You're Allowed to Want

It’s no surprise I’m very pro-birth plan. More, specifically, I’m very pro-thinking about your birth. Whether that leads to a birth plan or not is another story.

But if you’re pregnant or if you’ve ever been pregnant, you’ve probably heard things like the following...

“Write a birth plan, but write it in pencil,”

“Those moms who come in with birth plans always end up in c-section.”

“When a couple comes in with a long birth plan, we just make fun of them at the nurses station."

Who wants to hear that?

Very few things in life go exactly the way you planned: School? Nope. First job? Probably not. Your wedding? Nope. Second job? Maybe closer. That last party you coordinated? Nah. Today at work? I doubt it. This blog post? We’ll see.

No one says “The families who make weekly menus are the ones who always end up eating out.” And even though I can’t even get dinner to go the way I expect it to, I still plan it. Why? Because

1. I have the right to go for what I want in every part of life and...

2. Even with the surprise changes, it goes over better than it would have without a plan.

So can we collectively agree to stop passively threatening and punishing families who take the time to think about their birth choices? Can we stop assuming they are so immature they’ll fall to pieces as soon as things change? And can we care providers have empathy for parents walking into an unknown situation that is publicly associated with pain and fear?

That said, there are things that can help some birth plans be more effective than others.

You see, the value of a birth plan is not in the written piece of paper you give to your care practitioners. The real value is in what you and your partner go through to create the birth plan. When I’m working with my clients, I have them follow several steps for creating their birth plans. (Each person in the partnership can do this.)

1. Imagine your birth exactly the way you want it to be. Tap into your pretending skills from when you were a little kid. And by that I mean, this exercise has no limits on reality, geography, time, or people attending. If you would want to birth on the moon with your favorite Greek goddess catching your baby, then imagine it. Take it as a given that in your meditation everyone will end up healthy and safe, put on some relaxing, wordless music and close your eyes, let your imagination take you to your best birth place where only things and people you want are allowed to exist. (You can also use the meditations from DreamBirth by Catherine Shainberg) (NOTE: If you have a history of abuse or violence, please seek the guidance of a professional counselor, therapist, or hypnotist to help you with this step.)Where are you? What are you doing? Who is there? Notice these things and when your birth meditation is finished, journal about the details. See if you can infuse these elements into your birth setting with music, nature sounds, tokens or charms, and photos of loved ones.
2. Plan your ideal birth in adjectives. Just a few. More than one, but less than five. Something easy to remember. (Again, “safe" and “healthy" are givens.) Use these to create a mission statement for your birth. No one can predict how your birth will go. Chances are, you’re going to have to change your plan in some way. You can use adjectives or a mission statement as a reference to make decisions on any unexpected changes to your plan.
3. Start talking to your practitioner early. Most couples choose their provider based on very broad qualities-does she attend in the setting they want and do they like her? But birth is complex and practices vary from one provider to another. After you have established that you’re socially and emotionally comfortable with a provider, you still need to check in on specific details. What is your provider's comfort level on the details that are important to you? What are routine procedures and practices for your provider? When talking about your ideal birth, does your provider say “That’s my routine/I love working with clients who are pursuing that/I specialize in that,” or “We can do that, but…” Hear her out, but also do your own research on reliable sources (and here.) More routine interventions does NOT necessarily equal safer or better care. Keep in mind you are a client (as opposed to a patient)-this means you have a right to seek out the care you feel most comfortable with. If you find some red flags that make you want to find someone more aligned with you, it’s far less stressful to change providers early in your pregnancy than later.
4. Listen to yourself. Both in terms of your gut, but also in terms of what you find yourself saying. I’ve heard moms say things like “Assuming my doctor doesn’t screw me over…” For whatever reason, an element of distrust had come into the relationship and if that's there, (even if you can't put your finger on an exact event that led to it) listen to it! I know how hard this kind of self honesty can be. During my second pregnancy, I started talking to my practitioner about my birth early. I had been learning a lot about evidence through my doula training and I was noticing how many of my doctor’s routine practices would increase my risk for complications and c-section. And yet, I was convincing myself that I wanted to stay with him-that I liked him. With the help of some gentle, loving observations from my doula, I saw that I was setting myself up for disappointment-trying to get an OB to use a midwifery model of care for me. Once I was really listening to myself, I could act upon those thoughts and find a doctor who aligned with my birth preferences. I never looked back.
5. Don’t leave the informed piece of "informed consent and refusal” up to others. Take the time to inform yourself on the benefits and risks of the most common interventions (especially if your provider has mentioned them multiple times) and decide if you are willing to accept those risks and in what circumstances you may change your mind. It’s not always cut and dry, but having some understanding is helpful. Remember your providers are attending your birth, but also bringing with them recent births they’ve attended. So if one of those recent births were traumatic or worse, that provider may treat your care a little differently than if those recent births had been smooth. Providers are people too-they have good days and bad days. They work long hours and have their own stressors. Some are good at talking to people and some are better at other things. Taking the time to be informed so you’re not taken by surprise can help protect yourself during a vulnerable moment.
6. Don’t worry about every single detail. Some will be important to you. Some won’t. Even details that were important to your friend/mother/sister might not be all that important to you. Take the time to listen to your gut about what makes this YOUR birth. My usual response when my clients ask me what I chose for my births is “Who cares? What does YOUR gut say?” Once you’ve identified your most important plans, make it easy for your care practitioners to read and follow your most pressing wishes. Things you can use include colored paper (one color for vaginal birth, another color in case a c-section becomes necessary), large font, respectful wording. And trust yourself to work with your team to build the rest of the experience in support of those primary goals.

Remember you have a right to want. And even though we can not script pregnancy and birth, there is still value to imagining what your perfect birth would be like down to the most unrealistic detail.

So how might you come to your birth? With a mission statement, a few items to make your room feel more home like and supportive (if birthing outside of your home.) If you want to birth on the moon with a Greek goddess-bring a little statue or picture of that goddess and use it as a focal point. Practice relaxing and guided breathing to spacey-sounding music. Create a guided imagery script with your partner to use during labor. Bring a home made piece of art with you mission statement to hang on a wall for empowerment and focus. Bring your birth plan on multi-colored paper and spend a few quick minutes talking the the nurses and doctors about it at the beginning of the birth.

After reading this, what are you thinking of adding to your birth bag? Have you taken the time to imagine your perfectly unrealistic birth?

This blog post was also posted on St. Louis Birth Rhythms web page.