A birth plan is designed to facilitate communication between you and your provider, especially necessary if you are  birthing outside the home environment.  Secondly, it is to offer information on the individualized care you as the mother would like during labor, birth and immediately postpartum for you and your baby.

It should be brief (no more than one page) and only have the bullet point information that is specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

It is important to take a written birth plan to a prenatal visit at least a month prior to your given estimated due date in order to have a clear understanding of expectation and agreement. If it becomes apparent that you and your provider are not on the same page, this gives can give time to seek out another provider that fits you and you fit with. Remember it is not a legal document that your location of delivery or care provider must adhere to.

 =======================================================

Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

Labor

I am planning on a no to low-intervention natural birth.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

• I plan on wearing my own clothing. I will ask for a gown if I change my mind.
• I would like a saline lock in lieu of a running IV.
• Limited vaginal exams after initial assessment.
• In the event an induction and/or augmentation is medically necessitated-
  • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
  • Pitocin – A very gentle and slowly administered dosage increase.
  • AROM – will only consent to if an internal fetal monitor is a must.
• Spontaneous pushing and delivery in any position I am most comfortable with.
• No cord traction or aggressive placental detachment, including deep uterine massage.
• Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance while still attached to me).

Postpartum and Baby Care

• Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
• Delayed bathing
• Delaying vaccinations including eye ointment and vitamin k.
• Exclusive breastfeeding, no pacifiers, sugar water, or formula. I will hand express if necessary.
• No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

• Only essential conversation related to the surgery and delivery
• Lower sterile drape or have a mirror present so I may see my baby emerge
• Only one arm strapped down so I may touch my baby
• Pictures
• Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
• Baby to stay with me continuously in OR and recovery
• If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
• Breastfeed in OR and/or recovery
• Delayed immunizations
• Delayed washing and dressing of baby
• No separation from me except what is absolutely medically necessary

This “plan” may be copied, pasted and edited  for use by others.

It has occurred to me through my time with doula clients and students,  that many care providers serving hospital birthing mothers do not ask any questions of their pregnant patients during the 7-10 minute prenatal visits that lead to a substantive working relationship.

I have also learned that too often the pregnant “patient” does not know to tell her provider anything about what is going on in her life or pregnancy since she is not queried first.

Thinking there must be a way to better bridge this very real separation to solid patient-provider relationship building, I am drawing from my work as a midwife assistant in the making of this tip list.

Pregnant mothers your provider needs to know so much more about you and your pregnancy than blood pressure, weight, fundal height and fetal heart tones. I encourage you to freely offer the below information at every appointment to grow personalized care, advisement and support.

1) Appetite/Diet/Supplements – tell your provider if your appetite has increased or decreased between visits. Do you have food aversions? Are you taking any supplements or want to take supplements?

2) Sleep habits – tell your provider how you are or are not sleeping.  For example, are you having trouble falling asleep, falling back to sleep or staying asleep.

3) Nausea – Do you continue to have nausea? When? How often? Does it correlate with anything in particular?

4) Hemorrhoids – if you have them or not. What you are doing for them.

5) Varicose veins -  Are there veins sticking out or causing issue anywhere in your body?

6) Bowel habits – Are you experiencing normal or abnormal bowel habits?

7) Exercise – What have you been doing? Do changes need to be made?

Stress – Is there anything in your life that is really stressing you? Stress can impact pregnancy health. Important to discuss.

9) Related Providers – Are you going to any pregnancy related providers (such as chiropractor, acupuncturist, yoga, etc.)?

10) General  – Are you feeling well or not. Do you need more information or referrals?

There is so much more to you than a pregnant uterus. You are a holistic person who needs to be treated as such. I would venture that something much more individualized can come out of your care with simple sharing!

Here’s to whole care!

I am so thankful to all of the submissions I received for this Why I am Grateful for my Birth(s) blog carnival. I have found no matter what a woman can learn something and be grateful for something in every birth experience no matter how difficult or wonderful. Enjoy these quips and please go to their blogs to read in completeness.

Tiffany Miller of Birth In Joy says in an excerpt from her post The Most Important Piece, “I am thankful that Mom believed in my ability to breastfeed my new baby, even though it hurt at first. She never told me that I had so severely damaged her nipples, as she tried to learn with no support whatsoever during my own newborn days. Nary an ounce of bitterness did she carry from that time. She knew and accepted that my path was my own, and supported me completely.” She goes on to further outline how the mentoring and support of her mother paved her way.

