From the Archives: Writing a Birth Plan

how-to-write-a-birth-plan

The subject of using online birth plans came up last night, so I wanted to distill my advice here on the blog. Turns out, I wrote about it 4.5 years ago. Ha! Ah well, it’s still good advice.

-Veronica

Originally published February 7th, 2012:

First of, let me say this:  I know you can’t plan your birth.  You can’t decide it’ll last only 20 minutes, or that you’ll only push twice.  Do you know this?  I hope you know this.  Rather, a birth plan is a tool that should be used by a mother to sort out her options and to communicate those preferences to her care provider.  While she can not plan what will happen, she can give a good amount of thought to how she will handle what happens.  Also?  I believe very, very much that it’s something that should be done no matter the place of birth.  Even moms planning home births need to think about what they want or don’t want.  So, after giving much thought over the last couple of days as to what makes a birth plan good, and what can make it very, very bad, I give you the following advice:

DON’T: Go to a website that “writes” a birth plan for you by having you check off a couple of boxes that sounds good.  Why?  Well, it comes across that you put very little thought into writing your birth plan.  Also, you can end up “choosing” things that are not even an issue at your desired birth place (like saying you don’t want to be told what to wear during labor at a home birth).  However, if you feel completely stuck, you can check out one of those websites for some ideas, just make sure you rewrite things in your own words.

DO: start with an introductory couple of sentences. Think along the lines of: This is my second birth.  My first birth was very long, and very difficult, with many things that felt like I was not listened to.  I am hoping for a much calmer, more supported birth. Or whatever fits your specific situation.  Make it short, to the point, and applicable to this birth. It will help the people who are part of your birth team know very quickly what you are looking for, which means that (hopefully) they will be supportive of where you are physically and emotionally, not where they think you should be.

DON’T introduce anyone and everyone in your life in the birth plan.  A birth plan is not an autobiography.  Please don’t use it  to introduce the nursing staff to your cats, or your turtles, or your childhood home that you haven’t been to in 25 years.  And for goodness sakes– no pictures of these things!

DO keep the information relevant.  If there is something about your medical history that is relevant to this specific labor and birth, include it.  Yes, it’s in your chart…somewhere.  But save everyone a headache and confusion and include that important information right at the top of your birth plan. Have you already met with an anesthesiologist and found out that you are not, for a specific reason, a candidate for an epidural?  Include that!  Is the father of the baby not participating in the birth because of religious or cultural reasons?  Include that! Trust me, it will save so much time and frustration of everyone is, almost literally, on the same page.

DON’T make your birth plan more than a page long, two at the most.  Very important information gets lost in long birth plans, and it can seem like not much actual thought went into writing the plan.

DO make sure only time-specific information is in the plan.  Don’t bring a plan to the hospital that talks about laboring at home (or how long you’ll wait before calling your midwife for a home birth). You do need to think about things like that, but it can end up burying the more relevant information.

DO write out a really long plan, if you feel you need to.  You can include things like how long you want to labor until calling your doula, or at what point you want to o to the hospital, or fill up your birth tub at home–whatever.  But then sit down with someone and go through that list with a very critical eye, and think, “What will people need to know at the time?” Then start to cut things out, leaving a shorter version.

DON’T list things that are not done at your chosen place for giving birth. If they don’t do routine IVs, don’t say, “I do not want a routine IV.” On the flip side, be reasonable.  Don’t list things that just CAN NOT happen, like, “If I have an epidural, I do not want an IV.”

DO take good, comprehensive childbirth classes so you can understand all of your options and help you understand how to avoid those things you do not want.  So, for instance, if you don’t understand why IVs might be used, you might need a class.  If you were never told the many different ways an induction might be done, you need a better class.  This might ruffle a feather or two, but knowing about something doesn’t mean it’ll happen.  Ignorance IS NOT bliss.  Hopefully there are things you’ll never need to go through, but knowing about them, just in case, is always a good idea.

And finally:

DON’T assume that writing something down means that it will be so.  Make sure that your care provider (and, since most people see a group practice, ALL the possible providers) will take the time to listen and respect your voice.  There is nothing sadder to me than telling families prenatally to address specific things with a care provider, only to watch those parents find out that  Midwife X won’t allow it, or Doctor Y doesn’t believe in it while mom is in labor.  Yes, you are the patient, but birth time should not be battle time, and if there are options, find the very best care provider to fit what you want.  And yes, it is worth it.

Quickly, in my opinion, what should a birth plan touch on?

  • support people
  • environment
  • comfort measures
  • labor positions/ tools
  • medication preferences
  • pushing and birth positions
  • newborn procedures (right after birth and the few days after birth)
  • post-birth maternal procedures

I’m sure I missed a thing or two (or three).  What do you think?  What tips would you add?  What else do you think is a MUST INCLUDE?  Add it in the comments below!

