Creating a birth plan: What you need to know

Going into labor and giving birth can be a high-stress experience, especially for a first-time mother. To help ease any anxiety, it’s a great idea to have a birth plan in place before going into labor.

A birth plan is a document that outlines your preferences for labor, delivery and your postpartum experience. It also gives you the chance to be an active participant in your health care and offers you some control of your delivery experience.

Though I notice in my practice that birth plans are most often provided by mothers wishing to have an unmedicated birth (i.e. without pain medication), they’re a great option for any expectant mother. Birth plans are best suited for women with low-risk pregnancies who go into labor spontaneously as they are much less likely to require interventions that may deviate from their birthing preferences.

Some things to consider if you’re interested in creating a birth plan are your preferences when it comes to your labor, such as:

• Who you would like present in the room
• Pain management (i.e. no medication, IV pain medication, epidural)
• Fetal monitoring (this may not be optional depending on physician/hospital policy)
• Pushing and delivery (i.e. coaching from physician/nurse, pushing with urges, watching pushing with a mirror)
• Immediately after delivery (i.e. delayed cord clamping, cord blood donation)
• Care of baby (i.e. immediate skin to skin, breast vs. bottle feeding, rooming-in)

Most importantly, make sure your birth plan includes back-up plans if things deviate from your original wishes. For example, some information you may want to include are preferences you may have related to:

• If an induction of labor is indicated
• If an operative delivery is indicated
• If a cesarean delivery is required
• Visitation – Do you want family in the room right away, do you want time alone with just your partner and baby?

Things that do not need to be included in a birth plan are requests to avoid:

• An episiotomy – this is no longer a routine practice in most hospitals and episiotomies are only performed in special situations
• An enema – again, this is no longer a routine practice
• Shaving – clipping pubic hair is usually only done if a cesarean delivery is necessary

 Writing out a birth plan with your partner may be a great way to get them involved and remind them of the importance of their role as your primary support person during labor. If you’re planning on having a doula during labor, you may want to review your birth plan with them as well.

I also highly recommend writing out your birth plan to share with your physician during one of your routine appointments. I typically review with my patients in the early to mid-third trimester. An open conversation about expectations by you, your partner and the physician can go a long way in making your delivery experience an enjoyable one.

Your physician will also inform you of any hospital policies that may affect some of your delivery preferences (i.e. some hospitals limit how many people may be present in the delivery room, some may not allow video of the delivery, need for IV with heplock versus fluids). It’s possible you may need to make revisions to your birth plan after discussion with your doctor and it’s always a good idea to bring a copy with you to the hospital when you go into labor.

When it comes to writing a birth plan, being concise is best. Ideally, you should limit your birth plan to a one-page document in an easy-to-read format, using key headings with bullet points underneath (i.e. pain management, fetal monitoring, IV vs. oral intake, feeding baby, etc.)  Some hospitals may provide a template for you to fill out.

Lastly, keep in mind that flexibility is key when it comes to birth plans and I prefer to use the term “birth preferences.” Your birth plan may be limited by physician philosophy as well as hospital policy, so it’s important to discuss your wishes early on to make sure you and your provider are on the same page. Additionally, the labor and delivery process is very unpredictable and situations can change rather quickly. It’s a good idea to have back-up plans in mind should the unexpected occur. What would you want to do for pain control if your breathing techniques are not enough? If an induction of labor is required, do you have preferences for methods of induction? What preferences do you have if a cesarean delivery becomes necessary? Thinking about all of these things in advance is a chance to prepare yourself for unexpected changes in your birth plan and to feel empowered about the choices you’ve made should things not go as planned.