Whether it’s your first, second, third, or eighth pregnancy, you will probably have an idea of how you would like your labor and delivery to be and the kinds of interventions that you do and don’t want for you and baby.
The way to communicate your wishes is in the form of a document called a birth plan.
Your ob-gyn or midwife will discuss your birth plan with you around the start of your third trimester and help you get ready to put some solid plans into action for when the big day arrives.
It’s a good idea to give some thought prior to this in terms of any specific ideas or requests you might want on the day. Keep a notebook with you and write them down as they come to you, perhaps as you enter your second trimester.
A running list of ideas will help make it easier determine what’s important to you and what isn’t.
Is a Birth Plan Set in Stone?
No. A birth plan is a written guideline of what you would like to happen during labor and delivery. It’s a setting out of your intentions and wishes.
A birth plan is a good way to help plan things out e.g. what you want to take with you, where you want to give birth, who you want to be there with you, as well as any pain relief preferences or wishes about interventions that you have.
The main reason to write a birth plan is because during labor and birth it’s difficult (if not impossible) to make clear, informed decisions. If you’ve considered all the possible scenarios beforehand and done your research you’ll know what you want and it’ll be much easier to communicate those wishes.
You can also change your mind at any point during labor and delivery.
If you suddenly decide you can’t take the pain anymore and you want an epidural it won’t be a problem.
A birth plan is also a good way of organizing yourself and calming any anxiety you might have about labor and delivery.
By planning it out as much as you can you can gain a sense of control and many women find that formulating their birth plan helps to calm down any worries about labor and delivery.
It’s totally natural to feel worried or nervous about giving birth, you wouldn’t be human if you weren’t even a little scared. But the end result is worth the journey.
A birth plan is a good way to ensure that you give yourself as much chance as possible of having the experience you want and that you can look back in years to come without any regrets.
So, what kind of things should you think about when formulating your birth plan?
Decisions to Make as Part of Your Birth Plan
The following list is not exhaustive but does cover the main decisions you will need to make about your labor, delivery and baby.
It might be that you have a specific request that another woman may not even think about. The only advice is to think extremely carefully about your birth plan and get it written down so that your midwives, L&D team and obgyn can see your preferences.
Do your research for each item. Then read over it a few times to ensure you’ve not forgotten anything.
If you have, don’t worry, you can always add to it at a later date.
1. Where do You Want to Give Birth?
Would you like a home delivery? Would you prefer a birthing center or hospital as your delivery location? Is there another location you would prefer, perhaps a family members home?
There’s a lot to weigh up if you’re thinking of a home birth or hospital birth so make sure you do your research and consider the pros and cons of the various options.
2. Who Will be With You?
Depending on where you live you may only allowed one other person in the birthing unit room with you. Other places will allow two or sometimes more. Make sure you ask before the big day.
Who do you want there?
Do you want your partner there? Your mom? Or do you want someone else?
Do you want them to take turns being there with you?
If you are having a home delivery, do you want your other children to be in the house at the time?
You also get to choose who will NOT be with you. Sometimes mothers and mothers-in-law desperately want to be in the delivery room with you, but if you don’t want them there then say so.
It’s so important that you feel as safe, comfortable and relaxed as possible during labor and delivery.
Having someone there who you don’t feel 100% comfortable with won’t help at all.
3. What Will You Wear?
This isn’t about fashion but about what you’ll feel comfortable in.
Are you happy to wear a hospital gown?
Do you want take your own clothing and labor in that for as long as possible?
Would you like to buy a delivery gown of your own?
Some women prefer to labor without any clothing on at all (a big hands up for the nude option here) and others like to wear their underwear.
It’s really what feels comfortable for you.
4. What Items to Take With You?
Do you want to take your own music to listen to whilst laboring to relax and calm you?
Do you want to take a camera, your phone or a video recorder?
Ssome hospitals may not be too happy about recordings at certain times, e.g. if there is a medical problem and may not want images of hospital staff in the pictures.
This is something you will need to speak to the birthing unit or hospital about in terms of what their policy is.
Do you want to take any snacks and drinks with you to give you an energy boost? Eating and drinking to keep your energy levels up during labor is important and many hospitals are finally coming around to the idea that it’s better for mom.
What about some essential oils, massage oil or homeopathic remedies?
5. How do You Want to Give Birth?
This is the big one. Do you want a vaginal birth or do you want an elective cesarean section? What are your feelings about cesareans?
Some hospitals don’t provide elective cesarean sections without a medical reason for doing so such as severe anxiety, previous trauma etc.
This is something to discuss with your midwife or obgyn.
If you want a c-section will you choose a gentle c-section?
5. Methods of Induction
It might be that your little one doesn’t get the memo about leaving the womb at 40 weeks and induction is offered to you.
If labor simply doesn’t happen when expected, or your labor stalls mid-point, you need to think about intervention and how you feel about the options that will be offered so you’re not put on the spot at an important point.
Do you want a stretch and sweep to try to kick start labor?
Will you allow a rupture of membranes, and effectively breaking your waters?
Do you want an induction via a drip which contains synthetic hormone which stimulates labor and brings on contractions?
