Birthing Plans

When it comes to having a baby, one of the most important relationships you�ll have is with your doctor. In order to maintain a good relationship and ensure an easier delivery, there has to be an open channel of communication. That�s where Birthing Plans come into the picture.

Birthing Plans are written agreements between the patient and husband/coach and the doctor or midwife. They are essentially wish lists created to tell the doctor or midwife what the patient expects from the childbirth experience, including the following:
� Family/friend presence in the delivery and/or operating room;
� Atmosphere of the delivery room, e.g. music, lighting, freedom to move around;
� Medical procedures to be avoided, e.g. episiotomy, vacuum extraction;
� Procedures following the birth, i.e. who cuts cord, first feeding;

These plans, which try to decrease the number of medical interventions, have become popular over the last decade primarily because there has been more of an emphasis on patient education, especially with the increased use of the Internet.

�Back in the old days (that is, up until the mid-1970s)�, says Dr. Stefano Stella, an obstetrician and gynecologist, �A mother would come into the hospital, be sedated, have the baby, sleep, and then the next day be told by the doctor or nurse what she had.�

As hospitals began to move away from total sedation, other techniques were explored, and delivery practices from Russia and France became more fashionable. In Russia, some mothers gave birth in tubs under water. The Leboyer Method from France advocated immediately putting newborns into warm water, and Lamaze popularized the use of psychosomatic pain control, using breathing exercises. In the 1970s, epidurals and fetal monitoring became popular. Although epidurals allowed pain-free deliveries, doctors often resorted to forceps or Cesaerean births. In the 1980s, midwife-assisted deliveries became common, but when people started to move back to the hospital setting, many doctors began to encourage patients to invest more time in childbirth preparation by attending childbirth education classes and creating birthing plans.

The plans make patients and doctors aware of what to expect from each other so that there are no surprises at the last minute. Without them, sometimes a patient will assume that something is going to happen and then at the time of delivery, she says, �How about doing this?� and the doctor says, �I don�t do that�it�s against my philosophy.� Then the doctor-patient relationship breaks down. �I am certainly in favor of birthing plans�, maintains Stella. �But some patients have very high, and sometimes, unrealistic, expectations. Birthing plans should be used more as a way for patients to communicate their preferences to their doctor than used as a contract that cannot be revised. Patients do change their minds, and sometimes medical intervention is necessary. As an expectant parent, you have the right to give input on the birthing process, but you must also realize that everything on your �wish list� may not be possible at the time of delivery. Think of it as a team effort, and then everyone comes out a winner.�

Dr. Stefano Stella, MD, FACOG, is the Director of Obstetrics and Gynecology at St. Mary Hospital of Hoboken, New Jersey, and a partner in Amerimed.