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VBAC Cubby - vaginal birth after cesarean

VBAC Birth Plan
by Michelle Grassia
Writing a vaginal birth after cesarean (VBAC) plan is something that most VBAC advocates strongly recommend. There are many ways to go about writing a birth plan and those of us who wish for a VBAC have a few additional points to consider. This article is intended to provide some suggestions on how to approach the issue of birth plans and how to adapt them to your needs in the hopes of creating a safe and comfortable atmosphere in which to give birth. A little planning and discussion of birth wishes in advance may result in less surprises and disappointments in the heat of the moment.

There is often an atmosphere of fear surrounding those in the birthing profession that may cause unnecessary interventions or disruptions in the labor and delivery room. A birth plan can help a mother clearly communicate her wishes with her labor support persons and care providers. There are many philosophies on birth plans. Some women choose to make the plan very formal and request that their care providers, labor support persons and hospital staff officially sign the plan to acknowledge that they have read it. Others chose to write up a plan to use as a starting point for discussion of their wishes with their care providers. Both approaches allow for the mother's wishes to be considered and expressed to those who will be around her during labor and delivery.

Before writing your plan spend some time visualizing or writing what a perfect birth for you would be like. By this time you have decided what environment you wish to give birth in whether it be at home, in a birth center or in a hospital. Picture that environment and pay attention to the details that make you feel relaxed and comfortable. Then try to imagine what things would most distract or disturb you during labor and birth. Brainstorm on different scenarios that might come up and think of the options you could chose that would be the best options to assure the safety of you and your baby while still giving you the experience you desire. Since we are all individuals the criteria for a perfect birth will vary for each of us. One mother may want all the beeping machines and technology to be reassured that everything is fine with the baby, and another might want as little intervention as possible.

Consider each stage of labor. For stage one, is it important to have freedom to move? How do you feel about fetal monitoring? Would you prefer continuous electronic fetal monitoring or would you prefer to avoid it? Would you prefer monitoring with a handheld Doppler or fetoscope? Do you consent to internal monitoring or would you like to avoid that? Do you consent to having your waters broken? Do you want to limit vaginal exams or does it give you a mental boost to know your progress despite the increased risk of infection? Do you agree to a routine IV or heplock? Do you want a quiet environment with dim lights and little interruption or would you prefer to allow friends and family to come and go as you wish? Do you wish to eat and drink freely throughout labor? The answers to the above questions will vary greatly from one woman to another. There are no wrong answers, but some might be more accepted by care providers than others. It is important for you to decide which things are the most important to you and which points are the most flexible, and design a plan to express this.

When I was designing my birth plan I was advised to write in respectful tones so that the person reading it would not be put in the defensive. I started almost every line with, "I wish." or, "I would like." In contrast with regards to interventions I very strongly did not want I used the term "I do not consent." Some choose a more direct approach for their entire birth plan.

It is best to write your birth plan with headings and to keep it to a list. Lists are easier to read and the more verbose you are the less likely your care providers are to read your entire birth plan, particularly those care providers in the hospital such as nurses, anesthesiologists and on call obstetricians who do not have a previous relationship with you.

To cover bases it is a good idea to write an emergency cesarean plan. From talking with women who are trying for a VBAC, it appears that the more traumatic or disappointing her cesarean experience was, the more important it is to make a detailed plan for a possible repeat cesarean. I know this was the case for me. It was very important to me that a potential repeat cesarean feel more like a birth than my first cesarean. Even if you had a good cesarean experience, it is a good idea to have a plan in place. Hospital policies can change and often the doctors and nurses just do things according to protocol. Unless you clearly express your wishes, they will just go about what they are doing. Also be sure to include your post-partum and baby care wishes.

When writing my birth plan it was my goal to find a balance between safety and creating a comfortable environment to labor and birth in. It was extremely important for me to give consent to everything that was done to me. It was also imperative that my labor support persons have full access to be at my side at all times, during labor and at delivery no matter if the delivery was vaginally or by cesarean. I didn't want to be so inflexible and confrontational that my desires would be completely rejected, but I also wanted to be clear. Many of my wishes were completely alien concepts to the hospital where my first child was born. Fortunately the hospital where I delivered my second child had quite a different philosophy and they found none of my requests odd. It may be helpful to find out the routines of both the care and the facility you are using so that you know what points of your birth plan might clash with the typical routine. You can then better decide how important these wishes are to you and discuss those at greater length with your care provider. There is less need to emphasize the parts of the plan that are common with your care provider or birth facility's typical mode of operation.

To create a birth plan I did what many women do and searched the Internet for a site that would guide me as I wrote. There are many birth plan creation tools that can be found on the Internet by doing a search engine search for "birth plans." My doula and I then modified the plan that was spit out to better meet my needs. I should add that it was very important for my doula that I have a birth plan because it was a concrete list that she could refer to to make sure that she was supporting me in the way I desired and to make sure that she prompted me to be an advocate for my own wishes when I was not in a state where I was thinking of them. I showed my plan to my obstetrician who was fine with everything in it except she said she did not have the authority to allow my labor support persons in the OR in the case of a cesarean delivery. My doctor informed me that this was up to the anesthesiologist who is on call that day. She said that he is the manager of the operating room and what he says goes. Knowing this in advance let me know I needed to bring up these concerns with the anesthesiologist before we were put in a position where my wishes might be contested. When the anesthesiologist came in to check on me, my doula reminded me to ask him about his policy. He assured me that he saw no reason that I couldn't have both my mother and doula in the operating room with me should a cesarean be necessary.

Unfortunately my obstetrician was out of town when I went into labor so her partner attended the labor and birth. I had not shared my plan with her or even met her in advance, but she was fairly respectful of my wishes. I chose not to bring my birth plan with me to the hospital because I felt confident that my doula would support me and also because the hospital I chose to deliver at had policies very much in sync with my ideals. If I chose a hospital birth for my next baby I will be sure to bring the plan along just in case I again end up with a care provider who is a complete stranger.

I have provided examples of two birth plans. Both were for planned hospital VBACs and include comments from the mother on how well followed the plans were. Both births varied quite a bit from what was desired in the plan, but both mothers were satisfied with the births. Both mothers had VBACs. The first birth plan is my rough edit birth plan (I never polished it after the discussions with my doula and OB) and the second is a more polished and official plan that I have been given permission to include. I was hoping to have a homebirth birth plan, but written birth plans are less common for those planning a homebirth. It is still a good idea to consider writing a plan if you are planning a homebirth. First it provides an excellent format for opening communications on all aspects of the birth with your care provider, and secondly it can help assure that your wishes are followed as closely as possible if you require a transfer to the hospital.

It is my hopes that this article and these sample plans are helpful for the reader as she designs her own birth plan. In addition, if you would like to share your planned hospital, birthing center or homebirth VBAC birth plan please email me. I would love to add more sample plans to this article as they become available. Please include a brief explanation of how the birth went.

Planned Hospital VBAC Birth Plan #1
Planned Hospital VBAC Birth Plan #2

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