How grateful she is for all four natural births and her mother’s unwavering assistance. Assistance and presence she could never imagine doing without.  Just beautiful and shows how important in our lives are the ones who came before.

Kristen Oganowski of Birthing Beautiful Ideas in her post Your Births Brought Me Here writes this gorgeous, tear inspiring letter to her two children about what amazing changes they spurned in her own life, in the very life that they would come to know. Without one birth, would the other have come along the way it did?

Here is an excerpt: “When you both were born, I called myself: Graduate student (unhappily).  Teacher (happily).  Feminist (always).  Mother (timidly). Today I call myself: Doula (happily).  Birth and breastfeeding advocate (unflinchingly).  Blogger (smirkingly).  Writer (finally).  Feminist (permanently).  Mother (confidently).  Graduate student (temporarily). Your births brought me here, to this place where I am (finally) content and impassioned. All wrapped up  with a Love, Mom.

Our next post is by Sheridan Ripley of Enjoy Birth. She writes very plainly about how grateful she is for varied experiences that give her insight to what other women experience and that she is better able to support them.

Here is a peek.

• If I had only amazing natural birth experiences would I have judged those moms who choose epidurals?
• If I had only vaginal births would I have understood and fought so hard for VBAC moms?
• If I only had easy times creating that nursing relationship with my boys, would I have been as supportive of my moms struggling with nursing?

Very poignant and open…..

We come to Bess Bedell of MommasMakeMilk.Com came to a place of self-awareness, peace and a fierceness to help others in her experiences. Like others her heart grew and expanded with her own knowledge and walk. A strength and confidence awoke in her to the benefit of so many coming after.

My two births birthed a new women. A mature women who has opinions, knowledge, experience and a passion in life. If I had not had my c-section I may never had given VBAC a second though. The lack of VBAC support and availability would probably never have entered my radar. My second birth showed me that success and perfection are not the same but both are wonderful and I can be happy for and embrace a mother and her experience even if it wasn’t a completely natural, completely med-free birth. Both of my experience have prepared me for the future. My future of birthing, and next time I plan on birthing at home, and my future of educating and supporting pregnant and birthing mothers.

And lastly my own blog post entry. I know I rarely speak of my own births in any detail unless it is one on one. As a community member, advocate, doula, educator, I strive NEVER to be an intervention on a woman. Today I decided to give a small window into my own experiences and why I am grateful. Please read and comment freely – Grateful For My Births.

Thank you so much to those who submitted posts. The openness of other women allow all of us to learn, grow and share as we are meant to within a healthy society. We are not there yet, but I have a hope that through this sort of connection, we are healing some brokenness.

In reading all these posts, not one is the same, not in tone or style, but every woman was changed positively in the end.

I sit here and ponder Why childbirth education is important?. I am an educator because I think it can be a vital piece to the preparation puzzle prior to welcoming a baby.  I use the word “can” versus “is” due to the fact that all educational offerings are not created equally.

It is known that only a percentage of expecting mothers attend a childbirth class series. Perhaps they believe the staff will explain everything when they get to the hospital, they really have a deep trust in the process and are reading up on everything, or since they are having a home birth that additional education is unneeded. Whatever the reason, women are not getting the foundational information that can be incredibly helpful toward confidence, ability, decision making and mothering far beyond the birth itself.

A good childbirth class series (or rather perinatal class) is well worth the monetary and time investment for most first time mothers and can benefit those who have already birthed.  My post on choosing a childbirth class is a good jumping off point to figuring out what type of course suits the individual expecting mother (her partner or labor support).

A class series worth the time and effort will be comprehensive in nature, not just covering labor and birth. What does that look like? A class that covers midway third trimester pregnancy through 4-8 weeks postpartum. It is content that is deep and is applicable to real life.

A sample of course content:

• Pregnancy Basics
• Common Terminology
• Normal Physiologic Changes and “helps”
• Exercise
• Nutrition
• Prenatal Testing
• Birth Plans
• Informed Consent
• Communication and Self-Advocacy Skill Building
• Overview of spontaneous Labor and Birth
• Labor milestones with Comfort and Positioning Strategies
• Overview of all Options in Labor, Birth and Postpartum
• Labor Partner Role
• Immediate Postpartum
• Navigating first weeks Postpartum
• Overview of Infant Feeding and Norms
• Bonding
• Medications and Interventions
• Cesarean and VBAC
• Unexpected Events
• Role-playing Scenarios
• Relaxation and Visualization Practice
• Local/Online Resources

How the educator reaches her class is fundamental to the learning process and take away of participants.  I encourage women to interview the potential educator. Finding the right fit in a class is no different that in provider, doula or birth location.

