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Birth plans: from the L&D nurse point of view

Posted Jun 20 2010 2:52pm
I'm going to give you some straight up talk about birth plans, from the L&D nurse point of view, ok?

It's not always going to be pretty, flowery, shooting rainbows out my butt kind of talk either. Because, let's face it: sometimes things don't go as we like or plan. I invite everyone to agree or disagree to any and all parts of this post.

Birth plans and the L&D nurse: most, but not all, nurses will laugh and poke fun of your birth plan. Without a doubt, the longer your birth plan, the more laughs it will get. It does not mean that the nurse is being mean. It does not mean that the nurse doesn't agree with all or part of your birth plan.

It simply means that the longer your birth plan, the less likely you will have that birth plan followed.

So, the shorter the birth plan = the more likely it will be followed.

(Yes, I know, and I totally agree that laughing at someone's printed birth desires is not nice. It's wrong, plain and simple.)

Back to the birth plan.

Actually, let's back up even more. Let's go to the beginning of your pregnancy.

Rule #1: CHOOSE YOUR PROVIDER(S) WISELY. I cannot state this enough. Choose someone or a group of someones that will mesh with your pregnancy/labor/birth wishes. (Hint: don't go to a big medical group of physicians if you want someone to support natural childbirth. Pick a group with midwives, or pick and all midwife group, or go for a solo midwife practitioner.)

Rule #2: SHOP AROUND FOR YOUR LOCATION FOR BIRTH. I know that sometimes this isn't possible. Maybe your insurance dictates who/where you can go for birth. Sometimes you're stuck with whatever is available in your location. Well then, call the nurse manager or charge nurse of the L&D unit so you can talk to them (face to face is ideal) about what the typical birth practices/protocols/guidelines are. If this person hedges and refers you back to your provider, this is a red flag. Yes, the provider is who "orders" (writes orders, that is) about what happens in labor (IV or not, oral intake or not, pitocin or not), but it is YOU who ultimately dictates agreement or not to these things.

Rule #3: TALK OFTEN ABOUT YOUR BIRTH PLAN/WISHES. Talk early, talk often with your providers.

Rule #4: BE FLEXIBLE. You have no clue how things will go down when labor (or not!) actually starts. What if your water breaks, but labor does not begin on it's own? How long will you wait before doing anything to stimulate labor? How long is your provider willing to wait? What options do you have to stimulate labor? What happens if you do absolutely nothing? What happens if you want a natural childbirth, but you find you change your mind in labor? What are your options? Know your options! Be open to options! Being open to options does not mean you are "failing" at your birth plan. You don't have to take an epidural if you really, really don't want to.

What if your baby shows signs of distress? Remember that a good provider cares not only for your birth wishes, but cares that your baby has a good outcome too. Ask your provider to explain to you what exactly they feel is going on with your baby, if the baby is showing signs of distress. A good provider, a good nurse will explain what is going on. If they don't explain - ASK!

Rule #5 - KEEP BIRTH PLANS SHORT. The longer the birth plan, the more rigid it is. I have noticed that the more rigid the plan, the more control a woman/couple is trying to exert over something that quite literally cannot be controlled BY ANYONE! Labor is unpredictable. Labor cannot be controlled, no matter how hard *we* try. (We = the woman or the provider.)

I have noticed that the longer the birth plan, the greater attempt at control, the more likely that the woman will not get the birth she desires. The increased chance of pitocin, epidural and eventual c-section.

Keep it short and sweet. Many things can be excluded from your birth plan/list.

Here is an example birth plan/preference list
"I would like intermittent auscultation, as long as my/my baby's health status permits. I plan on natural childbirth, so please do not offer me pain medication, unless I request it. I have no required medical reason for an IV (GBS status is negative), but I have no problem with an IV only if and when it is medically indicated. My baby will not be separated from me unless it is medically necessary. I will remain flexible in my desires for my birth, pending my health and my baby's health status. I only want what is best for my baby and myself."

Don't go into great detail about freedom of movement in labor, lights down low, no students, plans to breastfeed, no supplements, etc, etc, etc. Many of those things you can control in labor. Get up and move in labor. Turn the lights down. Use the tub/shower.

Speak up, talk to the nurse who admits you to L&D about what your plans are. Many times, she's going to ask you some of those questions anyway!

Now readers, it's your turn. What have I missed? Am I off my rocker on some of these things?

PS - I, the L&D nurse, wrote a simple birth preference list (like above) for my 3rd child, when I was pregnant with her. I gave a copy to my providers early, talked about it frequently, and also gave a copy to the admission nurse on L&D. Each and every thing that I wished for my birth happened. Yes, I had to fight on some items, but it was a quiet fight - passive aggressive almost. My baby was healthy, as was I, and I simply kept her by my side and didn't allow the nurses to take her to the nursery. My kid, by my side. Simple as that.

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