Whether it’s your first, second, third, or eighth pregnancy, you will probably have specific wishes and requests that you would like to be accommodated during labor delivery if at all possible. Of course, your number one concern is the safe and healthy delivery of your baby. But it is also your right to have certain requests met if it is both safe for you and your baby and possible at the birth location.
The way to communicate your wishes is in the form of a document called a birth plan.
Your obgyn 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 to strike a few off you’re not so bothered about, and then identify the ones which really hold a special meaning to you. It is these which should be entered into your birth plan.
Is a Birth Plan Set in Stone?
No. A birth plan is a guideline of what you would like to happen during labor and delivery. It’s a setting out of intentions and wishes, but if your doctor or midwife feels that your baby or you are in danger at any point, then intervention may be taken.
For instance, you might write in your birth plan that you want a vaginal delivery, but if your baby is showing signs of severe distress on the day, it may be that you have no choice but to have an emergency cesarean section. The health and well being of your and your baby come first.
Having said that, a birth plan is a good way to help plan the day out for you, 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 you have.
You can change your mind at any point during delivery. If you suddenly decide you can’t take the pain anymore and you want an epidural, when your birth plan mentioned that you didn’t want that, it’s fine, you can have it. Your birth plan is not a legal binding document and should always be approached with flexibility.
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. Do your research. 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 if possible? Would you prefer a birthing center or hospital as your delivery location? Is there another location you would prefer, perhaps a family members home?
Remember, it totally depends on how your labor goes or any risks which might be associated with your labor in terms of if you will get your wish or not. If your midwife and doctor/consultant do not agree with your wish for a home delivery, you would be best to take their advice and book in for a delivery at a hospital birthing unit. Similarly, it might be that you begin laboring at home, but there is an issue and you end up in hospital as a precaution. These are things to be aware of.
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. 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.
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 as far as possible? Would you like to buy a delivery gown of your own? Some women prefer to labor without any clothing on at all 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? Do you want to take any snacks and drinks with you to give you an energy boost?
Remember, some 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.
In addition, if you are taking snacks with you, it might be that you can’t have them if you have complications and need to be nil by mouth for any reason. You can plan, but remember that it might not go according to your actual wishes.
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? Unless you’ve opted for an elective c-section the final call on how you deliver your baby will be down to the midwife or doctor in the room on the day because it all comes down to safety.
Provided everything is going smoothly, as we hope it does, you can choose your delivery method. Some units don’t provide elective cesarean sections without a medical reason to do 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. Do You Want to be Induced?
It might be that your little one doesn’t get the memo about leaving the womb at 40 weeks, and you need to be induced. If labor simply doesn’t happen when it is supposed to, or your labor stalls mid-point, you need to think about intervention and how you feel about it, so you’re not put on the spot at an important point.
If you need to be induced to bring labor on in the first place, do you want a stretch and sweep? Will you allow a rupture of membranes, and effectively breaking your waters? Do you want an induction with an injection of a synthetic hormone which stimulates labor and brings on contractions?
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.
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 regular pain relief e.g. 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 Bed-Bound?
If you opt for an epidural, or need to have one, you will need to be bed-bound. Some other pain relief options may 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 distress, you won’t have a choice and you will be strapped up to a monitor. Aside from that however, you can opt for either choice if things are going well. This includes regular cervical checks and fetal heart monitoring.
Think about whether you want internal examinations or not or whether you would accept a minimum amount?
11. Do you want a 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 do You Want 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? Do you want your partner 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. Do You Want 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. Do You Want Delayed Cord Clamping?
Some women prefer to have a delayed cord clamping, which means that the cord isn’t cut immediately, and instead is cut when pulsations have stopped, or 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 needto 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 not? 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. Do remember however, things can and do go awry during labor, and it is vital that you listen to the advice of your midwife or doctor at all times.