Congratulations on your pregnancy. Now it’s time to make plans for the big welcome: where will you labour and how? Who will be around you when you do? How do you expect to feel before, during and after? All these questions are your starting point for your birth plan.
We spoke to UAE-based doulas about making birth plans, what they should encompass and look like. Here’s what they had to say.
What is a birth plan?
Shereen Zarroug, certified birth doula and coach, antenatal educator, hypnobirthing practitioner, breastfeeding counsellor and founder of pregnancy centre Belly Baby Mom, explains: “A birth plan is a document that highlights your vision and preferences for your upcoming birth. The goal when working on a birth plan is for an expectant woman/couple to put down all the ways they would like to be supported informationally, physically and emotionally during the birth experience, so that their birth team is aligned in the support that the couple would like to be given.”
It minimises the scope of disappointment for a couple. It’s important to have as much detail as possible on there, because your idea of a ‘natural birth’ may not be the same as your doctor’s.
Jasmine Collins, hypnotherapist, theta healer, natural language processing practitioner and doula, urges couples to have the conversation about birth plans early in pregnancy so both couples and their doctors can be on the same page. “Every doctor has a different style of birthing,” she explains. The questions to ask, she says, are:
- Are they okay with you getting into whatever position you feel like to birth in?
- Are they okay with you using the tub to labour in?
- Do they support water birth?
A father’s role
It’s important for the dad-to-be to be informed about what’s expected and why; he can explain these choices to the midwives (shifts may change and debriefing may be needed) or doctors on the big day. “Your husband is your biggest advocate (if attending the birth) so it is important for him to support your wishes, ask questions and speak out during labour/birth if needed,” says Zarroug.
How long should the birth plan be?
Short and concise, say the experts. No more than a page or two. Zarroug says: “There are different ways one could work around their birth plan – some prefer a straightforward point by point A4 document, others opt for visual birth plans which are simple and highlight the important points graphically.”
There are different ways one could work around their birth plan – some prefer a straightforward point by point A4 document, others opt for visual birth plans which are simple and highlight the important points graphically.
Names of parents, other relevant details such as medical history, type of birth and who will be there are all important things to note down.
Zarroug says other things one should specify are:
- Vision for the birth environment,
- Your support team,
- Your preferences for pain management,
- Labour and birth positions,
- Use of water birth facilities,
- Use of synthetic oxytocin for labour augmentation, and
- Intermittent or continuous foetal monitoring.
Delphine Dumur, a UAE-based doula who runs the Instagram account @letsbirthtogether, adds: “It should include your personal information such as:
- Your beliefs,
- Past birth experiences,
- Trauma history,
- Fears, and
- Any concerns that your staff needs to be aware of.”
Sections to consider
For easily readability, says Collin, you may want to divide the plan into segments:
Is this something you are okay with or only want to do if there’s a medical necessity? If yes, what types are okay and in what order. Your medical options can include:
Membrane sweeps: “This is when they do a cervical check with their fingers. They separate the amniotic sack from the cervix. It’s a way to get things going at the end of your pregnancy,” says Collin.
Pessary (or tablet)
Breaking of waters: You are examined internally and using a small plastic hook the membranes are caught and broken, explains UK-based National Health Service (NHS) on its website.
Start of labour
When your contractions begin, you need have preferences about:
- Going to the hospital immediately
- Staying home for a while until labour is established: “You need to be very careful if you choose to stay home; if the water has any blood or meconium (baby’s first bowel movement, you may need to rush to the hospital,” says Collin.
Once at the hospital
- Will you be getting a cannula?
- Will you be given an intravenous drip?
- Vaginal exams: These are done to assess how dilated you are. You can say no, says Collin.
- Monitoring the baby: “It’s standard to monitor the baby – but then you have a choice to continually monitor the heartbeat, which means your movement is hindered. Some hospitals can do wireless monitoring. Or you can have intermittent monitoring,” she adds.
- How will you create a calm, undisturbed, comfortable and familiar environment? List out the things that will help including dimming of lights, aromatherapy, etc.
- Do you want to wear your own clothes or a hospital gown?
Pain management questions
a. Do you want an epidural?
b. Do you want an epidural to be your last bet and use other pain-relieving methods such as:
- Gas and air,
- Pethidine injection (can go through to the placenta)
Labour stage 1: Thinning and opening
This is the longest stage and as it progresses, the contractions will get longer, closer together and more intense. Things to ask yourself:
- Do you want to move freely or be on your back?
- Do you want to use a birth ball?
- Are you okay with vaginal exams – do you want none or do you want them kept to a minimum?
- Do you want to labour in the water: Do you want to use a pool/bathtub/shower?
- Do you want the drip, or want to eat and drink whatever you want through the labour?
- Do you want medication or people to just offer encouragement – unless you ask for it?
Labour Stage 2: Descent and birth
- Position of choice: Do you want to be on your back, on all fours, squatting?
- Breathing techniques: Talk about breathing and pushing, also called mother-directed birth.
- Doctor’s role: Talk to the doctors about what they are going to do to help the baby out. “You don’t want them pulling your baby or turning your baby’s head, but you do want them to keep an eye on your perineum and keep you from tearing. Sometimes, this means they need to put their hand on the baby’s head and slow the exit, so the perineum and vagina has a chance to expand. Breathing helps here too,” says Collin.
