I'm still trying to narrow down an OB/Midwife :( Every time I walk into an exam room with my (very reasonable) "wish list" I get eye rolls and chuckles- everything short of a condescending pat on the head. I live in an area with no mother-friendly birthing facilities within 100 miles. I'm just not sure what to do! I have to give birth in a hospital for insurance/financial reasons but I don't feel like it's fair that I have to (apparently) compromise my comfort and safety. I'm not even asking for special birthing equipment- just a heplock in place of an IV, no lithotomy or purple pushing, and food and drink when I get need it. I even have resigned myself to the two "guest" limit they put on the rooms. I'm not sure what else I can do. It's infuriating to feel so helpless. Not to mention that every provider I've seen so far tries to somehow disprove my reasons for wanting these things. Ugh I'm at my wit's end! I'm only 18 weeks but my options are already beginning to run out in this area. A home birth is ideal but I am going through medicaid (because my primary insurance flaked on me) and I just can't afford (no matter how comparatively inexpensive they are) to pay a midwife or doula out of pocket. I am literally reduced to tears on a weekly basis because of this. Any ideas that don't include a hormonal rampage through the women's center of my local hospital?

None of the poll options fully apply to me--my provider thought it was just fine and wanted me to keep my "mind open to the options" (no prob, Bob, I said--only it was a lady, not a Bob) but in the end it didn't matter because she couldn't be bothered to attend my delivery because she had a scheduled 8am c-section to do. The on-call provider obviously didn't read it because she showed up in time to hover at the end of my bed as I finished pushing my daughter out. The nursery nurse hadn't looked at it and violated all of the requests I'd held most dear--no skin to skin, she put the ointment in her eyes *immediately*, etc. My doula didn't do jack to alert me to what was going on or tip my husband off that he might want to speak up. Instead: she took pictures of them doing all the things I didn't want them to do, and gave them to me in a cutesy "birth day" CD I couldn't look at without bawling for months.
The only person who gave a crap?
My amazing L&D nurse.
She's the one who rushed over to the nursery nurse and tried to stop her from doing the eye ointment. She's the one who tried to make sure I held my daughter as soon as possible. She's the one who'd brought me cups of apple juice and ice and told me to let her know if there was *anything* I wanted.
What an amazing woman. Loved her.

Does any one have a link to a good birth plan. I have two right now and niether seem to fit me quite right. It's either too anal or too lacking. I had thought (and am doing so now any ways) of just taking what I like from both, but I was wondering if there are better options out there that I have not found.
Thank for any help!

I was encouraged to make a birth plan by my midwife (Hospital midwife at UCSF), and on arrival at the hospital (with my first and second baby) the nurses asked if we had one, expecting that we would. It was completely honoured. The first time without challenge. (I accepted an IV as I was dehydrated and felt it necessary, and I had sad on my plan that I would have one if deemed necessary), they brought me the gas and air, quickly checked if I wanted an epidural, but only asked once, and brought me the birthing stool. They got me on the bed for the actual delivery (again I had said this would be acceptable in my birth plan) My daughter stayed with me after birth, just as I wanted.

With my son I decided I didn't want the IV (This was on my birth plan this time) and prepared by having energy drink. My doula and husband reminded me to sip them. The Doctors were uncomfortable with me not having a vein pre accessed, (my midwife had warned me this would be the case) and asked repepatedly if I would have one, but with the help of our doula's patient repeat of my request I didn't have the needle put in.

My birth plan requested a glider chair (this had been where I spent most of my first labour) and the one in the room was broken, so the nurses got me another one, and again I laboured for a long time rocking in the chair.

They brought me the gas and air but I didn't use it, they brought me the stool when I needed to push and they got down on the floor to help me catch my son.

I really feel that I had the most perfect births, and the birth plans were a big part of that. The care I got at this hospital was very progressive, a model for maternity care. They were very patient centric, I can't speak highly enough of them, and this is a big high tech teaching hospital.

