Do I need to write a Birth Plan and what should I put in it?

Q : “I had a cesarean with my first birth, which I didn’t think was really necessary. The doctor didn’t want to wait. I’m having my second child and I would really like a normal birth this time. I have a midwife who is very encouraging of VBAC. I’m wondering if I should write a birth plan so that I don’t end up with an unnecessary c-section again.”

A : A birth plan is not always necessary, although it is useful as a communication tool and also the process of thinking about and clarifying what you want can be invaluable. You can’t just copy someone else’s birth plan because every woman is different in what they find important to them. Some women are totally happy with sections are some are disappointed.

It’s awesome that you know what you want and are committed enough to seek out a midwife. Good for you! The most important factor in helping you have a VBAC is choosing a caregiver, whether it is a doctor or a midwife, who has lots of experience successfully supporting VBACs.

Another very important factor is feeling clear yourself about what you want and why, and educating yourself on the evidence to support your preferences. For example, many doctors are not comfortable with VBAC’s because of the small risk of uterine rupture. If you understand the evidence based research, you can dispel your fears because overwhelmingly the evidence states that VBAC is safer than another section. There are far more risks associated with sections than VBACs. Uterine rupture occurs in less than 1% of vbacs, and of those, they tend to mainly occur only when pitocin (artificial oxytocin) or cervadil (prostaglandin) is administered because they can cause unnaturally strong contractions.

The third factor to increase your chances of having a VBAC is to hire a Doula. At my first birth, I made the mistake of thinking I didn’t need a doula because I had a midwife, but what I found was that the role of a doula and a midwife, although overlapping, are quite different.

Research shows that having a doula can reduce cesarean rates by 50%, as well as reduce the need for epidurals, instrumental deliveries, inductions etc. A doula provides continuous support, while a midwife may have other clients to attend to. Doulas provide emotional, physical and informational support. The doula goes to your home before you go to the hospital. This in itself helps moms stay home longer so they don’t show up at the hospital too early. The reality is that when you get to the hospital, you are on the clock. We don’t live in utopia. Doctors have other patients, hospital beds may be full etc. If a mom is in labor too long, there may be a lot of pressure to speed things up, whether or not there is a medical reason for it. And some women are glad to speed things up, but some are not. This is where knowing yourself is important and communicating with your caregiver about what’s important to you. There are many grey areas in labor where there is room for negotiation.

If you do decide to hire a doula, find one who connects with you and listens to your needs. Besides having three kids, I am also a doula and prenatal teacher in Surrey, BC, Canada. I also do birth plan consultations to help moms create plans that are individualized. You can contact me or find another doula who is local to you.

Have a great day, and have a wonderful birth!


Respecting the Mother’s Preferences for Birth

Yesterday I did a quick review of the new internet channel about birth – . After giving it more thought, I decided to add a point that I think is critically important in the debate, yet is often completely ignored. That is, what does the mom prefer for her own birth?

What does the mom prefer?! How does that matter?! Isn`t it just a question of safety and risk? Life or death?

Well, remember, in my review post I talked about most decisions in childbirth being in the grey area. What that means is there may be some risks to not using medical intervention, and some risks to using medical intervention. So caregivers and parents have to make a decision based on balancing the risks.

Because we are talking about those grey area situations right now, and not the out and out real and immediate emergencies, I would like to suggest that one critically important factor in deciding the course of action, besides weighing the risks, is knowing what the moms preferences are for her birth.

Seems simple really, but it is quite profound and has long lasting effects. Here`s why –

There are roughly 3 groups of women – Women who really don`t like medical interventions, women who do want medical interventions, and women who don`t care either way.  You may argue about which group is more common, or why they feel the way they do, but no one can deny that there are these three groups.

It`s funny because the women who really prefer natural birth simply can`t understand why some women don`t, and the women who really want a medical birth cannot fathom why anyone would want a natural birth. The point is not which is a better way. There is no such thing. The point is that different women prefer different experiences. The childbirth “Experts“ can debate all they want, but what do they women actually doing the birthing think?

Why this is so important is this : Say a woman who really wants a normal birth, goes to the hospital and has a long labor. The doctor comes in at some point and says, “Well, this has gone on for too long. I think we may as well do a cesarean.“The well-intentioned doctor may well be thinking, “No sense in letting her suffer. I`ll help her out by getting the baby out now and putting an end to her pain.“ This is an example of a grey area situation where there is no signs of distress in mother or baby. (i`m not talking about situations where there is a clear problem and a cesarean is clearly the best option.)

If the mom doesn`t have a discussion with the doctor about risks, benefits and her preferences, she may go on to have the cesarean then end up wondering for the rest of her life if it was really necessary. Besides physical effects, there can be emotional effects which can affect her self-confidence as a woman and as a mother.

If however, the woman doesn`t care either way, normal birth or cesarean, then she may be totally happy with her experience and won`t feel the same emotions as the woman who actually wanted the vaginal birth.

If the woman actually wanted a cesarean to start with, she would be so relieved and totally happy with her experience.

The thing is the doctor does not know which of these three categories of women his client is in. The doctor may not even know there are three categories. If you have a preference, it is your job to figure out what it is, and to communicate it with your doctor. It is easier to have these discussions during your prenatal visits rather than in thee middle of labor, although you can still discuss things as they arise.

That woman in the first example may still choose to go ahead with the cesarean, or she may not. But if she has a discussion with her doctor or midwife and takes into account her preference, she will feel much better about her experience, and feel more confident about herself and be more relaxed as a mom.

I hope you found this article helpful. Please leave your thoughts in the comment box. If you would like to schedule a birth consultation to clarify your preferences for birth (otherwise known as a Birth Plan) and write a list of important questions to discuss with your caregiver in prenatal visits, call 604 809 3288 or email kaurina @ prenatal journey . ca


© copyright 2011 Kaurina Danu The Prenatal Journey