Even if a woman knows she wants an epidural, TAKING A GOOD CLASS is vital because she will be having a natural birth the epidural is on board and her Plan B could very well be a natural birth. Being prepared will only serve her well in the fluid process known as labor and delivery.

Gaining knowledge that will help a woman to partner with her provider, address her own needs fully and help her to define her own birth philosophy gives her a leg up on being responsible and in charge in her own health care and even outcomes.

The vast scope of what a solid class series can offer an expecting mother (her partner or support person) is incredibly valuable and can not be understated. A class that provides for encouragement, comfort, safety, respect, connection, structure, evidence-based information and real life application can plant seeds and prosper skills that will carry a woman well into her mothering years. These skills are for life, not just for labor and birth. I am stunned often by how birthing knowledge carries me in daily ability with my own family.

Here’s to happy and deep learning!

Being a childbirth (perinatal) educator is a position that affords great opportunity to positively influence women in the childbearing year and far beyond.  It is also a great responsibility that ought include: self-assessment, continuing education, evidence-based curriculum, the ability inform with discernment and the willingness not to teach a good patient course.

With all of this in mind, it is important that pregnant women choose their childbirth class wisely. There is not any one-size-fits-all class.

How does one go about choosing a childbirth class? I encourage you to go about choosing a class series in the same way you would choose a provider or birth location. Do some investigating and even interview the educator.

Off to a good search:

• Get referrals from women who have had or wanted the type of birth you are desiring.
• Check out your local birth groups and get referrals.
• Ask your provider for a referral.
• Do a web search for classes in your area. You may be surprised that there are many offerings method and philosophy based outside and within the hospital setting.
• If thinking about a hospital sponsored course, find out if it is a comprehensive series or a what happens to women once they get to our hospital class? This is otherwise known as a good patient class.
• Check out the course website then call or email the instructor to get a feel for her style and philosophy. Even a hospital based educator should be able to call you back or email you.

Before registering for a class series:

• How long is the series? A minimum of 12 hours is needed to be a comprehensive series. At least 2 different class sessions over two different weeks, but  preferably a minimum of 4 class sessions. You may find classes up to 12 sessions. Be wary of condensed one or two day classes as there is not enough time to process information and retain it well. It IS worth the investment of time.
• When is the class? Day of week and time of day needs to fit into your lifestyle. Again, I encourage your investment over a period of time versus a one-day class.
• Where is the class held? Classes may be held in like-minded businesses, in home, care provider office or hospital.
• What organization is the instructor trained and certified with? Though certification is not required, it can be very important the training and background an educator has.  Check out the organization to make sure you agree with it.
• What does the instructor’s experience involve?
• What is the instructor’s philosophy and style?
  
• What is the cost of the course? Classes can cost anywhere from free through a hospital to a few hundred dollars. It really can be a wide range. Find your comfort level. Though expect to invest in a good class. Free or low cost for everyone is often not comprehensive in nature.
• What is the course content? A comprehensive class should include a variety of topics, such as, pregnancy basics,  common terminology, normal physiologic changes, exercise, nutrition, prenatal testing, birth plans, informed consent, communication skill building, overview of spontaneous labor and birth, labor milestones with comfort and position strategies, overview of all options in labor and birth, labor partner role,  immediate postpartum, navigating first weeks postpartum, overview of infant feeding, infant norms, medications and interventions, cesarean, unexpected events, role-playing scenarios, relaxation practice and local/online resources. It is usual to expect homework on top of class time as well.
• What are the birth outcome statistics for class participants? It may be difficult though to get true data whether a philosophy-based or method-based class.
• What is expected of me as a class participant?
• What do I need to bring?
• Who may come with me?
• Is there a lending library?

I hope you find this list helpful and are able to find the just right fit. I look forward to your feedback.

There is such a deep chasm and fracture within the doula community regarding in-hospital and out-of-hospital birth. On the one hand there are those who say anything goes in supporting women and their choices. On the other, there are those who say no doula should support a woman in the hospital environment because it is a “bad and dangerous” place to birth,  or at the very least should get kicked out if she is doing her job “right”.

