Birth Preferences
“Birth Plans” and “Birth preferences” are big talk in the birth world. I’m going to share my thoughts, based on my experience, as well as explain the template I use with clients so you can create your own. I’ve also attached some pictures of a few templates in color with design. If you would like a link to one of these to edit and create your own, shoot me an email at somaticbirthwork@gmail.com and I can send that over to you!
People are right, there’s no way to “plan” for birth. Unless you have a scheduled cesarean, you don’t know when you’re going to birth your baby. Even then, you can create a birthing experience that is more desirable than the standard surgical experience, if you choose.
Part of creating your birth preferences is giving yourself the opportunity to learn. There are so many options and this tells you the main things to look into. Your’e a better advocate for yourself if you know the reasoning behind your ‘yes’ and ‘no’. While I think this is a crucial step for people birthing in a hospital, I think it’s also helpful for out of hospital births too. Main reason being, an unplanned transfer to a hospital.. but also just to stay educated. An out of hospital birth could be at home or a birth center (or really anywhere I guess). Though midwives are not as ‘intervention-heavy’ as OBs typically are, it’s still important to know what you want out of your birth.
This gives you some talking points with your provider at a visit and to ensure they are on-board with your desires and if they’re not then you have a chance to talk about why, and maybe even find a new provider who aligns with the labor and birth you desire.
The provider is in the birth space with you a lot less than you may expect. Primarily it’s your nurse, and even then, they’re not in there often. Birth preferences sheet is important to give to your nurses so they know how to best support you through labor and birth and know what to offer/ suggest, or not. I even see that coming in to the birth space with a birth preferences sheet shows the nursing staff that you have done your research, you know what your’e talking about, and they are more likely going to respect your ‘yes’ and ‘no’ when you give it.
Templates -
Top of the sheet should consist of the most basic things the providers and staff need to know. Then work your way down based on relevancy and timeline. Go through your own birth preferences with your doula to understand what each portion means and what the options are in your birthing location.
Chronologically, labor is the first thing nurses are going to need to know about. This first bullet point is a big part of what I talk to clients about. An epidural is tool and should be taken advantage of as needed but should not be the entirety of your birth plan.. There’s a lot of education that needs to be done around epidurals, and that’s for another day, but the two big things I will put in here are 1, they don’t always work and at times they lead to negative impacts on birth so don’t count of them. 2, epidurals can slow labor, primarily, because you’re bed ridden so if you do want one, then try to wait until your’e in active labor. Some people go into girl wanting them as soon as possible, some people don’t want them at all, and there’s everywhere in between. If you are somebody that is trying to avoid an epidural or wants to put it off as long as possible then it’s important to put in your birth preferences that you don’t want it offered to you until you’ve hit whatever birth goal you had or until you just ask for it yourself. I explain it like if you’re trying to avoid eating the cake you have… If your cake is in the fridge and you just go about your day as normal, you’ll likely forget that the cake is there.. BUT if someone is offering you that cake every few minutes then you’re more likely going to eat the cake sooner than you intended.
There are other tools you can use to manage the intensity of contractions other than an epidural like nitrous oxide, movement, meditation, other analgesics in the birth space, counter pressure, and so much more. Do you research and talk to your doula prenatally to find what works best for you.
Most hospitals, all hospital in Austin where I am currently, has bluetooth monitors as an option. These can be especially helpful if you are wanting to move throughout labor so you’re not tethered to the bed and they don’t have to come in to readjust the monitors every time they pop off baby. This is a good thing to put down and ask for immediately u[on arrival because most floors only have a few.
Most hospitals have a policy that the birthing person cannot eat during labor. This is on the verge of abuse and it’s ridiculous to expect someone who is laboring for hours on end to not nourish their body with sustaining foods. I will dive deeper into the reasoning behind this policy and how to get around it in another months post, but this is something to consider if you are birthing in a hospital setting.
