January 21, 2011

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.



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