Writing Your Birth Plan

If you’re pregnant, you’ve probably heard about birth plans… but what exactly is a birth plan? Why might you need or want one? And what should be included in one?

We’re going to break that down for you here. We’ll offer suggestions and guidance as you develop your preferences.

A birth plan is a written record of what you’d like to happen (or not happen) when you’re having your baby and your choices - because birth is full of many choices!

Let’s start with the term “plan” and unpack that a little bit. It’s impossible to plan every detail of your birth - birth is a journey full of surprises and even the best laid plans sometimes need a bit of redirection. Because of that, we really like to use the term “goals” or “preferences”. It’s certainly okay for you to call it a birth plan, but just remember to be open-minded about the journey!

Your birth plan is mainly for your midwife/doctor and the nurse(s) at your birth. You’ll want to have this plan written to go over at one of your prenatal appointments in later pregnancy, and also take some copies with you to your birth location. In my experience as a birth doula, I’ve seen many care providers take great care in reading a patient’s birth plan. Oftentimes, the nurse keeps a copy of it in front of the monitors in the labor & delivery room and reviews it during the birth, or when a shift change happens, the nurse taking over reads it as well. Each birth location has unique protocols and procedures, so if any of your wishes are outside of those, you’ll definitely want to add that to your birth plan.

---

Okay, now lets go through some things you’ll want to think about and research to possibly include in your birth plan…

In Labor & Birth:

• IV preferences - Most physicians desire for their patients to have IV access (called a saline lock) in labor, while most midwives do not require or recommend IV access in low-risk, healthy mothers. This is something you will want to discuss with your own care provider. If you do not want IV access, then you will need to put this on your birth preferences sheet. Check out this podcast episode from Evidence Based Birth for more information.

• Intermittent monitoring - Evidence shows that continuous monitoring in labor 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. Check out this article from Evidence Based Birth for more information.

•Eating and drinking in labor - Most midwives encourage eating and drinking in labor (especially for low-risk, healthy mothers) while many physicians will not approve of solid food once a mother has been admitted to the hospital (usually they are okay with a ‘clear liquid’ diet which generally consists of broth, fruit juice, popsicles, water, and clear soda). It is important for you to educate yourself on the benefits and risks of this and make your preferences known on your sheet. Check out this article from Evidence Based Birth for more information.

•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 an epidural. You can always just state that if you need pain medication, you will be the one to initiate that conversation. Learn more about pain medication from Evidence Based Birth (IV opioids here and epidural here).

•Pushing preferences - 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? Oftentimes, this comes down to what the care provider is most comfortable with doing. Midwives will typically encourage the mother to push in whatever position is 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 before labor. Check out this article from Evidence Based Birth for more information on pushing positions. You also have options when it comes to being coached through pushing. Some mothers prefer to let their bodies direct their pushing and go with their instincts, while other mothers can feel ‘out of control’ when pushing and prefer helpful direction from their care provider. Check out this article from Midwife360 for more information about spontaneous vs. coached pushing.

•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, but you should share this preference on your birth plan if it’s important to you.

•Pitocin - How do you feel about the use of Pitocin in labor? Pitocin is a synthetic form of the oxytocin hormone. Pitocin is often used during inductions, but can also be utilized during a natural labor if contractions space out or stall. There are other options for progressing labor before the use of Pitocin, so including your preferences for Pitocin on your birth plan can be a good idea if you’d like to avoid it. Additionally, most care providers give a standard dose of Pitocin intramuscularly into the thigh muscle post-delivery (unless you’ve had Pitocin through your IV during labor, in which case they usually just leave it running until after the delivery of the placenta). The purpose of the standard dose of Pitocin is to prevent postpartum hemorrhage. Check out this article from Evidence Based Birth on the use of Pitocin during the third stage of delivery (delivery of the placenta).