I have a pretty comprehensive Birth Plan for my moms-to-be...It seems daunting at first, but as you go through it, you will see that if you choose the first scenario under a heading, about half of the other options will not be relevant. I also find out WHY they want/don't want something in particular. If mom says, "I don't want them to paint my toe nails." I will take down the reasons why...so that I can remind her during labor, "Remember, you didn't want anyone to paint your toe nails b/c you're all out of cotton balls at home." Or whatever her reason was. (Yeah, I know it was a silly example, I was just trying to give something generic.)

If she wants, I also have her list her reasons WHY under the list item. (We each have a copy.)
I don't want my toe nails painted because:
I don't have any cotton balls at home to remove the color myself.
My husband has a foot fetish.
I have a nasty fungus on the pinky toes.

This way...when she's trying to shift her focus from a painful contraction to calm herself & the doctor or nurse is shouting frantically, "PLEASE WE HAVE TO PAINT YOUR TOE NAILS RIGHT NOW!" I can gently repeat her WHYs...and she can remain firm in her stance.

One of the reasons I do that...is b/c I had that happen to me during my first labor. I did not want stadol, but as a contraction was peaking...and I started counting, waiting for the peak to ebb...oh jeez did I just get to 17??....it's still peaking?....That can't be...Stadol?...What...Umm...Less intense??....I didn't....I don't think....WHY AM I STILL ON THE FENCE?? Empty that damn syringe into the IV BAG YOU IDIOT!!! Later, I remembered my reasons why...and I also realized that it was quite tricky to ask me at my least coherent moment...and I wondered why I didn't tell them to shut up & leave me alone so I could contract in peace...then another contraction started and I forgot my husband's name.

A great read Gina, and I dialogue that needs to be out there and open. One thing you mentioned that I wanted to emphasize again was the notion of sharing your desires with you advocates. As a birth doula, I think this is so important and valuable to consider what you (birthing mama) want everyone's role to be, etc. It is especially important to also note that when in active birth a woman is in a particularly vulnerable state and a birth plan which was thoughtfully prepared and then shared with others (advocates) sets up a premise of autonomy and control that...well, we'll leave it at that for now!!!

I feel like a birth plan is a multi-faceted tool. There are many different versions and ways to do it.

I'm about to have my third homebirth so my birth plans were more of a verbal dialogue with my midwives. We extensively discussed options and choices all along the way. There was no need to state my preferences on paper b/c she knew them and had them documented.

However, I have attended homebirths with clients who do work out a birth plan and from my vantage point it seems like more of tool for the parents to explore their options/desires/beliefs around birth. Often the birth plan is written much earlier and by the time we get to the birth it's barely mentioned.

Giving birth in a medical facility and being attended by nurses and possibly doctors you've never met before is a WHOLE other ball game! Your birth plan becomes WAY less of place to work out your ideas about birth and much more of place to spell out your CHOICES. These are not preferences--these are choices that pertain to your body and baby.

If your doc won't look at your birth plan.......warning sign!!!!!!!!! Many docs look it over give a big "umm-huh" and then totally disregard (unfortunately). This is where a doula is priceless. You walk into that hospital with multiple copies of your birth plan and hand it out to the head nurse, your nurse and even have another one for your doctor. Part of your doula's job can be to gently and professionally remind everyone that you have a birth plan and expect that it is being followed.

Now of course, a birth may take a turn of events where some things become obsolete. Having a birth plan insists that you be told and asked for consent when the plan deviates.

This of course is not the norm, but it should be! I think mom's should take their birth plans VERY seriously and expect/insist that their care providers do too.

(Amber, I do agree with you, but I think it's a very ideal situation. Right now, most mom's are not in a mutually respectful and actual relationship with their health care provider. I think that's the goal, but insisting on being treating like a person with rights is the first step to getting there).

Great post Gina!

My birth plan went out the window when I unexpectedly gave birth at home after a very short labor (although, it went way better than it would have in the hospital.)

