You’ve thrown the gender reveal party. You’ve stocked the wardrobe with clothes so small they make your heart melt. You’ve thought about names and picked out your baby’s godparents. Now, it’s time to write a birth plan.
The birth plan is a relatively modern phenomenon designed to help expectant mothers communicate their wishes about an upcoming birthing experience. It’s a short guide – one page is plenty – featuring key details about pain relief, delivery preferences, emergency contacts, newborn procedures, and more.
While it’s not an essential part of preparing for a new life, a birth plan can allay common anxieties about going unheard. With a detailed plan to hand, a laboring woman can focus on the experience of delivering her child safe in the knowledge her wishes are being acknowledged.
At this time of extreme vulnerability, a little preparation can ensure you feel both safe and respected during delivery. This article offers some tips on writing an effective birth plan.
What Should a Birth Plan Look Like?
Here’s an example of a birth plan for a hypothetical patient:
Birth Plan for Katherine Morris
Patient Name: Kathy Morris
Partner’s Name: Tom Morris
Partner’s Phone Number: 0756 465 2329
Obstetrician: Sally Jenkins @ 0774 992 1536
Requests for vaginal labor and delivery:
- I am planning a vaginal delivery with a transition to C-section only if medically necessary.
- My husband Tom will be present during delivery. I would like him to remain in the room at all times.
- I do not want any other visitors in the room during delivery. I have no issues with them waiting outside.
- I have no medical intolerances to a saline-locked IV where necessary.
- Please do not use Pitocin to accelerate my delivery. I have had two prior c-sections and been informed the risk of uterine rupture is increased.
- For pain relief, I would prefer a walking epidural and only if the pain becomes too severe. Please ask for my consent before administering.
- During the early stages of labor, I want freedom to pace and use an exercise ball. I will move to a prone position when I feel the labor progressing.
- I would like the cord clamping to be delayed for 2 mins (min) after delivery.
- We would love to donate the cord blood and cord tissue for stem cell research. I have a kit I can provide. Please place the materials inside this kit after delivery.
- Please do not give me methergine without express consent. It caused feeding problems with my first child. I’d like to avoid it if possible.
If I need a C-section:
- During my second c-section, my hands were tied to the bed. I found this distressing. Please try to avoid this.
- I want to be fully aware of what’s happening. Unless there’s a medical emergency, please don’t give me a general anesthetic. I want to be present.
- If safe, I want to hold my baby on my chest asap. Please place the baby on my person as soon as it is safe to do so.
Requests for newborn care:
- After the delivery, I would like to attempt breastfeeding. Please delay anything except for emergency care. I am happy to go ahead with antibiotic eye ointments, vitamin K, weight measurements, other physical assessments, etc. I just want some time alone with my husband and the baby first.
- The baby can be given a pacifier after breastfeeding unless they are struggling to latch. In that case, please do not give a pacifier.
- I would like a copy of the results of the baby’s hearing screen, blood work, and any other tests/studies before we leave the hospital.
Do all women need to write a birth plan?
No. It’s entirely up to you. There is no requirement for expectant mothers to produce a birth plan. Some write a plan because it’s easier than explaining their preferences once labor is already underway. It’s just a way to make sure your preferences are acknowledged.
If you have no concerns about making your wishes known, you don’t need to write one. However, it always helps to prepare your medical team. If they’re prepared, your birthing experience is likely to come off without a hitch.
Does a doctor have to follow the instructions on my birth plan?
No. The doctors and midwives are the authority figures. They have a responsibility to accommodate your wishes whenever possible unless or until the baby requires something different. They will always act to protect yours and your baby’s health even if it means performing a procedure you have prohibited.
The medical team does not have the right to perform unwanted procedures if there is no emergency need for them.
What Should You Include In Your Birth Plan?
What you include in your birth plan is entirely up to you. Details that are relevant for one woman might not be useful for your delivery. Try to be concise; midwives don’t want to be reading reams of writing during labor. Be as clear as possible. Prioritize the details that are most important to you.
Before including any details about where you plan to deliver, discuss the options with your doctor. This isn’t a decision that can be made alone because some deliveries must be performed in a hospital for safety reasons.
If you have permission to plan your delivery outside the hospital in a specialist clinic or at home, specify your preferred environment. Some women use birthing pools in a clinic or at home. Others wish to stay upright and move around for as long as possible. If you’re delivering at home, you might have a preferred room that’s set up for the occasion.
In most cases, the birthing partner is welcome to witness all stages of delivery unless otherwise instructed by doctors. If this is not what you want, be very clear about it so the medical staff doesn’t assume. Make sure they know if the father or any other individual is unwelcome in the room.
If there are procedures you want to experience privately, state this in your birth plan. If emergency measures are required because a delivery becomes troubled, is your partner supposed to leave or stay in the room? Sometimes, a partner is asked to leave when an emergency occurs and the situation might become traumatic. Would you prefer they stay?
This is an important detail because the assumption is a woman will give birth lying on her back. Some women don’t want this. They prefer to be upright and free to pace, squat and move around the room.
Provided it’s safe for the baby, you can specify where and how you wish to deliver. If the traditional feet in stirrups position is unappealing, you can kneel, stand or squat during the final stages of labor. If you make this clear in your plan, the midwives won’t try to move you into certain positions.
This is arguably the most divisive issue in a birthing room. So, why not make your wishes patently clear by including them in your birth plan. If you do not want gas and air for pain management, state this. The midwives will not offer it to you unless they believe it’s a necessary part of keeping the baby safe.
