Today childbirth in many parts of the world has become a medicalized process, with many interventions and monitoring procedures being considered as components of routine care. However, many parents are becoming more and more conscious of their right to a natural childbirth, with drugs and other interventions being administered only after informed consent.
Moreover, there are many parts of the birth process that may not be acceptable to every patient, depending on their cultural background, beliefs, past experiences and research on the pregnancy and childbirth continuum.
Image Credit: Chrisbrignell / Shutterstock
The popularization of birth plans
In this context, birth plans are becoming popular again as tools to help expectant parents think over the process of delivery, discuss it with each other and with their support persons, and communicate more effectively with their care providers and receive optimal support during labor and delivery.
They also guide the kind of care the patient will receive and encourage a birth outcome which is more in line with the patient’s own desires and concerns. Ultimately birth plans may help move hospitals to offer a wider range of services to help their patients achieve a better experience during labor and delivery.
The following video link is helpful in presenting the primary aspects that need to be highlighted in each couple’s birth preferences.
Preparing a birth plan will help the couple understand more of the risks and benefits of the various options available to them, help them to cooperate better, and to complete whatever forms or other documents are necessary beforehand. The completed document should always be shared with the healthcare provider well in time, before the delivery date.
Components which need to be on a birth plan
Most birth plans available online are unnecessarily detailed, which may inhibit busy hospital personnel from reading through them. Sometimes they may mention outdated procedures such as enemas and perineal shaving which reflect negatively on the patient’s knowledge of what is actually taking place in the current labor and delivery setting.
To avoid these issues, it is advisable to prepare a preliminary plan which can be a basis for discussion with the care provider. It can help narrow down the areas on which specific instructions need to be recorded. These include:
The atmosphere in the labor room
While this seems a non-issue, it is important to empower the patient to ask for changes according to her preferences as far as possible, including such things as heating or cooling, music or silence, and which personnel are allowed to witness her labor and delivery.
The position of the patient during labor and delivery
While this may seem relatively simple, it is important to know that accepting one intervention may lead to a cascade of others which eventually result in an outcome quite different from what was originally envisaged. For instance, a couple may want to have the woman move about freely during labor to ease the pain, but may accept an intravenous line or continuous fetal monitoring, both of which require that the patient be in bed.
Thus mutually contradictory desires should be identified and eliminated from the birth plan. Some hospitals or managed care plans may not permit this under their routines, and early discussion of these aspects will help find the place most suited to the specific patient.
The type of pain relief
Many women who want a natural childbirth are emphatic on refusing any form of medication whatever during labor and delivery. This should be documented and made known to all healthcare providers involved so that the delivery may conform to the couple’s wishes as far as possible. At the same time, every couple should be aware that a plan is a guideline but a flexible one, capable of being altered according to the changes in the patient’s experiences and the medical situation.
If a woman is being distressed by unexpectedly strong pains despite support, for example, the couple may well choose to use analgesia rather than the techniques they practiced in the antenatal classes. If alternative techniques of pain relief such as acupuncture are chosen, the person who will administer them should be clearly identified, and prior clearance should be mentioned on the final document. All such interventions may not be covered under the applicable insurance plans, and this should be taken into account as well.
The presence of support personnel in the labor and delivery room
Every hospital may have its own policy on who are allowed into the labor suite. Thus a birth plan which details the presence of the support persons, including who they are, throughout labor and delivery, will be much more likely to be approved rather than springing the news at the last moment that the couple want to be together until birth occurs. All options may not be acceptable in all centers.
Other medical interventions
Modern hospital delivery includes the almost routine use of interventions such as insertion of an intravenous line, the use of labor augmentation drugs, artificial rupture of the membranes, the use of continuous fetal monitoring, episiotomy, the active management of the third phase, and early cord clamping. It is necessary for the laboring couple to express their consent or decline the use of such interventions on a routine basis. They should also discuss whether the support partner should be in the theater in case a Cesarean section becomes necessary.
In any case, the simple questions, “Is this really necessary?” and “Are there any alternatives?” can help to prevent many of these from occurring unless essential. The presence of an active and informed support team is crucial to this as the woman in labor is often unable to focus on these details.
Procedures after birth
If the couple desires the baby to be with the mother from immediately after birth until discharge from the hospital, this must be specifically mentioned as desiring skin-to-skin contact with the infant during this whole period. In case the baby is separated, the couple must decide if the father should stay with the baby during this time, and this choice should be mentioned and discussed.
This blanket guideline will prevent many detailed instructions from having to be provided, since the parents will be aware of any potential intervention in baby care, including bathing the baby, feeding the baby, the use of pacifiers, supplements, or vitamin K, and breastfeeding. This will help guide the care provided in tune with the couple’s strong wishes.
Reviewed by: Dr Tomislav Meštrović, MD, PhD