By Lynne Heydenrych
Why a birth plan?
There are many options and possible ways to approach your labour, birth and parenting.
If you are used to taking responsibility in your daily life, weighing up advantages and disadvantages and making choices and decisions based on the information you have gathered, then formulating your birthplan will be a natural step towards planning your birth.
You will also realise that being a parent starts with conception (planned or not!) and requires decision-making throughout the childrearing years.
If, however, you normally depend on others to make decisions for you, then you will need to develop your communication skills and actively seek out the relevant information to enable you to take part in the planning process for labour and birth.
Parenting decisions will then also be easier. Antenatal classes will help you considerably - birthplans will be discussed and your antenatal teacher will assist you .
Who is the birth plan for?
You and your support person/partner
The hospital midwife and staff
Your doctor or midwife (normally referred to as your caregiver).
Setting the tone
Start by explaining that this is not a contract or a prescription. You realise that it may not be possible to have the birth you planned due to the unpredictable nature of labour, but that your birthplan expresses your ideals and wishes - your priorities for a fulfilling and positive birth experience.
There may be areas where all the parties concerned (doctor, midwife, hospital and you) may need to compromise.
You are aware that emergencies in childbirth do occur and require medical intervention. Your birthplan is an excellent communication tool, encouraging exchange of ideas.
Issues to include
Choice of caregiver: Midwife-private or hospital-based; doctor
Choice of birthing place: Home; hospital - private or government; birth unit in outlying clinic
Choices during labour
1. Presence of your partner or person chosen by you to support you in labour. What about siblings and other family members?
2. The opportunity to return home if your labour is in the early stages and not yet fully established.
3. Personalising your birth like wearing your own clothes in labour.
4. Freedom to choose positions and activities that assist you in labour like walking around, sitting, kneeling.
5. Eating and drinking during labour.
6. Routine procedures on admission to hospital as enema and shaving are no longer considered essential for a vaginal birth.
7. Methods used for monitoring the baby during labour. You may prefer the hand-held stethescope rather than the continuous electronic monitor.
8. Vaginal examinations for specific medical reasons only.
9. Rupture of membranes - spontaneous or artificial.
10. Use of water (bath or shower or jaccuzi) to provide pain relief and comfort.
11. Use of music.
12. Use of massage.
13. Use of aromatherapy oils, candles or other comfort measures.
14. Pain relief options - what is available and your preferences.
15. Informed consent. Explanations of all risks and benefits of medical procedures and how they impact on the baby, the mother and the progress of the labour.
16. Episiotomy vs. tear
17. Induction.
18. Time limits for various stages of labour.
19. Caesarean birth. Your preferences should this be necessary.
20. Positions for pushing stage like use of gravity.
21. Use of touch or the mirror during pushing stage.(This can help you connect with your baby and your body and improve the experience for you.)
22. Pushing techniques.
23. Baby's first few moments. (Suctioning, contact with parents, keeping warm)
24. Cutting the cord.
25. Avoidance of separation of baby and parents.
26. Method of placental delivery.
27. Breast-feeding
28. Delaying bathing, weighing, measuring until after the initial bonding period.
Choices for your hospital stay
1. Length of stay
2. Rooming in with your baby
3. Visitors
4. Help with feeding and learning baby care.
5. Circumcision - is it necessary?
6. Choice of paediatrician or doctor to check the baby.
7. Examinations of baby in the presence of the mother.
8. Use of dummies and bottles - you may wish to restrict their use if you are trying to establish breast-feeding.
It is important to realise that you need to submit your birthplan to your caregiver and hospital well in advance.
Discuss your preferences and try to work out mutually acceptable compromises where necessary.
You may need to look again at your choice of caregiver or birthplace and consider changing if you are not entirely happy.
Tips
1. Be specific.
2. Keep it short and to the point.
3. Prioritise.
4. Be polite and not aggressive.
5. Make several copies for the doctor, hospital, midwife and yourself.
6. Highlight and emphasise your definite likes and dislikes.
7. Be flexible.
8. Attend antenatal classes.