Wagner (2008) states that woman-centered birth—birth where the mother’s needs come first—is primarily shorter and less painful than others, and also causes fewer complications for women and infants—all of which are desirable outcomes

Lothian (2006) says that a birth plan encourages women to clarify their wishes and expectations, communicate with healthcare providers, and create a feasible plan for care during labor. The tension that arises between healthcare providers and the laboring woman/patient due to the birth plan represents one of the major problems with current maternity care: conflicting beliefs about birth, what constitutes safe, effective care, and ethical questions regarding informed choice. If we focus on the birth plan, we should answer three questions that center the laboring woman/patient: “What should I do to stay confident and feel safe? What should I do to be comfortable during contractions? Who will support me through labor and what do I need from them?”

Quality research has shown that simply asking questions before individual procedures during labor, such as: “Is this really necessary?” reduced the number of unnecessary interventions. Another important question is: “Are there any other options?” (Wagner, 2008).

A midwife who gets to know the woman during pregnancy plays an important role in providing information and weaving communication pathways. Midwives should not withhold information or encourage women to be compliant/obedient. If a birth plan contains a desire for a potentially harmful intervention, such as an unjustified desire for a cesarean section, the midwife can provide the woman with important information about risks and benefits based on the best evidence (Marolt, 2009, citing Lothian, 2006).

Moore and Hooper (2007) report that in early 1993, a plan was made to introduce birth plans in two district hospitals in Australia. How useful and effective they were was assessed from May to July 1993 with a questionnaire given to the first hundred women who had created their own birth plan. All women were invited to complete it, regardless of whether they used a birth plan during labor or not. 95% of women responded that they would encourage other women to use a birth plan, as it increases understanding of labor and birth and the options available to them at the chosen hospital. They also said that the birth plan is useful because it allows them to express their needs and wishes, and improves trust and better communication between them and the staff. The birth plan demonstrates healthcare workers’ commitment to recognize and support diversity, enables critical evaluation of existing hospital policy and practice, provides an opportunity to improve quality within the framework of patient rights and wishes, and supports or increases women’s role by expanding their knowledge and understanding of birth practices and helps them make informed choices.

KEY POINTS OF A GOOD BIRTH PLAN:

– Environment. Where you want to give birth: in a maternity hospital, birth center (currently the nearest one is in neighboring Austria), or at home with the help of a trained midwife (I am honored to add that women today can also choose independent home midwives. When I was writing my thesis, it was the case that individuals hired midwives from abroad, most often from Austria). The healthcare system in Slovenia is organized differently than in neighboring countries, so the laboring woman must arrange in advance with the chosen midwife about possible transport and other procedures in case of complications during home birth.

– Birth companions. Who you want with you during labor: your partner, other family members, and/or a birth companion (doula). Indicate if you do not want students present.

– Procedures and interventions. What are your wishes regarding rupture of membranes, shaving of pubic hair, enema, episiotomy, drinking and eating during labor, freedom of movement and positions, use of intravenous fluids and cardiotocography, artificial augmentation of labor, pain relief methods, and other procedures (Buh, 2010, citing Rant Hafner, 2010).

SIGNIFICANCE OF INDIVIDUAL PROCEDURES

Artificial rupture of membranes: accelerates the release of the body’s own chemicals that speed up contractions—labor progresses faster naturally (Buh, 2010, citing Rant Hafner, 2010). Amniotomy is considered a fairly non-invasive procedure for accelerating labor by some healthcare workers. Nevertheless, according to World Health Organization recommendations, rupture of membranes is not desirable until labor has progressed significantly. Routine early rupture of the membranes is not scientifically justified, as it does not guarantee that shortened labor will benefit the fetus, newborn, or laboring woman. Quite the opposite. After rupture of membranes, there is a possibility of cord prolapse, which in the vast majority leads to cesarean section. Until the baby’s head is fixed in the pelvic outlet, the laboring woman must lie down after rupture of membranes, and at the same time is more susceptible to infections. We treat rupture differently when it comes to labor induction.

