How Can You Plan for the Birth You Want?

An interview with doula and birthing expert Jada Shapiro

by Kate Rope

Jada Shapiro, cofounder of Birth Day Presence is the kind of doula I'd like to have for my next delivery (if I were planning to have another delivery, that is). She's not only kind and comforting but also incredibly down to earth. For me, someone who twice aspired to a medication-free birth, but who also really enjoyed my labors once I opted for epidurals, she strikes the right balance of offering ways to make birth as natural as you want with the openness to choosing whatever makes you comfortable.

So I asked Jada to give Seleni and Kaity Velez of Well Rounded NY the lowdown on how you can work toward your dream birth – whether that's in your home surrounded by your family or at a hospital with a good epidural and a level 4 NICU nearby. Here's what she told us.

Kate Rope: How do you decide what kind of birth you'd like to have?
Jada Shapiro: You don't get to decide what kind of birth you'd like to have! The most important decisions you can make, in our opinion, are choosing the person who is going to deliver your baby and deciding where you want to give birth. Some of what you are hoping for in a birth should influence who you hire for your birth team and where you plan to deliver.

Consider whether you would like to use pain medication. Think about how much freedom of movement you'd like to have. Do you want the option to give birth in a tub? Do you want to be able to have lots of support people around you? Do you hope to avoid a cesarean unless absolutely medically necessary? All these factors will dictate your choices.

A mom who hopes to give birth in the water should not choose the labor and delivery floor of a hospital. A mom who definitely wants to use an epidural early in her labor should not opt for a birthing center. And moms who feel strongly about avoiding an unnecessary cesarean should look for doctors with a low c-section rate (say, around 15 percent, although it could be higher if they see a lot of high-risk patients).

KR: Why do you need a birth plan?
JS: You don't need a birth plan to move toward the kind of birth you'd like to have. In fact, if you hire a midwife or doctor who you know shares your birth philosophy and supports your choices and options, as long as they are safe, then you seldom need a written birth plan. If you are birthing in an environment that does not typically support what you are hoping for during your birth, it can be nice to have this tangible, easy-to-read list to help communicate your wishes quickly.

There are two real benefits of writing a birth preferences sheet, which is how we like to think of it. The first is that you can sit down, alone or with your partner, and really get clear on what is most important to you. The more clarity you have, the more effective you will be at communicating your hopes to your care provider. Secondly, you can take this document to your care provider well before you give birth to make sure you and your midwife or doctor are on the same page about delivery. As hard as it is to switch care providers mid-pregnancy, it is much harder to find out during labor that they don't support you!

KR: Do doctors and nurses really read it?
JS: Totally depends on the health care provider. Your preferences sheet should be clear, concise, and one page long – like a resume. Put things in a positive voice. The last thing anyone wants to receive is a long list of things they don't want you to do to them. So for example, instead of: "Don't give me an IV," try "I prefer to eat and drink to remain hydrated and nourished. Please offer an IV only in the case that I am dehydrated or need specific medicines for my labor."

The best way to get a nurse to read your birth preferences is to take a moment to introduce yourself to her, and then kindly ask if she would mind reading through some of your preferences when she has a little time. Respect her time and her job and you will find you will have a much easier time with some of the negotiable aspects of childbirth.

KR: Do you need a birth plan if you're having a home birth?
JS: It's worth discussing with your midwife whether you want to actually write down your birth preferences. In a home birth setting, you can be a bit more luxurious with your vision, including how you envision laboring, what kind of pain relief you imagine might help, and any environmental factors that will help you. You should absolutely write a preferences sheet to have ready in case you need to transfer to a hospital during labor. This can be packed in your hospital bag and only needs to come out if your midwife determines you need to give birth at the hospital.

KR: What happens if your birth does not go according to your plan?
JS: Birth seldom goes according to your plan. You should plan that birth won't go according to your plan! Going to a childbirth class that addresses issues like this and helps prepare women to meet whatever kind of labor they have can help. Talking with a therapist or close friends or your doctor or midwife can also help.

If you find that in writing your birth plan, you are adamant about avoiding a procedure, try to talk with your care provider about how best to deal with the procedure if it becomes medically necessary. Your birth preferences are a general guideline. Ultimately, if medical necessity dictates changes in the labor, hopefully you have chosen a care provider you trust! The best we can do for ourselves as birthing mothers is choose the best team of support and then step back and let labor unfold.

Birth Day Presence offers childbirth education classes and doula services at birthdaypresence.com.

Well Rounded NY is a pregnancy and new parenting site founded by Jessica Pallay and Kaity Velez.

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Kate Rope

Kate Rope serves as editorial director for Seleni, and is an award-winning journalist with expertise in health, pregnancy, and parenting. She is coauthor of The Complete Guide to Medications During Pregnancy and Breastfeeding, and her work has appeared in many publications including the New York TimesLifeParadeParentingReal Simple, and Shape. She lives in Atlanta with her husband and two daughters.

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