By Michelle Gabriel-Caldwell, CD, CBE, LE
Birth planning and setting up birth preferences can be a daunting task. To some, it may seem as simple as filling out a template that may or may not be provided by your medical team. As a doula of 18 years, birth plans are the main tool to ensuring improved birth experiences…when they are used correctly!
What is A Doula?
Let’s backtrack a bit to define the terms doulas and birth plans, so we are all on the same page.
A doula is a birth professional, not a medical professional, who is trained and most often certified through a private or state organization to provide services that impact the full life and reproductive experience, this means from fertility to postpartum and all steps in between. They can sometimes be called birth workers, birth assistants, birth coaches, or companions.
Doulas are not confined to the birth space itself. We assist with informational, emotional, and physical support every step of the way through the gestational journey. We are there when that journey has trouble starting or abruptly ends.
There is a tenet of doula work that is considered controversial within some training organizations, that is whether a doula can advocate for you. Advocacy is rather crucial when it comes to enhancing your birth plan. When asked about their style or mission, some may feel advocacy is out of their scope of practice. NOT amplifying your voice during the most vulnerable time of your life may be a deal-breaker for you. I will discuss this in future articles about how to hire the right doula.
We have the gist of what a birth doula is, but please note there are sex and “end of life” doulas too.
What is a birth plan?
A birth plan is more than just a piece of paper. It should represent the culmination of conversations between you and your birth team before the birth.
Imagine that you are an actor and have been given a script on the day of filming. The expectation that you will know your lines is extremely unfair. The same holds true with handing your medical team your birth plan on the day of your labor. It’s not fair to expect them to follow this when there were no discussions beforehand.
Realistic expectations are often missing. That may be why some medical providers like the word ‘preferences’ instead of plan. We know the famous line; “when we fail to plan, we plan to fail.” Scribbling down a bunch of things that sound like a great experience is not creating a plan.
What have you done to prepare your body for this plan? What conditions within your pregnancy will possibly prevent some of these things from happening? And is this just a list of “I don’t want this or that?” Birth planning should be a positive and thoughtful discussion that takes your current pregnancy condition into account from a realistic health perspective while honoring your values.
We encourage you to write one to two questions down during each prenatal visit with your provider to build the foundation of your plan.
How Can Doulas and Birth Plans Be Beneficial?
During your perinatal visits with your doula, most often beginning your 20-28th week of gestation, they are helping to orchestrate your birth. These meetings help ensure that your midwife or OB/GYN visits are most impactful by understanding the layout of the possibilities and limitations to your birth preferences.
Developing a birth plan is like developing the best screenplay ever written, starring YOU and YOUR BABY! Who will be the main characters? Supporting actors? What are their roles? What happens when one of the characters can’t be there? Or if the health of the stars isn’t strong enough to perform the stunts required?
In this analogy, YOU are the director. One would argue that the medical provider is the director, but they are supporting actors. YOU know the direction you want this movie to go. You need an assistant to be open and honest with you, to provide you with the latest information about the location, the process, and the team. That person can be your partner. However, a doula has more experience in these settings, knows the terminology, and offers a unique and objective perspective few people on set will have.
OK, OK…I’m moving away from movie analogies.
Your Doula As A Liaison
Your doula has spent their career working in the latest evidence-based birth research, so you don’t have to spend the time on Google, in parent forums, or questionable apps. Your doula built their reputation on no judgment or bias and hovers in the space of facts not anecdotes. Here are just a few of the ways a doula can be a part of your pregnancy, birth experience and birth plan:
- Nutrition and exercise information is shared to assist in maintaining good health for fewer interventions and better recovery. Your birth plan should take this information into consideration.
- Your doula is the liaison between the medical team and your base team, they can help define medical terms and conditions and reduce the white coat syndrome that often occurs when speaking to medical professionals. Your birth plan will take into account all of the information gathered from each team member during your pregnancy.
- Doulas are a source of support for the partner as well, ensuring their values and goals are heard. Birth plans may include agreed-upon ideas from your partner.
- Doulas are empathetic, and when plans must take a turn we are there for the letdown, all while creating an alternative framework (in addition to a few extra hugs). A good birth plan takes this into consideration.
- Lastly, in the space of advocacy, we can help to ensure you are receiving the necessary informed consent to make the best decisions before birth and in the moment. Labor (at some point) requires tuning into one’s inner self; your voice may be missing in those tender moments. Your partner may be wrapped up in the emotion of the now and your doula and your birth plan is there to help calm the waters and relay your wishes.
Of course, there is the obvious form of doula support, the physical support. If you plan for freedom of movement, your doula is calculating and analyzing the best positions for you to be in based on your cervical dilation, the baby’s station, and your overall demeanor. Assessing the progress of labor is an art and skill that many doulas possess, as they do not perform cervical checks. Timing contractions/waves/surges, all while observing with a deep understanding of physiologic birth, is our claim to fame. We can reduce the need for pain medication by 10%, reduce the use of Pitocin by 30%, reduce surgical births by 25% and increase positive experiences by 30%.
Not only will your birth plan be read and supported it has a greater chance of coming to fruition when hiring a doula.