Birth Plan A, B and C

Birth Plan A, B and C

There is a running joke amongst Labor and Delivery Nurses about birth plans. It goes something like this, “What do you call a woman that comes in and presents her birth plan to the staff? The next cesarean section.” Now don’t get me wrong, I do have a sense of humor, but I don’t really find that very funny. The idea behind it is that birth doesn’t follow a plan. The writer of such birth plan is very attached to her birth plan, and deviating from that plan can often lead to disappointment, or unwillingness to see beyond the original picture.

I believe it’s essential to discuss your wishes and pain management techniques with those planning on attending the birth. How else will these people know your birth birth preferences, or how you need to be cared for? Understanding the different options and knowing your preferences is important; however, within this discussion it is necessary to come up with birth plan A, B and C. “Plan A” is the “ideal vision” of how you may like to see your birth unfold. That may include ideas like labor at home as long as possible, try the shower or tub for pain management, or birth in the Birth Center. “Plan B” relates to what you would do if you needed an unplanned intervention, such as labor augmentation or if your water broke prematurely, or you go past your due date. Then there is the final birth plan, “Plan C” should you need major intervention like a cesarean or induction. What does that look like, and and what are the limitations of these procedures? Plans B and C are not necessarily the most desired, but within these procedures, what are your options for still honoring some of your original ideas?

The other day in class, we discussed the “cesarean section” chapter that is in most childbirth education books. One of my students, who underwent a c-section for the birth of her first child, said that she skipped that chapter because she didn’t think it was going to apply to her. She now advises all her friends to read that chapter even though it may be scary and unpleasant. Unfortunately, the reality of our current culture is that approximately one third of all expectant mothers will give birth via cesarean section. It is a wise move to educate yourself as much as possible, as it can happen.

This morning I met with my doula client and her husband to discuss her upcoming birth. She is hoping for a HVAC (home birth vaginal birth after cesarean). She has put much thought and many hours into researching such an option and seems very excited about her choice. I am 100% behind her decision and will support her to the best of my ability. Part of my support comes from openly discussing the somewhat uncomfortable subject of, needing to transfer to the hospital or the possibility of a repeat c-section (since induction is not a possibility once a mother had a cesarean.) While these ideas are not the way my client would like to see her son brought into the world, they need to be discussed so should they need to happen, she is both mentally, emotionally and physically prepared.

I urge you to think beyond your dream scenario, read the “scary chapters” and put real thought into the many possibilities of your birth. This way you are not caught off guard. If you do veer away from your original Plan A, you can be comforted in the knowledge that there is a Plan B and C ready and waiting.

  • NavelgazingMidwife
    Posted at 11:01h, 22 January

    HBAC – Homebirth After Cesarean (the vaginal part is implied because it’s at home)

    VBAC – Vaginal Birth After Cesarean (the hospital part is implied because it doesn’t say HBAC)

    I’ve written extensively on birth plans and you are *so* right when it comes to Plans A, B & C.

    But, talking about any aspect outside of the actual labor & birth (“wants to labor at home as long as possible” or “no circumcision”) can be eliminated from the written birth plan. As can outdated procedures that haven’t been done for 15 years (“no shave or enema”); writing things like these screams INTERNET TEMPLATE.

    Really good article! Thanks for writing it.

  • Sandi
    Posted at 12:45h, 22 January

    Great post. I highly recommed Birthing from Within’s Caesarean chapter, to be able to see it is possible to give birth in awareness by Caesarean if that’s the way your labor goes.
    BTW, Congratulations on yoru pregnancy Deb!

  • Heather
    Posted at 17:55h, 25 January

    ITA with NavelgazingMidwife and second all she said.

    I had B&C covered on my birth plan. They moved into plan B as fast as they could at the hospital, sadly. As for my cesarean, that I prepared for with Birthing From Within (which is probably the only reason I was able to deal with it, honestly), all of the things I had hoped for to make it an atypical cesarean were basically ignored. I wasn’t even allowed to hold my husband’s hand as the needle I was so terrified was placed into my spine. It was a terrible experience.

    But one other thing is incorrect: induction is completely possible after VBAC and is still safer, statistically, than a RCAC. HOWEVER, induction often LEADS to cesarean in the first place and outside of medical necessity (which going past your EDD is NOT… you aren’t even medically ‘overdue’. despite doctors’ cries to the contrary, until 42 weeks) should be avoided. Personally, I would accept an induction (as a VBAC mother) before a RC.

    Honestly, the best thing to do is to search for a care provider that routinely assists in the type of birth you envision and plan with them for plans B&C because they will better know what the options will be in those plans.

    And always have a doula 😉 My regret about my VBAC is that I did not have a doula and I felt very alone when my labor became complicated with premature transition leading to FTP until an epidural was administered (after 8 hours of contractions that included 30-45 minute blocks of 120 second contractions every 2 minutes) that relaxed my body and allowed it to progress rapidly, as it’s supposed to in transition, and led to my successful, though very much plan B, VBAC.

  • c2011
    Posted at 17:58h, 25 January

    I planned to VBA2C but when I developed complications, such as high blood pressure and low amniotic fluid, my O.B. convinced me that the induction would last 15 minutes and I’d have to have a c/s anyway. So I went quietly and had a planned c/s.

    In the O.R., my doctor found a hole in my uterus and a large “window” or aneurism. I would undoubtedly have ruptured if I had VBACked. Also, there were other unfavourable conditions (the placenta had started to shrink).

    I knew my plan A was contingent on perfect conditions, and I’m glad that I had the best possible outcome considering.

  • Deb
    Posted at 10:18h, 27 January

    Thank you, Heather for your comments and thoughts.

    The one comment that confused me a bit is your remark about VBACs having the option to be induced. I would love to hear more about this. Since currently, in NYC, no doctors i know of will not induce a mother if she is going for a VBAC. Some will using a little bit of pitocin once labor has started on it’s on but they will not initiate labor through artificial induction like cervidil or cytotec.

    Please share if you have new information I can pass on to the students!!



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