The meetings you have with a couple during this 3rd trimester are often more focused on labour and birth. This is an ideal time to start discussing birth plans. You will have mentioned a birth plan/wishes/preferences during previous meetings and around 36/40 is a good time to put pen to paper and refine the birth plan.
A birth plan is so important – no matter what you may hear from hospital staff. This is a personalised written document stating the preferences/wishes a woman would like for her labour, birth and baby.
Not all hospital staff give birth plans the respect they deserve. You will find many templates online. DO NOT USE TEMPLATES! The Birth Plan/preferences should come from each individual woman/couple. As a doula, you can help them devise a birth plan that is just right for them, making sure they have included the essentials. DO NOT ever write the plan for them. A doula may suggest she make a list or birth plan and email it to you so you can then discuss at the next meeting. Explain it is important to use language that staff will respect.
There are basic considerations which all people need to think about for a birth plan, but there also may be specific cultural or religious considerations. These should definitely be included in a birth plan.
It is important for you to encourage your clients to ask a lot of questions when they do a hospital tour, to find out if the facility they have chosen will provide the services they may want. (See Birth Right book, p.62-68) for an example of questions to ask.
Hospital staff, and in particular Obstetricians, do not like being handed a ‘list’ of ‘definitely do want, definitely don’t want!’ Because the birth plan becomes a legal document in the ‘patient notes’, and there may be many requests that a hospital simply cannot provide.
Using language that is respected by the staff is key to ensuring the birth plan is acknowledged and accommodated.
A good opening sentence to suggest to your clients may be:
Dear Midwife, ‘As long as it is safe for me and my baby these are some things we would appreciate during my labour and birth’.
As you can see, this is a good opener for a birth plan and does not put anyone offside! Some people go into hospital with very unrealistic statements written on birth plans, some go in with ‘demands’. Depending on the facility, it may not be possible to have a waterbirth for example, as they may not have a bath, or may not have any midwives trained in waterbirth. Obviously you do not want to have a situation where the woman is hoping for a waterbirth, the doula is supporting her in this decision, and you find out on arrival to hospital that waterbirth is not permitted!
When you arrive in hospital and meet the midwife who will be caring for your client in labour, it is important to make sure she reads the birth plan. After an initial introduction, and depending on what stage of labour she is, either you or the woman might say “I have a few things written down, that are really important for me in labour. I would really appreciate it if you could read this with me now and let me know if there is anything that you are unable to provide’. As the doula I think this is very important for you to make sure this happens, so that everyone is on the same page. Once again, you do not want to have a situation where the woman particularly wants a physiological third stage, only to find out during labour that because she has a private obstetrician in a private hospital, that it is not possible. All of these ‘issues’ can have an impact on a woman’s labour and birth and her baby. It is a wise doula who makes sure a woman has sorted all of this with not only her caregiver, but also the hospital she has chosen. This is especially important if she is wanting something unusual. It may be religious or cultural. It may be a ‘lotus birth’ (you may not think this is unusual but it is certainly ‘outside the square’ for most hospitals and staff.) Your role as her doula, is to make sure her birth plan is respected.
FOLLOWING ARE SOME REAL LIFE SCENARIOS
Lisa is 18/40 pregnant and you are having your first meeting. Her partner, Ben, expresses his feeling that Lisa does not need to have a doula because she has him. He states he is just going along with whatever she wants.
At your first meeting with Anne and Andrew, Anne says she likes the idea of a doula in case Andrew faints at the birth. Anne sates she is no ‘hippy’ and is happy to have drugs if the pain gets too much. Andrew says she has a low pain threshold and will probably be screaming for drugs after the first contraction.
Alice is 37/40 pregnant and you are having a final meeting with her and Sean to discuss their Birth Plan. They present you with 5 printed pages of what they want for their birth. Some of the issues they have highlighted are: definitely do not want forceps or an epidural, and she definitely wants a waterbirth (which is why she has chosen a Birth Centre) She also does not want continuous monitoring