Little by little, the birth plan has gained the importance it deserves. From becoming an anecdotal document with overtones of bureaucracy that some hospitals offered to do “per procedure”, it has become a document that, in addition to making you investigate what can happen during and after childbirth, is the most effective means of specify what your preferences are in any of the situations that may arise , in such a way that the medical staff is aware of them at all times.
What is a birth plan
As its name implies, a birth plan is the document in which you establish or plan how you would like your birth to go. It works as a kind of guide so that the medical staff knows your choices and/or preferences for the moment your baby is born .
A labor and birth plan can be drawn up at any time during pregnancy, although a good time to do so is at 28-32 weeks, asking the midwife or medical staff any questions.
At the time of delivery, the mother may modify any of the preferences written there , according to her condition and the development of events. Although it is recommended that all pregnant women carry out their birth plan, giving it to those who care for or assist them is optional.
What can not be included in a birth plan?
This document cannot contemplate the choice of practices not currently recommended by scientific evidence because they are unnecessary or harmful in the course of a normal delivery. The different alternatives must guarantee in any case the health of the mother and that of the baby.
Alternatives cannot be included that are not as safe and effective (for example, a caesarean section when there is no medical reason to perform it), or others whose professionals or capacity of each hospital cannot be attended, such as dilation or delivery in Water.
What should be included in the birth plan?
The birth plan should consider your preferences from the moment you arrive at the hospital until you are discharged with your baby, summarized in the following sections:
1. Arrival at the hospital and accompaniment
At this point, health personnel are reminded that a pregnant woman who arrives at the hospital to give birth is not sick, but is in a moment of special emotional vulnerability and that is why a good evolution should be favored and confidence generated in her.
At this point you can indicate who you want to be accompanied by and who you don’t , as well as if you have any need for reasons of ability or culture (language, for example).
You can also specify if you authorize the presence during the delivery process of professionals in training with assistance capacity who, obviously, must always act under the necessary supervision.
2. Assistance and care during the dilation period
At this point, key points must be specified for the moment of delivery, such as previous analgesia, the use of the epidural and all the alternatives that we want to contemplate (and that the center offers) for the treatment of pain.
Although we do not include it in the birth plan, it is important for the pregnant woman to know that the administration of enemas before or during labor is not recommended, nor is it necessary to shave the genital hair.
Also that it is possible to drink liquids during dilation, and that there is neither a position (lying down, standing, squatting, etc.), nor a definitive place to facilitate delivery. The choice depends on each woman and her needs or desires at each stage of childbirth.
The first thing that we must take into account in this section is that there must be a justification for carrying out any intervention, control or administration of medication during childbirth.
These interventions include monitoring, tacts, administration of medications to speed up or induce labor, cannulations, catheterization, and rupture of the bursa.
During labor, it is necessary to monitor the baby, but in a normally progressing one, it is not necessary to be permanently connected to a monitor, which allows greater freedom of movement and more comfort.
Regarding the tacts, we must know that the minimum number necessary to evaluate the evolution of the delivery should be carried out by the personnel that assists it, and always asking for consent.
With regard to the administration of medications (oxytocin or others), they should not be used to accelerate labor routinely, unless there is an indication for it. In this case and when the rupture of the bag must be carried out, the mother must be informed and consent requested.
4. During expulsive
In this section, the assistance by the health workers in pushing (especially when we have received the epidural due to decreased sensitivity), and the performance of an episitomy should be considered.
At this point, it is essential to bear in mind that it is currently not considered appropriate to perform it routinely , since it can have complications and negative effects. It should only be done in some situations in which it is necessary to facilitate the baby’s exit.
This is a unique moment in our lives, so the medical staff should ensure that the baby’s first contact is with the mother through the skin, the gaze, the smell, the sound and the sucking reflex. That is why in this period the minimum controls and the necessary surveillance should be carried out , maintaining a quiet and calm environment for the parents and the baby.
It is important to specify the specifications of skin-to-skin (for example, if we want the father to do it before a cesarean section), if we want the father or ourselves to cut the umbilical cord, if we are going to donate cord blood, and if we want to start (or not) breastfeeding.
6. Delivery of the placenta
The current clinical practice guidelines recommend assisting in the discharge
of the placenta with massage and drug injection. However, after receiving information about advantages and disadvantages, at this point we must specify whether we request spontaneous or physiological delivery.
7. Care and attention to the newborn
At this point we must specify our preferences in case we have to separate from the baby, the administration of medications and vaccines, as well as their hygiene.
Whenever possible, the newborn should stay with the mother. The separation must only be carried out for clearly justified reasons that must be recorded in the clinical history . If necessary, prior consent must be informed and requested.
As is known, health authorities and scientific organizations recommend the administration to all newborns of:
- Ophthalmic antibiotic eye drops or ointment, in a single dose, either
that prevents severe eye infections.
- Hepatitis B vaccine (1st dose).
- Vitamin K for the prevention of hemorrhages. The latter is optional and we must specify at this point if we authorize its administration and if we commit to continue doing so if the doctor recommends more doses after discharge.
Finally, here we must express if we prefer to take care of the care and hygiene of the baby ourselves, our partner or another person.
In this section we must specify if we have any preference when we go to the plant , such as if we want to practice co-sleeping.
It is important to bear in mind that in the event that one of the two is admitted to special units, the hospital must facilitate mother-baby accommodation together, or a stay in open-door neonatal units with the possibility of practicing mother-kangaroo care. .
At this point we must also specify the way in which we have decided to feed our baby, either through formula milk or breastfeeding. In the latter case, unless medically indicated, it must be performed exclusively, and when the baby demands it.
Serums, infusions, pacifiers or teats should not be offered to breastfed newborns, nor should artificial milk supplements be offered, since all of this can hinder or prevent successful breastfeeding. The mother should be consulted before giving any other type of feeding to the baby if necessary.
9. Part Instrumental
In this section we must specify what our preferences are in the event that the delivery process is complicated or intervention or instrumentalization is required from the beginning for a justified reason. The rest of the good practices that facilitate the optimal state of health of mother and baby must always be respected, such as continuous accompaniment, intimacy, or immediate skin-to-skin contact after birth.
In this link you can download the Birth Plan proposed by the Ministry of Health , in which you have the spaces available in each section to fill it out easily.