Who is right? This is where it gets tricky to be sure.

With upwards of 98% of the birthing women going to the hospital in the United States, are WE really within the general doula scope of practice by taking such a hard stance of ignoring those women in need? Who is benefiting here? It is well known, that I am all for a doula deciding her practice style, what scenarios she is best suited to support within, and knowing who she is best able to support.  But to abjectly say, no doula should ever support a woman in a hospital birth, is to me akin to very interventive practitioners who believe that birth is inherently dangerous and a trauma waiting to happen. Thus, viewing every women and baby through high-risk lenses and subjecting them to high-risk protocols where there is no medical need encourages more intervention and higher-risk scenarios to actually occur.

Who does this serve taking such a hard line? Perhaps those speaking it, thinking they are pressing for the greater good. Definitely not the mothers who need the support and assistance navigating a sometimes difficult and stressful system. The mothers and babies are caught then between a rock and a hard place. Then they are effectively forced to go without support and help. The truth is women having hospital births NEED DOULA SUPPORT MORE than women choosing an out-of-hospital option.

Bottom line: I make no claim that it is an easy task to doula within the hospital environment. It is not. It can be brutal. Imagine for a moment, really, close your eyes and think of what happens, what you witness as a doula when you are there — then think of all the women who have no doula present — what happens to them? What do those women experience? What do those babies experience? Now, open your eyes and breathe for a moment. It is not pretty is it?

Right there is what keeps me taking hospital birthing clients. It requires very open communication and immense work prior to labor during prenatals running through scenarios, detailing needs and desires, making certain informed consent and refusal is understood for a variety of procedures, medications, and cesarean. A mother needs to be well-versed in how to use her self-advocacy voice as does her husband, partner or other main support person.

Looking at the flip-side now.

So the other ideal, er rather idea, is that a doula should support anyone and anything because she is a doula poses other issues in my mind.  I do not see anywhere in the job description that this is what a doula ought do.  Any one doula cannot be the right doula for every mother or scenario. This way of thinking can fall into  a cookie-cutter way of practicing, thinking one can be all to everyone. Doulas are people too. Each has individual abilities, biases that need to be addressed, history and points of view.

I think it has been mistaken that a good doula is one that has no say in how she practices or who she is best to serve.  I believe there is a doula for every type of scenario and mother. It is a very individual pursuit and fit.

I know some amazing niche doulas out there who support only high-risk mothers, multiples, same-sex couples, in-hospital birthers, planned cesareans….. The list could go on.

Honestly, I will say there are some amazing doulas who can work under this very open practice style effortlessly and with excellence.  I applaud those doulas, though I think that is the minority and most are not able to keep it up without finding a comfort zone long haul.

Childbirth is such a deeply intimate and intense process with so many variables, being the right fit all the way around is necessary in my humble opinion.  I have seen doulas deeply wounded and traumatized by what happens in the birth room. Sometimes that is unavoidable, but through years of interaction with many doulas, the running thread is that the doula had misgivings even during the interview that this was probably not a good fit but chose not to refer the mother out to someone she knew was better suited for whatever the reason.

Are women and babies really being served best under this model of practice? This is for you to go ahead and answer for yourself.

Bottom Line: Women and babies need individual care whether from a doula, nurse, or care provider. Can a doula be all things to all mothers? Some, I am sure. Overall I believe not. For the health of a doula and the health of her ability to practice and support well, finding the “comfort zone” can make the difference for the mother, baby and doula. Why? Because doula work is such an intense giving of oneself (emotionally, physically, even spiritually). A continual self-assessment needs to be done just where her true and honest “comfort zone” is. By doing this, a doula is caring not only for herself by avoiding burnout, but also for her future clients and her ability to care for others with excellence and utmost professionalism.

There has been much ado surrounding the language of breastfeeding being normal and usual versus the best for baby and mother in great thanks to Diane Weissinger. It is so valuable to recognize that while we all desire to be the best, we often hit the normal everyday averages in life. We are comfortable reaching a goal that seems more attainable. Best or better can feel so far out of reach where average and usual seem quite in reach most of the time. None of us generally want to be below the average or usual. Thus the language of the risks of NOT breastfeeding is so vital.

I would like to see the same type of language revolving around pregnancy and birth as well.

In the overall picture here is the usual occurrence: Ovulation leads to heightened sexual desire, which leads to sexual activity, which leads to pregnancy, which leads to labor, which leads to birth, which leads to breastfeeding…..

