Close your eyes and picture your birth experience. What do you see, hear, smell, and feel? Maybe you hear your favorite songs playing on the iPod “labor mix” you made months ago; maybe you smell a lavender massage oil; or maybe you see your three-year old sitting on your mother’s lap across the room. Whatever comes to mind is unique and it is you. And those are the types of things you should have in mind when writing your birth plan, or birth wishes.
A birth plan should be your philosophy of what a birth is like and should incorporate your personality, wants and needs. Though birth plans can be as specific or as general as you would like, it’s important to allow for changes along the way. Some women who do not allow for flexibility in their plans may get discouraged if all events do not go exactly as planned. Viewing your birth plan as more of a list of preferences may help you to avoid this sentiment and not get caught up in all the specifics.
So what exactly is a birth plan? Well, it’s a document about one page in length that communicates to your nurses, midwives or doctors, and any other providers what you have in mind for your child’s birth. There is no specific way to write a birth plan; it can be simple and written by you or you can use a template, which can be found in many pregnancy books and on websites. (There are even birth-specific types of templates, like for a VBAC.) When writing your birth plan, it may be helpful to organize your ideas in the order that things will happen, first discussing your preferences for labor, then delivery/birth, and finally post-partum.
The following questions were adapted from the American Pregnancy Association, BabyCenter.com, and StorkNet and are most applicable to women interested in normal, evidence-based childbirth, also referred to as “natural,” “physiologic,” or “unmedicated” childbirth; however, even for women who are not planning a natural birth, researching birth plans and options may actually change their ideas of birth once they realize all the choices they actually have. “You mean, I don’t have to have an IV?” or “I can have intermittent monitoring so I can walk around?” etc. Please note that not all questions below will apply to you and your child’s birth, as all births, providers, and birth locations are unique. The following questions may be overwhelming, especially if you are unsure of what all the choices entail; that is why it is important to plan ahead and take time to educate yourself. Talk with your provider, ask questions, and find out what are the standard procedures and what options are available where you will be giving birth.
Start by giving some general background information about yourself and why you are writing a birth plan. Provide any information that you think your providers and nurses should know. By giving them an idea of who you and your partner are, you allow them to see you on a more personal level, instead of just another patient. (i.e. I work as a nurse…we had a previous loss… we have two dogs, etc.) You may even want to include a picture. It’s also helpful to have a statement about open-mindedness to set the stage for the team that will help you and your partner during your birth (i.e. “We understand that unexpected things may arise which require deviations from our plan. In such cases, we trust our providers will communicate with us and allow us to be part of the shared decision making.”).
- Who will be with you during your labor? (Partners, coaches, doulas, children, other family, friends, photographers) Will you plan to have visitors wait in the waiting area?
- How will you handle your contractions? (i.e. have you taken classes in preparation, will you use breathing techniques, positioning, hypnosis, water/shower, birthing ball or bar, massage, distraction, relaxation, etc.)
- Would you prefer for people to avoid certain language when talking with you about your labor? For instance, mothers preparing through hypnobirthing avoid use of the words “contractions” or “pain” and instead use language such as “surges” or “pressure waves.”
- Do you want medications, and if so, when and what types do you prefer? Do you want them offered to you, or will you ask for them if needed?
- Do you have a preference about having an IV? Or do you prefer to have the option to eat and drink in labor?
- Do you prefer to let the bag of waters break naturally?
- What would you like the room atmosphere to be like? (quiet, soft music, lights on, the room dimly lit, etc.)
- What do you plan on wearing? (i.e. hospital gown, your own clothes, etc.)
- What methods do you prefer for monitoring the baby during labor? (continuous monitoring or intermittent monitoring with a Doppler/fetoscope)
- Do you prefer to have only limited vaginal exams? Do you prefer to know or not know cervical dilation when a vaginal exam is done?
- In the event that an induction is recommended or in the event of a stalled labor, would you be interested in first trying natural induction or augmentation methods like acupuncture, nipple stimulation, and/or homeopathic/herbal medications before moving to things like Pitocin?
- Do you want to have options to give birth in certain positions or locations?
- Will someone be coaching you to push, or will you follow your body’s instincts?
- Do you want to use a mirror to see the baby crowning?
