Rethinking the Birth Plan

At the CAPPA Labor Doula training I attended this past weekend, Crystal Marris Sada (doula genius) spoke with us about going beyond the birth plan with our clients (Crystal offers a professional workshop called Beyond the Birth Plan which I will attend should the opportunity arise). She said that birth plans are wonderful for the client to understand what she wishes to happen at her delivery and to discuss her desires with her physician/midwife. BUT, Crystal says, there are two things a woman must do to understand what her birthing experience in a particular hospital with a particular practice will be like.

ONE: Every woman who is considering delivering in a hospital needs to contact the Obstetrical/Maternity Nurse Manager and she must ask what specific hospital policies and procedures the hospital has created for families delivering in their unit. What are the basic expectations/limits the hospital risk-management department has given to the maternity unit. The client can also ask questions like: Do you have tubs to labor in (with waterproof telemetry for monitoring), how many labor/peanut balls do you have available, how often do your nurses work with patients desiring an unmedicated labor? The nurse’s willingness to discuss these matters and her specific answers will tell a client much about her birthing environment. (Remember to ask if it is a convenient time to speak and if not, can you make an appointment for a call?)

TWO: Every woman must ask her doctor to see a copy of the standing orders s/he leaves for clients who are admitted. Regardless of what a woman discusses with her doctor, the hospital staff is bound by the standing orders the physician has left for his/her patients. Does the physician order intermittent monitoring instead of continuous? Does the physician order ‘bed rest’ for all patients or are they free to move as desired? Are all patients NPO (nothing to eat) or are they allowed light foods during labor? Will the client need to have blood pressure taken every ten minutes throughout labor or will once an hour be sufficient? Will the client receive saline via IV automatically or will a HEP lock (or nothing) be allowed? All these types of standing orders can tell a client much about her physician’s attitude toward birth. The client can ask to review her Face Sheet (specific patient orders) with her doctor a few weeks prior to expected delivery so they are in agreement about the specific orders being made for her delivery.

Understanding how the hospital operates and understanding what medical care has been ordered before she ever walks into the maternity unit, is very helpful for clients to understand what a hospital experience is likely to look like. Having this information can help a client focus on the things that are truly important to her in her birth and can help avoid disappointment during her labor and delivery.