So how do we look at language as an important part of our social fabric and belief systems surrounding this process?

Let us look at contrasting statements of what is often heard and how a positive point of view can be adapted.

Pregnancy is: a burden, an illness, an affliction, a mistake, something to be tolerated……

Pregnancy is: a gift, wonderful, amazing, part of the design, someone to grow…..

Labor is: scary, worth fearing, the unknown, unpredictable, painful, to be avoided, to be numbed from, to be medicated, to be induced, out of control, unfeminine…..

Labor is: what happens at the end of pregnancy, hard work but worth it, manageable by our own endorphins and oxytocin, an adventure, not bigger than the woman creating it, to be worked with, worth be present for, is what baby expects……..

Pushing and Birth are: terrifying, physically too difficult, only works for women who are not too small, short, skinny, big, fat, young or old, responsible for pelvic floor problems, out of control, horrible……..

Pushing and Birth are: what happens after dilation completes, to help baby prepare for breathing, bonding and feeding, sometimes pleasurable, sometimes fast, sometimes slow, able to occur in water, standing, laying down, squatting, on hands and knees, often most effective when a woman is given the opportunity to spontaneously work with her baby and body, not always responsible for pelvic floor issues, amazing, hard work, worthwhile, sets the finals hormonal shifts in motion for mother and baby……

Is it really BETTER? I say no. It is usual and normal.

• Spontaneous labor is not better – it is the expected usual occurrence at the end of pregnancy.
• Unmedicated labor and birth is not better – it is what the body mechanisms and baby expect to perform at normal levels.
• Unrestricted access to movement, support and safety in response to labor progression is not better – it is the usual expectation to facilitate a normal process.
• Spontaneous physiologic pushing is not better – it is what a woman will just do, in her way.
• Spontaneous birth is not better – it is what a mother and baby do.
• Keeping mother and baby together without separation is not better – it is what both the mother and baby are expecting to facilitate bonding, breastfeeding, and normal newborn health.

Denying the norms and adding in unnecessary interventions, medications and separation is creating a risky environment for mothers and babies. Thus increasing fear, worry,and even a desire to be fixed at all costs.

Perhaps even worse, an atmosphere has been created where the abnormal has become the expected norm and the normal has become the problem to be eradicated.

Bottom line, our language matters and will help shape for the positive or negative the future of birth.

Women and babies are not made with a pop out button like some Thanksgiving turkeys indicating being done. That pesky due date becomes such great topic of debate. It can lead to unnecessary interventions (such as induction, provider change because of regulations or cesarean), emotional unease (I am broken, this baby is never coming, I am LATE one minute past 40 weeks), physical distress by way of decreased pregnancy change tolerance, and mess with a woman’s work schedule (when to start maternity leave or return to work date).

Prior to home pregnancy tests and ultrasound dating, the due date was much more of a due month. Now it seems everyone has bought into this mysterious due date being something very hard fact and unfailing.

Henci Goer wrote a tremendously helpful article called “When is that baby due? ” several years back that sheds light on this very issue. She states: “When it comes to determining your due date, “things,” as the Gilbert and Sullivan ditty goes, “are seldom what they seem.” The methods of calculation are far from exact, common assumptions about the average length of pregnancy are wrong and calling it a “due date” is misleading. Understanding these uncertainties may help to curb your natural impatience to know exactly when labor will begin.”

The most common way women are finding out the due date of their baby is by using an online calculator such as this:

However, this even from the federal website does not take into consideration ovulation, only length of cycle (which is an improvement over straight up LMP dating).

So how do women handle this notion of a due date? I asked the question and here are some responses.

• KZ -    “Last time, I told everyone my due date, and when E had other plans, I got the, “Have you had that baby, YET?? How long are they gonna make you go?” *cringe* This time, I’m wising up and saying Spring. That’s it. Spring.”
• SL – “I used a “due season”. I told my three year old that the leaves would change on the tree and we would probably have Thanksgiving dinner and she would be here sometime after that. ”
• KMC-M -”I love the Ish… december-ish”
• CLM -”I always give very generic answers to avoid the annoying “aren’t you due yet???” comments. I’ve also written on Christmas cards … “baby #3, due Spring 20??”. Once I was due at the very end of July. My well meaning neighbor was asking … “are you STILL pregnant?” on July 4th. Ugh.”
• LE – “Whenever someone asked my due date I always said, “he’ll come when he’s ready” or “when God decides he’s ready”
• SC – “Mid to late month was the closest I’d get.”