- Episiotomy: Medicine.net describes an episiotomy as “…a surgical procedure that involves making a small incision in the perineum (the area between the vaginal opening and anus) to widen the opening of the vagina while giving birth.” Is it okay for them to give you one or only if it’s essential?
- Receiving the baby: You may choose to receive the baby or dad can.
- Announcing the gender or other traditional practices.
Labour Stage 3: Placenta
- Do you want to do delayed cord clamping?
- Delivering the placenta: natural physiological (can take up to 60 minutes) or active management (medical intervention). Or the wait and see approach.
- Who can cut the cord?
- See or save placenta?
- Do you want to do stem cell collection?
In case of a C-section
In case you need to have a C-section, says Collin, think about a ‘gentle C-section’. “This is where the head is assisted out but then you wait for the baby to push itself out of the incision, and this kind of mimics the vaginal birth more than the grabbing and pulling them out,” she explains. The surgery is explained, you can do delayed cord clamping, and have skin to skin contact.
Should a birth plan also include post-natal preferences?
Yes, say the experts. These include:
Skin to skin contact: This refers to the practice of putting a newborn on a mum’s chest right after birth. The benefits of this action, various studies have shown, are numerous and it stimulates certain areas of the child’s brain. United Nations International Children's Emergency Fund (UNICEF) says the benefits include:
- Calming mother and baby,
- Regulating the baby’s heart rate and breathing, helping them to better adapt to life outside the womb,
- Stimulating digestion and an interest in feeding,
- Regulating temperature,
- Enabling colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection,
- Stimulating the release of hormones to support breastfeeding and mothering.
Your feeding philosophy: Formula or breast milk. You can write in your birth plan, says Collin, that no formula or pacifiers can be used without consent.
Delayed cord clamping: This is the practice of not immediately clamping the umbilical cord thereby allowing blood from the cord and placenta to flow into the baby. Read all about delayed cord clamping here.
Stem cell collection: That is the collection of stem cells from the umbilical cord shortly after birth. This is sometimes in conflict with delayed cord clamping however, warns Collin. Read all about stem cell collection here.
Routine actions affecting your baby such as nose suction or vitamin K shots or vaccinations.
This, she explains, is because babies are born with very little vitamin K in their bodies and Vitamin K deficiency in newborns can cause Haemorrhagic diseases.
Dr Puneet Wadhwa, Specialist Paediatrician at Prime Hospital, explains that vitamin K does not cross the placenta within the womb and breast milk too doesn’t contain enough vitamin K to make a difference in the child’s levels. A deficiency can cause bleeding in the intestine or in the brain and can be life threatening. A child is at risk of suffering from a deficiency fallout up to their first six months of age.
Dr Ajesh adds: “Vitamin K is necessary for the body to form clots and stop bleeding. Without sufficient vitamin K, babies cannot make the substances utilized to create clots, called ‘clotting factors.’”
Vitamin K can be given in either oral or injectable form – put your preference down in your birth plan.
Baby to be around you: Your demand that anything related to your baby be done in your presence.
The vernix: This is an anti-fungal, anti-bacterial, moisturising white substance that coats the newborn. “It smells like amniotic fluid so it makes your baby feel at home and calm. It doesn’t mean you don’t clean face and genitals, it just means you don’t immerse them in a bath,” says Collin.
When the baby is born through the virginal pathway, they pick up all the good bacteria that they will need to create the flora and fauna of their microbiome. Unfortunately with C-section this doesn’t happen. But there are some ways to do the seeding.
Microbiome seeding: “When the baby is born through the virginal pathway, they pick up all the good bacteria that they will need to create the flora and fauna of their microbiome. Unfortunately with C-section this doesn’t happen. But there are some ways to do the seeding,” she says. US-based Cleveland Clinic explains the process as: “Vaginal seeding is the practice of wiping a baby's mouth, face and skin with its mother's vaginal fluids after C-section. This process transfers vaginal microbes to the baby to help establish the baby's own microbiome to promote good health and fight disease.”
When should you write the plan up?
Zarroug says: “It is important for a woman to start thinking about the kind of birth she wishes to achieve, and how she would like to be supported throughout her experience, early on in her pregnancy. However, I would say an ideal time to start putting these preferences down and formulizing a plan, would be sometime around 25 to 32 weeks.”
Who can help you with your birth plan?
If you are taking a birthing course or working with a doula, she can help you create a plan. “If a couple hires a doula, they can most definitely work together on the birth plan, where the doula can share some suggestions, recommendations and evidence-based resources for the couple to make well informed choices and preferences to include into their plan. Sometimes, the couple prefer to work on it on their own, and as their doula, I would review it and offer helpful feedback if requested.
It cannot be stressed enough that the pregnant person needs to take ownership of her plan, and have her team entirely on board. She is the leader of that team, and they should see her strength and commitment to the plan before they do.
“Once a birth plan is finalised, it is recommended that the couple present it and discuss all options with their doctor, so that their provider understands and supports their wishes, and keeps it in file for the midwives team to review during your labour. Additionally, the couple can then also determine whether their provider is aligned with their preferences or if it would be best for them to find a different provider, that may be a better fit,” says Zarroug.
“It cannot be stressed enough that the pregnant person needs to take ownership of her plan, and have her team entirely on board. She is the leader of that team, and they should see her strength and commitment to the plan before they do,” adds Dumur.
Arm yourself with information when you plan your big day. And remember: Your body, your choice.
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