Your Natural Hospital Birth Plan is Not a Contract

A birth plan for couples planning a natural hospital birth can be a double edged sword. It is a great tool to help you and your partner decide what interventions you want to avoid, who will cut the cord, etc. It's a great way to organize your wishes and begin a discussion with your provider about them.

However, a birth plan can also give couples a false sense of security. Some couples think that their birth plan is a shield that will protect them from unwanted interventions. Unfortunately that is not the case. Think of your birth plan as a list of requests. You may get everything, you may get nothing, in most hospitals you will probably get some requests honored, and that mostly depends where you are birthing and who is attending the birth. This uncertainty is scary for most couples, as it should be! So what are couples planning a natural hospital birth to do?

Learn Your Options
Don't google "natural birth plan" and just copy what you find online. You need to learn your options, the reasons behind hospital interventions, and what alternatives are available. The best way to do that is with a natural birth class. A weekend course will not give you enough information if you are planning a natural birth. One thing you will learn in a comprehensive class will be the impact each intervention has on birth. Instead of just writing "no IV" and hoping for the best, your childbirth educator can give you concrete suggestions on how to avoid this intervention without fighting with the staff. No mother should have to fight while she is in labor!

Make a Plan With Your Partner
Sit down with your partner and figure out which options are important to you. Once in labor, mom will need to focus on being relaxed and open, so it's important that dad knows mom's wishes and can advocate for her.

Take Your Plan to Your Provider
Do this early! Not at 37 weeks... as early as it occurs to you that you want a natural birth. Pay close attention to your provider's reaction and be prepared to switch. Just because you have liked your provider up to this point does not mean they will be supportive of your desire for a low intervention birth, which may be inconvenient for them or make them feel vulnerable to malpractice suits.

Listen to what your provider says and how they say it. If you want freedom to birth in whatever position is most comfortable and your provider says "well you can push standing on your head for all I care," that is not support! That is sarcasm. They are not taking your wishes seriously and you should not expect to be respected any more than this in labor. If your provider is skeptical or unsupportive, then there is a very good chance that once in labor, your birth plan will not be respected, or even looked at.

Consider switching, it may feel awkward, but I assure you, he or she will probably never think about you again and the switch can be done without ever telling them face to face. Just find a supprotive provider and have their office call for your records. Contact your local Birth Network or ask your childbirth educator about providers that are supportive of natural birth. Your birth plan should help you find a provider that will help you achieve your desired birth.

Choose a Supportive Practice
If you have a supportive provider, make sure that if they rotate call with a team of other providers that they are also supportive of natural birth and mother-friendly care. If your doctor agrees to intermittent monitoring, even signing your birth plan and putting it on your chart, but the on call OB is uncomfortable with it because they are ignorant of the research on intermittent monitoring or because of malpractice fears, then there is a good chance you will be monitored continuously. If you are in an unsupportive practice then the thought of finding a whole group of providers that believe in natural birth may feel daunting, but they do exist! Getting the "wrong" doctor in a practice can be the difference between the natural birth you desire and a c-section.

Take Your Plan to Your Hospital
Sometimes your provider may be supportive of your birth plan, but the hospital is not. You will not be able to change hospital policy with your list of requests. Take a tour, bring your plan, and instead of asking if the hospital will "let" you do what's on your list, see if their standard policies match your desires. Is it standard that babies are given right to mom after the birth? Or is it standard that they are taken to a warmer and brought to mom later? Even if they say they will bring the baby to you, though it's not standard policy, there is a good chance that the nurses will forget and whisk your baby away, because that's what they do for every other birth. If it's hospital policy that once your water is broken you have only 12 hours until you are given a c-section, even if you are strong willed and plan to refuse it, It can be an impossible battle to fight in labor. Doctors and nurses can be very persuasive, especially if they bring up a possibly dead baby.

Use your birth plan to find a hospital that is used to accommodating naturally birthing mothers, otherwise a day that should be beautiful might be filled with conflict and disappointment. Keep in mind that a hospital is a business and they want you as a customer, they may initially tell you what you want to hear. Be a very skeptical consumer and shop around. It is not unreasonable to travel 30 minutes to an hour for a supportive hospital.

Can't We Refuse?
In a hospital nothing can be done to you without your consent, so why can't you simply refuse to lay in the bed or to get an IV? Well, you can, but you probably won't be able to stick to your guns in labor, or continue to labor while sticking to your guns.

A laboring woman requires a safe, peaceful environment for the hormone that causes effective contractions, oxytocin, to flow. Conflict may cause an adrenaline rush which inhibits oxytocin. Labor may stall, so mom may need Pitocin to start labor again, but then she will need an IV, continuous monitoring, maybe an epidural to cope with being confined to the bed and the stronger "Pit" contractions.

Conflict will also cause her to be tense, making contractions much more painful, causing her to likely need chemical pain relief. The fight itself ends up robbing her of the natural birth she was fighting for.

You are also not the first couple to refuse an intervention that the hospital staff truly believes will help you birth more safely. They know exactly what to say to change your mind. And remember, mentally you will not be where you are right now reading this, you will be in a very vulnerable state.

Another possibility is that you will never be given the opportunity to refuse. My first birth plan was 2 pages of "we do not consent to..." Like many other couples we believed it would protect us in a hospital that was not supportive of natural birth. The on call Dr. did not look at it and broke my water before I even knew what he was doing. Once my son was born, they cut his cord immediately, even though we asked for delayed clamping and for my husband to cut the cord (they let him trim it later, very anti-climactic). This is not uncommon.

Keep It Simple
Once you have chosen a supportive provider and birth place, keep your plan simple and easy to read. One paper posted on your door with a "yes please" and a "no thank you" column will be just enough to remind the staff that you are having a natural birth. I love these visual options some couples are choosing.

Ultimately, your birth plan should be more than a piece of paper, it is all the time and energy you put into preparing, interviewing, and investing in your birth. Don't make your birth plan something you have hide behind, you won't be able to any way. Use it to build a birth team that wont just tolerate your desired birth, but celebrate it!