"tone" of the birth plan

[MommaJayla]

I am drafting a birth plan for what I hope will be a reasonably low-key hospital birth (no choice on that).

I know the things I want to include and I know that I plan to keep it v. concise, but I'm struggling with how the wording will be read/interpreted by staff.

Just for ex. would it be better to say I DO NOT consent to x,y,z OR something like Please respect our wishes to avoid x,y,z. kwim at all? I know you catch more flies with honey and I don't want to step on toes so to speak, but I also want to be clear and taken seriously.

My ob and I are generally on the same page and I will be having her sign a copy of the birth plan, so I'm just wondering in your opinion or experience is it better to be nice or more direct, I have seen birth plans that fall into both categories.

[mamatolevi]

I use very blunt and clear language for what I will not consent to - and was asked to change it to "I would prefer..." Not happening. I tried that before and it was completely disregarded. I'm not rude about it, but very clear. ("I DO NOT consent to a routine dose of pitocin after the birth. If I have received pitocin to augment my labor, I do not consent to an increase in the dose.")

If it's something I want, I'm polite and friendly. I even tossed in a couple of jokes. ("I plan on using tub/shower for pain mgt. Don't worry about walking in on a nekkid husband; I packed trunks for him." and "If I'm napping, please don't wake me; I have hard work to do soon.") I also included a warning that I'm wrapped a little tightly and need my attention gotten before being touched.

I liked the information on nursingbirth's blog about birth plans.

[Kidzaplenty]

I think if you put something like "I would prefer" or "Please respect our wishes" it leaves it open to them doing what they think is best.

If I put "I DO NOT CONSENT", there is no room for them to budge.

I think a birthplan should be concise but specific. You can make it come across more "nicely" when you are face to face with them as you hand it to them. You can be polite and friendly while being specific and blunt, at least IMO.

[katelove]

I agree about "We would prefer...", it's not a definite no.

I used a combination of "No...", "Please do/do not...", "We choose to/not to..." and "We do not consent..." I'm pretty happy that it came across nicely and the midwife at our first appointment loved it, so I guess it reads nicely from the other side too

I also tried to use positive statements where possible instead of negative statements so instead of saying "No syntocinon" I said "We would like physiological managment of third stage".

[Bluegoat]

I agree that affirmative language is better than negative language. Tell people what you want rather than what you don't want.

Honestly though, if you are two rigid in your plan it may get ignored. Many procedures and interventions you would want to avoid are appropriate under certain circumstances, and if you simply say you would never consent, then they may well think you don't really understand the issues. A statement saying something like "We understand that birth is a fluid situation. We are willing to discuss changes and modifications to our plan as becomes necessary" can go a long way toward making the staff comfortable with your care plan.

[cileag]

I'm a L and D nurse and to be honest, it doesn't make that much of a difference what language you use. If your nurse is the type that respects and goes out of her way to honor birth plans, she'll do it whether or not you say please and thank you. If she is one that thinks a birth plan equals an eventual c-section, than the language probably won't change her thinking.

That being said, in general, I like short, to the point birth plans with a list of only the most vital information. Info about lights, sounds, doors etc---things that you and your birth team can control--I recommend just leaving off. Things like medicine, procedures etc--put those in and make it clear. For example, I birthed at home, but my transfer plan said:
Yes, please give me the flu shot.
No thanks, we decline hep B.
No thanks, we are not circumcising.
etc.

In general, I strongly also recommend REALLY talking to your OB about what protocols the hospital has in place that would conflict with your birth plan. Is he or she actually going to be managing your care or are you at the mercy at the on call doc who may choose to totally disregard your birth plan?

[mamabadger]

I like the direct refusal in theory, but it can still be phrased politely. For example, "Please remember I am refusing cord clamping except in an emergency," or "Kindly avoid mentioning pain medication unless I request it."

Originally Posted by cileag

That being said, in general, I like short, to the point birth plans with a list of only the most vital information. Info about lights, sounds, doors etc---things that you and your birth team can control--I recommend just leaving off. Things like medicine, procedures etc--put those in and make it clear.

I absolutely agree. As a doula, the biggest mistake I see in written birth plans is not the tone, it is that they are too long and contain too much unnecessary information. There is no need to mention anything that does not require the help or cooperation of the hospital staff.
Also, I would suggest combining points into one comprehensive request wherever possible. "No procedures without prior informed consent" covers an awful lot.

[khaoskat]

I would do a very short birth plan:

Mother's Care: I DO NOT CONSENT TO:
x
y
z

Mother's Care: I DO CONSENT TO:
a
b
c

Baby's Care: WE DO NOT CONSENT TO:
t
u
v

Baby's Care: WE CONSENT TO:
d
e
f

Baby Feeding - We are Formula/BF'ing.
Rooming In - Please do/do not take baby from room without a parent to go with.

If I have to transfer I plan on putting this note on my door:
Please do not come into this room if you cannot respect or work withing my environment.