My OB was supportive of my plans for a natural birth, but she was very against eating/drinking, no iv, and refused to let hubby catch the baby because "he would drop her."

My husband safely caught our baby and she was a slippery little thing.

I like the idea you mentioned in a comment above that, as a doula, you ask clients to write a birth plan as a way to understand what kind of support they're looking for in labor. That makes a lot of sense to me b/c most doulas respect and actually care about what a birthing woman's goals are, but I can imagine that sometimes it's hard not to transpose the kind of labor you would choose onto the wishes of the woman you are helping.

That said, I'm not a big fan of birth plans in general - I think the function that you're talking about them serving is one that a doula (a real live person who can think and reason and talk back to a doctor or nurse) should ideally fill. Yes, women need to know what kind of birth they would ideally like to have, and for that I agree that writing it down for themselves or their doula is helpful, but in most cases I've seen or experienced birth plans have been largely dismissed by doctors. (Mine actually sighed with relief when I told him I didn't have one - no, he wasn't a stellar guy but I feel like working with him, or at least him thinking that I was, let me get away with a lot more of my requests, i.e. no IV, intermittent fetal monitoring, etc.)

I only had one hospital birth and chose not to write a birth plan mostly b/c I'm not a planner and it just didn't feel right personally. I did educate myself extensively; I did have a doula; I did know what I wanted; and I did feel confident in my ability to refuse any intervention I felt was unwarranted. I think that's a large part of why I managed a natural birth in a hospital at a pretty young age the first time around. I don't think it's so much a matter of having it on paper as it is knowing in your core what you want, what you're willing to fight for, and when it's time to say when.

I said I don't say, "I ensure", not that you do, and sorry, I know that might have sounded personal..it wasn't. And I don't think it's invasive either, if that's what you want to ask them. Things get really personal with our clients. We know what colour mucous comes out of them, what their sexual history might be like...it's not a problem to ask about a birth plan if that's something you like. I just end up thinking of future writings while I'm writing in the present, and it gets mixed up. Not the first time someone has called me on it, won't be the last. I feel sometimes like I'm writing 3 things at a time.

I just mean I don't have much of a formula when I work with people. I have a basic intake form, but many things I'll add or not ask, just becase I sense it is or is not the time. What I am saying is that it is very cool birth plans work for you and your clients, but in my practice they don't have much value...I still have great stats and happy clients...and it's all good. But if someone approached me really adamant about wanting a birth plan and feeling that was the thing for them, darn tootin'! We're doing a birth plan, regardless of my personal opionion.

It's so funny to see this post- I just blogged about birthplans a week ago. My take:it is extremely helpful for a woman to just think these issues through and know for herself what she would like. I also encourage women to make a list of her top 3 or 5 priorities and bring that list, rather than a 3 page elaborate birthplan to the hospital/birth center with her.
http://frumdoula.blogspot.com/2010/06/to-plan-or-n...

And to want to know your clients that well in advance is extremely important. But I cannot expect clients, some of them coming to me as babes in the woods, to be able to even know or articulate what they want, never mind formulate something on paper. Some don't even know they're allowed to want. This is why I do very thorough childbirth education with them, often deprogramming a lot of engrained, typical beliefs if that is something that could work for them. It's not only the converted that come to me. And when I have gone through what they can typically expect in the hospital (having attended at least 100 births at EACH hospital), I ask them to begin thinking about what resonates with them.

I have a health intake I do with my clients, and I ask them what they fear, what they envision, what they want, what scares the pants off them, and make note. But when we get to the hospital, we allow it to unfold organically. I teach them how to recognize signs of discomfort in their boundaries and how to speak up. I don't speak for them.

There are many ways to doula. If you like birth plans and that's a tool you feel comfortable with, fabulous. I feel that if a doula really digs a particular tool, she works well with it.

