The document helps pregnant women think about what procedures are desired or not during and after childbirth; instrument is a form of protection against obstetric violence
EINSTEIN AGENCY – Pregnant women or those who are thinking of becoming pregnant have probably already heard about the importance of preparing a birth plan. This document, which has legal validity, lists which procedures the woman does or does not authorize on her body during childbirth, as well as in relation to the child after birth.
Obstetrician and gynecologist Gabriela Bezerra, specialist in fetal medicine, explains that the birth plan is a tool that allows pregnant women to inform themselves and think about the birth they want and need. “I advise patients to think step by step about what they would be like from entering the maternity ward to discharge.”
The specialist explains that it is important for pregnant women to speak to one of the healthcare professionals on the team who will carry out the operation, be it the doctor or the obstetric nurse. The woman must be informed about what is expected to happen from the moment of her arrival until she leaves the maternity ward in order to authorize it or not in the birth plan. “If the pregnant woman has already informed herself about which situations, from a safety point of view, she should be examined, she can deny the vaginal examination, for example, in situations that are not mandatory,” explains Gabriela Bezerra.
The midwife and other professionals consulted by Agência Einstein also recommend that in the birth plan the woman expresses the desire to receive information on the procedures carried out during hospitalization and the reasons for their implementation.
What should the preparation be like?
The birth plan must be drawn up by the pregnant woman, her companion (the father or another person of her choice) and the medical team that will accompany the birth.
“The plan is a way for the doctor and the pregnant woman to start talking about the birth. Even the doctor on duty, when he talks to the patient about what is written, finds a moment to clarify doubts and clarify what he can or could” It will not be possible. There, the doctor shows that he is willing to understand that patient and treat her as dignified as possible, but showing the possibilities of what could happen, “says Gabriela Bezerra.
It is also important to present your birth plan to the hospital to avoid frustration. It may happen that the maternity ward or health institution does not have the necessary facilities to fulfill the intentions described in the birth plan, such as a bathtub. Or even have certain rules that prevent certain procedures from being performed.
“If any intention in the birth plan goes against the rules of the hospital, it cannot be fulfilled. Not all hospitals allow water birth, for example. Or now, more recently, the issue of the mother taking the baby out during a cesarean section, most hospitals do not authorize it. So this must be clear to everyone because birth is a unique moment and we want to avoid frustrations”, says Dr. Rômulo Negrini, coordinator of the obstetrics department of the Maternity Hospital Israelite Albert Einstein.
Some examples of work-related topics:
- I would like the presence of a companion and/or doula of my choice
- I want to have freedom of movement and walk when I want
- I don’t want to be kept on an empty stomach
- I want to be offered non-pharmacological methods to relieve pain, such as bathing, using a ball, massage, among others
- I want to receive pain medication
Some examples of delivery time requests:
- I want to listen to music
- I want the environment to be dimly lit
- I wish the air conditioning was turned off
- I want to choose the most comfortable position for me
- Don’t perform a routine episiotomy; WHO recommends an episiotomy rate of no more than 10%
When should I start writing mine?
According to Negrini, the birth plan must be implemented from the beginning of medical follow-up. «Of course, some things, even the expectations of the pregnant woman, will change over time and the desires for the birth plan will begin to strengthen towards the third trimester, that is, after the 28th week of pregnancy. But some intentions can be agreed upon right from the start,” she says.
Midwife Gabriela Bezerra agrees: “I think it’s a good idea to start from the 26th or 28th week onwards. The pregnant woman will probably think about giving birth from the beginning of the pregnancy, but I think the woman will have the maturity to judge certain scenarios later. ahead”.
“It is from the beginning of the third trimester that we will begin to analyze the condition of the pregnant woman for childbirth. Indications for a cesarean section before the woman enters into a birth plan are very rare, but can possibly occur, such as a placenta previa”, in which the placenta covers, for example, the opening of the cervix. This will influence the intentions described in the birth plan,” adds the doctor.
Negrini explains that those who know they will have to undergo a caesarean section can also draw up a birth plan in which they describe their intentions regarding how they want to be welcomed in the operating room, such as the possibility of having music, the request that, instead of immediate delivery of the baby to the neonatologist, whether it is handed over to the mother or her partner, the desire to breastfeed during the first hour of life and any other care for the newborn.
Doctor Einstein explains that the pregnant woman will also have to agree with the neonatologist what care will be provided to the newborn and express her preferences in the birth plan. Some examples in this category are:
- I want the baby to be placed in skin-to-skin contact with me or the support person immediately
- I want to try breastfeeding in the first hour of the baby’s life
- I want silver nitrate eye drops (given to prevent infection with gonorrhea or chlamydia bacteria that may be present in the vagina) to be/not used
- When will the baby’s first bath be given and by whom?
How to write a birth plan
There are ready-made templates, such as the version prepared by the team of the Specialized Center for the Promotion and Defense of Women’s Rights (NUDEM) and the Specialized Center for Children and Youth (NEIJ) of the Public Defender’s Office of the State of São Paulo , or made available by birth services, in which the pregnant woman can fill in previously created fields.
Or, if the pregnant woman wants to write a personalized one, the advice is to separate the moment of birth into different phases and list her preferences and expectations.
How can I ensure my birth plan is respected?
Lawyer Ana Lucia Dias, specialist in mothers’ rights, underlines the importance of the document for the protection of pregnant women against obstetric violence, both in the Unified Health System (SUS) and in the private network. The document also serves as evidence that there has been a violation of rights, if so. “If the pregnant woman clearly wrote down what she wanted and something was done differently, without the woman’s consent, can sue“.
The specialist explains that the birth plan must be signed by the pregnant woman and the doctor and must be taken to the maternity ward to register the document a few days before giving birth. In São Paulo there is a state law (nº 17.431/2021) which guarantees pregnant women the right to prepare an Individual Birth Plan.
According to Dias, even in the absence of a federal law, doctors must follow the birth plan, since the document has legal value as a declaration that formally expresses the will of the pregnant woman.
However, in some cases the doctor may need to intervene and go off plan, especially in situations where there are risks to the mother or baby. “In case of medical emergencies, we do everything necessary to save lives,” explains Gabriela Bezerra.
“The birth plan should not handle emergency procedures because there is no way to combine this kind of thing. When there is a need to act immediately to save someone’s life, this goes beyond the birth plan,” adds Negrini.
Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