Would you rather be monitored and wait for baby to come in his or her own time?
It’s worth finding out all about why inductions take place, the methods of induction and how long they might take so that you’re fully informed of your choices if it comes to that.
If induction via pitocin or syntocinon is offered these are 5 important considerations.
6. Do You Want Pain Relief?
Remember, you can change your mind at any time. What are your pain relief preferences?
Do you want to try without pain relief and labor naturally? What about a TENS machine?
Do you want an epidural?
Do you want to try with gas and air?
There are quite a few different pain relief options both natural and medical for you to look into and think about before you make your decision.
7. Do You Want to be Mobile or in Bed
If you opt for an epidural you will need to be on the bed because you won’t have control over your legs. Some other pain relief options may make you drowsy and make it difficult to move around as well.
Otherwise, do you want to be mobile and walk around the room?
Movement helps to speed up labor and keep your contractions strong.
8. Is There Any Type of Equipment You Want to Use?
Do you want to use a birthing pool? If so, you will need to tell your obgyn or midwife beforehand so that availability can be looked into.
Do you want to use a bean bag, or a birthing ball? These are things to think about.
9. What Labor Positions do You Want to Use?
Do some research into positions beforehand and find the ones which you prefer and which are comfortable to you. Do you want to be on the bed with legs up? Do you want to be on all fours?
10. Do You Want to be Monitored?
Depending on the type of birth you’re having you may have a choice whether you want to be continuously monitored or intermittently monitored.
Having said that, if your baby is showing signs of distress, you may not have much choice and will be encouraged to have continuous monitoring
Think about whether you want internal examinations or not or whether you would accept a minimum amount?
11. Managed or physiological third stage
This decision is all down to how you want to deliver your placenta. Do you want to allow your body to deliver it naturally, or do you want intervention to deliver it for you?
The normal procedure in hospital births is to give you a shot of pitocin (called syntocinon in the UK) in your thigh just after baby is born. This helps to expel the placenta quickly.
The important thing to note is that if you have a managed third stage you won’t be able to delay cord clamping. That’s because the cord must be clamped to prevent the drug in the shot reaching baby.
12. What to do With The Placenta?
The placenta is rich in nutrients and some women like to keep it and consume it. This can be done in many ways, and is nowadays often turned it into tablets.
This is called placenta encapsulation and is usually carried out by a doula. If you don’t want to keep it or you don’t specify what you want done with your placenta, it will be taken away as medical waste.
13. Specific Requests at The Moment of Birth
Do you want the moment of birth to be filmed? Does your partner want to see it?
Do you want a mirror so you can see baby’s head emerge?
Do you want to pull the baby out yourself, do you want your partner to catch the baby?
Any specific requests for your baby’s first seconds of life need to be thought about.
14. Immediate Skin to Skin
Most birthing units and hospitals have an immediate policy on skin to skin, so you’ll be handed your baby before they’re cleaned up.
How do you feel about that?
Immediate skin to skin contact is considered to increase bonding between mother and baby, but it is your choice whether you want him or her to be cleaned up first.
15. Delayed Cord Clamping
Some women prefer to choose delayed cord clamping. During delayed cord clamping the cord isn’t cut immediately, and instead is cut when it stops pulsating or when the placenta has been delivered.
This is because around a third of your baby’s blood is in the placenta and cord at birth.
By delaying cord clamping you allow all that blood to go into baby rather than be thrown away.
It’s definitely worth researching the benefits of delayed cord clamping and deciding if you’d like this for your baby.
16. Do You Want Your Baby to Have Vitamin K?
You will have been given information on about the vitamin K injection by your obgyn or midwife and you’ll need to decide if you want your baby to have it.
It’s an injection given to newborns to help prevent serious brain bleeding caused by vitamin K deficiency and is recommended, but it is your choice.
You can choose to go for oral vitamin K instead of the injection or choose to have none at all.
17. Do You Want Eye Ointment For Your Baby?
An antibiotic eye ointment is now routinely given to newborns to help prevent what is known as pink eye or conjunctivitis. Do you want this to happen to your baby or would you prefer them not to have it?
This is something to put in your plan.
18. Do you want baby to be hatted?
In some hospitals it’s routine to put a hat on babies heads as soon as they’ve been weighed and measured after delivery.
If you’d prefer your baby not to have a hat put on their head put this in your birth plan.
It’s an unnecessary intervention and may hinder bonding by preventing oxytocin release.
19. How Long do You Want to Stay in Hospital?
If you have to stay in hospital what is your preference? Many places like you to go home as soon as you can after delivery often as soon as 6 or 12 hours afterwards.
If this is something you’re eligible for because you and baby are both healthy enough to go home, you should mention this in your plan.
Perhaps you would feel calmer if you stayed in overnight, and whilst this can’t be guaranteed, you can request it. Of course, how long you stay in hospital really comes down to your health and that of your baby.
So there we have it. Some big and not so big decisions to make about your labor, your birth and your baby.
These are nineteen items you need to think about when putting together your birth plan, as well as any other items you can think of which are personal to you.
If there is something you feel very strongly about, mention it.