Once we cling too hard to "shoulds" in birth and doula-ing, we lose sight of how dynanmic and mysterious it all is. I attend around 60 births on average per year, and learn something new every time, finding more ways to be yielding, new ways to be strong. I don't ever say, "I ensure ALL my clients do such and such," because every single person is different.

I had a birth plan, but left it in the car! I never discussed it with the docs because there were 8 of them and I had no idea which I'd get. (It turned out I had never even met the one who did the delivery.) In fact it never would have come up if my wonderful L & D nurse hadn't asked me about what I wanted!

The only way I got my doctor to do anything the way I wanted was to argue each point in the moment. For example, when she reached for the episiotomy scissors, I asked her please not to do that (and she didn't), when she started with "purple pushing," I thought about arguing it and decided it didn't matter enough. Bad call -- I got a third-degree tear. Next time I am going to make sure I meet with the actual person who will deliver the baby (a midwife this time!) and discuss ALL of my wishes. No good to have a plan if they've already decided how they do things ... they don't care what you think. But if I can make sure they agree with everything I want beforehand, maybe I can get some better results.

Tomato, tomahto...they're just terms, both a bit silly as far as I'm concerned. One is oxymoronic and the other is a little fantastical. Either way, I think it's really up to the mom what makes her feel secure.

I've been a doula and a mom for going on 2 decades, and I don't do birth plans...unless the couple really really wants to. I figure if they get a sense of security from having something written to bring to the hospital, and that peace of mind can create a sense of relaxation (which helps labour)...whether that birth plan is ever read by the staff or not, then fabulous. I'm all about peace of mind and relaxation, whatever that means to a couple.

I think a birth plan or wish list, that paper brought to the hospital, is not the same thing as my helping couples to clarify their values prenatally. You are right..it is crucially important for a couple to know the reality of the system they're birthing within, to explore how they feel about a given routine or procedure, see how it fits with their situation and beliefs, and then encourage them to become proactive about setting some boundaries for themselves.

For the things that stand out as their fiercest concerns, I have them discuss them with their caregivers and have it put into their chart, signed by the doc. This would be for someone who has a really big concern. I know docs who do this all the time. This way, if that physician is not present for the birth, the one on call will see the request in black and white, backed up by their colleague's support. Now, this doesn't guarantee much, because if the doctor on call is adamantly opposed to the request, well, then you have an argument anyway. But just the exercise of saying, "hey, this is my birth and this is what I want" to your doctor is a step that strengthens and empowers, so even if there is an argument, the parents are prepared to speak up.

I spend a lot of time prenatally with my clients, so I know what their concerns are. MOst of them end up NOT bringing their requests written on paper. I am privvy to the comments many doctors and nurses make about patients with their doulas and birth plans (insert eye roll here). Now, if the couple are not at all concerned about the fact that some staff members may become defensive about a birth plan, and it means a lot to them to have one, Yay! That is their act of empowerment, and bless them, they are fully entitled to it! Otherwise, we don't bother.

What I can tell you is that the vast majority of my clients birth naturally and happily, whether they have OBs, family docs, or midwives...and look, Ma, no birth plans. I have never seen a written birth plan be responsible for a great, natural birth, though I do believe prenatal clarification of values contributes to this success in a huge way.

If a birth plan is several pages long, I worry about a)a client believing they have a ton of control over how birth unfolds for them, which is a bit of a red flag, and b)the staff NOT treating them well, the birth plan actually having the opposite effect of what the couple had hoped for. It is intersting, and I have even heard primary caregivers and nurses agree with me on this one, but very often the longer the birth plan, the higher the rate of everything going opposite as "planned". But if it's a little list of preferences, hey, it does no harm. The strength comes from the thinking about their desires and discussing them together themselves and with their caregiver, not from committing them to paper. Oh, and support from we doula-folk goes a long way too :)

Great thread of conversation! Thanks for the post!