Shaving pubic hair around the vaginal opening and on the perineum: in the event of a possible perineal incision or tear, hair can be very bothersome during suturing and wound healing (possible infections!) (Buh, 2010, cited by Rant Hafner, 2010). Healthcare professionals must act according to modern trends. Numerous studies have shown that shaving pubic hair does not contribute to better progress of labor. If an emergency C-section were necessary, the surgical area could be shaved immediately before the procedure. Shaving pubic hair has not been proven to reduce the number of infections in the case of a perineal incision or spontaneous tear.

Enema: accelerates intestinal contraction and stool elimination, and thus also uterine contraction (which speeds up labor); during the baby’s birth, stool is less frequently expelled from the rectum, which reduces the cleanliness of the “surgical” field of birth and thus increases the risk of infection for the baby (Buh, 2010, citing Rant Hafner, 2010). This data is also incomplete and presented from only one perspective. Laboring women who receive an enema may have more liquid bowel movements, which are harder to clean and thus the “surgical” field is a greater source of bacteria. Recent studies also reject the thesis that stool obstructs labor progress. An enema is much more unpleasant for most women than spontaneous stool passage during pushing. We consider the possibility of an enema or suppository when a woman has not had a bowel movement for several days.

Episiotomy: the midwife assesses the perineum’s elasticity during the baby’s birth: if she assesses that it is a rigid perineum, it is safer to cut it; otherwise, extensive perineal, vaginal, rectal, and intestinal tears can occur, which can affect stool retention problems for life. Therefore, from our perspective, it is safer to cut the perineum, because any further tearing usually extends in the direction of the cut (away from the intestine) and does not leave such severe consequences for the woman (Buh, 2010, citing Rant Hafner, 2010). Opponents of episiotomy have already refuted most of the listed arguments. They present numerous serious shortcomings of routine episiotomies such as: pain from the cut, additional blood loss. Despite the cut, additional, more severe tears can still occur; later the stitches can give way, become inflamed, a hematoma can form, which additionally prolongs and complicates wound healing. An episiotomy wound heals longer than a tear, and women also have pain in the wound area longer after episiotomy, which makes movement difficult, which can affect breastfeeding, as the woman has difficulty finding a comfortable position. Later they may have problems with sexual intercourse.

Read more: episiotomy; Techniques and procedures that help preserve the perineum; Perineal injuries; Preparing the perineum for birth

Drinking and eating during labor: contractions are uterine contractions, but they also affect the digestive system. Most laboring women feel nauseous and vomit if they consume food before or during labor. However, drinking fluids during labor is desirable—as often as possible in sips, so that the stomach is not overloaded and the laboring woman does not become dehydrated (Buh, 2010, citing Rant Hafner, 2010). According to available data, no medical research conducted to date has proven the validity of routine use of infusion that would be set up before the need for urgent medical intervention arises (Furlan, 2010, citing Drglin, 2003). Restricting eating and drinking during labor therefore results in the use of intravenous fluids, which is yet another invasive procedure. I believe that laboring women should not be restricted from eating and drinking if it suits them during labor. This prevents increased acidity in the stomach, which would be even more harmful than food aspiration itself during aspiration, and at the same time food is a good source of energy that the laboring woman really needs. In case of cesarean section, spinal anesthesia could be used.

Read more: Eating and drinking during labor

Use of intravenous fluids: precisely because of reduced fluid intake during labor (nausea) and increased loss (accelerated breathing, vomiting), we recommend infusion fluids so that the laboring woman is not too dehydrated (Buh, 2010, citing Rant Hafner, 2010). Current trends aim to not restrict eating and drinking during labor. This avoids infusion, which hinders the woman’s movement, yet she still has a feeling of dry mouth and thirst.

Freedom of movement and positions: in principle, the laboring woman can move in a limited space if the head is low enough that the probability of cord or arm prolapse is very small. The fact is, however, that most laboring women want to lie down when strong labor contractions begin. Regarding positions, the laboring woman should talk to the midwife leading the labor. She will advise on the appropriateness of positions (Buh, 2010, citing Rant Hafner, 2010).

