Birth Plans/Preferences

Being a L&D nurse I actually like it when patients come in with a birth plan. It shows me that they have put some thought into their wishes and it makes it easier for me to provide care for the mom and partner if I know what they want or are expecting. However, sometimes people come in with very elaborate birth plans and have unrealistic expectations, which can make caring for them more difficult for all parties involved. Most people who write birth plans have realistic wishes that are most likely already going to be done; like putting baby on moms chest right away, waiting for the umbilical cord to stop pulsating, wanting the baby to stay with the parents in their room, or mom wanting to breastfeed, to name a few examples. 

The most crazy unrealistic birth plan I ever saw was…my own. During my first pregnancy I hadn’t been a nurse for very long and I was working in long term care. I thought I had done adequate research on pregnancy and birth, but what I was actually researching was severely biased. With my second pregnancy I was working in L&D and had been for about a year or so. I went back to look at my previous birth plan as reference to make another one and what I saw was shocking. I hadn’t even remembered everything I had put on there and then looking back at it with my new nursing experience made me realize that moms and their partners need more education on pregnancy and especially the birthing process. 

One important thing to note is that no birth plan is going to go the way that it's planned. You can't anticipate everything that's will happen. So, it's good to be mindful that things can change and that what you had in your mind as to how your beautiful birth would go down flexibility and having an open mind is essential. Here’s what is going to be useful in a birth plan/preferences.

·      Your name and your partners name.

·      The name of your doula if you have one.

·      Your doctors name and clinic

·      Your baby doctor and/or clinic

·      The name of people you would like or not like in the room during birth. If the nurses need to kick people out at your request we will. We don’t mind being the bad guy. Realistic Expectation #1: Sometimes people like to have their whole village come to see them in labor or afterwords. If there are too many people in the room in order for the nurses and doctors or midwives to care for mom and baby safely we will ask people to exit the room. But we do want you to have the people around you that you love but as long as we can ensure safety.

·      What do you want to do for pain relief or comfort? Hydrotherapy (laboring in the tub), positioning, counter pressure, music, lighting, aromatherapy (if the hospital allows it), birthing ball, walking, or you may not know. 

·      How do you feel about medications for pain relief? Usually there are two options, if not three. Obviously the most common one is an epidural. Another option available (but may not be available everywhere) is IV pain medication, called fentanyl. A third option has only in recent years become available in the United States, even it’s been available in other countries like the UK for many years. The third option is nitrous oxide; which may not be available everywhere. If you don’t want us to ask you about pain medication in fear that you will ‘cave’ and want it even though pre-labor you doesn’t want it, we should accommodate that. Realistic Expectation #2: I will say that sometimes pain medication is what the mom NEEDS. I only say this because of my own experiences, more specifically my own births. With my second birth, my plan was to have an unmedicated water birth. My anxiety completely took over my mind and I was no longer in control. I believe that I needed it in order to move forward. Sometimes when pain medication is administered, it allows the cervix to relax and is more apt to open up and be less tense. This works for some but not all, because of course not all births are the same. 

·      Do you have thoughts when the time to push comes? Do you want to be able to move around? Do you want to have a water birth? Do you want to be in bed? Do you want to have a mirror so you can see your pushing progress (trust me it works)? Do you want the Lion King soundtrack playing in the background?

·      Are you going to breast feed, formula feed, both, or exclusively pump?

·      Medications to give your baby. There are typically 3 kinds of medications given to the baby after delivery. There is an antibiotic eye ointment, the first of the Hepatitis B vaccine series (this is a shot, which can be done later at the clinic depending on your provider), and a vitamin K shot. Realistic Expectation #3: PLEASE PLEASE PLEASEgive your baby the vitamin K shot! I will do another post about these 3 medications, but it is my professional opinion to encourage parents to give their baby vitamin K after birth. Babies are born with a limited amount of vitamin K and this is necessary for blood clotting and can prevent brain bleeds. 

·      Are you ok with testing? Typically 24 hours after delivery there are some tests that are performed on the baby. These include:

o  A hearing screen

o  Checking baby’s heart rate and oxygen levels together to screen for possible heart defects. 

o  A bilirubin screen. Bilirubin is the product of red blood cell breakdown, which is normal. Eventually, bilirubin is passed through the liver and leaves the body. When there’s a high build up of bilirubin, it can cause jaundice. This is when the skin and eyes will turn an orange/yellow color. When the bilirubin level is higher typically the treatment is bili lights or phototherapy. 

o  There’s also a small blood sample taken to test for congenital diseases. 

·      Realistic Expectation #4: Sometimes people come in and either don’t want to be on the fetal monitor or only intermittent monitoring. I’m 150% an advocate of natural birth and doing less monitoring, IF it’s safe for mom and baby. If the nurse or provider wants to check on the baby, it’s because they are concerned for you and your baby. I want you to be an advocate for yourself, but also realize that we all want a healthy and happy mom and baby at the end of the day. 

·      Do you have plans for your placenta? I know what you’re thinking: What would one do with a placenta and why would I have plans? Some people ahead of time have made plans to consume it in some form, bury it for cultural practices, take a picture of it or whatever your heart desires I suppose. I can do another post on this topic if people would like. 

·      Are you doing cord blood banking? This is not commonly done, however if this is something you want to do you need to let us know beforehand.

·      Do you have specific desires about your baby’s first bath. Most people don’t care when this is done and will have it done within a couple hours after birth. Some choose to wait 24 hours and others wait until they are home. Some want the staff to do it and others prefer to do it themselves. If you’re a first time parent, demonstration of the first bath and education is very helpful and necessary. Some people choose to wait because some believe that the vernix is good for the baby’s skin among other reasons. 

·      If you’re having a boy, do you want a circumcision? If so, do you want it done in the hospital before you leave or in the clinic? PS…It’s usually cheaper if you do it in the clinic. 

There are other things you can add to your birth plan of course if there’s something that is really important to you. I highly encourage everyone to take their birth plan to their appointments to have their provider read it. This sets you up for realistic expectations for your birth and have questions or misunderstandings answered.