Birth Plan Considerations

Newborn laying under a blanket on mother's stomach. Birth Plan.Preparing for baby can be so exciting.  Take some time during your pregnancy to plan for your labor and delivery.  It’s helpful to remember that everything may not go exactly “as planned,” but it’s important to have a clear idea of your priorities and preferences well before the big day.  Below are some options and considerations for your planning.  Discuss all of these in detail with your care provider.  If you’re searching for one, really understanding your preferences can help you pick the best provider for your birth.

Preparing for baby can be so exciting.  Take some time during your pregnancy to plan for your labor and delivery.  It’s helpful to remember that everything may not go exactly “as planned,” but it’s important to have a clear idea of your priorities and preferences well before the big day.  Below are some options and considerations for your planning.  Discuss all of these in detail with your care provider.  If you’re searching for one, really understanding your preferences can help you pick the best provider for your birth.

Start by considering your ideal birth experience.  Do you feel more comfortable with a midwife or an OB?  Who do you want present during your labor?  Do you intend to give birth at a hospital, or a birth center, or home?  Having a clear picture of your desires will help guide you to the best preparation for your particular situation.

Labor and Delivery

Induction

Baby knows when to arrive!  The American College of Obstetrics and Gynecology recommends that induction not take place until after 39 weeks unless there is a clear medical indication.  Inducing labor has resulted in many babies being born too early, possibly due to confusion about dates or incorrect dating by ultrasound. Medications used for induction have the potential to cause significant complications for mom or baby.  Also consider that if induction is attempted and then unsuccessful a Cesarean may then be required.

Pain medication

Remember that there are a variety of ways to help control pain besides an epidural or IV pain medications. Massage, acupressure, relaxation/breathing exercises, and a warm bath or shower may help.  Consider that an epidural will limit your ability to freely move if this is important to you.  An epidural is also likely to lengthen the “pushing” stage of labor.

IV Fluids and Eating/Drinking

Discuss your provider’s recommendation regarding IV fluids.  For a well hydrated patient, IV fluids may offer no benefit and possibly increase risk for further interventions.  Do you want to be able to eat and drink during labor?  Particularly for a natural labor, keeping energy and hydration up is important.

Cervical Checks

There are differing viewpoints here.  The midwifery model tends to do cervical checks only if there is a specific reason or if requested by the mother.  Obstetricians or RN’s in a hospital setting tend to do much more frequent cervical checks.  Dilation on exam is not a reliable indicator of how quickly labor is progressing.

Monitoring – Continuous or Intermittent

Continuous monitoring will make it more difficult for mom to move around during labor.  This may be required with pain medications or when an epidural is performed.  If no interventions have taken place and your provider believes mom and baby to be well, then intermittent, occasional monitoring is likely to be sufficient.  To date there is no evidence that continuous monitoring results in any better outcomes.  There is evidence however that the Cesarean Section rate is 1.7 times higher when continuous monitoring is used.

Pushing Position

Pushing in an upright position such as squatting may facilitate an easier labor and reduce risk of tearing. Additionally being able to change positions during labor can be helpful.  Again, this is easiest to accomplish without an epidural.

Episiotomy

Many women choose to refuse this unless there is imminent danger to mom or baby, and the procedure is performed emergently rather than for convenience.

After Delivery

Medications After Delivery

Ask your provider if they routinely give medication such as pitocin after delivery.  Giving mom pitocin will alter her own oxytocin production and needs to be carefully considered, fully evaluating risks and benefits.

Cord Clamping

Learn the benefits of delayed cord clamping.  If you are seeing a midwife it is likely their standard procedure is to wait until the cord stops pulsating to clamp.  See Dr. Greene’s article TICC-TOCC for more info.

Skin to Skin

Immediate skin to skin care with mom is preferred if at all possible.  It is best for baby to be placed directly on mom with a blanket over baby, rather than wrapped in a blanket and then placed on mom.  This immediate touching helps with transition to extrauterine life and initiates bonding for mom and baby.

Feeding Preferences

If you plan to breastfeed, the best option is to give baby breast milk and nothing else.  It is normal for your milk to “come in” a few days after delivery.  In most cases formula during this time is not necessary and decreases chances for successful breastfeeding.  Let all staff know if your preference is to avoid formula, sugar water, and anything else by mouth.  This includes your pacifier preference.  The best recommendation for successful breastfeeding is to avoid pacifiers and bottles for at least for the first few weeks.

Newborn Practices

Common newborn procedures include eye ointment, Vitamin K injection, Hepatitis B immunization and PKU testing.  If baby is transitioning well, newborn procedures can wait until after initial bonding and breastfeeding.  Clearly document any refusal of procedures if necessary.

If you’re having a boy, consider whether or not you would like your baby circumcised.  This can be a very controversial topic.  Don’t assume that all boys are circumcised.  Learn about the rationale, risks, and benefits of declining circumcision.

Interested in Natural Birth?

I was fortunate to have a natural and unmedicated delivery. If this is important to you, adequate preparation is vital. I think Ina May Gaskin says it best:  Birth Matters – Educate Yourself.  It is important to understand that interventions may lead to more interventions that may not have been part of your plan.  The Cesarean Section rate in the US is 33%.  Certainly some Cesarean’s are necessary for the health of the mother or baby, but excessive interventions have most certainly contributed to the high rate seen today.

Homework!

Make your big decisions, and then share with your care providers and anyone else attending your birth. Make it one page, simple and easy to read.  While never required, treats for your team never hurt either:)

Additional Resources for Pregnancy and Birth

How did you prepare for birth? Will you do anything differently next time?

Amanda Queen

Amanda Queen, PA-C is a mom, a graduate of Dr. Andrew Weil's Integrative Medicine program at The University of Arizona, and a Blogger. She blogs about nutrition, botanicals, essential oils and family wellness at Essentially Be Well.

Note: This Perspectives Blog post is written by a guest blogger of DrGreene.com. The opinions expressed on this post do not necessarily reflect the opinions of Dr. Greene or DrGreene.com, and as such we are not responsible for the accuracy of the information supplied. View the license for this post.

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