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Birth Plan Strategies

By the time the second trimester kicks in, most expectant moms have studied up on childbirth and have a fairly firm idea of what they want to happen during delivery. Some hope for a natural, drug-free birth; others may welcome medication. From pain-relief methods to delivery positions to the number of support people, the options are myriad. That's why most mothers-to-be are encouraged to write a formal birth plan-to record choices they may be in no position to articulate once delivery time rolls around. "It's tough to convey preferences in the middle of a contraction," observes Penny Simkin, a childbirth educator in Seattle. "A birth plan gives you a voice during labor."

The idea of a written document to help mothers achieve the labor they've always envisioned was introduced about 20 years ago as an outgrowth of the natural-childbirth movement. But birth plans are by no means exclusive to women who expect to deliver vaginally. "Even someone who has scheduled a C-section has a vision of what she wants her delivery to be like," Simkin says. A birth plan lets her specify that she wants her partner by her side throughout the procedure, for example, or that her baby should be placed on her chest immediately after birth.

Of course, making a birth plan doesn't guarantee a seamless experience, as new mom Julie Bartha-Vasquez, of Burlington, New Jersey, discovered. "My goals were to be able to walk around and to avoid pain medication and an episiotomy," Bartha-Vasquez says. But at eight months, an ultrasound revealed that her amniotic fluid was dangerously low. Four days later, her doctor induced labor.

"I had my birth plan with me at the hospital, and the nurses read it," recalls Bartha-Vásquez. "But as soon as my contractions began, nothing went the way I intended." The IV required for induction kept her confined to bed. She also ended up having both an epidural and an episiotomy. Even so, Bartha-Vásquez is glad she wrote the plan. "It helped me take a positive, proactive approach to delivery."

"About 80 percent of my patients write one," notes Patricia Rodrigues, M.D., an obstetrician and gynecologist at Northwest Hospital, in Seattle. "The process gives them a chance to clarify which aspects of childbirth are important to them, and it helps me better understand my patients."

A birth plan can be typed up as a list or neatly handwritten as a letter. Most experts recommend organizing the document into concise, numbered points and limiting it to one or two pages.

As you gather your ideas, be open to the unpredictable nature of labor, suggests Kathleen Slone, a certified nurse-midwife in Baltimore. You may have firm ideas about holding your baby right away, for example, but you should avoid sounding adversarial or overly demanding. Always preface each statement with "All things being normal, I'd prefer . . . "

Pam Cass, a certified doula from Warrenton, Virginia, suggests opening with a statement like "I realize that any birth may take unexpected turns. These goals reflect my idea of a model birth, and I thank you for your support in helping me achieve as many of them as possible."

Then emphasize one or two of your most important objectives, she suggests. (You might underline them or put them at the top of your list.) Focusing on the issues that mean most to you can help you feel good about your labor -- no matter what happens. "I attended a birth in which the mother needed several interventions that she had wanted to avoid," Cass says. "But because she wasn't separated from her baby after delivery -- her top priority -- she felt everything was great."

A good birth plan, however, should be more than a list of preferences; it should convey a sense of who you are. For instance, you might write, "I've never been in a hospital before except when my grandmother was dying, so I'm a little fearful" or "It took us nine years to get pregnant, so we want every bit of technology you've got to ensure that our baby is born healthy."

"Disclosing a little personal information can make the hospital staff more likely to rally around your plan, because they'll see you as a person, not just a patient," Simkin says. You should start thinking about what to include in your plan as early as your second trimester, though you needn't put it down on paper until the 32nd through the 36th week of pregnancy. Bring up your questions with your obstetrician or midwife, and negotiate any areas in which you might have different viewpoints, suggests Slone. Once you've written your plan, give a copy to your doctor and schedule an appointment that will be slightly longer than usual to discuss it. Make sure the plan is part of your medical records, which are automatically sent to your birthing site.

Go over the plan with your partner as well as any other support people who will be involved in your delivery. "My husband wanted labor to be very medical, and I wanted it to be more natural," says Gillian Cilibrasi, of New York City. "Writing a birth plan helped us find places to compromise and made us feel close."

When the couple arrived at the hospital to deliver their baby last year, they were delighted to discover that the nurses had read their birth plan, right down to the fact that they wanted the lights turned down low in their birthing room. "Everything went beautifully," Cilibrasi says. "We knew that no labor goes exactly the way you anticipate it, but our attitude was, you make a to-do list to plan your average day, so why not do it for childbirth? Could there be a more important day than that?"

Beyond the Birth Plan
Beyond the Birth Plan

Copyright © 2000 Ginny Graves. Reprinted with permission from the August 2000 issue of Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.