Include details on alternative pain management methods you would like to try. For instance, you could have your partner massage your shoulders and abdomen in the early stages of labor. Some women use acupuncture needles. Other women listen to special music to help them relax and breathe through the pain.
It’s useful to state your preferences regarding the epidural as well. If you do not want one, include this in your plan. Don’t forget, a birth plan isn’t a binding document. You are always free to change your mind. The birth plan is simply there to avoid confusion and help your medical team give you a comfortable experience.
Midwives sometimes give women hormones or even use a manual technique to accelerate the speed of delivery. This is normally done when a patient has been laboring naturally for a very long time and is at risk of becoming overly tired.
If there is no medical need for induction – sometimes, it is absolutey necessary for a safe delivery – you don’t have to accept one. It is up to you to continue or speed up the labor provided your baby is in no danger. If you do not wish to be induced unless medically necessary, put this in your birth plan.
Most hospitals allow birthing mothers to bring in personal items from home (within reason). Some commonly requested items include yoga balls, beanbags and portable stereos. Including these details in your birth plan is a way to ensure they’re expected and accommodated for.
For example, if you want to bring a stereo and listen to music, the staff might need to place you in a room away from other patients. It gives them plenty of time to provide the things you need for comfort.
Women preparing for vaginal births must make sure their preferences on episiotomies are extremely clear. While sometimes performed as an emergency procedure when a baby is distressed and unsafe, they are more commonly used as a preventative measure. The episiotomy creates a surgical incision between the vagina and anus during deliveries with a likelihood of tearing.
The purpose is not to stop an opening from being created but to ensure it is a clean, well formed wound that can be easily repaired. If you would rather take your chances and avoid the episiotomy (except in an emergency), state this very clearly. If it is in your birth plan, the medical team should not perform this without your express permission.
The vast majority of women prefer to touch their newborn child as soon as possible after delivery. It’s the norm but it doesn’t have to be your experience of birth. You can ask the midwife to wash your baby and wrap them in a blanket before they are handed to you.
It will be assumed you want physical contact immediately (provided you’re well enough). Informing your medical team of any deviations from the ‘norm’ is very important. They’re not mind readers. They can only provide the things they know about.
It’s common for trainee midwives, nurses and doctors to be present in birthing rooms. Sometimes, they merely observe. Other times, they may perform parts of the delivery or associated procedures under the strict supervision of a fully trained professional.
This is an important part of a trainee’s learning. They need some hands on experience to develop into a skilled professional. However, you are under no obligation to allow this. If trainees are not welcome in your birthing room, make a note of it in the plan.
What Is a Birth Plan?
A birth plan is a one-page document that lists your preferences and requests for delivery. They’re more often associated with traditional births, but only because scheduled cesareans tend to involve discussions with medical teams that cover much of the same ground.
Natural births can be a lot more chaotic, noisy, and unpredictable. There may be fewer opportunities to communicate requests to medical staff verbally. Handing over a prewritten plan is a quick and easy way to communicate when contractions are intense, and you can barely remember your name.
Things to include are preferences on where you will deliver (what type of environment), whether you want pain relief, whether you’re happy for doctors to use forceps or ventouse, who is permitted in the delivery room and what degree of exposure you can handle in the event of an emergency C-section.
You can also include requests not directly related to the delivery itself, such as your preferences on immediate contact, breastfeeding, and gender reveal. For instance, some couples do not want a midwife to be the first person to announce their baby’s gender. It’s precisely the type of detail you need to state very clearly.
It should be noted a birth plan has no legal authority. Your wishes must be respected, but medical staff can and will disregard them if they are unsuitable for the circumstances. For instance, if a birth plan specifies no forceps, the doctor can still use them if the delivery becomes troubled, and the baby needs to be birthed as quickly as possible.
Your birth plan is an agreement to follow your wishes when safe to do so. Ultimately, the medical staff always has the final decision.
Do I have to write my birth plan in a specific style?
No. It can be submitted in any format you like, provided the instructions are clear and legible. You’re advised to type your birth plan to make sure there are no issues with unclear handwriting. This is the only recommendation on style or format.
There are various types of birth plan, including natural (vaginal), surgical (cesarean), home, twins, etc. The right type for you depends on your circumstances. Don’t forget a plan can encompass more than one type of birth. Many women preparing for vaginal births include details relating to c-section delivery just in case plans change.
What do I do with my birth plan when it’s finished?
Ideally, you’ll finish writing your birth plan with plenty of time to spare. That way, you can discuss it in detail with your doctor, doula, and midwives. These discussions may lead to alterations as you discover what is and isn’t possible for your delivery.
Edit your birth plan accordingly. It’s essential to listen to the advice of all relevant medical professionals. Once everybody agrees, you can give copies to all members of the birthing team or give one to the lead midwife. Keep a spare copy in your hospital kit for emergencies.
On the rare chance, your regular doctor cannot deliver your baby, you’ve got a copy of the instructions to hand to the replacement doctor.
Can I use the same birth plan for two different deliveries?
Yes, it’s entirely your choice to do so. Though, it’s worth extensively reviewing any old birth plan that might be recycled for a new delivery. The details included must suit your needs right now. If they haven’t changed since your last birth, there’s no need to make edits. Just make sure all details are relevant and suitable for this new experience.
Second and third deliveries are a great opportunity to scrutinize what you did and didn’t like about the birthing experience. If you had an adverse reaction to a particular treatment, you could reject it this time around. If you felt uncomfortable lying on your back, you can try an upright position for your next birth. Make the plan work for you.