An ideal delivery?

My birth plan when I was pregnant with my son, Truman, was this: I had no plan.

I knew I wanted a hospital delivery, so I selected one that had a maternity unit known for family friendliness and an obstetrician with a reputation for erring on the side of safety. Beyond that, I just packed my iPod in my hospital bag, let my doctor know that I’d rather skip the C-section, thank you, and trusted that somehow the process of giving birth would take care of itself. My friend, Lynn, was shocked by my nonchalance.

“Oh, my God!” she said. “You have to have a birth plan!” Lynn had wanted – and, after 51 hours of labour, got – a completely natural delivery. She firmly believes that her no-detail-overlooked birth plan helped her enjoy the childbirth experience she wanted. “If you don’t have a birth plan,” she warned me, “you forfeit control of this beautiful, natural process to the medical system.

Oh no! Just as I started to panic – and cobble together a detailed birth plan at 38 weeks – my friend Jeanette, an ultra-practical mother of four, offered another point of view.
“Don’t bother,” she advised. “Birth plans don’t work. Something always goes wrong, and you’ll just have to trash the whole thing anyway. Why set yourself up for failure?”
So who was right? Turns out, both – and neither.

“Birth plans are useful because they help couples think through the process together and decide what’s most important to them,” says gynaecologist Dr Sharon Phelan. “Some women like a high-tech birth; others have a Mother Earth image of birth. Either way is fine, but it helps to have those expectations expressed so everyone understands what the goal is.” But Dr Phelan also warns that while you can try to guide it, childbirth is something you can’t fully control, so don’t even try.

Make your birth plan work

Here are some additional tips from Dr Phelan and other experts for making your birth plan work for you.

Start shopping early
Create your birth plan early in your pregnancy, use it to “shop” for a care provider whose vision most closely matches yours and make sure that person knows about any special concerns you may have, suggests professor of nursing Dr Cynthia Flynn. “When you show up in the delivery room with a birth plan, you’re saying that you don’t trust your care provider to do it your way,” Dr Flynn maintains. “Why not just find someone who normally does it your way?”

Keep it short and sweet
A cursory Web search will turn up any number of lengthy checklist-style plans to help you start the process, but don’t get too detailed. See “4 key questions” for topics to focus on.
“There’s a grim joke among care providers that the minute we see a three-page, single-spaced birth plan, we get the theatre ready because we know it will all go wrong,” Dr Phelan says. “It happens so often, there must be something to it. I think the more attached you get to certain fixed ideas, the more likely you are to tense up around them, and the natural process has more difficulty happening.” Bottom line: keep your plan to a page, maximum.

Research your baby’s birthplace
Once you choose a doctor or midwife and the venue (hospital, active birth unit or home) where you’ll deliver, do a little research into its policies to find out if they’re basically OK with your wishes. But be realistic. “Every hospital has its own way of doing things, and nurses – the ones who are there with you throughout your labour – do their best to articulate between the patient’s wishes and the care providers’ orders, while staying within the bounds of hospital policy,” says midwife Lindsay Rogers.

If you do have a detailed plan in mind, Lindsay suggests taking it in ahead of your delivery and discussing it with the maternity staff to see where the sticky parts might be. And have your doctor sign your plan prior
to admittance.

Watch your language
What you do write down, write with care. Care providers appreciate language that lets them know you’re working together as a team and you respect their professional judgment. You should express your goals and desires in a way that’s not contentious so that it doesn’t set up a boxing match. Would you like it if somebody with no training in your field did some Internet research and then came in to tell you how to do your job? I don’t think so.

Go with the flow
Midwife Meena Naidoo says she’s seen it all. In her opinion, birth plans are best viewed as a wish list. “You have to wait and see how labour goes to have any clear idea about what you really want or need,” she says. “You may think you don’t want any pain medication, but then find you really need it. Don’t start motherhood feeling guilty or feeling that your expectations weren’t met.”

Instead, Meena encourages her patients to aim high and focus on what’s most important.
“We always shoot for a healthy mom and a healthy baby.”

Long birth plans offer the illusion of control over everything from the lighting in your hospital room to whether you’ll have a C-section. The reality of childbirth, however, seldom lines up with these neat little boxes. Avoid yes/no questions and write open-ended answers to these four crucial questions:

Four KEY Questions:

• Are you willing to be induced?
  
• What is your attitude towards pain relief?
  
• Who do you want in the room with you when you deliver and/or need a C-section?
  
• What are your hopes around breastfeeding?