Are you ready to create your birth plan? As an L&D RN I’ve seen a LOT of different birth plans. I’ve seen the positive experience they can provide, but also the way they can set some women up for disappointment.
One thing that’s certain, I DO recommend creating a birth plan before giving birth.
Overall, I see birth plans as an empowering tool that gets mamas researching and thinking more about birth before it happens!
Just like good childbirth education, the process of creating a birth plan helps eliminate some of the fear and anxiety surrounding birth because it erases a bit of the unknown.
Ready to dive into the ins and outs of creating a birth plan, different types of birth plans, and things to consider as you create yours? Let’s go!
The caveat to birth plans
There is a pretty big caveat I like to say surrounding birth plans—don’t let them be the downfall of your positive birth! A birth plan should be something you think of more as your “birth wishes”.
It’s a chance for you to reflect on what you think you want, and what you think you definitely don’t want.
Try your best to let it be flexible! It’s impossible to know how your unique birth will progress. Setting yourself up with a rigid birth plan and then having things go differently can set you up for disappointment and a more difficult birth to process mentally.
I don’t want to see that happen to you!
What is a birth plan?
Okay, so a birth plan is basically a guide or form that lets your provider and birthing team know your preferences surrounding labor, birth, immediate newborn care, and postpartum hospital stay.
It’s a chance to think through your preferences before you’re actually IN labor. It’s meant to get conversations about interventions, pain relief, and newborn care procedures going before the big day.
Birth plans are a way to have your voice heard prior to and during birth so that we (your labor and delivery team) can help you have the best birth possible!
When should I make my birth plan?
You definitely want to have your birth plan completed before you go into labor…but a little bit ahead of that is even better! I recommend starting to think about your birth plan at the beginning of the third trimester.
You don’t have to sit down and complete the whole thing, but looking over some birth plan templates and considerations (like the ones below!) can get the ball rolling and conversations started towards creating a plan you feel good about.
Complete it before you’re full term
Ideally, you should finish your birth plan sometime between weeks 35 and 37, this way you can discuss it in detail with your provider. Then, ask if the birth plan can be included in your hospital pre-registration packet. Some hospitals do this as standard practice, but many will accommodate it if not.
If you are able to hand over a copy of your birth plan early, great! But still, bring a printed back-up copy just in case it gets lost somewhere down the line.
Why is it important to create a birth plan?
On the surface, a birth plan tells your birth team what you want and don’t want to happen during your labor and delivery.
But more completely, here’s why birth plans can be so effective and important:
- Gets you thinking about labor, birth, & newborn care decisions
- Sparks dialogue and questions surrounding labor, delivery, and newborn care
- Helps you visualize your experience
- Exposes you to possible options and outcomes
- Gives you a voice in your birth experience and can help with advocacy
- Provides your partner and other members of your birth team with a source for advocacy on your behalf
- Inspires research on various interventions, options, policies, and norms associated with labor, delivery, immediate newborn care, and your hospital stay after birth
- Creates an opportunity to learn more about your birthing place’s policies and standard care procedures
- Reduces anxiety about birth and creates a sense of control and confidence
- Empowers mamas to take an active role in their care!
What are the goals of a birth plan?
The goal of a birth plan seems obvious. It’s documentation of your preferences related to the birth process. It’s an outline of your wishes and hopes for your birth, but remember that it’s NOT a binding contract.
The most important component of EVERY birth is to keep mama and baby safe. And sometimes, for that to happen, things don’t go according to plan.
But, one thing you can do to have a more positive birth experience, is note 1-2 goals on your birth plan that feel MOST important to you. While this isn’t a guarantee, by highlighting these, your birth team can try to honor some of these wishes even if the overall birth outcome progresses differently than you hoped.
Okay, so what do I mean by this?
Here are a few examples of these bigger picture goals that we can try to honor regardless of how your birth unfolds:
- Always having your partner or birth support person at your side (or as often as possible!)
- Getting to practice skin-to-skin care immediately after birth (if medically safe for baby) – even if this ends up being with your partner
- Initiating breastfeeding within 1-2 hours after birth
- Inclusion and consultation in care decisions whenever possible (barring emergency situations, of course)
Do you see what I mean? Many of these can be upheld whether you labor unmedicated, get an epidural, need labor augmentation, an unplanned C-section, or anything in between!