Read more: Birth positions

Use of CTG: if enough devices are available, the baby’s condition is monitored during labor. This allows for earlier detection if the baby is not doing well (Buh, 2010, cited by Rant Hafner, 2010). Some maternity hospitals also have portable CTG devices, which allow women more freedom of movement during labor. Maribor Maternity Hospital also has one portable CTG. Routine CTG use should be avoided; instead, the midwife would monitor the baby’s heart rate (and the mother’s) with a Pinard stethoscope (obstetric stethoscope) or a minifetone. Midwives must trust themselves more than machines. IMPORTANT! Before choosing a maternity hospital, find out if continuous CTG monitoring is in line with their policy. In this case, you will not have a choice. Furthermore, using a Pinard stethoscope generally requires a “one-on-one” model.

Augmentation of labor with medication: prolonged labor tires not only the laboring woman (pushing at the end of labor, fatigue after birth), but also the baby, which can lead to poorer birth outcomes (weakened baby, vacuum delivery, cesarean section) (Buh, 2010, citing Rant Hafner, 2010). The most common reasons for labor induction include the assumption of insufficient placental function, fetal growth restriction, and labor arrest. Each of these must be carefully verified (Furlan, 2010, citing Drglin, 2003). At the coordination meeting “Appropriate technology for birth,” organized by the World Health Organization in Fortaleza, Brazil in 1985, they recommended: “In no country should the percentage of induced labors be higher than 10% (Furlan, 2010, citing Gaskin, 2007). With artificially induced labors, laboring women have stronger contractions, which can be a double-edged sword, as the laboring woman may need even more pain relief medication.

Choice of pain relief method depends on what is available in individual maternity hospitals. This needs to be inquired about before labor. In some hospitals, consultation with an anesthesiologist before labor and certain tests are desirable to make the procedure (e.g., epidural analgesia) safer (Buh, 2010, citing Rant Hafner, 2010).

Read more: Pain relief during labor – epidural analgesia

Ullman (2012) in her article titled “How to make a birth plan” says that choosing a “provider” is the first and most important decision in birth planning, as not everyone has the same background, thoughts, and methods about birth. If the provider rejects the woman’s thoughts about how she envisions birth, it is her right to seek other opinions and a better provider who will be understanding of her wishes.

If women have been enabled to make decisions about childbirth, it is important that the midwife discusses her wishes and feelings about the birth options available to her. Providing practical and reliable information should help the woman create a realistic picture of fears, hopes, and expectations regarding the approaching birth. To make the process easier for midwives as well, a flexible framework for a birth plan has been proposed. This is a simple way to help a pregnant woman master her ambitions and wishes regarding birth. Since experiences differ, it is recommended that midwives compare what was expected in the birth plan with the actual birth outcome. The results could inform them about whether the satisfaction with the birth experience and the quality of care the laboring woman expected was also received. Clearly expressed wishes about birth would facilitate understanding of why satisfaction or dissatisfaction occurs at all (Hollins Martin, 2008).

Sometimes complications arise that no one expected. The main goal is to give birth to a healthy baby, so it is necessary to allow the doctor to act and trust him (Johnson, 2001).

A doula is a birth companion who does not necessarily have medical training, but knows the physiology of birth well and has usually given birth herself. She is not a doctor, nurse, or midwife, as she is not trained to make decisions about medical interventions or give medical advice. The essence of her work is in loving continuous support of the woman, ensuring a sense of safety and control over the birth experience, and in trusting her own abilities, thereby reducing the need for medical interventions. Her role begins during pregnancy. The results of extensive research involving over 13,000 women from eleven countries showed that women who received continuous support during labor had a greater chance that their labor would end spontaneously, without interventional medical procedures (e.g., use of vacuum, forceps, or cesarean section). The presence of a doula thus somewhat shortens the length of labor, and the use of pain relief significantly decreases (Narayani Mihevc, 2012).

HOW TO WRITE A BIRTH PLAN?