Postpartum:

•Delayed cord clamping - Everyone knows that delayed cord clamping is important. But each provider practices a different amount of time for delayed cord clamping. Many physicians clamp and cut around 30 seconds after birth, while some midwives wait minutes. 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 and has turned white? Talk to your care provider about what they typically do and your preferences. This is a good discussion to have prenatally. For more information on delayed cord clamping, check out this Committee Opinion by The American College of Obstetricians and Gynecologists (ACOG).

•Vitamin K shot/Erythromycin/Hep. B vaccine - All of these are standard to be given to your baby at the hospital. If you do not want them for any reason, you’ll want to include this in your birth plan. Here is more info on each: Vitamin K shot, Erythromycin, Hep. B vaccine.

•Baby’s first 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. For more information, check out this Position Paper by International Childbirth Education Association (ICEA).

•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 Placenta Encapsulation Specialist about the procedures at your hospital for placentas. Either way, if you want to keep it, state this in your birth plan.

•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 (especially if your baby needs to go to the NICU), 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.

•Circumcision - If you are having a baby boy, you’ll have the important decision to make of whether or not you’d like to have a circumcision performed. Check out this article and podcast from Evidence Based Birth on circumcision.

C-Section:

•Support people - Who will go to the operating room with you? Will it be your partner? Your doula? Both? Consider who you want with you and also check to see what your hospital’s policies are on this.

•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 in their first moments outside of your belly through the clear drape. Many moms love this – but you need to ask about it ahead of time so they can set it up.

•Skin-to-skin - As long as your baby’s vitals are stable a few minutes after birth, you should still be able to establish skin-to-skin in the operating room. Be sure to ask your nurse to help you initiate this. If you don’t feel stable enough to start skin-to-skin before your surgery is over, we highly recommend that your partner establishes skin-to-skin until you’re able.

• Music and smells - Most of the time in the operating room, the staff is happy for you to play your own music (partners, take note - bring your phone for this). You can also have your partner carry a bottle of essential oil for you to sniff if you start to feel nauseous - peppermint can be great for this.

---

Some additional things to consider when writing your birth plan:

•In the event your baby needs to go to the NICU following a vaginal birth or c-section, do you want your partner to go with your baby or stay by your side?

•Keep your birth plan short and concise - no more than 1 to 2 pages in length.

•Utilize bullet points to make things clear and simple to read.

•Make sure you are properly educated in your choices - if you are choosing to decline something that is standard, know your “why”.

---

Here is an example of a simple birth plan outline:

John + Mary’s Birth Preferences

Our goal is to have a totally unmedicated birth. We understand that things may happen outside of our control, but before intervention takes place, we would prefer to discuss options whenever possible. Thank you for your support and kind attention to our wishes. We look forward to sharing the birth of our baby with you all.

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 prefer no labor augmentation or artificial rupture of membranes unless agreed upon with my midwife.
•I prefer as few cervical exams as possible, and only with permission.
•I am aware of my choices for pain medication. However, please do not offer me any. I will ask for it if I want it.
•I would like to push in whatever position is most comfortable for me.
•No students in the room, please.

Postpartum:

•Please allow the cord to stop pulsating and turn white before clamping. I'd like to feel it before it is clamped and cut. I would like for my husband to cut the cord. 
•No erythromycin for the baby.
•I am planning to have my placenta encapsulated - I brought a cooler for it to be placed in on ice after birth.
•I want to breastfeed exclusively.  Please ask my permission before supplementing.
•No bath for the baby in the hospital - I will do this when we get home. 
•We do not want to have our baby circumcised.

C-Section: 

•I would like my husband and my doula to accompany me to the operating room.
•I would like a clear drape, please. 
•I would like to establish skin-to-skin with the baby as soon as possible. If I an unable for some reason, I'd like for my husband to establish skin-to-skin until I am able.

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. Although this is a good option to include in the event of a c-section.

• 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.

The most important thing to keep in mind when putting together your birth plan 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.