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When I was a brand new labor and delivery nurse, I decided to take a Doula training course as a way to expand my knowledge of the best ways to support pregnant people. At that course, we did an exercise around birth planning that has stuck with me throughout my career. The instructor gave us each a set of index cards, about 15 cards in total, and each card represented a choice we might have to make – vaginal or cesarean birth, epidural or unmedicated, IV fluid or oral hydration, continuous or intermittent fetal monitoring, etc. The instructor told us to imagine our ideal birth scenario and lay the cards out to reflect that vision. So we made our choices and set the cards to reflect our (oversimplified) dream birth. Once we had the cards set, the instructor said, “Now remove five.” So we had to go back to the cards, consider the alternatives, and think about which elements of our “ideal” birth we could let go of most easily. After making these choices, resetting the cards, and settling into our new expectation of what our ideal birth might look like, the instructor said, “OK, now remove five more.” Ouch. Now it got really hard. We had to identify the details that felt most important in our ideal birth while at the same time finding a way to let the other things go. This is the art of birth planning.

Why is a birth plan important?

A birth plan is a communication tool and a conversation starter between the team that you have built throughout your pregnancy (your midwife or doctor, your partner, your doula or your labor support person) and the additional team members you will meet on the day of your birth (the nurses, the particular provider on-call the day of your birth, and hospital OB or pediatric doctors who may be part of your family’s care). A birth plan is a document that distills the work you have done to understand your options as a birthing person. A birth plan makes it clear that you’ve done your homework and are looking to create open lines of communication with the team who will support you in your birth.

What should be included in a birth plan?

Writing a birth plan should start with your ideal birth scenario. If everything goes exactly as you hope – what does that day look like? Who is with you? What are the small and large details that make your perfect birth, well, perfect? Write those things down and set them as your vision board. It is important to hold this ideal scenario in your mind and your heart.
For many people, writing a birth plan ends here. They imagine their dream birth scenario and write it down. But folks who only consider one version of birth sometimes feel upset when the events of labor and birth unfold in ways that deviate from the ideal plan. While we never want to say that a “perfect” birth is unachievable, we also don’t want to set people up for disappointment. We know that the nature of birth brings many variables to consider – most importantly your well being and the baby’s well being – and the ways that those variables play out is sometimes difficult to predict or control. At Oula, we suggest that your birth planning go a few steps further. Your ideal birth is your baseline, now the real work of birth planning begins.

Questions to Consider When Drafting Your Birth Plan

Once you have established the baseline set of birth intentions for your “ideal birth”, it is important to consider the alternatives. Think of this as working through what’s “on the other side of the card”. Perhaps your ideal birth imagines you going into spontaneous labor and laboring in the shower with intermittent monitoring, but because of risk factors you end up with continuous monitoring and an induction of labor. What are the details that felt important in your ideal birth that you can carry forward into your less-than-ideal scenarios, perhaps a priority for movement, hands-on-support, or pain management? Once you start to imagine the alternatives that may unfold during your birth, you can start to see how, even as your ideal birth might start to go a little sideways, there are core details of your “perfect birth” that you can continue to advocate for even as the variables change.

As you work to consider alternate birth scenarios, we recommend that you also identify a few true priorities. Think of these things as the last cards you’d be willing to remove. Once you have established these priorities, it is important to create a work plan to achieve them. For example, if laboring without pain medication is one of your priorities, your work plan might include taking a childbirth class, working with your partner to practice coping skills, hiring a doula, keeping your body moving so you’re in great shape on “labor day”, or talking to your Oula midwives about how to prep your body for spontaneous labor. It’s not enough to set the intention, you also need to make a plan for how you’ll achieve the things that are most important to you!

Sharing Your Birth Plan with Your Care Team

Birth plans come in many forms. Of course, it’s helpful to write things down so your birth planning is memorialized. You can write your own, use an online template, or use the birth plan tool in the Oula portal. We recommend that you bring a draft to one of your prenatal visits in the third trimester, and if you’re an Oula patient using the portal, this will also appear directly in your medical record for your care team to see. Your Oula care team is eager to be part of the work of building and finalizing your plan. We can use our experience to build on your ideas and we can discuss your intentions to ensure that everything on your plan is achievable in the hospital environment. Once your birth intentions are set, we do recommend that you bring a copy of any written plan to the hospital to share with the on-site team. Whether or not you have a written plan, you’ll be prompted by the hospital team to offer up any intentions for the “white board” in your labor room – this is a great place to write those high priority items so your birth team has a visual reminder of what is most important to you. Learn more about what it means to have a hospital birth at Oula.

The old adage in birth work is that you can “plan” birth with about the same success as you can plan the weather. Our goal is that by the time you get to your labor and birth, you’ve had plenty of opportunities to consider all the paths, and that you have deep trust in your team to support and guide you forward. Until then, we look forward to building your birth plan with you – the Oula “Birth Plan Workshop” is a great place to get started!

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