Wagner (2008) asks, what are the advantages of giving birth in a maternity hospital? Certainly, it is the immediate proximity of surgery, in case something goes seriously wrong. In addition to the midwife, obstetrician-gynecologists are also constantly present. In a maternity hospital, better access to technology and medication is also possible, which can be a double-edged sword, as many maternity hospitals use medication and various technology too routinely. A good side of giving birth in a maternity hospital is also the departure from the home environment, which allows some laboring women to relax more easily, as they do not worry about everything that needs to be done at home. In the hospital, a woman exchanges her clothes for hospital clothes, and a wheelchair or bed is often used for transport.

Choosing a “provider” is the first most important decision, immediately followed by choosing the environment and companion (Ullman, 2012).

Wagner (2008) states that a birth plan is an approach to birth that makes it easier for a woman to create conditions for a complete birth. Thus, it is about planning an event that no one can really control. Nevertheless, birth planning affects how well it will go. Thus, Dr. Wagner advises women to plan the birthing process, not the final outcome. Most births proceed as planned. However, it is good to build a certain possibility of adaptation into the birth plan. Thus, when creating a birth plan, a woman needs unbiased data (positive or negative) about different types of perinatal care. It is a woman’s right to have informed choice. Regardless of how many children a woman may already have, no one can accurately predict what the next birth will be like: long or short, painful or painless, difficult or easy. Likewise, no one can accurately predict whether complications will occur. And all this evokes strong emotional responses in a woman. Therefore, it is crucial that a woman trusts herself and the people around her. This will make the birth calmer and simpler. A healthy baby is the primary goal of birth. However, a successful end to labor is much more than mere survival. We must not underestimate the impact that the birth experience has on an individual. A positive birth experience helps a woman become a good and confident mother.

On the website www.naravniporod.si, an article titled “Factors affecting birth” is published, which presents the “law of three Ps,” which medical textbooks cite as factors affecting birth. We also learn about some others.

Law of three Ps:

PASSAGE (size, shape, angles of pelvic bones),

POWERS (their strength, frequency, effectiveness), and

PASSENGER (the baby—fetus, its size and position).

The experiences of many experts in the field of birth, especially in the field of physiological birth, have shown that many more factors affect birth, which Dr. Michael C. Klein summarizes with the following seven added Ps:

PARTURIENT

The woman and her beliefs, preparation, knowledge, and ability to participate in the birth process.

PARTNER

How he supports the woman and his knowledge, beliefs, and preparation for birth.

PEOPLE

Companions, others involved in pregnancy and birth who interact with the woman. Companions have their own beliefs, knowledge, are differently prepared, and this negatively or positively affects the woman and her partner.

PAIN THRESHOLD

The effect of pain on the woman, experiences and cultural representations of pain held by the laboring woman and her birth team affect the woman’s ability to tolerate labor pain. It is clear that how a woman perceives and copes with pain affects the birth process.

PROFESSIONALS

How healthcare staff supports, informs, and participates in care for the laboring woman strongly affects the laboring woman’s response to the birth process.

PRIVACY

The experience of pregnancy and birth is special and unique for every woman. For everyone involved in caring for the woman, it is crucial to be aware of how important this experience is for her and that this guides them in their actions, so that they recognize and protect the privacy of this pivotal event.

POLICY

By this we mean primarily the financial aspect, which makes the quality of midwives’ work more difficult.

Additionally, we can mention: PSYCHE, PLACE, POSITION, PROCEDURES…

Birth plan: a signed document that will clearly communicate to healthcare professionals what the laboring woman’s choice and decision is about the help she will accept. In urgent decision-making, it will help staff become familiar with the woman’s expectations (Wagner, 2008).

By creating a birth plan, a woman is also preparing for birth. A woman learns about the choices available to her, can more easily assess the risks and benefits of different procedures, and alleviates unfounded fears (Wagner, 2008).

