Here's my suggested approach. Keep in mind that I wrote this at 2 am after not being able to sleep while all these ideas kept running amuck in my brain!
How to write a Great Birth Plan and then Deconstruct it.
First Draft: First trimester or even when you are TTC
Step One: Title this "The Way too long list"
Step Two: Create 4 sections:
- Labor
- Pushing & Birth
- Special Circumstances
- Newborn Care
Step Three: under each of these headings, list anything and everything that is important to you about your birth experience.
Now what?: Based upon your lists, consider whether or not your caregiver will be supportive of such requests. If you know this without a doubt, then you can readily move forward to Step Four. If you are unsure or are just guessing they will be because they have been nice during your GYN visits, ask around the natural birth community and ask your caregiver directly about how they handle natural births. These answers will give you an indication of whether or not you need to act now to change caregivers. Be certain of this, as your caregiver's protocols will have a direct and strong influence over your birth experience.
Step Four: Choose a couple of your most important items and discuss them with your caregiver at your next appointment. A friendly approach is best. "How do you feel about intermittent monitoring?" goes over much better than, "I refuse to be monitored during my labor." This dialogue will give you an idea of where your caregiver stands. A natural birth advocate will likely answer many of your unspoken questions within the first conversation. Resistance to your questions merits follow-up, but often is your first clue to seek care elsewhere.
(Note: For newborn care, follow same process with pediatrician.)
It is here that I must interject that there is a time and a place for every practice, from the most natural to the most medical. It is your responsibility to educate yourself by researching and asking questions so that you can determine this reasonably and responsibly.
Step 5: Review your list and note answers where you have received them and highlight questions that have now come to the top of the list. You will want to continue your research until your questions are answered. However, you may be able to seek this information from other sources within the birth community who are familiar with your caregiver and place of birth, such as doulas or childbirth educators.
Second Draft: After the first has been worked on a bit
Step 1: Sort through your first draft and transfer the items to a new list if you feel that they a) require further discussion or b) you have come to a compromise with your caregiver that is outside of their normal practice and needs to be noted.
Step 2: Research a bit deeper on each of these items to consider the options available to you, as well as their benefits and risks.
NOTE: You will always have options. They become fewer when an emergency arises, but labor and birth does not often involve true emergencies (ie, life or death). So your first question in a moment of choice is, Is this an emergency? If not, then proceed with standard questions: What are my options? What are their benefits/risks, advantages/disadvantages? What if we wait x time? What if we do nothing at all?
Step 3: Take a hard look at your list. Have you asked all the questions you need to ask? Are you satisfied with the answers? Do you need to revisit anything?
Step 4: Consider what preparation YOU need to make in order for your birth preferences to become real - additional support, classes, tools, etc.
Final Draft: Last few weeks before EDD.
Step one: Review your previous draft and see if anything can be marked off that you feel confident is well-understood between you and your caregiver.
Step Two: Transfer only those items that the nursing staff will need to be aware of when you are checking in at your place of birth. This should be short and to the point, friendly and easy to read. Anything more than a minute to read will likely not be read at all.
Step Three: Make 3 or 4 copies of this single page document to share with your caregiver (prenatally), the nursing staff upon checkin, post on the wall/have on hand in your LD room and to give to the nursery staff.
A footnote on the Unexpected = C-sections
It's like hurricane preparation. You don't want to think it will really happen, but it is certainly better to be ready for it than to be caught by surprise.
Who goes with you? The reality: Baby will be out and on his/her way to the nursery in the first 5-10 minutes. Then mom will be in surgery for another 45 minutes or more. It is important for mom to not be left alone. It is also important for someone, preferably the father, to be with the newborn to record all those precious first moments for mom to later see. Therefore, plan for who will stay with mom in the OR. If two persons are allowed to accompany, then the father and another can go in, then father can leave with the baby and be present for his/her care. If only one person is allowed, it is better to have a secondary person (doula?) go into the surgery and let dad wait outside ready to follow the baby to the nursery. Seeing the surgery isn't very important for most family members, and there will be plenty of crying to hear from then on!