As such, DO NOT
talk about pain relief medications unless asked

do not talk to Mother unless absolutely necessary or unless asked questions

do not force your will upon Mother or Father

do not change the lighting levels - if you temporarily need more light, please turn off what you turned on when you leave

do not change music or volume unless absolutely necessary

Mother is giving birth without use of pain medications and Mother and Father have made informed choices about pain relief options and medical interventions

If you do not plan on listening to Mother, then please do not even enter this room.
(This last statement is because I have had nurses listen to their electronic equipment over me in the past, when I have been telling them I am ready to push and baby is coming. They told me I was not even in real labor yet, because I was too calm, and their equipment showed I was only contracting maybe every 4-5 minutes and they were not strong or lasting any longer than 40-50 seconds.)

[MommaJayla]

Originally Posted by Bluegoat

I agree that affirmative language is better than negative language. Tell people what you want rather than what you don't want.

Honestly though, if you are two rigid in your plan it may get ignored. Many procedures and interventions you would want to avoid are appropriate under certain circumstances, and if you simply say you would never consent, then they may well think you don't really understand the issues. A statement saying something like "We understand that birth is a fluid situation. We are willing to discuss changes and modifications to our plan as becomes necessary" can go a long way toward making the staff comfortable with your care plan.

I think I will definitely include something to that effect, thanks.

I also think it's a good idea, but I am struggling with finding affirmative language for some/many things that I need to include. I have to wonder how nurses would take something like "I would rather my baby be raised by wild dogs than injected with your hep b vaccine"

[amyjrn23]

birth plan tips

I'm an L&D nurse and this is my advice. The absolute best thing any women wanting a natural/minimal intervention birth can to is to call the L&D unit (or have spouse call) and say:

"Hello my name is so and so. I am a patient of Dr. X. I am en route to the hospital because (my water broke, I am in labor....fill in the blank here). I am very much wanting natural child birth. If it is at all possible I would very much like to have a natural birth friendly nurse assigned to me. Thank you so much. I should be there in 20 minutes."

On any given L&D unit there are nurses who absolutely love NCB patients and to be frank nurse that loathe them. By giving a little warning this gives the charge nurse the opportunity to adjust and reassign patient assignments as needed.

Doing this one little thing is (in my opinion) way more effective than a written birth plan.

As to the birth plan. It really doesn't matter what wording is used. When patients say there are wanting NCB we know what that means.....seriously....you don't need to include all the minute details. What concerns (or ticks off if I may be so blunt) L&D nurses are the 14 page long birth plans that include things like "if my baby's heart rate decelerates I would like to opportunity to change positions prior to discussing a c-section" or "if a c-section becomes absolutely medically necessary I would prefer a spinal vs general anesthesia." My internal thoughts to things like this are....if your baby's heart rate decelerates I will be referring to my years of education and training in order to perform the steps necessary to properly oxygenate your baby....I will not be referring to your birth plan under such circumstances. Or...if a c-section becomes medically necessary we will give you the safest type of anesthesia possible. If fetal status permits you will get a spinal...of not you will get general. I know that when the patients include things like this in their birthplans what they are really wanting is to have control over decision making, but this is the sort of thing that rubs nurses the wrong way.

It is completely reasonable to include all the things in which you have a definite say and a definite choice to consent or not consent to. i.e hep b, circumcision, no pacifiers ect... then include your preferences i.e I would like/not like a mirror at delivery, infant on tummy at delivery ect. Also, don't be afraid to include personal things that you feel are important to your desired birth. Example: I feel very strongly that I want only my husband present at the labor and birth. We have made our wishes known to our families. It is very possible that my mother will try to weezle her way in. Thank you for helping to keep all visitors out of the labor room.

Just my suggestions. Best wishes.

[mamabadger]

Originally Posted by amyjrn23

On any given L&D unit there are nurses who absolutely love NCB patients and to be frank nurse that loathe them. By giving a little warning this gives the charge nurse the opportunity to adjust and reassign patient assignments as needed.

Doing this one little thing is (in my opinion) way more effective than a written birth plan.

Very true, and a wonderful suggestion. I have seen the choice of nurse make or break a birth experience.

When patients say there are wanting NCB we know what that means.....seriously....you don't need to include all the minute details. What concerns (or ticks off if I may be so blunt) L&D nurses are the 14 page long birth plans that include things like "if my baby's heart rate decelerates [...skip...] I know that when the patients include things like this in their birthplans what they are really wanting is to have control over decision making, but this is the sort of thing that rubs nurses the wrong way.

It is completely reasonable to include all the things in which you have a definite say and a definite choice to consent or not consent to.

I appreciate what you are saying, but in my experience, what is the patient's choice and what is not, or what is medically indispensable and what is optional, varies a great deal from one nurse/hospital to another.
I have encountered L&D nurses who regarded continuous EFM, confinement to bed, purple pushing, separation from the baby at birth, or fasting during labour as medical imperatives. One nurse even argued at length with a client that wearing her own nightgown instead of the hospital johnny shirt could endanger her baby. The nursing staff's idea of what NCB is might not be mine.