When it comes to birth, it is difficult to be smarter than nature. In our culture, we have forgotten how to allow nature to take the lead. In reality, giving birth is something women do and are biologically equipped for, not something that happens to them. Science shows us from study to study that for a healthy woman, natural birth is safest, with as few interventions as possible, because routine interventions even hinder natural birth processes. Technology, medication, and surgical procedures are useful and save lives in case of complications; however, during normal labor, a woman benefits more from the continuous presence of a professional or companion who will guide her through difficult moments. Watch and wait—these are two key procedures for safe and fulfilling birth. If we allow nature to work undisturbed, there is usually no reason to interfere. A professional who is patient and attentive to signs of distress and poor or good labor progress provides the laboring woman with the right amount and right kind of support.

Those who think that a birth plan is a sign of being spoiled are quite mistaken. A birth plan (more accurately it would be called a birth care plan, because no one can really plan birth itself, but that is just a detail) is a way of communicating how a woman sees her birth. Every good obstetrician and good midwife should be happy about it, as they do not know the woman beforehand and such a message facilitates communication. If we had our own midwife throughout pregnancy and she cared for the woman during labor, such a plan would probably be less important (Drglin, 2012). Juliana Fehr, PhD, midwife and coordinator of the nurse-midwife program at Shenandoah University in Virginia, USA, describes the relationship between a woman and professionals in a completely woman-centered environment. “Birth is a dance and during it we follow the woman. We dance around her. She is the most powerful, because she is giving new life. We stand aside until we sense something specific—the smell of amniotic fluid or some other sign of change; then the energy in the room intensifies. She calls us.” Juliana Fehr continues: “The mother must feel that she is in a safe environment where she can trust us. She must know that we accept her and love her, whether she screams, cries, or does whatever she wants. She creates the circumstances that will help her. The realization of birth must be in her hands” (Wagner, 2008).

When a woman feels that she controls her birth, and when she knows that professionals are with her to support her in meeting her needs, this allows her to relax and surrender to bodily processes. Giving birth is an activity of the autonomic nervous system—like digesting food or orgasm—in which fear and stress hinder progress. Conversely, a sense of comfort and safety facilitates the process (Wagner, 2008).

The Coalition for Improving Maternity Services in 1996 identified five factors that ensure the safest birth experience:

• understanding birth as a normal and natural process (birth is not a disease);
• limiting the use of medication and interventions based on considered scientific findings (“First, do no harm.”);
• empowering the mother and family;
• respecting women’s autonomy;
• everyone—professionals, institutional leadership, and laboring women—takes their share of responsibility in the birth process.

WHERE AND HOW TO GET INFORMATION

Wagner (2008) advises that if a woman wants more information about technology, medication, and procedures, prenatal visits are a good opportunity for questions. The purpose of prenatal visits is to encourage the woman to take appropriate care of her health, prevent complications, and early recognition of deviations from normal. In a healthy pregnancy, there are no deviations and no complications. And if they would like to better understand the birth professional’s views on technology, medication, and procedures during labor and their role in their birth, this is a good starting point for conversation.

This gives the woman information that seems important to her in creating a birth plan, and also allows women to get to know the professional as well as possible and establish trust between them. It will also be easier for her if someone she knows enters the delivery room. By visiting the chosen maternity hospital, a woman gets the most realistic answers to her questions and wishes, and the midwife helps her plan the birth plan so that both will be satisfied. It is important that the woman becomes familiar with the established care in that maternity hospital. She should bring her birth plan to the maternity hospital before labor, where it is filed with other documentation before admission. She should review it again with the midwife, comment on it, and clarify disagreements. The woman’s duty is to have all necessary documents with her when arriving at the maternity hospital, along with the maternity booklet and at least three copies of the birth plan, which should be signed. She will give one to the midwife upon admission, another to the midwife in the delivery room, and an additional copy for other professionals who will come to work during labor.

The following characteristics apply to natural or physiological birth (natural birth):

• begins and progresses spontaneously;
• includes biological and psychological conditions that enable effective birthing;
• ends with vaginal delivery of the infant and placenta;
• ends with physiological blood loss;
• enables optimal newborn transition in skin-to-skin contact and continuous rooming-in with the mother in the postpartum period;
• supports early establishment of breastfeeding (Wagner, 2008). Read more: Breastfeeding in the delivery room and 9 instinctive stages of the newborn

Wagner (2008) emphasizes that it is important for a woman to know and understand the stages of healthy labor—one that develops without complications and in which natural progress is allowed. In other words, one that does not include medication (used by doctors), herbal remedies (used by some midwives), or surgical procedures or instrumental interventions.