Seems these particular women either have previously gotten bitten by the pesky due date or learned in the first pregnancy not to put too much stock in an arbitrarily determined date. I say good for them!

As a midwife assistant, I now participate in the baby assessments. Some of these post birth assessments gestationally date baby. Often the dates are different than the due date assumption. Some earlier and some later.  This happens even with women who knew exactly when the last menstrual period, ovulation, and conception occurred along with cycle length.

Only the baby (and God according to my belief) knows the due date aka when he or she will press start.

Early is not one day prior to 40 weeks EDD just as late is not 40 weeks and 1 day over EDD. Full term pregnancy is defined as 37 weeks-42 weeks gestation.

I think it is high time “we” layoff pressuring mamas and their babies. “We” must stop trying to evict them earlier than they desire without a true medical reason. One day to any adult is nothing, but even a day to an unborn baby coming earthside can mean the difference between alive and thriving.

With the majority of women heading to the hospital to birth their babies, planning for the impending birth has become an important aspect of preparation in the United States (though the percentage of out of hospital births is rising).  Standardized, highly medicalized, non-individualized perinatal and postpartum care has really led the way to this being a need. Sadly for most women, attaining evidence-based and individualized patient care going into the hospital environment is not often simple or accessible even with a well thought out, communicated, and researched plan.

In light of the care women are likely to come across for themselves and their babies, below is a list of the common information that needs to be addressed during pregnancy for labor and birth  (for a comprehensive pdf, please email me at desirre@prepforbirth.com):

• What level of care is needed – low-risk (the most common) or high risk
• Eating and Drinking Orally
• Saline-Lock, running IV or Neither
• Fetal Monitoring – continuous or intermittent
• Pain Management Options
• In the event of Labor Induction
• In the event of Labor Augmentation
• Pushing and Delivery Options
• Cord Clamping Options
• Immediate Postpartum Baby Care, Assessments, Interventions & Treatments
• Immediate Postpartum Mother Care, Assessments, Interventions & Treatments
• In the event of a Cesarean
• Infant Feeding Options
• In the event of Mother/Baby Separation or NICU Stay

Once the information is gathered women are often urged to write it all down in document format.  The most recognizable term is Birth Plan. The very word plan though can be a stumbling block for both mothers and staffers alike.  It can come across hard line and lacking flexibility. Unfortunately, this can be construed by a staffer or care provider that a woman is telling them how to do their jobs or that she has very set even unrealistic expectations. Don’t kill the messenger here, that is really how it can be looked at and thought of by the medical professionals receiving it. I am not saying it is the “right” thinking.

The idea that the term “Birth Plan” may very well be outdated is intriguing to me.  Upon research, I have indeed found so many other ways to name this document.  I highly encourage a pregnant woman to try many different titles on for size to see what best suits her communication style and personality.

A birth plan by any other name list (please send me any other titles to add that are missing):

• Birth Preferences
• Birth Map
• Birth Dreams
• Birth Vision
• Birth Wishes
• Birth Needs
• Birth Desires
• Birth Wants

Be aware that whatever the document is called, it should be no more than a single page that speaks to the current practice culture in any given area. For example, if Cytotec (misoprostol) is never used for ripening, then saying it isn’t to be used is moot and can negate the other portions of the document to the reader because the reader may think the writer is out of touch with what goes on. Do the research on the birth location practices and protocols along with the care providers standing orders so the details are up-to-date.

By no means though should cookie-cutter care be what defines a woman’s options, desires or needs for her written “Birth Plan”.  Always discuss with care provider ahead of time. If a provider uses responses like, “You can try that but…”, “Just get the epidural because….”, “Why would you want to do that?”, “Having a natural birth doesn’t make you a hero.”, or anything similar, these are giant red flags. This could be the first insight that a woman and her provider do not share the same philosophy or idea of expected care. Red flag responses may very well be leading to a serious compromise to the provider’s desires no matter what is agreed to. Well crafted and designed lip service is how I see it. Please listen intently to the answers to questions.

Writing a “Birth Plan” is a valuable and pretty necessary undertaking when birthing in the hospital in my opinion and experience.

As a last thought, a “Birth Plan” document is not legal, but rather a communication tool and values clarification vehicle for a woman, her provider and the staff she will come in contact with.