Teaching about Birth Plans

Here are the steps I teach for how to develop a birth plan. I do a brief walk-through of a birth planning process. For each, describe how to do the step, who participates, and the primary goal.

  • Birth Plan Checklist – Pregnant Parent and Partner
    • Find a checklist such as http://www.pcnguide.com/wp-content/uploads/2016/03/2-Preparing-Your-Birth-Plan.pdf. The pregnant parent and the primary support person walk through this together, making sure they understand what each of the options are (and if not, learning more), and making sure the support person knows her preferences for each. There is no need to share this detailed checklist with their care providers, it’s just for their own reference – it’s worth tucking it in the bag they’ll take to the hospital in case they would like to refer back to it in labor.
  • Top 3 – 5 Priorities – Discuss with Care Provider.
    • While completing the checklist, they can determine what their top priorities are. They should discuss these with their care provider at a prenatal appointment. Will these choices be options for them during their birth process? What can they do to increase the likelihood of reaching those goals? This discussion allows them to develop realistic expectations and increase the chance the expectations will be met. (Note, sometimes this can lead a parent to re-examine whether the caregiver and birthplace choices they have made are the best fit for their goals.)
  • Written Birth Plan – To Share with Nurses at the Hospital
    • A birth plan is the primary tool for communicating with nurses about the family’s goals and priorities, and what kind of support from caregivers would be most helpful to them.
    • It should never be more than one page long (in a easily readable format.)
    • One format is to have three sections. The first describes who they are as a family and who will be at the birth and what they have done to prepare for this birth. The second gives the big picture of their preferences for labor support, pain medication, and interventions. The third is optional, and explains any special information that “if the nurse only knew this about me, they could better support me.” This is a good place to address religious or cultural preferences, history of sexual abuse or other personal history that may affect them during the birth process, any particular worries they have about the birth.
    • If parents are planning a home birth, they may not need a written birth plan for their midwife if they’ve been in deep discussion for the whole pregnancy. However, they absolutely should have a written birth plan in case of transfer. In a survey of birth satisfaction, some of the lowest rates were for people who had planned an out-of-hospital birth and transferred. They could increase the chance of a satisfying birth experience by taking time to articulate their wishes.
    • Sample birth plans are available at http://www.pcnguide.com/wp-content/uploads/2016/03/2-Preparing-Your-Birth-Plan.pdf. Feel free to print several examples to share in class to show there’s no one right way to write a birth plan.

Childbirth Educators can support students with figuring out their top 3 – 5 priorities using the Birth Plan Card Sort exercise: https://transitiontoparenthood.files.wordpress.com/2018/10/birth-plan-card-sort.pdf. Instructions are on the last page.

Learn more about the steps of teaching about Informed Decision Making, including Values Clarification, and how to make the decision after gathering information.

Pain Medications for Labor

This episode offers an overview of medications for labor pain and childbirth – nitrous oxide, IV opioids, and epidural analgesia. For each it covers how it’s administered, the benefits – how it helps with labor pain, and the possible side effects. There is also a detailed discussion of labor support for a person using epidural analgesia.

A full transcription with links to more information is available at https://transitiontoparenthood.wordpress.com/for-parents/labor-and-birth/pain-medication-for-labor/

Labor Support

Continuous labor support, which can be provided by a partner or spouse, other family or friends, a professional doula or by medical caregivers has been shown to reduce interventions, improve outcomes, and improve satisfaction with the birth. This episode is all about how to provide effective labor support: by learning about childbirth, learning about what best comforts the person you will support in labor, creating an environment where she is comfortable and feels able to do what she needs to do to cope without being judged, watching for Relaxation, Rhythm, and Ritual and reinforcing those, and – most importantly – helping her to feel safe, loved and protected. When someone feels safe, loved and protected, oxytocin and endorphins flow, and labor progresses faster and hurts less. [Transcript of episode.]

Comfort Techniques for Labor

Learn comfort techniques and learn why they work. Cognitive strategies include education, visualization, affirmations, and choosing to view pain as a positive sign of labor progress. Gate Control techniques work by focusing  your attention on something pleasant (like music, a beautiful view or aromatherapy) instead of focusing on the labor pain – this blocks pain signals from reaching the brain, so you’ll experience less pain. Counter-irritants include things like biting your lip – a pain you control – to help make the pain you can’t control feel more manageable. And body mechanics involves using position, movement and massage to encourage baby to move into the best position to help labor to progress and be less painful. Here’s a printable handout that summarizes comfort techniques for labor.

[Transcription of episode and checklist of comfort measures available at https://transitiontoparenthood.wordpress.com/for-parents/labor-and-birth/comfort-techniques-for-labor/]

Stages of Labor and the 3R’s

An overview of the stages of labor and comfort techniques for the first stage of labor: Early labor, as the cervix moves from 0 to 5 cm dilated is the longest phase of labor, but also the least intense. The focus is on Relaxation, so techniques like slow deep breathing visualization, massages and baths all help. In active labor as the cervix goes from 5 to 8 cm, contractions are longer, stronger, and closer together and take more work to cope with. The focus is on Rhythm, so rhythmic breathing helps, as does movement such as walking, slow dancing, or rocking on a birth ball or in a rocking chair. In transition, as the cervix dilates to 10 cm, contractions are coming hard and fast and it can be very overwhelming. So, the focus is Ritual – find something that works to reduce pain, and just keep doing it on every contraction to help feel like there’s some control over the process. [Transcript of podcast episode 3 at: https://transitiontoparenthood.wordpress.com/for-parents/labor-and-birth/]

Understanding Labor Pain

I discuss the physiology of pain and ways that people who have been through birth  describe how contractions feel. Given all of the physical changes and challenges of labor, it’s not surprising it is painful for many people. The acronym P.A.I.N. can remind us that labor pain is Purposeful, Anticipated, Intermittent, and Normal. However, understanding what factors make that pain worse than it has to be helps us learn how to reduce it. The Fear Tension Pain Triangle theory tells us that when we’re fearful, we tense up. As we tense, the pain increases, which frightens us more…. the fear increases, and so on. Instead, we want to explore ways to shift this to the Confidence Relaxation Comfort Triangle to make labor more manageable. [Transcript of podcast episode.]