With my first I was actually asked to make one by my provider, and then brought it in to talk about/check over. He welcomed it, said that he preferred attending drug-free/low-intervention births, and so forth. Of course, when the time came, it being a military hospital I was stuck with whoever was on call. They all seemed fairly on board with the whole thing, and most of the LD staff was, although there was one young nurse that rolled her eyes over it more than once.

(It was a cytotec/pit induction though, so the whole plan went out the window fairly quick and even the things I'd requested post-partum, like no eye ointment or bathing the baby, were totally ignored.)

For my second baby (vbac) I never made one, as I was at home and it was all on my orders anyway. :)

I have had an unassisted birth and am planning my next, and I do have a birth plan despite the fact that my provider is myself. I make sure that the people who I want at the birth (my DH and anyone else I feel like inviting) have an understanding of it, too. It doesn't look like a "normal" birth plan: it has things like "Remind me to drink at least every 2 hours and eat something at least every 3." But it also includes transfer plans, "If I need to transfer postpartum, but the baby doesn't, then the baby will stay behind and not be admitted to the hospital, but be brought to me as a visitor once I'm admitted" and "if the baby needs to transfer, we won't allow artificial nipples, circumcision, or vit. K. The PKU may only be done after our questions are answered to our own satisfaction and we agree to it." My husband also knows that if the birth has to transfer for a cesarean, but the baby is born fine (decent APGAR), he knows to just take the baby from the nurses/doctors and hold it skin to skin or give it to me, if that's possible.

I know the worst case scenarios can happen and I want to make sure that we can get the best out of a worst case, especially skin to skin contact and breastfeeding initiation.

But the plan overall is "I give birth, you do whatever I ask (compresses, counter pressure, etc) and remind me to eat and drink."

Did not answer to the poll because answer would be 'provider required it' i am ashamed to say I never thought of a birth plan until they told me I needed one.

Had to follow up since you helped me move forward to at least print out my birth plan (I call it my Birth Vision and have it Titled "Sarah's Birth Views"). Since the last post on Birth Plans I have shared it w a doula friend who has offered her support of "my birth my way". Yahooo! :)
While my DH and fears constantly remind me that the perfect vision may not be feasible, I am indeed going to fight like hell to get there. I had so badly wanted to prove that I could do it by myself but began remembering how difficult it was n the midst of labor to "make right brain decisions". I went through w/o my emotions and made responsible informed decisions w/o being in the middle of a spiritual & emotionally overpowering event, it makes me feel confident. Hopefully having it already written out will at least make it a more healthy birth in the least & a beautiful birth I dream of in the ideal.

I had a hospital based, group midwife practice with my first child and they specifically asked for a birth plan. Although I had a good relationship with the midwife that I saw regularly and I had met some of the other midwives in the group, they worked in shifts so there was no guarantee that I would know the midwife or midwives who were on call when I was in labor. We went over my birth plan at a prenatal appointment and edited it to remove things that were standard practice and discussed things that would require exceptions to hospital policy and we had to talk to in order to have said exception made. Then a few weeks before my due date, the whole group discussed my birth plan at their weekly meeting so all the midwives would be familiar with my preferences.

The L&D nurse read my birth plan when I got to the labor room and went over a few things with me. When the nurses changed shifts, she briefed the new nurse about how things were going and what I wanted. I can see how a lot of this wouldn't be necessary with an independent midwife, but with the group practice it worked out really well.

I always think of it as a way to make the decisions I'm expected to make while in labor prior to a point where I can't think clearly. If someone has the urge to ask if I want x, y, or z, but I'm mid contraction, it's (hopefully) covered in my plan.

These are not things that we dream about and tell to shooting stars, but carefully researched, well thought out, educated decisions regarding what we think is best for our minds, bodies, and babies.

The birth plan is the point at which I left my first care provider with my first pregnancy. When I raised the subject of writing one, he told me not to bother because he is "a professional who knows what he is doing." That's great... if I wanted birth to be something that was done to me.

my doctor's nurse and I went through mine line by line with her telling me what was and wasn't possible around 34 weeks and then I took my concerns with that convo straight to my doctor.

