(reading time ~9 minutes)
This article will discuss "How To Make The Best Labor And Delivery Birth Plan?" I suggest this be a combined effort between mom and dad. This important document can help you stay on the same page and is also an opportunity to bond together. See also, "How Can You Be A Supportive Dad During Pregnancy & Labor?"
I'm confident you and your partner will find consensus on most labor, delivery, and postpartum preferences, and where there's a tie, the decision goes to the mom. After all, it is her body, and she is the one giving birth.
Once it is written, you will need the physician's or midwife's feedback on it for your revision.
What Exactly Is A Birth Plan?
A birth plan is a guide that communicates to your medical care team your best hopes and preferences for your birthing experience if everything goes according to plan. This may include any choices that help make your labor, delivery, and postpartum care more successful, comfortable, or memorable.
A birth plan is not a legally binding document. It is an expression of your best plan and most pressing concerns, which may change throughout the course of labor and delivery. Some doctors will invite you to fill out a birth plan. Others will be happy to oblige you if you volunteer it. Or will they?
Physicians Who Discourage Birth Plans
Many physicians are now discouraging patients from including a birth plan in their file primarily for two reasons:
- No one can predict how your term of labor and delivery will proceed. Some physicians liken it to stating your weather preference for the day of a wedding.
- Many birth plans are written in more of a demanding voice than a preferential tone. Keep in mind the role of the doctor or the midwife.
State A Birth Plan In Terms Of Preferences
Some patients may dictate, "Don't induce labor." "Don't offer me an epidural." "Don't formula feed the baby." See where this is going? It's not your place to give the doctor instructions, and a doctor or midwife isn't at liberty to deny you options.
So do not include the word "don't" in your birth plan. Instead, write for instance, "My preference, if possible, is to..." That way, no one is offended or turned off to help you.
So state medical interventions as your preferences. "I would like to labor without medications for as long as possible." "I understand emergency interventions must be acted on immediately, but please explain non-emergency interventions to me before undertaking them."
Keep Your Birth Plan Terse
Some birth plans are written with such detail as to lose their viability as a helpful document. They're too long to be taken seriously. They won't be remembered and tend to be ignored. Some doctors may be concerned you have rigid ideas that will get in the way of their medical care.
Flexibility And Your Birth Plan
This brings us to a birth plan's most important aspect – flexibility. Nothing is set in stone. Your wishes are only preferences. It's imperative to be willing to revise your plan if things don't go as hoped for or if complications arise.
Sixteen hours into labor, the picture you initially painted may change. If a fork in the road comes, always be prepared to take the wisest path.
For example, one study found that 50% of women with birth plans did not want an epidural, yet 65% received one. Of those that did, 90% were glad they did. So flexibility is the name of the game.
When Should We Write A Birth Plan?
Consider what to include in your birth plan during the second semester, and write down your birth plan as early as possible during the third trimester. Your prenatal birthing classes will help you to formulate ideas. See also "Benefits Of Prenatal Birthing Classes."
Be Realistic About Your Birth Plan
Your plan is individual to you. It depends upon your medical history, what your practitioner will accommodate and what is available at your maternity service. That's why it's essential to go over your plan with your medical personnel to determine what will be allowed and accommodated.
This brings us to two side notes that will frame your thoughts and preferences about your birth plan – specifically, who will be delivering your baby and if you are hoping for a vaginal birth or C-section.
A Word About Physicians Vs. Midwives In The U.S. And Abroad
A primary decision to make is whether to be attended to during delivery by a physician or midwife.
Both an OB-GYN and a midwife practice evidence-based care and favor healthy, vaginal births whenever possible. It's important from the outset to consider which type of care provider best matches your style and vision for delivery.
Midwife-attended births have been shown to be as safe as those attended by a physician. Midwife deliveries are also associated with lower rates of C-sections, other interventions, and generally better outcomes.
Midwifery-attended births, however, still remain in the minority of maternity care in the U.S.
In one study, a full 90.6% of deliveries in the U.S. were attended by physicians, whereas certified midwives or certified nurse midwives attended only 8.7%. The story is different in the U.K. and many other countries where midwives attend over 2/3rds of births.
A Word About Previous C-Section Deliveries
If you've had a cesarean section with a past pregnancy, don't assume that you have to do the same this time around.
You may be better off choosing to deliver vaginally. Up to 90% of women who try a vaginal birth after having a cesarean section, which is called a VBAC, have successful vaginal deliveries. Talk with your obstetrician or midwife to see if VBAC is a good option for you.
Is It Necessary To Create A Birth Plan?
No, your care provider team is getting to know you and will anticipate most of your preferences. But there are many good reasons for drafting a birth plan nonetheless. Most importantly, preferences will be better understood by yourself and your healthcare providers.
Sitting down, thinking, and discussing a plan with your partner can help you focus and understand what's most important to you. It can also help open up better communication between you and your maternity care providers.
A Good Birth Plan Builds Confidence
Allowing you and your partner to express your preferences helps you feel more on top of your upcoming delivery.
It helps to minimize disappointment by heading off any unrealistic expectations you may have. And it paves the way for a better birthing experience by minimizing miscommunication between you and your labor and delivery team.
Having a birth plan can be particularly important in a large practice, where you may never have met your delivering physician. He or she may have little idea what your birthing preferences are.
Working on a plan with your partner can also make him feel more a part of things and more comfortable playing an advocacy role for you on the big day.
What Is The Proper Form To Write A Birth Plan?
There isn't one. Some plans follow a formal template, and others are written more freestyle. Click here for an example of a birth plan template. My advice is to use it as a springboard to writing your own, terse birth plan.
