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Melanie Cole: Welcome. This is Checkup Chat with EvergreenHealth. I'm Melanie Cole and today we're discussing taking an active role in your birth plan. Joining me in this panel are Dr. Bettina Paek. She's a Physician at Eastside Maternal Fetal Medicine at EvergreenHealthand Dr. Angela Chien. She's a Physician at EvergreenHealthObstetrics and Gynecology Care. Doctors, thank you so much for joining us. I just love this topic. I love a birth plan. Dr. Paek, I'd like to start with you for the listeners, tell them what that is. What's a birth plan and why is it important?

Dr. Paek: Well, a birth plan is something that you have thought about, your birth, what you really want to have happen, how you want to feel, how you want this to play out, who's going to support you, and what are the things that you most avoid. It's the way to communicate with your care team, where you're coming from and what is really important to you and your family so that you can communicate that and then share that with your teams so that we can integrate that into the medical decision making and come up with a solution that really works for you and is individualized for you and your family.

Host: Well, thank you for that very comprehensive explanation Dr. Paek. So Dr. Chien, are there different types people hear about the different types of, you know, ways to give birth and there's a Secarean section and natural childbirth and then V-BAC and all these different ways. Is that included in the birth plan? Can you even figure out ahead of time how you will give birth?

Dr. Chien: Well, I think that's the whole difficulty with having something that's called a birth plan because we really don't know how your labor is going to unfold until it starts. And the challenge when you have set up a lot of expectations for the perfect story of your birth is that things change once you get on the labor unit. And sometimes we can't honor your birth plan in the way that you'd like us to. For example, most patients come to us with the hope of having a vaginal birth. And I think the most common time that we have to violate that is if your baby isn't in tune with that story and your baby doesn't tolerate labor, sometimes we have to have that conversation about delivery by Cesarean section before you even get to page two of your birth plan. So, that's when you have to be flexible and we as the care team hope that we can still honor the important things in your birth plan, knowing that we're making you change how you wrote it.

Host: That's such a good point and I think it's really an important point for couples that are making this birth plan to hear you say that you really want to adhere to it as much as possible. But sometimes there are things that get in the way. So Dr. Paek, how do you go about creating it and what's the process like? Is there a right way or wrong? And when should planning a birth plan begin?

Dr. Paek: There really isn't a specific way to do a birth plan, there isn't a wrong or a right way. I would recommend starting in the pregnancy just to mull over who is going to be there to support you during labor or during the birth? Do you have any specific values that are really important to your family? Where are you going to give birth? Who is the doctor or the midwife who's going to be taking care of you? And then kind of flushing that out as you go along and during your appointments, bringing up things that are pertinent at that particular time in pregnancy to your birth plan or how the birth might unfold. I also think it's important to cultivate resiliency and figure out who is going to support you or how are you going to cope with the inevitable challenges of labor and coping with the challenges if there are medical, unanticipated things that you weren't really prepared for that you might, that might require you to change your plan as Dr. Chien had mentioned. I think that's an important part of a birth plan too is to say like, well, if things don't go as planned, how am I going to deal with that? What kind of coping skills am I going to use and cultivate? And how is my birth team going to support me in that? There are specific templates that some people use, that can be downloaded from the internet. I don't think there's one that is specifically better than the other and a lot of them focus just on the very superficial things like who's going to cut the cord and who's going to be there with me. And I really encourage families to dig a little bit deeper than that and get to what's really important to them at the end of the day.

Host: Expand on that, Dr. Paek for us, if you would, certainly there's the basics, like you said, who's going to cut the cord, who's going to be in the room, but what else is included that you feel is important that people consider and think about?

Dr. Paek: Well, for example, how to cope with the discomfort or pain of labor. What methods are you going to implore you? Am I going to employ, am I going to lean towards an epidural? Do I lean away from that? Do I want to use other different methods of coping? And then what are those going to be and who's going to support me in those, for example.

Host: That's so interesting, Dr. Chien. I know it can be difficult to speak up sometimes and when you trust your doctor but you have questions or if they've recommended something to you about your care that you're not so sure about, what advice do you want to give to women who are in a scenario where they want to have more input about their and their baby's care? What do you recommend as far as for them to speak up? How do they do that?

Dr. Chien: Well, first I think every woman should just come have their baby at Evergreen because I think we've done a fantastic job in including the patient in every conversation about how their care is to be structured. I think that, um, this is exactly where, this project we've worked on called team birth, which really includes the patient in every conversation about every intervention, about every care decision, so that they don't have to feel uncomfortable asking a question because we actually invite them to ask questions. That's part of the process is that we talk about the options and we really value the patient's input and we hope that all of our patients feel comfortable really telling us how they feel because, and I think that's not the structure in some places, which is why patients have those concerns about, well, what do I do if I don't feel comfortable with the plan? Who do I go to? In the past, I would say historically, patients will often go to the nurse in the room and say to the nurse, Hey, I don't feel good about this plan. And the nurse will then come to the provider and say, you know, your patient said this to me. Our hope is that the future model of how we deliver care in the maternity unit is that the patient is always included in the conversation.

