Birth plan

A birth plan is a written description of the preferences and desires of parents-to-be that is prepared for medical professionals and others who will assist with the delivery of a child. It is prepared ahead of the anticipated delivery date to identify the type of birth, delivery, and aftercare the parents prefer. The plan usually includes information on where the mother wants to deliver; who she wants with her; what she prefers for pain relief; which technologies or procedures she prefers to use or to avoid; and where and how the child will be cared for after delivery. Some experts have raised doubts about the usefulness of birth plans because they can create unrealistic expectations and may be based on outdated obstetric policies and procedures.

Background

For centuries, women gave birth at home or in a home-like setting with assistance from female relatives or sometimes a woman called a midwife who specialized in helping women give birth. By the early part of the twentieth century, this changed in the United States and some other developing countries. Baby delivery increasingly became a task designated to a physician, and women began delivering babies in hospitals.

In time, new technologies and medications were developed and began to be employed for all deliveries, including those considered routine. For example, it became common to sedate a woman during delivery or to use a form of injectable anesthesia called a "saddle block" that numbed the pelvic area. The saddle block prevented the woman from feeling the pain of childbirth but also left her unable to use the muscles in that area to assist with the delivery. As a result, doctors began to use special tools, such as forceps, to reach inside the woman and pull the child out by the head.

By the mid-1960s, women were objecting to these procedures. They began stating preferences to be awake during delivery and to have pain relief that did not necessitate mechanical assistance to deliver their children. They began requesting the presence of the father or another coach in the delivery room. Many showed a preference for settings that were calmer and more soothing than a sterile operating room. Midwives, who are medically trained, and doulas, who are not medically trained but are trained to help a mother through delivery, became popular alternatives to physician-assisted births.

In the 1980s, the World Health Organization (WHO) was among a number of groups that endorsed the creation of a birth plan as a way to improve infant mortality rates and the birth experience. Since then, birth plans have been praised by some and criticized by others. Those who favor them say they provide the mother with more control over what happens to her body and her child at a very vulnerable time. They say that thinking about the birth procedure and deciding on preferences helps women stay informed and gives them a voice in things that are important to them. Critics say that birth plans have done little to decrease birth-related problems. They also note that birth plans can create unreasonable expectations and additional stress for parents who view them as instruction lists rather than lists of preferences.

Overview

A birth plan is a way for parents to communicate their hopes and preferences for the birth of their child to those who will help with that birth. Birth plans often are completed well before the expected delivery date. Preparing to craft the plan usually requires parents to investigate how births typically are handled by the midwife, doctor, doula, or other professionals who will be assisting and what the practices and procedures are at the facility where the birth will take place. Some experts say this opportunity to research birthing practices is one of the most valuable aspects of a birth plan because it helps parents better understand and prepare for what will happen. It also provides information about potential problems so that parents are not completely unprepared if the delivery fails to go as planned.

Some delivery professionals or facilities have their own forms that they ask parents to complete. In other cases, parents write their own plan without a form. Often a midwife or doula will help with this process, and some physicians' offices may have people designated to assist with the plan. At its most basic, the birth plan will list where the mother plans to deliver, who she plans on having as her assistant, and who else will be present during the birth (partner, family members, friends, etc.). It usually indicates the mother's preference for pain relief and how she wants to give birth. For instance, would she prefer to be in a bed or on a birthing stool or ball? Does she want to be lying down, squatting, or positioned on her knees? Some of these decisions will be dictated by the facilities where the birth will occur.

The birth plan may indicate which interventions the mother prefers. If labor is slow, does she favor medication to help speed it up? What preferences does she have for monitoring the baby's heart and for the use of forceps or other devices to assist with the birth?

Birth plans can address issues such as who will cut the umbilical cord, whether cord blood will be saved, and whether the mother prefers to have the baby placed on her chest or belly immediately or cleaned and dressed first. Instructions for the baby's first days of life may be included, such as whether the child will be nursed or bottle-fed, whether supplemental feedings or pacifiers should be offered, and whether the child will remain in the room with the mother or in the nursery. The plan can express the parents' preference for circumcision, if the child is male.

Other matters that parents can consider in the birth plan include any special needs because of disabilities, health conditions, or religious preferences. Birth plans may include items such as who will be allowed to visit after the birth, who will bathe the baby after birth, and where older siblings will be during and after the birth.

Experts caution that there is no guarantee that the birth will go according to plan. Unforeseen problems may lead to changes. In those cases, experts say it is important for all to consider the health and well-being of the child and the mother above preferences.

Bibliography

"Creating Your Birth Plan." American Pregnancy Association, americanpregnancy.org/labor-and-birth/birth-plan/. Accessed 17 Jan. 2018.

Fink, Jennifer L. W. "The Birth Plan: How to Make It Work for You and Your Patients." Medscape,22 Sept. 2017, www.medscape.com/viewarticle/885375. Accessed 18 Jan. 2018.

"How Has Childbirth Changed in this Century?" Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, www.takingcharge.csh.umn.edu/explore-healing-practices/holistic-pregnancy-childbirth/how-has-childbirth-changed-century. Accessed 17 Jan. 2018.

"How to Create a Birth Plan." WebMD, www.webmd.com/baby/guide/how-to-create-a-birth-plan#1. Accessed 17 Jan. 2018.

Isidro-Cloudas, Terri. "Writing a Birth Plan." Parents,www.parents.com/pregnancy/giving-birth/labor-and-delivery/writing-a-birth-plan/. Accessed 17 Jan. 2018.

Kaufman, Tamara. "The Evolution of the Birth Plan." Journal of Perinatal Education,vol. 16, no. 3, 2007, pp. 47–52, www.ncbi.nlm.nih.gov/pmc/articles/PMC1948092/. Accessed 17 Jan. 2018.

"What to Include in Your Birth Plan." Medline Plus, 26 Jan. 2016, medlineplus.gov/ency/patientinstructions/000567.htm. Accessed 17 Jan. 2018.

"Writing a Birth Plan." BabyCentre UK, www.babycentre.co.uk/a544479/writing-a-birth-plan. Accessed 18 Jan. 2018.