What Should A Birthing Plan Contain?
A good birth plan should convey a sense of who you are and what's most important to you. This helps motivate the hospital staff to pull for you.
Make Your Birth Plan Brief
It should not be too long, so it's easy for physicians and other healthcare providers to read. One page is a good length, and bullet points are an effective way to communicate clearly.
Make requests that are easy for medical personnel to read. You don't want to alienate people with informational overload. A birth plan is a blueprint of what matters most to you. So prioritize and look at the broad strokes.
Highlight a few options you want the most and leave the details of how to accomplish them to your care team. You might say, for instance, "I would like to have a birth with as few medical interventions as possible." Or, "It is my preference for labor and delivery to go as quickly and painlessly as possible." The broad strokes.
Keep it terse. If you know medical personnel will have no problem with some of your requests, these really don't need to be communicated.
Think of your birth plan as a birthday wish list. If you list 60 items, you're not going to get them all. Your reader will most likely lose interest. Instead, pick out the highlights most important to you or perhaps those you know are the most controversial.
You can figure that all of the usual stuff or the things you don't have a preference about don't need to be discussed. You will be provided with most options as you go along anyway. Pick what's most important to note.
The idea is to make your birth plan user-friendly for your medical team. One page that can easily be read and absorbed.
So you don't need to note customary options that you know will be asked over time, such as if you want your baby to room with you at all times or sometimes brought to the nursery so you can sleep, or if you want your boy to be circumcised. Again, the idea is to keep your wish list terse.
Having said that, I'm going to give you over a page of things to think about, but remember to streamline, keep in mind the broad strokes and pick your preferences (or battles) carefully.
The Birth Plan
The following are some items you may want to touch on briefly in your birth plan:
- Depending on its relevance, you may or may not want to mention mom's current health factors such as gestational diabetes or preeclampsia that could impact delivery. You may also want to give a thumbnail sketch of any past pregnancies and how the deliveries went.
- Who will you have with you during labor and delivery? Your partner, who may also be your birth and labor partner? A doula, which is a professional birthing coach to provide emotional and physical support? Any friends, family, children? There is likely to be a limit as to how many can attend.
- Do you have a preference for being out of bed during labor? (Intermittent fetal monitoring allows for moving around during labor. Continuous monitoring usually requires you to stay in bed.) How often would you like the baby checked? Or you may want to leave this up to your physician or midwife.
- Would you prefer to be able to eat and drink during labor?
- Would you like to wear your own clothing?
- Would you like your support person to take photos or videos of labor and birth?
- What about using dim lighting, scented candles, or incense? Or aromatherapy with lavender, peppermint, and other soothing smells?
- Would you like to have any special equipment available, such as a tv, exercise ball, shower, TENS unit, birthing stool, or birthing tub?
- Do you have a strong preference regarding positions for labor or giving birth?
- What preferences do you have concerning pain medications? Are you planning on an epidural, or are you hoping to avoid one? What about intravenous narcotics?
- Have you a preference for non-traditional, non-medicated pain management such as acupressure, guided meditation, reflexology, or a technique called hypnobirthing? (Hypnobirthing relies on positive affirmations, breathing techniques, and visualizations to relax the body and overcome pain.)
- Would you like non-emergency medical interventions to be discussed with you?
- Would you like your room as quiet as possible, or would you prefer soft music? Would you like music playing while you give birth? Will you be providing the music?
- Would you prefer a water birth, which is giving birth inside a shallow tub of warm water? Is that an option at your facility?
- Would you prefer delivery on a birthing bed or a birthing chair?
- Have you a preference for vacuum extraction or forceps to assist in the birth?
- If necessary, have you a preference for an episiotomy or natural tearing?
- Would you like to have your partner help catch the baby?
- Although it may be argued that delayed cord clamping (for 1-5 minutes after birth) should be practiced everywhere, you can state your preference for it.
- Would you prefer for your partner to cut the umbilical cord?
- Would you prefer to bank, donate or have the cord blood disposed of? (Banking the cord blood is costly, and the AAP, American Academy of Pediatrics, suggests donating it to a public cord blood bank.)
- Would you like your baby placed on your abdomen immediately following delivery for skin-to-skin bonding?
- Would you like to delay any newborn procedures, such as being weighed or administered eye drops, until after you and your baby get a chance to "greet" one another?
- Do you wish to breastfeed immediately? Would you like a lactation consultant there to help?
- What would you prefer to feed your baby? Breast-milk only, formula, or a combination? See "Is Breast Feeding Or Formula Feeding Better For your Baby?"
- How would you like to deliver the placenta? Do you want to keep the placenta to take home?
- Is it okay for staff to offer the baby a pacifier?
Discuss Your Birth Plan With Your Obstetrician Or Midwife
Creating a birth plan can be a springboard for discussion between you and your practitioner, especially if you're not sure if your healthcare provider will be on board with some of your birth preferences.
Let her know that you've done a lot of thinking about preferences that are important to you and which you would like to discuss for her input. She may not be receptive to some of your ideas. She may view your list as being too demanding or increasing certain risks.
Your care provider will be able to let you know what may not be possible and what does and doesn't align with her or the hospital's or birthing center's policies. Listen to the input you get from your healthcare practitioner and update your birth plan accordingly.
Consider making an appointment with the labor and birth department at your hospital or birthing center to review your plan for compliance with their regulations.
Keep in mind, too, that if you like, you can request to spend time in an empty labor or birthing room to become more familiar with what to expect and gain an added perspective on your birth plan.
Once your birth plan is finalized, give a copy to your doctor for your records and another copy to the hospital or birthing center for your chart.
I hope you have found this article helpful, and I welcome your comments.