Birth plans: Taking a new look
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A birth plan, at its best, is a statement of your preferences for labor and delivery. It can be a great tool for facilitating communication, as long as you understand it's not a binding contract. Diana Korte, author of The VBAC Companion: The expectant mother's guide to vaginal birth after cesarean offers some information about the best ways to use a birth plan -- with extra advice for those planning a VBAC birth.
Learn as you decide
Beginning in the early 1980s, childbirth educators and activists suggested that pregnant women make a list of the maternity options that they wanted. This newly-named "birth plan" would then be discussed with and signed by their doctors. As time went on, preprinted, "fill-in-the-blank" birth plan forms -- some that went on for pages -- became available.
Today, the best thing about birth plans is that you have to become
knowledgeable about birth to write one. For many women, used to following
someone else's lead and doing what they're told in medical matters, this is a wholly new idea.
Do they really work?
Birth plans are written with great promise, but how often do they really
deliver on that promise? Perhaps what you want is not routine for the doctor and
hospital you've chosen. Sometimes a doctor or a nurse will go out of her way to
accommodate you, but you can't count on it. These professionals will do what they
think is best. Why should they act otherwise?
Be aware that birth plans often give false hope -- you may believe you will get
what you want because you put it in writing, but the signatures of health care
providers are not legally binding. Many women have discovered that their birth
plans are not much more than wish lists. Still, you need to think about your
options -- writing up a birth plan forces you to organize your preferences. After all,
if you don't know your options, you don't have any.
Getting what you want
These suggestions will help you get what you want for your VBAC:
In the same way, if 75 percent of the women who give birth with the doctor and hospital you're considering have epidurals, don't say you don't want to be offered any pain medication. Go elsewhere. If all of the patients of the doctor you're considering are hooked up to IVs as soon as they get to the hospital, don't write "No IV" on your birth plan. Find another doctor or midwife who doesn't have this protocol.
Many hospitals will plan to have you on an electronic fetal
monitor (EFM) all during a VBAC labor, in part because prolonged fetal distress is
the only indicator of the rare uterine rupture. (A rupture occurs in about one
percent of VBAC labors.) If you want EFM flexibility, find a doctor and hospital who
will give it to you. Don't just request it on your birth plan. If you want more
flexibility in general, don't forget to interview midwives. A midwife offers a "menu"
that is almost always longer than a doctor's, especially a midwife who works outside
of hospitals.
Shop for what you want
If some of the healthcare providers you interview tell you that your ideas are unsafe, unrealistic, or unnecessary,isn't it better to determine their attitude early while you can still change doctors more easily? When calling hospitals, ask about everything on your birth plan. Don't assume that if you're breastfeeding, for example, they won't offer your baby formula in the nursery. Don't take for granted that if they have a Jacuzzi for laboring women to help relieve labor pain, it will be available to you. Ask first.
"I started with a big upscale OB practice with seven OBs and, as I found out, seven different opinions on how to treat a VBAC. One doctor said external monitoring was fine, another wanted an internal pressure catheter, etc. At 32 weeks, I finally got the nerve to investigate the other OB practices available through our HMO. I actually interviewed the doctors about their VBAC procedures, quite a change from my 'trust your doctor' mindset in my first pregnancy. I ended up switching to a 'no nonsense' HMO group -- no fancy examining rooms, no classical music piped into the waiting room. They all knew me as the lady who wants a natural childbirth. But they gave me respect and treated me as an educated adult who wanted to be an active participant in her birth experience. I spoke to all four OBs in the group about my birth plan, brought my doula with me to an appointment with the doctor I was least comfortable with, and took a proactive role in my pregnancy." Alexandra G., Tennessee
Keep it minimal, keep it flexible
Try our birth plan creator! Summarizing your birth preferences is easy with our free interactive checklist. Click here to try it