What type of birth interests you?
One of the first steps to creating a birth plan is thinking through what TYPE of birth you want to have. While you don’t HAVE to decide this ahead of time, it can inform your birth plan (and necessary preparations before birth) quite a bit.
Let’s take a look at the options:
- Natural Birth/Unmedicated Birth: Natural birth is widely accepted to mean birth without an epidural or C-section. And for some, it means without any medical interventions (100% all-natural pain management strategies).
- Birth with an Epidural: If you already KNOW you don’t want to deal with any kind of labor pain, or need an epidural for medical reasons, then it’s best to plan and prepare for birth with an epidural. Epidurals are not bad. I repeat, epidurals are not bad! In fact, a TON of mamas think they’re totally amazing!!
- Planned C-section: By now, you may already know that you will need a C-section for a medical reason. Or it’s something that may come up as your pregnancy progresses. Things like placenta previa, breech positioning, and twin pregnancies can all require scheduled C-sections for your safety
- VBAC: If you’ve had a past C-section and are hoping to have a vaginal birth this time around, I want you to rock this mama! Because it’s totally possible! You’ll need to learn a bit about what this entails, but also decide specifics about your VBAC and pain management.
Okay…so now let’s look at some birth plan specifics for different types of birth!
Epidural birth plan
Here are some key components to writing a birth plan that includes an epidural:
- Upon admission to the hospital, how long are you imagining you’ll go without an epidural? For example, do you want to go as long as possible or are you hoping to remove pain ASAP? This will help your birth team know when to evaluate you for getting an epidural in place
- Because an epidural can take about an hour to get in place from the time it is requested, how do you want to labor during that time? What other interventions are you interested in?
- What atmosphere do you wish to maintain during labor?
- Who will be joining you in the labor and delivery room?
- Note that you’d like to emphasize positional changes once your epidural is in place; this can significantly move your labor along but you’ll need your nurse to help you!
- Include preferences for the event of an unplanned C-section. It’s better to prepare so that you aren’t taken completely off guard if this becomes necessary
Don’t forget, you probably won’t be getting an epidural placed until you are 4-6 cm along…let’s go over some natural pain relieving strategies for the early active labor stage.
Related: 12 Epidural Facts You May Not Know
C-section birth plan: Gentle C-section plan
For many of you, a C-section is a far cry from the birth you’d hoped for, but taking steps to have a gentle cesarean, also known as a family or mother-centered cesarean, can make for a MUCH more positive experience.
The idea is to take steps that will help the event seem less like a surgery and more like a birth:
- It will put an emphasis on mama being an active participant in the process
- The goal is getting baby to mama as quickly as possible after the birth, like with a vaginal birth
- The healthcare team can take small steps to make it easier for mama to hold baby as soon as possible
- Everyone involved is aware of making the atmosphere feel more calm and peaceful
While gentle cesareans are becoming more popular, in most cases it’s still something that you need to discuss and request and will not just be “the norm”.
My top tips for making your scheduled C-section feel more like a birth and LESS like a surgery:
- Request an epidural or spinal block so that you are awake during your C-section and only numb from the nipple line down (this is USUALLY the norm in planned cesareans, but still worth confirming)
- Ask about a clear drape so that you can see baby as soon as they enter the world!
- Let the team know you’d like to do skin-to-skin while your incision is closed up instead of waiting to leave the OR
- Note that if you are unable to do skin-to-skin for medical reasons that your partner will take your place to do immediate skin-to-skin
- You can still opt for delayed cord clamping if medically safe for baby, and see if your partner can cut the cord
- Newborn care procedures can be delayed to promote a golden hour after birth
- Ask if music can be played to create a calm atmosphere
- Request as minimal talking as possible to promote a calm and tranquil birth
- Talk about having IVs, blood pressure cuffs, etc. placed on your non-dominant arm to make holding baby easier after they are born
Natural birth plan
Here are some things to include on your natural birth plan:
- Use of pain medications: just no epidurals, no to any medical pain interventions? Consider narcotics and nitrous oxide in this decision
- What language do you want the team to use surrounding medical pain relief options? Will you tell them if you want it, do you want to be reminded of options, do you not want it mentioned at all?
