By Rachel O'Donnell


Many of us think: “Birth is a natural event. Women have been giving birth forever. So why should I need to do a lot of research about it and record my preferences in a Birth Plan? Birth is going to happen whether I make a research project of it or not.” Nothing could be truer. It’s going to happen. But today what we may consider normal labor and birth, is not necessarily what the hospital considers normal management of your labor and delivery. Normal medical management of labor and delivery in Houston County in 2008 meant a Cesarean Section rate of 42% at SAMC and 38% at Flowers. Compared to a national C-section rate of 33%, those are pretty scary numbers. Enterprise comes in just below the national average, at 32% (Center for Health Statistics, www.adph.org/healthstats/assets/mch08table14.pdf). A birth plan is a great way to help stay off the slippery slope of medical intervention. For women hoping for an un-medicated delivery, a birth plan is an absolute necessity. With the majority of Wiregrass mothers choosing an epidural, the natural standard will not be hospital standard. For women planning on an epidural or other pain relief, there are still many choices being made for you and your infant that you may wish to consider. We are individual mothers and hospital standards of care are one size fits all. Once a mother is in labor is not the time to try to explain why you don’t want continuous fetal monitoring or an IV or why you don’t want to lay on your back to push. Most doctors and nurses are more than happy to do their best to accommodate and even advocate for patient wishes if they know what they are.

Making a birth plan is a great opportunity to research birth issues, find out what the current medical birth culture is like, and come to decisions about what your own preferences are. Some issues to consider in a birth plan are: Would you like to avoid Pitocin/induction or augmentation? Do you want to limit cervical exams? Do you want to know your progress? Does it really matter how far dilated you are? Monitoring: do you want continuous fetal monitoring, cordless or intermittent monitoring?  Do you want anesthesia or not- when, not unless you ask, do you want it never mentioned to you? Do you choose to have an IV, a hep loc, none at all? If things slow down would you prefer amniotomy? Nipple stimulation? Pitocin? Nothing?  What position do you favor for pushing- anything but on your back? Props (i.e. squat bar, birthing ball, etc). Coaching- mother directed pushes vs nursing directed? How do you feel about episiotomy? If you are beginning to tear, before any hint of a tear? Would you rather tear? Who do you want present or not in the birthing room?  Do you want immediate skin-to-skin for mother and baby?  Cutting of the cord: who and when- after it stops pulsating? Who would you like to announce the sex of your child? Placenta delivery: are you ok with cord traction, manual removal, Pitocin? Vernix- rub it in or wash it off? Do you prefer to delay routine tasks to enhance bonding and early breastfeeding; Do you want to insist on breastfeeding only  and your choices in case of problems, hypoglycemia etc? Do you consent to Vitamin K injection for your infant?  Hepatitis B vaccination? Does your baby need the gunk in his eyes? Do you choose to circumcise?  

The number of issues may seem overwhelming. Some of these routines will be very important to one individual mom, and others not at all. That is why we all need a birth plan! You want to have a good birth experience. The hospital staff want you to have a good birth experience. A birth plan is the beginning of the positive communication that can bring these goals together.