Friday, May 4, 2012

The best laid plans

We all make plans for our days off…get laundry done, run errands, play soccer. I planned on going to an outdoor movie this weekend. I packed a picnic dinner and a blanket and walked over to the park. I sat for a while, enjoying the weather, watching the rain clouds in the distance, and waiting for the movie to start… it never did. The recorded message alerted me “Cancelled due to the weather.”

When I was a little girl, I planned to become a professional softball player, an astronaut, and the first woman president. To this day my mother loves to remind me how adamant I was that I would make this happen. Life has a funny way of molding and re-adjusting the plans we have in childhood…playing high school softball and bossing my little brother around is as close as I got to those plans.

Birth is another part of life that people plan for. Informally, couples whisper about what they will name their baby, who they might look like, who will hold him/her first, who will cut the umbilical cord. Over the years, a formal tool has been developed for couples planning their birth… the “Birth Plan.” By simply Googling these two words, over 90,000,000 results pop up. There are websites, and templates, and suggestions for phrases to be included. The resources for birth plans seem endless. And just as every member of my family had a suggestion (and theirs was the best suggestion) about what I should be when I grew up, there is an endless supply of “experts” ready and willing to tell you what your birth should be like.

During their pregnancy, I ask all of my patients what are your plans for this birth. I have noticed that women tend to be on one end of the spectrum or the other. Some women are confused by this question and simply shrug their shoulders. Others have their birth planned down to the minute and are adamant about the way things will happen. I think that both of these responses are problematic. I do not think that it is possible to plan every detail of a birth…just as it is not possible to predict the weather or to look at a small child and know 100% what they will be when they grow up. There are many variables that can occur during the course of a pregnancy as well as during labor. The quality of a woman’s birth experience should not be inseparable from her vision of that birth that occurred the moment she saw those two pink lines. That being said, I believe that women should absolutely make plans for their birth!

The first step in creating a birth plan is to take time to decide what is important to you. The number one thing to consider when making any plans in life is safety. At the top of the list for every birth plan should be a safe and healthy mom and baby. Next, work your way down the list and start to form a picture of your birth. Who do you want with you? Is the mode of delivery important to you vaginal vs C-Section? Do you want to avoid medications during your birth? Do you want labor to start on its own? Do you want someone other than the doctor or midwife to cut the umbilical cord? How soon do you want to hold your baby after he/she is born? Although there are things about pregnancy and childbirth that cannot be controlled there are many things that can be done to help you have the birth that you want that is specific to you.

There are so many different ways to paint your birth. Take the time to create a birth plan and then communicate your plans with your OB provider so that you can all work toward the same goal. It is our responsibility as OB providers to learn what you would like for the birth of your child and help you get there safely. The responsibility is also shared with you. Remember, if you plan on doing laundry this weekend you will need to buy laundry detergent…if you plan on certain things for your birth you need to find out what it will take to get there.

Keep in mind that birth plan should be just that…a plan. There are so many things in life that happen not quite as we plan them due to a variety of reasons. I was not emotionally scarred or traumatized, nor did I have a horrible weekend due to my movie plans being cancelled. Neither should you define your birth experience as any of those things due to events that occurred outside of your control. Childbirth is an event that we have as much control over as the weather. Make a birth plan with the knowledge that there could be rain and trust that your provider has an umbrella. The birth of your child should be something that is always remembered as a wonderful experience. Always keep in mind what you put at the very top of your list.

Rachel Zimmer, DNP, is a Certified Nurse Midwife who cares for patients at Texas Health Harris Methodist Hospital Hurst Euless Bedford.

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