- Do you want the opportunity for you or your partner to touch your baby when he is crowning?
- Would you or your partner like to pull the baby up as he is born or up out of the water if you are planning a waterbirth?
- Do you want the baby placed on your stomach/chest immediately after birth?
- If the gender is unknown, do you prefer that you or your partner announce the sex?
- Who will cut the umbilical cord and when?
- What is your preference regarding naturally tearing vs. an episiotomy? Do you want gentle coaching to let the head ease out slowly to avoid tearing? Do you want perineal massage or warm compresses?
- Do you plan to bank your cord blood? (Note: Banking should be arranged prior to labor.) Or plan to delay cord clamping?
- Do you want the baby examined while you hold him, or can the nurses examine him under the warmer in the room?
- Do you want the baby bathed after birth?
- Do you want your baby to receive antibiotic eye ointment that is routinely administered to prevent newborn blindness, and if so, do you have a preference for when it is applied?
- Do you want your baby to receive an injection of Vitamin K that is routinely administered to prevent bleeding in a newborn?
- Do you want to see the placenta?
- Do you want routine pitocin after delivery to avoid postpartum hemorrhage?
- If a Cesarean is needed, do you have any specific preferences during the surgery? (i.e. have your support person present with you, curtain lowered so you can see your baby, have the baby skin to skin even as surgery is being completed, keep the baby with you in the OR, breastfeeding in the recovery room, etc.) Click here to read more about Family-Centered Cesareans from ICAN (International Cesarean Awareness Network).
- Do you plan to breastfeed, formula feed or both?
- Would you like to see a lactation consultant if one is available?
- Will the baby “room-in” with you or stay in the nursery at night?
- If the baby will stay in the nursery, is it okay for the staff to give your baby a pacifier, formula, or sugar water? Do you want them to bring your baby to you for feedings?
- What vaccinations, if any, do you want your baby to receive before discharge? (i.e. Hepatitis B)
- Should your baby require any medical procedures, will someone accompany the baby out of the room?
- If you have a boy, what are you preferences regarding circumcision?
- Do you have preferences about discharge? (i.e. as soon as possible, as late as possible)
- In the event that the baby needs to be observed in a special care nursery/NICU, would you like to visit as often as possible and/or have extra assistance in pumping if the baby is unable to breastfeed for medical reasons?
For waterbirths, you may also want to consider the following:
- When do you want to get in the water?
- Will you shower with antibacterial soap before getting in the water?
- Will anyone be in the water with you?
- Do you want to deliver the placenta in the water?
After you’ve completed your birth plan, bring it to one of your prenatal appointments to discuss it with your midwife or doctor. He/she may be able to shed some light on questions you have, or even remind you of some additional things to think about. After you’ve both agreed on your preferences, he/she can put a copy of your plan in your chart at their office. You should also print several copies for your hospital bag. Once admitted to the hospital, these can give your nurses and the on-call provider an idea of what you have in mind. Having your partner or doula familiar with your birth plan can also help to keep things on track during your labor as they can speak and communicate your wishes when your focus is labor.
Merriam Webster defines plan as “a method for achieving an end.” For birth plans that “end” is simple: a healthy mother holding a healthy baby. So while a birth plan is helpful in letting others know what you would like to happen on the big day, be sure to allow for flexibility and keep that ultimate goal in mind. Some variations may be out of your control and some things that you thought you would like just don’t quite make the cut in the moment. (How could you have known you wouldn’t want to hear Johnny Cash’s “Burning Ring of Fire” while you were pushing?) There is no right or wrong way to write your birth plan, so start envisioning the day of your little one’s arrival, get creative, and make a plan that is unique to you and your family. Helping to plan the day can be empowering and can make the day even more special. Happy Writing!
- American Pregnancy Association. 2008. “Creating Your Birth Plan.” http://www.americanpregnancy.org/labornbirth/birthplan.htm
- BabyCenter. “Birth Plan Worksheet” http://www.babycenter.com/calculators-birthplan
- Grassia, Michelle. “VBAC Birth Plan.” http://www.storknet.com/cubbies/vbac/vbacplan.htm
- ICAN. http://ican-online.org/pregnancy/family-centered-cesarean
- Merriam Webster. http://www.merriam-webster.com/dictionary/plan