- What pain relief strategies DO you want to try. List any and all strategies that interest you. Keep in mind that water is a POWERFUL pain-coping tool for natural birth
- Opt for limited cervical checks: too frequent of checks don’t have much benefit and constantly knowing your “progress” can have an undesirable effect on your mental focus
- Requesting the use of intermittent vs. continuous fetal monitoring will probably allow you to focus and relax better during labor
- What do you want the birth environment to be like? Usually more relaxed is better. Note that you prefer low lights, privacy, music, etc.
- Opt for natural tearing vs. episiotomy (learn about the two in this article!)
- Be sure to include preferences in the event of an unplanned C-section. It’s better to prepare so you aren’t taken off guard
Creating your birth plan: What to include
Alright, so now that you know some birth plan specifics for different types of birth, let’s take a detailed look at the specifics.
This is meant to serve as a detailed birth plan template, inclusive of all different types of births and desires.
While the above questions were meant to get you thinking in specific terms, I recommend all mamas use the following guide and questions when planning their birth!
- You and your partner’s names, address(es) and telephone numbers
- Due date
- Provider’s name
- Emergency contact
- Note any relevant pre-existing conditions
- GBS positive or negative
- Note if baby’s gender is known or unknown
- Vaginal birth
- Scheduled induction
- Planned C-section
- Water birth
- Formula feed
- Who will be in the room with you during labor?
- Who is your main support person?
- Will you have a doula?
- Lighting preferences? (low/dim light, natural light if possible, regular lighting is fine)
- Sound, music and other media preferences
- What is the general atmosphere you’re hoping for during delivery (calm and relaxed, upbeat and positive, hands-on, more quiet and private?)
- Photography and video plans (your hospital/birth center may have a policy on photography and video during delivery, so be sure to check with them beforehand)
- Would you like to eat or drink during labor if possible? Is this allowed?
- Can you use candles or essential oil diffusers in the labor room?
- If there are different types of labor rooms, which do you prefer? (some hospitals have labor rooms with different features and amenities for example labor tubs vs. hydrotherapy showers)
- In regards to hands-on labor support from my nurse or provider:
- I definitely want this!
- I’m open to this, but will let you know if I’m uncomfortable
- I definitely don’t want this
- Would you like to limit the number of hospital staff in the room if possible? Are you open to student nurses, midwives, or practitioners observing or participating in your labor and delivery?
Medical pain management for labor
- What are your plans for epidural use?
- Definitely NOT interested
- Maybe interested
- Definitely want one!
- What other medical pain management options are you interested in?
- Nitrous oxide
- Pudendal blocks
- How do you want your birth team to discuss and present medical pain interventions?
- Don’t bring them up unless I ask about them directly
- Actively deter me from medical pain interventions by suggesting non-medical coping strategies to help me achieve an unmedicated birth
- Mention and educate about options so I know what’s there
- Regularly discuss and suggest medical pain interventions to keep my options open
- Plan for pain interventions and discuss them from the start
Non-medical pain relief strategies
- What non-medical pain relief strategies am I interested in?
- Breathing techniques
- Labor tub
- Counter pressure/massage
- Position changing, and suggestions to change position at least every 30 minutes
- Regular position changing with an epidural
- Laboring on the toilet
- Walking around
- What labor positions am I interested in?
- Hands and knees
- Birthing ball
- Laboring backward on a chair
- Laboring on the toilet
- Standing, leaning over a chair or bed
- Standing draped over partner
- “Slow dancing” with partner
- Hands and knees leaning over a birth ball
- “Child’s pose”
- Side-lying, supported by pillows
- Side-lying with pillows or peanut ball between your legs – with epidural or not
- Whatever feels good!
