I think in the past I have addressed my feelings on birth plans.  As  an LDRP 
nurse and Childbirth Educator over the last 30 some years I have seen  the 
pendulum swing and hope to see the swing back one of these days. Currently  
birth plans to most labor nurses in our area are like the joke of how fast will  
she get her section.  But in reality birth plans span the spectrum of the  
pregnancy thru postpartum and even to the beginning of settling in at  home.
 
In my classes I ask my parents to take a realistic look at what they  desire, 
what is possible, what is available and then add flexibility into the  plan. 
I tell them keep it simple...don't impose impossible time limits, but  rather 
think in terms of what is important to their experience and what  can they 
live with and what can they live without.  "Think like 5  things you would like 
to see happen in your experience and 5 things you would  like not to happen."
I give examples like "I would like to breastfeed as soon as possible after  
my delivery.  I would like skin to skin at time of delivery. I would like  my 
baby not to receive any formula, pacifiers. I would like to keep my baby with  
me at all times."  Then the don't list might include: " I would like not to  
have_________present at my delivery. (they all laugh) I don't want the small  
room in postpartum. I don't want a steady stream of visitors all day long. I  
don't want to miss my epidural." 
 
Giving them flexibility can be simply something that puts them at ease in  
decisions that may effect the plan.  They are encouraged to discuss it not  only 
with each other, but with their caregiver and staff. I remind them that  
birth plans may become very bulky and they can choose to edit them.  I also  
remind them they can feel if something doesn't seem "right" to rethink it and  with 
flexibility they can have a comfort zone.
 
Birth Plans shouldn't leave a bad taste in the mouths and minds of  medical 
staff. We should try to educate or reeducate all staff, physicians and  nurses 
alike as to the benefits of communication with their patients.  In  this day 
and age of patient satisfaction surveys some of the requests can begat  higher 
scores as well as have a feeling of a job well done by both patients and  
caregivers.  Patients also need to know why we deviate from a  plan. 
 
So for the time being I will try to keep my patient/clients looking at the  
big picture of things they feel important and not focus on some of the minute  
things, unless they feel its the big item for them personally. My plan for 
them  is to develop a sense of flexibility and provide them with resources for  
survival after they are on their own.
 
Just reflecting,
Leanne Jewell RNC, IBCLC, LCCE, FACCE
SFl

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