Warmly,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Twin Cities Cesarean Rate Trends, 2005-2015

OK, so I’ve been collecting historical data on Cesarean rates in the Twin Cities metro hospitals from as far as I could go back, which was 2005. I’ve finally had enough time to pull it all together. There are some pieces of info missing, but here’s a decade’s worth of Cesarean rates:

twin-cities-cesarean-rate-trends

Back in March, I made some predictions for 2015 overall Cesarean rates. I had written:

Speaking of 2015 Cesarean rates, that info isn’t available, but I’m going to throw caution to the wind and make a few guesses. I think we’ll see an increase in rates at Woodwinds, a slight increase at Methodist and a larger increase at Maple Grove (largely as a result of the high primary rates from OBGYN West and Western OBGYN), increases at Ridges, Southdale, and Regions. I’m going to predict a drop in the overall censarean [sic] rate at Abbott Northwestern, St. Joe’s, and North Memorial. I don’t think there will be many changes at St. Francis, St. John’s, or United. As far as the Unity and Mercy…who knows. Now, we’ll have to see if I’m right.

 

So, how did I do?

I was right about Woodwinds, Methodist, Maple Grove, Regions, Abbott, and North Memorial. St. Francis saw a significant increase. St. John’s held pretty steady, and United had a teeny drop, but still a decrease in their Cesarean Rate. St. Joe’s saw the trend continue, with an increase in their rates that began in earnest in 2010. Woodwinds trended higher again in 2015 after a decrease from 2012 to 2014. Regions, Waconia, and St. Francis had the most significant increases, While Stillwater and Mercy had the largest decreases. And THANK HEAVENS that Abbott has made significant strides in reducing their overall cesarean rate after 2010.

See my previous post if you have questions about why this stuff matters. Otherwise, these trends are very interesting to look at! Now to wait again until data comes out in March again….if it comes out. If you’re looking at this data and mad that more isn’t out there, well, start pulling together the resources to get laws like the ones in New York passed. Without a state grassroots effort, we get what we get and we don’t throw a fit, unfortunately.

Warmly,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Corrected 2015 Minnesota Cesarean Rates and Insights

First of all, I had warned that last week’s post may have some numbers that end up changing. Yeah, a few numbers changed. The reality is, to calculate one hospital’s rate, you have to go on 6 separate screens to get 6 different numbers before you can figure out a cesarean rate for one hospital. And since I calculated numbers for the 89 hospitals that provide maternity care, that….that’s a lot of screen toggling.

Second, while I’ve been blogging about these rates every time they come out, the backlash to releasing the numbers was abnormally defensive. Comments on social media were not what I’d seen previously. There are a few things I want to get straight first:

  • From the joint statement from ACOG and SMFM: “In 2011, one in three women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused.” You can read through the full Obstetric Care Consensus here.
  • The sad fact is, while there are times that Cesareans are truly needed, our rising Cesarean rate is causing a rise in maternal mortality rates in the United States. Overall, Minnesota is better than the national average, but some rural hospitals have rates that are too high. Discussing these numbers is critical for protecting the health and safety of pregnant patients and their babies.
  • Multiple studies, including studies published by Consumer Reports and Blue Cross Insurance networks, continue to affirm that the biggest factor in if a birth will be done vaginally or by cesarean is the place of birth and care provider preference.
  • If you’re questioning how different clinics affect each hospital’s rates, check out my blog post from the beginning of the year with that information.

This information does matter- a lot. We believe that childbirth education and informed choices are the key to empowering families that will allow them to make the choices that best suit their situations. And I do want to point out that, at least in the Twin Cities, Cesarean rates peaked in 2009, with Abbott Northwestern reaching 37.1%. Rates have gone down overall since then.

In the next blog post, I’ll compare this year’s results with those over the last decade.

updated-2015-mn-cesareans

page-2-cesarean-rates

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

2015 Minnesota Cesarean Rates

Update 10/12/16: Corrected tables have been posted below and the old numbers have been removed.

I have had a very, very long day. Very long. A long week, actually.

But enough about me. It’s my favorite thing ever! Time to figure out 2015 Cesarean rates!!!!!!!

I can’t even tell you how excited I was when the raw data from the Minnesota Hospital Association was available. I’m SO excited that I’m going to post all of the rates for hospitals with more than 100 births. There are some limits to the info that’s released publicly, but this is true for any health information that’s made public: numbers that were small than 5 were not reported. There is a whole category that only 5 hospitals in the entire state had numbers high enough to count. This info is the best I can do right now with what info there is. It may change after a good night’s sleep and my eyes are no longer crossed.

More posts will come in the next few days, including some handy-dandy printables you can use because, while I’m thankful for the Pawlenty Administration for mandating this info get released, ease of use was not a priority.

Enjoy, and be peaceful to one another.

updated-2015-mn-cesareans

page-2-cesarean-rates

 

 

 

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.