The following factors disrupt normal physiological birth (natural birth):

• induction and augmentation of labor;
• unsupportive environment: bright lights, cold room, lack of privacy, staff changes, lack of supportive companions, etc.;
• time pressure, including that caused by institutional protocols and shift work;
• denial of food and drink during labor;
• opiates, local analgesia, or general anesthesia;
• episiotomy;
• operative vaginal delivery (with vacuum or forceps) or cesarean section;
• immediate cord clamping; Read: Cord clamping
• separation of mother and newborn;
• and/or any situation where the mother feels threatened or unsupported (Wagner, 2008).

For the early hours of labor, it is good if the woman is alone, but not without contact. If something should go wrong, her partner, neighbor, relative, or someone else should be in the apartment or house to help her during this time. During early labor, before she goes to the hospital or before the midwife comes to her, she should rest at home. Many professionals recommend that she drink a glass of beverage, eat a small meal, and lie down. It is wise to save her strength for later, as she will really need it. When should she go to the hospital? This depends on several factors, including how long it takes to get to the hospital; whether this is her first baby or not (in the first case it will usually take much longer); how she feels, and her ability to wait without becoming panicked; and whether she has someone with her. If she thinks labor has started, she should call her obstetrician, midwife, nurse, or healthcare staff at the maternity hospital, describe her feelings, and talk. If she calls a professional, it helps him because it opens the path for communication, alerts him to what is happening, and she gets the advice she needs. The professional often says: “It sounds good; if it continues like this, come when your contractions are five minutes apart.” He may also mention special signs to watch for. Thus, the woman forms an initial plan (Wagner, 2008). Read more: Latent phase of labor – stay calm

Dr. Marsden Wagner in his book “My Birth Plan” also lists some questions that make it easier for a woman to determine whether hospital birth is in line with her wishes and expectations:

• When is it recommended to come to the maternity hospital? – this is usually also covered in prenatal classes
• How soon after arriving at the maternity hospital will I meet the healthcare professional who will care for me?
• During which part of labor will this healthcare professional care for me?
• If I write a birth plan, will you respect it? Will you add it to my birth record and other medical documentation?
• How often do you perform internal obstetric examinations during labor?
• Is it possible to shower and bathe in a tub during labor to help relieve labor pain?
• Are water births allowed at the maternity hospital? What equipment is available for water births?
• How many of my loved ones can be present during the birth?
• How many loved ones can be with me if a cesarean section becomes necessary?
• What are the hospital’s rules regarding children being present at birth?
• Do you allow eating and drinking during labor?
• Which birth positions do you recommend and/or allow? Can I give birth in any position I want, including an upright position during the second stage of labor? What equipment do you have available to help with this (e.g., birthing ball, birthing stool, rope hanging from the ceiling, etc.)? Should I bring my own equipment? Can I walk and move freely during labor?
• Which routine interventions and procedures do you use? Is it possible to decline them and replace them with natural methods, and if so, which ones?
• How many women in your practice give birth without using pain medication?
• Is video recording allowed?
• Can my partner cut the umbilical cord?
• Will you place my baby on my chest (skin-to-skin contact) after birth and examine them there? Will I be able to breastfeed my baby within the first half hour after birth, and will you only attend to them after that?
• Can my baby stay with me in the room or will you take them away?

