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Birth Plans - are they worth it?

April 10, 2017

There are plenty who comment “my birth plan went out the window during labour, so what’s the point in having one?!” The foundation of a birth plan shouldn’t be the “tick and flick” sheet of preferences, nor a lengthy essay about what you do and don’t want during labour and birth, but rather, what really needs to underpin your birth plan or preferences is education. That is, researching the evidence of what you want for birth. Developing an understanding of body autonomy and your legal right to informed consent (you are presented all the benefits and risks from your care provider, and ultimately you are the decision maker in your care).

 

It is imperative you keep in mind to choose a care provider who is going to support your birth preferences. We know private hospitals have much higher rates of intervention than public hospitals, who again have higher rates than private midwives and MGPs (midwifery group practices). This is due to a combination of fragmented care (seeing multiple care provider, including during birth), and care provider attitude towards birth (medicalised, risk perception). 

 

It should ring alarm bells if your care provider is not on the same page as you e.g. talking induction without medical evidence, routine vaginal exams from 38 weeks (these are real-life examples I hear ALL the time!). I certainly encourage couples to review their care provider options, and switch care providers if they're feeling uneasy (trust your intuition!). Labour and birth is not a time you need to be fighting for your birth preferences to be upheld.

 

There is value in looking at a variety of scenarios for birth, and develop your preferences accordingly. BUT, when you look at all your different options, make sure you become well educated.

 

You may like to write an introductory paragraph overviewing your birth preferences, for example:

 

“We have decided to have a natural birth, without pain medication or intervention (unless medically necessary) and expect your support in achieving this. We expect we are kept fully informed, and are the final decision makers in labour and birth…”

 

“We have decided on …….. and expect/prefer/would like……”

 

 

Keep your birth preferences short and concise- so dot point is fine, but also sentences are okay too, provided they’re no longer than about 2 pages, in order for care providers to read them. Make sure your birth companion (partner/husband/doula) is also aware of your preferences.

 

There really needs to be 3 sections to a birth plan; labour, birth and baby.

 

There is a great resource article on BellyBelly about Birth Plans too, which the author and founder of BellyBelly, Kelly Windor details from her experience as a doula and maternity advocate. 

 

Some things to consider researching:

 

Labour:

  • benefits and risks of routine interventions such as:

  • vaginal exams {Sara Wickam has written about how the research now refutes the accuracy of vaginal exams here. and Dr Rachel Reed explores how labour progresses, and how care providers can simply observe mum’s behaviour, movement etc. to assess labour, rather than routinely intervening.}

  • induction {Midwife and researcher, Sara Wickam has summarized a lot of research around post-term induction here.}

keep in mind, some care-providers may also want to “speed labour up”, which is also a form of induction. Be very mindful of the benefits and risks, as the synthetic hormone used to speed up labour is nothing like our natural oxytocin we produce in our body, which is responsible for our surges (contractions)

  • stretch and sweeps

  • pain relief

 

  • How your birth companion is informed, who else stays with you in the room.

  • Wear clothes that are comfortable

  • consider whether you’d like to be upright/active/eating/drinking/using water immersion/music/massage/essential oils etc for relaxation and comfort. {Dr Sarah Buckley has written more about birth environment here.} 

  • environment- level of light, noise, medical equipment

  • CTG monitoring versus doppler

 

Birth

  • “hands off” baby for birth. Who is receiving baby?

  • “coached pushing” versus mum following the lead of her body

  • managed versus natural birthing of the placenta (3rd stage) {Dr Sarah Buckley’s research into 3rd stage of labour.}

  • intervention such as episiotomies, vacuum, forceps

  • skin-to-skin with baby – for mother and father

  • undisturbed 1st hour {Dr Michel Odent, the most famous Obstetrician in the world, outlines the importance of undisturbed 1st hour (at least) after birth here.}

  • delayed cord clamping (or until cord stops pulsing)

 

cesarean births:

  • drape lowered in order to see baby born

  • skin-to-skin

  • maternal assisted cesarean

  • noise levels

  • delayed cord clamping (or until cord stops pulsing)

  • vaginal seeding

  • mother or father to announce baby gender

Baby

  • bathing of baby/wiping off vernix

  • skin-to-skin

  • Vitamin K injection/oral dose

  • Hepatitis B

  • Low lighting/noise

I’ve included only a few links to some good research, as I really want you to take charge of developing your birth plan/preferences and decide what is best for you and your baby. This isn't an exhaustive list either, but certainly a good general basis to begin. 

 

It’s so important you become aware of how often opinion trumps research in the maternity care sector. Not only will this be an empowering activity for you, it’ll also ensure you’re fully informed around aspects of labour and birth, and rather than trying to think about it during labour, you’ll be well educated and understand the possible implications when accepting interventions.

Evidence based Birth is also a great website, full of research based articles to educate around birth. https://evidencebasedbirth.com/

As is the Cochrane Library- http://www.cochrane.org/

 

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