Ask the Sterling, Va. Doula: Birth Plans… What’s the Point?

whats the point of a birth plan sterling, va doula answers“My birth plan was to have a healthy baby!” [end of post] Right?! No, there’s actually more to the story. As a doula in the Sterling, Va. area, part of my job is to keep tabs on the climate, so to speak, for childbearing families. Recently I noticed there’s a gap in understanding about birth plans and birthing options in our area which I’d like to address. First off, let’s establish that a healthy baby is every birthing person’s top priority! But there is also nothing silly, frivolous or ridiculous about a desire to create a birth plan. That is because birth plans are not “plans” exactly, but rather a list of preferences which have the ability, when well-executed, to create the healthiest experience for both mother and baby. What could be more worthy of your time and attention? After all, a healthy birthing parent, mentally and physically, is able to meet the demands of parenthood with perhaps a bit more ease. 

The prevalent belief seems to be that birth plans are silly because the professionals–the doctors or midwives and the nursing staff–will handle everything, and because birth can have unexpected twists and turns. I can definitely understand how that’s the bottom line for a lot of people. The reason that it isn’t the bottom line though–and the real point of creating birth preferences–is the fact that many labor & delivery procedures are actually not created purely for safety reasons. Some policies and procedures exist mainly for convenience. And unfortunately some of these policies are not at based on any evidence for what actually optimizes the short- and long-term health of the parent-baby dyad (duo). 

Now, in a very high-risk, high-volume setting I can see how convenience can actually lead to more safety. But the fact remains that if you are a low-risk, healthy parent and baby birthing in a high-risk setting, you may be like a fish swimming upstream, unless you research, create, and discuss your birth preferences ahead of time and unless you have the support, through a class, a doula, or both, to help keep your desires at the forefront during labor. And those are actions that anyone with the financial means can choose to take. But I know it’s overwhelming, so let’s break it down.

The first two big questions are: 1) Do you want to be induced or do you want to go into labor on your own? 2) What is your pain management plan? First let’s look at some of the common reasons for being induced.

Common reason
Tired of being pregnant
You’ve reached week 40 of your pregnancy
Baby getting too big*
Pre-eclampsia or high blood pressure that doesn’t resolve at home
Gestational diabetes

Making the choice to induce or to wait for labor to begin on its own is a process of weighing benefits versus risks. Sometimes the benefits of waiting for labor to begin spontaneously outweigh the risk of inducing, and sometimes the benefits of inducing outweigh the risk of waiting.

*If you’re told your baby may be getting too big, you should know that the most reliable method for detecting your baby’s size is to weigh and measure your baby after delivery. If you’d like to read more about this from a medical standpoint, you can do so here. The bottom line is there is no way to tell for sure whether your baby will fit until you try pushing; keep in mind that ultrasounds can be off by 2 lbs. in either direction and that weight estimates are just an educated guess.

There are legitimate reasons for both choices; it just depends on you and your baby’s unique situation. There are also a few benefits of waiting for labor to begin which I’ve listed below. I know that the end of pregnancy is very challenging for some. I like to encourage my clients that those discontented feelings are actually good hormones and a very early sign of labor. In the absence of unresolved blood pressure issues/pre-eclampsia or gestational diabetes, you can always choose to wait for labor to start on its own. Remember that normal pregnancy can last anywhere from 37 to 42 weeks and that due dates are far from an exact science. Remember to double-check your estimated due date and find out if it was determined based on last menstrual period (LMP) or an early ultrasounds between 8 and 12 weeks. The early ultrasound is often more accurate in determining the length of your pregnancy and whether you are actually 39 weeks when your provider says you are 41.

Benefits of spontaneous labor
Baby’s lungs fully developed
May increase the likelihood of a vaginal birth
May shorten labor
Increases production of natural birthing hormones (nature’s pain relievers)

Which brings me to my next point about a plan for pain management. There are a lot of different options for reducing or eliminating pain and discomfort during labor. I’ve listed a few for your consideration. The good news is that there are no drawbacks to working with the natural gifts your body gives you through movement, positioning and normal consumption of liquids and foods for energy, and even if you plan to skip the epidural but change your mind, that’s OK! Epidurals cannot be administered right away and are often not administered until at least 4cm dilation, so even if you plan to get an epidural eventually, you will benefit greatly from creating an early labor plan.

Comfort measures
Movement/positioning
Massage/light comforting touch
Baths or showers
Hypnobabies
Eating and drinking lightly to keep your energy up
Narcotics (Stadol, Nubain, Fentanyl, etc.) given through the IV
Epidural

Other items for your birth plan may include different options for induction (Cervidil + Pitocin vs. Cytotec, foley bulb, or more soft induction techniques such as stripping the membranes or in some cases, amniotomy*) benefits and risks of IV fluids, Pitocin for augmentation (to strengthen contractions), vaginal exams during late pregnancy and labor, *amniotomy (artificial breaking of water), pushing positions, episiotomy, vacuum/forceps and Cesarean birth preferences, as well as delayed cord clamping, skin-to-skin, and other options for your newborn. I hope this has been enough to get you thinking about the point of having a birth plan. For more information and confidence-building techniques, I hope to see you in class or visit with you after you schedule a doula consult! Thanks for reading!

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