The other bullet point int his section that’s worth discussion is Pitocin. Pitocin is a synthetic version of oxytocin. It’s not innately bad, I even believe it can be really helpful at times, but it does make it more difficult to labor unmedicated because your body and mind don’t have the same time to adjust to the intensity of the contractions and can lead to quicker exhaustion of the birthing person and their uterus specifically. I’m hoping to do another monthly post to go over Pitocin and the pros and cons of it too, but for now, talk to your provider and doula about the pros and cons to get a better understanding.
Birth is the next section I have, following labor. Most providers will want you to push on your back because it’s easier for them to see what’s going on in their seated position at the end of the bed but YOU CAN PUSH HOWEVER YOU WANT! Most hospitals have a policy that you have to push IN the bed so baby doesn’t slip and fall on the floor, but there are so many positions you can push while in the bed, even with an epidural. Being on your back closes your tailbone and pelvis in a way that gives baby a smaller space to come through so you typically push for longer. People are also more likely to tear while on their back.
There is evidence to show that delaying cutting the cord until it is done pulsing is best for the baby. In a cesarean, they likely will cut the cord immediately so that they can close the womb space back up as quick as possible. In a vaginal delivery it is important to advocate for this so that baby continues to get those nutrients as long as possible. It usually takes a few minutes for the cord to stop pulsing but the birthing person can reach to feel the cord to know when it is done pulsing. Some people also opt for a lotus birth, or some version of it to keep the placenta attached to baby longer.
Skin to skin is ~said~ to be common practice now but I see time and time again that nurses rush to put a blanket down on the birthing person’s chest as soon as baby comes out. I’ve seen then tell bold face lies that the blanket needs to be there to keep baby warm.. THIS IS NOT TRUE. There is no better way to regulate a baby’s body temperature than to be places directly on someone’s skin and using their body warmth. Babies are slippery and covered in fluids when they come out so it’s up to the birthing person if they want that blanket there or not, but it IS your choice. It’s also helpful in regulating the baby when they can hear and feel the heartbeat still. Leaving the womb space is a huge huge transition and environment change, so trying to keep as much similar sensations as the womb are going to be key in those beginning moments and months.
Postpartum and Infant Care Wishes is next -
Traction on the placenta can be so very painful when the placenta has yet to detach from the uterus. The placenta will typically detach on its own within the first 20 minutes or so. If it goes much beyond an hour then sometimes providers get a bit concerned. If you’re in a hospital setting then they will typically start pulling on the umbilical cord to pull the placenta out as soon as baby is born. There are plenty of other ways to encourage the placenta to come out without just pulling on it. Pulling on it when it’s not ready can cause more harm than anything. But as soon as placenta is out and bleeding is good then the OB can head out. This is something to look into and consider putting on your birth preferences sheet if you are seeking little intervention.
All the vaccinations are things to look into on your own. There are the typical ones hospital offer. Some homebirth midwives and birth centers offer these as well.
Cesarean is at the bottom because if your goal is a vaginal birth, then hopefully this is not relevant and they only need to read this portion in the case of a medical emergency. If you are planning on having a cesarean from the start then that’s all that’s on your sheet and you don’t need the previous sections at all!
A cesarean typically looks very ‘medical’ but there are ways to make it feel more personal if that is something you are wanting. Ways that I suggest making a cesarean feel more personal are things such as listening to your music to avoid the surgical noises and listening to the staff talk about random other stuff, asking to lower the drape so you can see your baby born, have the providers tell you when baby is close so you can still use your body’s ability to push baby out, bring in essential oils for better smells, and more.
Skin to skin is still possible when you have a cesarean, though you will likely need someone’s help to hold baby on your chest or your birth partner can do skin to skin as soon as possible. It’s common that birthing people are nauseous and not mentally present due to the heavy medication and skin to skin may not be something the birthing person can do because of their own abilities.
Listed below are a couple other Birth Preferences sheets I have. Let me know if you want me to send you a personal link for you to edit right on the sheet! It’s through Canva, so you must have or create an account to gain access. It’s free!