Wagner (2008) states that the task of midwives is thankless and often impossible: they strive to simultaneously attend to several women in labor. Midwives are defined and limited by the fact that they have very little autonomy and can do little more than what routine care dictates without a doctor’s permission. If complications arise, the midwife has no right to act independently, except to seek a doctor. Her duty is to anticipate the moment of birth. If she calls the doctor too early, she wastes his time. If she calls him too late, the doctor misses the birth. The doctor is supposed to appear at the end of labor to “catch the baby.” If a woman gives birth in a hospital, midwives will be the primary birth professionals when the doctor is not present, which will be most of the time. Doctors are usually absent during most of labor. In some cases, both a doula and a midwife will care for the woman in labor simultaneously, with the midwife handling the clinical aspects. Staff caring for women in labor must rotate according to a specific work schedule managed by the head midwife, so a woman cannot choose her midwife to be with her during birth. A good midwife is a wonderful ally for a woman in labor. She is often an important source of information in the process of informed choice and helps the laboring woman find natural alternatives to medications and high-tech procedures. The midwife knows what to expect during labor and encourages the frightened woman to persevere and trust her body. If something goes wrong, she emotionally supports the woman and assures her that she did her best. When the baby is born, the midwife creates the right atmosphere and bonding between mother and child. However, it happens that a midwife obstructs the implementation of the birth plan. Because midwives often shape the atmosphere of the labor ward, a problematic midwife in the delivery room may act aggressively or even hostilely, and in some cases may try to pressure the woman in labor in various ways. In such a case, the woman in labor must stand up for herself. She can protect herself by having an advocate with her—a partner, companion, or doula who stands by her side. She can also complain to a supervisor, usually the head midwife, and this should resolve the problem.

Official statistics show that doctors assist in more than 90% of all births. In practice, midwives assist in most hospital births. The labor ward usually monitors several women in labor simultaneously, so they rarely provide continuous individualized (“one midwife – one woman”) care for each individual. Eight-hour shifts also do not allow for continuous care by one midwife for an individual woman in labor throughout the entire birth. Data show that continuous care by one professional for an individual woman throughout the entire labor is associated with shorter labor, less pain, fewer complications, and better outcomes (Wagner, 2008).

If a woman discovers discrepancies between her wishes and principles and the provider while writing her birth plan, Ullman (2012) recommends the BRAND formula or the Slovenian TANKO. This means that when choosing a maternity hospital, a woman follows these principles:

T – risk to the baby, risk to the mother; here mothers ask themselves questions such as how quickly emergency medical help is available in case of complications, who will care for the baby in case of complications and how quickly, etc.

A-lternative; e.g., if the birthing person does not want to receive intravenous fluids, what are the other options to replace the fluid.

N-othing: What if we do nothing and just wait for nature to take its course? The birthing person should continue asking questions until they get all the answers. They should be persistent;

B-enefit; If they choose, for example, Maribor Maternity Hospital, what do they gain: rooming-in, a pediatric intensive care unit (EINT) in case of complications with the child, proximity to home, etc.

D-ecision. Not in the delivery room. They should think about this before birth, discuss it with their partner, and talk about the topic multiple times; in what environment they want to give birth, who they want as a companion, who will cut the umbilical cord, etc.

or ALWAYS USE YOUR BRAINS:

• B – What are the Benefits? What are the benefits?
• R – What are the Risks? What are the risks?
• A – What are the Alternatives? What are the alternatives, other options?
• I – What do your Instincts tell you? What do your instincts tell you?
• N – What if we were to do nothing? What if we did nothing?
• S – Please give us Space to consider our options / will this choice result in the Safe outcome we desire? Please give us space to consider my options / will this choice lead to the safe outcome I desire?

Be brave with writing birth “plans” 🙂 But don’t forget your “postpartum plan” click

P.S.: Even if you don’t go to the maternity hospital with a written birth plan, it’s already a lot if you’ve thought about yourself and your birth and informed yourself during pregnancy!

Diploma thesis “Implementation of the instrumental plan in Maribor Maternity Hospital (2012)” by Nastja Pavel, mentored by Senior Lecturer Teja Škodič Zakšek, B.Eng. Rad., B.Sc. Midwifery, M.Sc. (UK).

Read more:

• Bonding between mother and child after a C-section
• Answers to research questions in the master’s thesis “6 areas in the delivery room for better birth practice”
• The first hour after birth
• The newborn’s 9 instinctive stages
• Fear of childbirth
• Birthing Positions
• First care of the newborn after birth – washing
• Breastfeeding in the delivery room
• Parenting and attachment
• Umbilical cord clamping
• Postpartum plan

Photo