WHAT'S MISSING FROM YOUR BIRTH PLAN

There’s something missing, something just as important as freedom of movement, intermittent monitoring, and self-directed pushing.

In your preparation for a great birth, you’ve definitely gone through the list.

Doula? Check.

Birth class or prep? Check.

Great supportive provider ? Check check check.

Birth plan…

What about that Birth Plan? Scouring the interwebs, you’ll find all kinds of mixed opinions on a Birth Plan. Online pregnancy forums list formats and tips while others scoff at the premise. Mean spirited maternity care professionals say a plan will never be read – or worse, it’s an indicator of Birth Doomsday.

Let’s call it birth preferences. You’re not planning your birth. You’re letting your team know what you prefer, what’s important to you, if everything is going smoothly.

Low-intervention birth preferences probably look a bit like this….

Thanks for coming to my birth! These are our preferences to welcome our baby. If anything unexpected comes up, we’ll be happy to discuss alternatives.

We prefer:

• freedom of movement throughout birthing
• intermittent monitoring during the birth process
• minimal vaginal exams

During the birth we’d like:

• self directed pushing
• optimal cord clamping
• immediate skin to skin with baby

And that’s it! Short and sweet, just like the blogs, birth boards, and baby class suggest. Newborn preferences are on a separate index card. Copies made for doctor/midwife, nurses, and birth partner. Backup copy in the birth bag. Check check check. There’s something missing, something just as important as freedom of movement, intermittent monitoring, and self directed pushing. Maybe even more important.

Your baby’s birth. The actual birth itself when your baby is descending, crowning, and emerging. What’s going on then? What are your preferences in that moment? You’ve researched the heck out of choices and talked to your provider about all of your options… no one said anything about pushing/birthing preferences!

This is a great chance for more discussion with your doctor or midwife. You want to know what the moments leading up to birth and what the actual birth itself look like. You can ask your provider, “Can you walk me through this?”

“Tell me what a typical birth looks like from the moment you walk through the door.” (Since most providers are arriving just as birth is imminent.)

“Doctor, where are your hands as baby’s moving down?”

“Midwife, are you using warm compresses and oil?”

“And are you using your fingers to stretch me or supporting my perineum?”

“What position am I in?”

“How much are you touching or turning baby?”

“Do you use traction to assist in the birth?”

And then…baby arrives! While you enjoy that “Oh Baby” glow and skin to skin with this new little one, what’s your provider doing? Massaging your uterus, ordering pitocin, watching to see if your baby’s cord has stopped pulsating, keeping an eye on bleeding? When does your provider clamp the cord? Do they wait for the placenta to arrive on it’s own or do the practice active management – applying traction to the cord to remove the placenta?

What do birth preferences for pushing/birthing (also known as second stage) look like?

During birthing, as baby is descending and emerging:

• please support my perineum with warm compresses
• I will be pushing in whatever position in most comfortable to me at the time
• please allow our baby to be born without pulling or turning baby’s head

Following the baby’s birth:

• I prefer spontaneous delivery of the placenta without traction or pitocin
• after the cord has stopped pulsating, my birth partner or I would like to cut the cord
• I’ll be breastfeeding and using nipple stimulation to reduce my risk of bleeding