What is a birth plan? What is the purpose of it? And where do you even begin?
We like to use the term “birth preferences” or “birth goals” rather than “birth plan” because we know that it’s impossible to plan every detail of your birth. First, let’s talk about who is reading this piece of paper. Your nurse and your midwife/doctor are the ones who read this – they are your audience when you are writing this birth preferences sheet. There are certain protocols and procedures that happen in a hospital. If you plan to do anything outside of the norm, then you’ll want to include this on your birth plan. Here are a few things for you to research…
In Labor and Birth…
IV access in labor. Most physicians desire for their patients to have IV access in labor. Most midwives do not require or recommend IV access in a low risk, healthy patient. This is something you will want to discuss with your care provider. If you do not want IV access, then you will need to put this on your birth preferences sheet.
Intermittent monitoring. We know that the evidence shows that constant monitoring does not improve maternal or neonatal outcomes in healthy women who had a good looking NST (non-stress test) at the beginning of their labor. Constant monitoring means that you may be limited in where you can labor (possibly not in a shower or tub based on your birth location) and it also means that you will have monitors on your belly. If you desire to have intermittent monitoring, it’s important to discuss your care provider’s definition of what this is and to have it on your birth preferences sheet.
Eating and Drinking in Labor. We wrote an entire blog post about this a couple of years ago. Most midwives encourage eating and drinking in labor while many physicians will not allow solid food once a mom has been admitted to the hospital. It is important for you to educate yourself on the benefits and risks of this and make your preferences known on your sheet.
Pain medication preferences. What are your preferences on pain management? It’s important to make these known. If your desire is to have a totally unmedicated birth, it can be discouraging for your nurse to ask you several times if you need something for pain. If you ideally don’t want an epidural, it can be frustrating for your doctor to walk in the room and ask if you are ready for the epidural. You can always just state that if you need pain medication, you will be the one to initiate that conversation.
Pushing positions. When it is time to push, do you want to have the freedom to push in any position that is comfortable? Or will your care provider tell you that you need to push on your back? Often times this comes down to what the care provider is most comfortable with doing. Midwives will typically encourage the mother to push in whatever position seems most comfortable to the mother. Many doctors these days will do this too, but it’s an important discussion to have with your care provider.
Students. Some hospitals have students in them. Do you want to have students at your birth? Or would you rather only have necessary personnel in the room? This decision is yours.
Postpartum
Delayed cord clamping. Everyone knows that delayed cord clamping is important. It is important for you to research how long you ideally want to wait until the cord is clamped. Do you want to wait 45 seconds? Or until the cord stops pulsating? Talk to your care provider about what they typically do and your preferences.
Hep B Vaccine / Vitamin K shot / Erythromycin. All of these are standard at the hospital. If you do not want and of them for any reason, you’ll want to include this in your birth plan.
Bath – It is standard for the hospital to bathe your baby during their stay at the hospital. If you don’t want your baby to have a bath, include it in your birth plan.
Placenta. Do you want to encapsulate your placenta? Do you want to take it home yourself? If you want to do anything with your placenta, make plans before your birth and talk with your doulas about the procedures at your hospital for placentas. Either way, if you want to keep it, state this in your birth preferences sheet.
Breastfeeding. Are you planning to breastfeed? Make sure you get sufficient lactation support during your hospital stay. If you don't want your baby to be given formula, ask about donor milk. Hospitals typically do not provide donor milk to full term babies, but you can bring in your own donor milk to some area hospitals.
C-Section Birth
Your support. Who will go to the operating room with you? Will it be your partner? Your doula? Both? Consider who you want with you.
Clear drape. You can have a clear drape that can be used when your baby is born! You will not see any part of the surgery, but they can drop the blue sterile drape and you can see your baby come out in their first moments outside of your belly through the clear drape. Many moms love this – but you need to ask about it so they can set it up.
Here’s an example of a SIMPLE birth plan outline:
Birth Preferences
Our goal is to have a totally unmedicated birth. We understand that things may happen outside our control, but before intervention takes place, we would prefer to discuss options whenever possible. Thank you for your support!
Labor/Birth
I do not want IV access
I prefer intermittent monitoring as long as the baby is healthy
I plan to eat and drink in labor
I will ask for pain medications if necessary. Please do not ask me
I would like to push in whatever position is most comfortable for me
I would not like students in the room
Postpartum
Please allow the cord to stop pulsating before clamping
I plan to delay the Hep B vaccine until my baby's first pediatrician appointment
No erythromycin for the baby
I will bring my placenta home with me
I want to breastfeed exclusively. Please ask my permission before supplementing
Now you may ask – why is that birth plan so short? I want to include so much more! There are some amazing templates out there that can help you create very long plans. While we love these and think it is wonderful for the mom and partner to work through these so that they know all their options and think about every consideration, your doctor and midwife don’t need to read a plan that’s SO long. Here are some examples of things that you don’t need to put on your birth plan:
I would like the room to have soft music, dim lighting, and no tv – you don’t need this information in the birth plan because these are all things that you and your doula control anyway
I would like to have skin to skin contact immediately after the birth – this is the standard practice at all hospitals these days. The only reason this wouldn’t happen is if you or baby needed extra medical attention
I would like to use pain management techniques of massage, breathing, and visualization – this isn’t necessary to write in your birth preferences sheet because your nurse, midwife, or doctor will not be the ones to help with massage, breathing, or visualization. All of those things are activities that your partner and your doula do.
It’s important for you to share your birth preferences sheet during one of your prenatal visits with your midwife/doctor well before your birth. That way, they can sign off on this sheet and when you go to the hospital when you’re in labor, your doctor/midwife and nurse will all be on the same page. You’ll want to discuss all this before you are in labor so that you can have a peaceful uninterrupted experience as you welcome your baby.
The most important thing to keep in mind when putting together your birth preferences sheet is to remember that this is a tool. It can help you think through your wishes and communicate them to your care providers. Your birth goals may need to change in the midst of your labor - but it's still worth putting these goals together so you can think through all your options. Ask your doulas if you need help knowing what to put on your birth preferences sheet! We are always happy to help and we think it’s a wonderful exercise for you to do in preparation for your birth.