Host: Dr. Chien, I love that answer. I'd like you to expand a little bit more as well in how you would EvergreenHealthwork to empower women and families. You talked about it, but tell us how you work with them to actively contribute to their birth plan and be vocal about their needs and preferences?

Dr. Chien: Well, we have recently completed a project called team birth in which we implemented, a very basic whiteboard. So this board sits in the patient's room. It has designated areas on each board where we write specific things like the care team, the patient's birth preferences, the plan of care, and then the time for the next evaluation. And this is basically in our minds a little bit like a living, a living birth plan because it changes as the course of labor changes, and everybody in the room is allowed to contribute to the board. It's a little bit hard to describe without giving a visual. But functionally it's just it literally is a place where we gather, we take a dry erase marker to update all the quadrants of the board, including the patient, the nurse, their support people, so that everyone's opinion, everyone's concerns can live on this document, on the whiteboard in the room.

Host: How cool is that? So Dr. Paek, how do you work to make sure moms and families are informed and involved in that decision making process along the way from inception through birth? And I understand sometimes things change. How are they involved in the decision making?

Dr. Paek: That's a great question. So as Dr. Chien had referenced, the team birth process actually starts with identifying the team members on the birth team and that includes the expected mother and her support people as well as the medical care team. And then the next step is really to solicit input from everyone, including the mother and their support people about what's important to them, what's important to the family, right at this very juncture. And then we kind of fold in discussions about the medical situation and then options for what we can do as medical care providers and what the mother and her support persons can do as well. And to flush that out, we've actually created a electronic resource, called E-doula that has a lot of content. How mothers and their support partner can really help them stay active during the labor, can support the mother by massages, by techniques with like the double hip squeeze with certain maneuvers with positions to really enhance the normal physiologic part of labor. And then we discuss again about, you know, what we're seeing in terms of labor progress and how the baby is doing. And then we circle back to the preferences and say like, look, knowing what we know now, what is the best path to move forward to best meet the goals that you have.

Host: What a great way for a couple to go through this whole process. And it's such an exciting time. Dr. Chien, before we wrap up, tell us the importance of communication between patients and providers and some of those day to day strategies for enhancing and improving that communication.

Dr. Chien: Well, I think, you know, really when you look at pregnancy care, it's a little bit like a relationship, right? You have us the patient, you have this eight month relationship with this provider who you're really trusting to help guide you through one of the most exciting, but for many kind of the scariest parts of life. And like with any relationship, I think, communication of course is absolutely key. I think for us as providers, we're pretty good at talking. You know, I think sometimes we need to step back and really become better listeners so that we can really hear what is bothering our patient, what their concerns are. And that takes practice. And for the patients, they just need to feel empowered to really ask us questions and to realize that it's okay as a patient to even question your provider. You know, that it's okay to say, Hey, I'm not sure I'm comfortable with that decision. I think sometimes patients feel like they shouldn't question their doctor or their midwife because their doctor or midwife should know best. But really what's best for the patient is what the team decides. And so that's important for, you know, the provider, the patient, to figure out along the way. And that just really requires open, honest communication.

Host: Well, it absolutely does, certainly for mothers. And as you said, it can be a scary time, but such an exciting time. And Dr. Paek wrap it up for us. Your best advice for formulating that birth plan, knowing realistically that it might not go always as planned, but really what you can do for women and their partners at EvergreenHealth.

Dr. Paek: I would really know what's most important to you, kind of make a list of priorities, and then also see who is really best equipped to help you and how, what you can do and what your support partner can do to really support you in your goals. And also maybe think about what you'd really like to avoid, what your biggest concerns are and being very clear with your care provider right out of the get go so that you can have a discussion, so that you can make sure that both of you and in fact the care team, that of course that includes the nurse and your support person, that everyone is on the same page.

Host: Thank you so much Doctors for joining us today. What a great topic, what a great program that you have there. And that concludes this episode of Checkup Chat with EvergreenHealth. The birth team at EvergreenHealthwork together to empower women to take an active role in the birth plan. To learn about EvergreenHealth, OB GYN and midwifery services. Please visit evergreenhealth.com/gynecologist-OBGYN to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealthpodcasts. For more health tips and updates, follow us on your social channels. I'm Melanie Cole.