There is a running joke among labor and delivery nurses about birth plans. It goes something like this: “What do you call a woman who comes in and presents her birth plan to the staff? The next Cesarean section.” Now, don’t get me wrong–I do have a sense of humor, but I don’t really find that very funny. But I understand the idea behind it: births rarely go according to plan. And when a woman is very attached to her birth plan, deviating from it can often lead to disappointment or unwillingness to see beyond the original picture.
I do believe it’s essential to discuss your wishes and pain management techniques with those planning on attending your labor and delivery. How else will these people know your birth preferences, or how you need to be cared for?
But within this discussion it is necessary to come up with not just one birth plan, but plans A, B and C. “Plan A” is the “ideal vision” of how you may like to see your birth unfold. That may include ideas like laboring at home as long as possible, trying the shower or tub for pain management, or having your birth take place at a birth center instead of a regular hospital. “Plan B” relates to what you would do if you needed an unplanned intervention, such as labor augmentation, if your water broke prematurely or you went past your due date. Then there is the final birth plan, “Plan C,” which might take place should you need major intervention like a C-section or induction. Plans B and C are not necessarily the most desired, but within these scenarios and the medical procedures they involve, what are your options for still honoring some of your original ideas?
The other day in one of my classes at the Prenatal Yoga Center, we discussed the “Cesarean section” chapter found in most childbirth education books. One of my students, who underwent a C-section for the birth of her first child, said that she initially skipped that chapter because she didn’t think it was going to apply to her. She now advises all her friends to read it even though it may be scary and unpleasant. Unfortunately, the reality of our current culture is that approximately one third of all expectant mothers will give birth via C-section. It is a wise move to educate yourself as much as possible on the procedure.
I recently met with my doula client and her husband to discuss her upcoming birth. She is hoping for a “HVAC” (home vaginal birth after cesarean). She has put much thought and many hours into researching such an option and seems very excited about her choice. I am 100 percent behind her decision and will support her to the best of my ability. Part of my support comes from openly discussing the somewhat uncomfortable subjects of needing to transfer to the hospital or undergo a repeat C-section if all does not go according to plan. While these are not the ways my client would like to see her son brought into the world, they need to be discussed so should they need to happen, she is mentally, emotionally and physically prepared.
I urge you to think beyond your dream scenario, read the “scary chapters” in your childbirth books and put real thought into the many directions your birth can take. This way you are not caught off guard. If you do veer away from your original Plan A, you can be comforted in the knowledge that Plans B and C are ready and waiting.
Debra Flashenberg is the director of the Prenatal Yoga Center in New York City.
