCard Number:

Prenatal Care: 

Birth Partner:                                      Labour Support: 

Thank you for being here for our labour! Please include us in all decision making.

This is our second baby, our son’s birth was very quick (under 5 hours), very sudden (dilated from 3cm to 10cm in an hour), and completely natural with no complications. We are very confident this birth will also be complication-free,with your support!

We are planning on having the most natural & peaceful birth as possible (we had planned a home waterbirth), but if our baby girl's safety is at risk, we will be more than willing to change our plans. Please just keep us informed!

Please ask me (or my labour supports) for details if needed, we'll be happy to clarify anything you need.

Labour and Birth:

● I wish for my husband, _______________, to be involved in all aspects of my labour/delivery/recovery.

● A doula *may* be attending our birth, if so her name is _____________ and we wish to have her with us at all times of my labour.

● I am aware of other ways to induce and speed labour, I wish to use those instead of any use of syntocinon or pitocin.

● I have studied and understand the types of pain medications available. I will ask for them if I need them. Please encourage me to utilize water (shower, bath) as pain relief before offering medication.

● Please encourage me to change positions often (hands and knees, swaying, encourage my husband to massage my lower back) if what I’m doing isn’t working, I wish to be squatting for pushing.

● My mother, ___________, would like to cut the cord, but please double check with __(husband)__ before doing so in case he changes his mind.

● When toweling her off, please do NOT wipe off her hands.

● Please use numbing cream instead of needle anesthetic for any stitching if possible. 

In Case of Emergent (or Planned) Cesearean: 

This is our worst-case scenario, these wishes can be changed according to

our baby girl's needs and the health of both mother and baby.

● If possible, please lower the curtain at birth so both my husband and I can see our baby for the first time together. When I can't see, please explain what is happening to help keep me calm.

● I wish to utilize your skin to skin & delayed cord clamping (2 minutes) policies if safe for the baby.

Baby Care:

● If our baby has temperature regulation problems: Please allow one of us to try skin to skin with her for at least 20 minutes to see if that stabilizes her temperature, before taking her to a warmer.

● Please do not give or suggest any formula without our consent, and only if there is serious concern for our baby's health, to support early success with breastfeeding.

● We are aware of the risks of bedsharing, and will attempt to place her in the bassinet for us to sleep, but if she won’t settle on her own we wish not to be bothered as we practice safe bedsharing (baby on their back, smoke free environment, no blankets or pillows, etc).

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Important Notes About *My* Birth Plan:

Identifying Info:

• I like to put my name, health care information, and labour supports on the top of my birth plan/birth wishes. This is probably unnecessary as it will be going right into your file with all that info anyway, but I feel like it makes it look a little bit more official.

Introduction:

• I worded this very carefully, to give off the respectful feel I describe above (point #2 of my birth plan writing process) so immediately anyone reading it will know I am explaining my wants, but understand emergencies happen, we would just like to be informed along the way if the plan changes.
• I mentioned my previous birth, including how fast I dilated and the length of my labour, because in general second time (or more, also called multipara mothers) are taken a bit more seriously in early labour due to already having done this before, and with my short first labour I have a good chance of this labour also being quick, which is important when determining when to admit me.

Labour & Birth:

• To aid in my natural birth, I hope to use water, lower back massage & different positions to cope with the pain, as this helped with my first birth. Things like not liking to be touched, not wanting a lot of talking in the birthing room, wanting music to be playing, etc should also be noted here.
• Not drying her hands may seem weird, but amniotic fluid actually tastes similar to how colostrum (your first milk) tastes/smells, so when she begins rooting for the breast and gets her hands in her mouth, as most babies do, the taste will help her locate the breast & connect hunger to my milk. It may not help much, but I did it with my son and figured it can't hurt.

In Case of C-Section:

• I try to be really flexible here, as a c-section for me would have to be extremely necessary, so whatever they need to do, they can do to get her out safely. I only request that I be informed as it's happening so I can stay calm, and immediate skin to skin/delayed cord clamping if safe for the baby.

Baby Care:

• Mentioning skin to skin and breastfeeding success aid in the overall impression that we are hoping for the most natural experience possible, while wanting to be involved with her care & give consent should complications arise.
• The bedsharing is a bit of a stretch, but my midwife said to leave it in and hopefully it won't be an issue as I will either birth at home as planned or aim to be discharged sooner than later so extended sleeping situations won't be an issue. I would also look into signing a disclaimer agreeing that I understand the risks and am bedsharing against medical advice, so would not sue if anything happened, should it be a real issue.

Here are some local resources for my area, British Columbia, Canada. Definitely look these over and research the appropriate resources for your area when considering your birth plan:

Place of Birth (Choice of Hospital or Homebirth in BC, Canada) Handbook:
http://www.cmbc.bc.ca/pdf.shtml?Registrants-Handbook-13-07-Place-of-Birth-Handbook
HealthLinkBC : Pregnancy & Childbirth
http://www.healthlinkbc.ca/commonhealthconcerns/womenshealth/pregnancychildbirth.html
Society of Obstetricians and Gynaecologists of Canada

http://sogc.org/
Baby Center Canada:
http://www.babycenter.ca/
What to Expect.com
http://www.whattoexpect.com/what-to-expect/landing-page.aspx
World Health Organization (look up topics related to pregnancy, and especially breastfeeding):
http://www.who.int/topics/pregnancy/en/

I hope this helped you decide whether a birth plan is right for you, and how to write one! Have a healthy & empowering birth!!

~The Pregnant Doula