Tuesday, July 22, 2008

Unlocking Birth Plans

When I was pregnant, I thought of a writing a birth plan for a hospital birth was like a cafeteria, you had choices--you could take and leave what you wanted. That's when I developed my birth plan based on the real life example of others. I wrote all the things I wanted with provisos about all the things I didn't want. It was three pages, complete with a very nice letter to the nurses, midwives and doctors I would be working with.

Then after I discovered what hospital birth is really like, I heard birth plans being maligned. I learned that birth plans aren't typically read but are often scoffed at before they are thrown in the trash. But information still promulgates that birth plans are useful tools in having individual desires, wishes, cultural and religious values being respected; while others state that birth plans are useless.

I've been trying to figure my through this chasm of opinion. I wasn't quite prepared to throw away the birth plan idea all together, but understood how they often do not have the effectiveness that families desire. One solution I've heard touted is a birth plan should take up no more space than a 5 x 7 index card with easy to read font (no 7 pt business). I didn't understand how that was possible, based on the number of birth plans I'd read and the one that I too composed in preparation for birthing in a hospital.

Recently, in the book "Pregnancy, Childbirth and Your Growing Latter-day Saint Family" written by a registered nurse and certified childbirth educator, I read an example of what a index card birth plan would look like and I began to see how this would be plausible. I will attempt to reproduce what I found:

Room: Labor, deliver, and recover in same room at local hospital
Other people present: husband, doula (a woman who provides professional labor support), and maybe mother
Food and drink: light foods, juice, water as desired
Fetal Heart Rate: intermittent, with initial 20 minutes electronic monitoring, then hand monitored every 15 to 5 minutes as needed.
Pain Relief: relaxation, breathing, comfort measures, shower, hug and kisses from husband!
Labor Stimulation If Needed: walking, changing positions, nipple stimulation
Labor and Birth Positions: mother's choice
Pushing Techniques: short (limit to six seconds), spontaneous bearing down
Perineum: try to prevent tearing with support, gentle pushing, no episiotomy
Cord Cutting: father cuts cord after pulsating stops
Immediate Baby Care: baby held by parents for first hour and given opportunity to breastfeed
Feeding and Contact with Baby:feeding on demand with 24 hour rooming-in

I had to see it to believe it, but that fit on a 3 x 5 index card (admittedly with probably 8-9 pt font). It concisely described a family's desire to have "as natural a hospital childbirth as possible." Having seen the example, I can see how it can be adapted to an individual's wishes. In the space remaining on the line regarding immediate baby care, I would make a note refusing the Vitamin K shot, vaccines and erythomycin). I would make use of those blank lines and add no artificial nipples of formula supplementation; supported squat, upright pushing positions; warm compress and counterpressure on perineum, etc.

But there you have it, a short, concise, fit in the palm of your hand birth plan. They do exist.


siobhan said...

i love that book! i came across it a good ten years ago, long before i was even married, and i'm SO glad i've always kept it in my stash!

the best piece of pregnancy or birth advice ever given to me was about birth plans. i swear by it and i pass it along to everyone i can. each doctor has a set of standing orders... just the standard stuff that particular doctor likes or how he operates. it gets stuck into each patient's file. ASK FOR A COPY OF THE DOCTOR'S STANDING ORDERS. this is what nurses and on-call doctors will see when you check into labor and delivery and it is what they will follow.

when we asked for a copy of our doctor's standing orders, he instead asked to see our birth plan. what he did was customize a set of orders based on our birth plan. i canNOT stress how important this is and what a key to success it can be. when it was time to give birth to our second daughter, no one gave us guff about anything. the nurses didn't roll their eyes or disregard anything because hey! doctor's orders!

i was told that they were not allowed to offer me medications, so i needed to approach them if i wanted any. this was HUGE because with my oldest, they were cramming them down my throat. i did not have an iv and none of the nurses ever even mentioned it to me because, again, it was in the doctor's orders. i could eat, move, and do essentially whatever i wanted.

obviously this isn't going to work if you have an uncooperative doctor (ours was an osteopathic family practitioner, so he was more agreeable to things than a lot of ob's are). but if you have a doctor unwilling to work with you on this stuff, it's time to change doctors. i really think it's great advice and something every birthing woman should look into.

Jenne said...

That is new information to me! Thanks for sharing it! I hope I'll hear some more examples of that working for people when they go to a hospital to birth.

Maggi said...

Wow, these are both great ideas. I've read a lot about drs. and nurses ignoring long (multi-page)birth plans, but a 3x5 is so simple and non-threatening!

My dr. broke my water, after asking, but I was stunned she asked and hadn't researched why she shouldn't, just kinda knew I didn't want her to, but well okay. I'm guessing she routinely does it. so asking what 'routine' procedures your dr. does also would be good. I had focused on no episiotomy and didn't really ask about other things.