March 28, 2013

Your Doctor’s Birth Plan

I recently met with a couple for a private childbirth education class. When we started to talk about birth plans, the mama-to-be told me that her doctor didn’t want her to write a birth plan. I asked her why and she said that her doctor didn’t want all the details of her birth mapped out in case things didn’t go the way she had hoped. In some ways, I completely agree with her doctor. It is important not to get too attached to one specific way to birth and be open to the possibilities that there may be unplanned events. However, I do think it is necessary to go over your “birth preferences” with you doctor so that there is a general understanding of what you want for your birth. (I am going to go ahead and say “doctor” because most of these points are a given when working with a midwife.)

I suggest making two birth plans- one for you and your partner and one to discuss with your doctor. The one for you and your partner can be a little more fun and playful and may include things like, what type of pain management techniques would you like to try? For example: massage, counterpressure, getting in the bathtub or shower, visualization, and aromatherapy. It can also be fun to discuss, practice and experiment with different laboring positions. Usually your doctor will not really care about what positions you want to labor in as long as the fetal monitors can pick up the baby’s heart rate.

You and your partner may also want to talk about if you want music playing or if you have pictures you find inspiring you want around the room. Another topic to discuss is who you want in the room with you. In teaching hospitals, you may have students that would like to observe, you are free to choose not to have them there. I would also suggest adding to your personal plan: whether you would like newborn procedures delayed, especially if you are planning to breastfeed, or if you are planning on rooming in with your baby. None of these things are of all that much concern to your doctor, but would be ideal for you to have thought out ahead of time. Also skin to skin contact with your baby is a given unless the baby or you need immediate medical attention.

The areas to talk about with your doctor are:
When to head to the hospital or birth center
If you are planning in not taking pain medication, your doctor will likely advise you to come when you are in a very steady active labor pattern. To identify if you are in active labor your doctor may refer to the “3-1-1 rule” – meaning your contractions are 3 minutes apart, lasting a minute and this pattern has been going on for an hour. If you are planning on pain medication or you are high risk, you may be asked to come in at 4-1-1 or even 5-1-1.

What kind of freedom of movement is to be expected?

If you are hoping to be able to pace the halls or get into the bath or shower at the hospital, is you doctor on board with having intermittent monitoring? Or should you expect full time monitoring which will limited your freedom of movement?

Some doctors are fine with you continuing to nibble lightly or at least drink clear fluids. Others have a strict “ice chips only” rule. Find out ahead of time what your doctor’s protocol is. Keep in mind, while you are at home and in transit, you can eat and drink whatever you like! And you SHOULD continue to nourish yourself!

Epidural and other pain medications

You may find your doctor to be a good advocate in helping you achieve a natural birth should you opt for that. I was once at a birth where the mother had chosen to have a drug free birth and as the woman was saying how hard the contractions were, the doctor rubbed the woman’s back and said, “This is what you said you wanted, and I am here to help you.” I still remember being moved by that doctors commitment and compassion toward her client.

Labor augmentation

There are many ways to naturally move labor along: nipple stimulation, sex, acupuncture, and castor oil, just to name a few. If you are facing an induction date, check with your doctor to see if these ideas are an option. It is also helpful to know if your doctor regularly uses pitocin to help move labor along. You can discuss with your doctor if you would like to avoid artificial augmentation and what their comfort level is with you incorporating some of the natural methods already mentioned.

Over all schedule
It is important to get a general sense of your doctor’s expectations for what kind of schedule will you be on before and during labor. Some questions to discuss are:

-How far past your due date can you go before discussing induction?
-If your water breaks before the onset of labor, how long could you expect to labor at home before your doctor wants to intervene with pitocin?
-Once you are in the hospital, are you expected to have full time fetal monitoring or can you have intermittent monitoring? And if full time monitering, for how long? All of your labor or just early labor?
-Once in labor (assuming mom and baby are doing fine) are you expected to progress at a certain rate?
-How long can you push for?

Positions for second stage of labor (pushing)
There is a wide spectrum in how each doctor approach pushing position. A lot of doctors have the protocol that you can push in any position you find beneficial, but when it is time for the baby to actually crown and be born, they want you on your back. Some doctors I have heard say, as long as they can see the baby emerging they don’t care what position you are in and others say you have to be on your back or side the whole time. At one birth, I witnessed the woman asking (pleading) to push on all 4’s but the doctor insisted she be on her back. During the labor is not the time to find out how your doctor assists in the delivery of your child. You don’t want to meet resistance or confrontation at this time. If you have strong feelings one way or another, negotiate with your doctor ahead of time

I would also suggest making a list of your top 3 priorities for your birth, and making this list known to your doctor.

There are other topics that I usually include on my “birth preference” worksheets I use with my clients, but honestly, I don’t think the doctor pays too much attention to these. In situations when these may come up, usually the doctor is going to go with their interpretation of the situation to make a final decision. These topics are: episiotomy (considering most OB/GYNs do not regularly do this unless they need to use a vacuum or foreceps to aid in the birth or immediately need to get the baby out), using instrumental assistance – foreceps or vacuum- even if you said you did not want this, if the doctor thinks this is necessary and it is between that or a c-section your opinion or preference is really not going to matter. A lot of women bring up their desire to avoid a c-section if possible. Unless a c-section is medically necessary, avoiding it is usually the doctors preference as well! 🙂

To help you better understand all your options and start to carve out a personal birth plan, check out my blog, Educate Yourself, Know Your Birth Options.




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