My biggest thing was I didn't want to be "that guy" with a birth plan and have everyone hate me. (oh, what a nonconfrontational first time mom I was...)

My doc (who I liked -- a lot) said "don't worry, you're not that guy".

My plan ended up getting me a lot of good stuff. The L&D nurse took one look at my wording and said "great...I had 2 natural births myself and I can tell you're committed and I'll do what I can to help."

She said she sees wishy-washy birth plans and doesn't take them seriously because 9 times out of 10 the mom doesn't stick to her guns when confronted with more pain than she expected and a longer birth than she expected. (she also said most moms she encounters show up for their 39 week induction and are surprised when it hurts and takes a long time)

she initially balked at my request for a glass of water and I said "It's in my plan and my doc signed off on it." and it was like a magic ticket!

I digress...

My birth plan was helpful, it helped everyone else (including husband) know exactly what I wanted and why and it wasn't a waste of time for me. It was more like a playbook for a football game than an actual PLAN of how things were supposed to go.

Next time, I plan on writing and "In Case Shit" list b/c I don't plan on doing a hospital birth and don't expect to have to fight for all that normal stuff (monitoring, hep lock, food, etc.) It'll be more like a transfer plan.

That's a good point, Amber, and that is largely why I went with midwives the second time too -- so we'd already be on the same page. BUT the benefit of having a birth plan written is that others can be alerted to your wishes in the event of a change in caregiver. Of course, they have to read it. Case in point, my primary m/w attended my birth, with another m/w I hadn't met with previously. My son was born with fluid in his lungs, and out went our plan to delay cord cutting. OK, there wasn't anything we could do about that. In the meantime, I had some bleeding issues, so the primary m/w was caring for me while the other m/w was with DS2. She didn't realize we had planned to opt out of the eye gunk, until after she'd administered it... :/

Here's my answer to the "poll". I did not do a birth plan, however, I delivered at a freestanding birth center and the midwife and doula and my husband knew what I wanted my birth to be like and would accompany me to the hospital if that was needed (I knew it wouldn't be though). I trusted them 100% to give that to me and sure enough, I had the most wonderful, empowering, positive, peaceful natural birth possible! I would do a birth plan if I was delivering in a hospital though, no questions asked!

Our doctor wouldn't look at the birth plan until 30 weeks. That should have been a signal that she wasn't interested, but we were new in the area and had no idea of alternatives. Mind you, when she "looked at it," I was naked from the waist down and still poised on the exam table. We got lucky at the hospital (I was 6 cm going on 7 cm when I got there), and our L&D nurse was awesome. When she went off shift, the next one wasn't quite as good, but by then, most of the hard work was done. The first nurse even held off on the "required" heplock until the doctor yelled at her. So overall, the birth plan was helpful and was read. But I give credit to this to the nurse, not so much the doctor.

I didn't do birth plans. The first time I gave birth unexpectedly at 34 weeks, and I didn't have time to get one together. Plus, any plans I did have definitely did not take into account a high risk baby and a pre-term baby. It ended up being OK because my midwife was 15 kinds of awesome and so my birth was pretty much the best I could hope for under the circumstances.

During my second pregnancy I read "Birthing From Within", which actually argues AGAINST birth plans. She says that you need to have a trust relationship with your health care provider and other people who are at the birth. If you have that relationship, then you don't need a piece of paper. If you don't have that relationship, then a plan isn't going to help because they'll just disregard it. After my experience the first time, I kind of agree with her. My birth was much more about my awesome midwife and fabulous husband than anything else.

The second time, with a similarly awesome midwife, we talked about things up front and I knew we were on the same page before I went into labour. This is the upside of midwives - long appointments meant that we had lots of time to talk, and I feel that I knew and trusted them very early on. Because of that I didn't miss having a birth plan either time.