Birth plans have become commonplace among expectant parents.
You may have questions about exactly what a birth plan is and whether a birth plan is optional or required. Simply stated, a birth plan is a list of preferences that the parents have regarding the management of the labor and delivery process. It makes sense to think through what your preferences are and share those with your doctor, but a written document is not required. If parents choose to prepare one, it should be brief. We encourage you not to use templates or outlines from internet sites as these are often too detailed and include discussions about obsolete practices such as routine enemas and shaving, etc.
The following is a list of responses to commonly asked questions to aid you in the development of a birth plan should you desire to do so.
Q. What should I expect after arrival at the hospital for possible labor?
A. Your nurse will greet you, gather information about your past history and current complaints, obtain vital signs, place you on a fetal heart rate monitor, examine your cervix if appropriate, and then notify your doctor.
Q. Is continuous fetal monitoring required?
A. In many cases when the mother and baby have no medical problems, intermittent monitoring is acceptable. This is very individualized, and the situation can change as labor progresses. Examples of conditions requiring continuous monitoring are maternal high blood pressure, and history of previous cesarean section.
Q. Is an I.V. required?
A. We would like all laboring patients to have an I.V. Often this can just be a catheter inserted in the vein and taped to the arm, called a hep lock. This permits a more rapid response to emergency situations.
Q. What about the ambience of the delivery suite?
A. This aspect is entirely under your control. You choose lighting and number of visitors, and you are encouraged to bring your own music if desired.
Q. How involved can my partner be?
A. We encourage active participation with you, but that is your decision as a couple. In most instances, your partner can cut the umbilical cord after delivery.
Q. What about pain management?
A. Options for pain management will be covered in childbirth classes. We will be supportive of the choices you make in this regard.
Q. Will I be able to move around in labor?
A. In most cases, if there is no epidural in place, mom can move around freely.
Q. How long will I be allowed to push and what positions are OK?
A. If there is no epidural in place, staff will assist mom in trying various positions until she discovers what works best for her. As long as there is normal progress of the baby through the birth canal, and there is good evidence of baby’s well-being, a mom may continue to push. For first time mom’s this process can take from 1 to 3 hours. Going beyond this time frame, even with normal fetal heart rate pattern, can pose excess risk to the baby.
Q. Is episiotomy routine?
A. Episiotomy is not routinely performed, and in most cases is not necessary. Decision about whether or not one is needed is not made until moments before the baby is born.
Q. What can be done to avoid a cesarean section?
A. We recognize that most women prefer to avoid a cesarean birth if possible. Some of reasons that a c-section might be recommended include breech presentation of the baby, signs that the baby isn’t tolerating the labor well, and signs that the baby won’t fit through the birth canal. Before labor, if the baby is found to be breech, it may be possible to attempt to turn the baby. If there are signs that the baby isn’t tolerating the labor well, the mother may be given IV fluids and oxygen to alleviate the situation. If dilation of the mother’s cervix stops or is very slow, indicating that there may be a problem with the baby fitting through the birth canal, often the labor can be stimulated by breaking the bag of water and/or administering pitocin. Finally, once the pushing part has begun, it may become necessary for the doctor to assist with vaginal delivery using forceps or vacuum. This is not common. These procedures are done when fairly immediate delivery is needed and cesarean section is not the best choice. The most common situations are prolonged pushing leading to maternal exhaustion and concerns about baby’s well-being. Still, even with all these possibilities, sometimes a c-section cannot be avoided.
Q. What will happen if I go past my due date and labor hasn’t started?
A. You and your doctor will discuss an individualized plan for you. In general, induction of labor is considered at approximately one week past the due date if it appears that your body is ready.
Q. Will my baby be able to stay with me after birth?
A. In the vast majority of cases the baby will stay with you at all times. There are some unforeseen conditions that can develop that necessitate other arrangements. You will be fully informed if this occurs.
Q. What newborn procedures are required?
A. In most cases, your baby will be given immediately to you, depending on your preferences. Often the partner or labor coach cuts the cord. Once there has been an appropriate amount of time to get acquainted with your newborn, the nurse will then measure and weigh him or her, apply antibiotic ointment to the eyes and administer Vitamin K. If there are any procedures that you plan to refuse, please discuss them ahead of time with your pediatrician.