- I’d like my birth team to actively suggest non-medical labor strategies and ideas
- I’d like my birth team to actively suggest position changes if I’ve been in a position for too long, or I’m not progressing
Ways my partner can support during labor
- Counter pressure
- Birth affirmations
- Help with changing positions
- Suggesting pain relief options (medical/non-medical)
- Offering lip balm and sips of water/ice chips
- Closing the door of the room if it’s left open
- Helping with mom’s lighting and sound preferences
- Asking questions and advocating on mom’s behalf
Other important preferences for labor
- I would like to avoid a planned induction for as long as possible and is safe for me and baby. Spontaneous labor is my goal
- I would like an elective induction as soon as possible and is safe
- I am interested in these induction methods:
- Membrane sweep
- Foley bulb
- Rupture og membranes
- Prostaglandin gel
- If my labor stalls, I am interested in the follow labor augmentation methods
- Rupture of membranes
- Going for a walk/movement
- Nipple stimulation
- Doing the miles circuit (a series of positional changes/movements to start or re-start a stalled labor)
- I would like to use medical intervention to augment labor at any sign of a stall
- I would like to use non-medical interventions/natural methods to augment stalled labor for as long as possible
- I am open to suggestions about labor augmentation
- I’d prefer to avoid labor augmentation unless baby is in distress
- I would like cervical checks as often as possible
- I would like as few cervical checks as possible
- I would prefer not to have any cervical checks if possible
- If/when you do cervical checks…
- Tell me my progress/dilation
- Tell me a range, or note my progress without specifics
- Do not tell me my progress/dilation
- If possible, I would like things explained to me in as much detail as time and safety allow
- I would like my partner to stay with me during the procedure
- I’d like the drape to be lowered so that I can watch baby be delivered, if possible
- I’d like to engage in immediate skin-to-skin, if possible
- If baby needs to go to the NICU I’d like my partner to go with baby
- I’d like my partner to immediate hold baby after birth and do skin-to -skin if I cannot
- I’d like baby to stay with me during recovery, if possible
- I’m interested in continuous fetal monitoring
- I want to avoid fetal monitoring as much as possible
- I would like intermittent fetal monitoring
- I only want fetal monitoring if there are signs of distress
- I would like an IV placed with a saline lock, just in case it’s necessary
- I do NOT want an IV placed until it is deemed necessary
- I would like an IV in my non-dominant arm
- I would like an IV in my arm, not my hand
- I do not have strong preferences surrounding IV use and placement
Pushing and birth preferences
- I’m interested in guided pushing
- I’m interested in open glottis pushing (pushing based on the urge to push!)
- I’m open to suggestions surrounding pushing
- I’m interested in trying different pushing positions
- I’d like to push as long as possible, as long as baby isn’t in distress
- I am interested in using a mirror to see baby’s head while I’m pushing
- I’m interested in feeling baby’s head crowning while I push
- I’d like my partner’s support while I push
- I’m interested in a warm compress applied to my perineum while I push to help prevent tearing
Episiotomy and tearing
- I want to avoid an episiotomy at all costs, even if it increases the risk of tearing
- I’d like an episiotomy to avoid tearing
- I’d like to discuss episiotomy vs. natural tearing
- I trust my provider’s judgement surrounding episiotomy
- If I tear, I’d like my provider to check in about pain relief before stitching me up and discuss treatment options
Immediately following birth
- I’d like to delay all newborn care procedures (including weight) until after skin-to-skin/first feeding
- I’d like newborn care procedures to happen immediately, then begin skin-to-skin care
- I’d like to breastfeed within 1-2 hours of birth
- I’d like to give my newborn the opportunity to do the “birth crawl” and self initiate breastfeeding
- I would like to delay wiping vernix off my baby’s body
- I’d like my partner to announce baby’s gender
- I’d like another member of the birth team to announce baby’s gender
- My partner will cut baby’s cord
- I am interested in delayed cord clamping, if medically safe
- I’d like to wait for the cord to completely stop pulsing before clamping, if possible
- I plan to bank cord blood
- I plan to donate cord blood
- I want to save my umbilical cord
- I’d like to let my placenta come out naturally, if possible
- I want to see my placenta after it comes out
- I would like my placenta saved for me to take home
Newborn care procedures
- Antibiotic eye ointment
- Vitamin K shot
- Blood test
- Hepatitis B vaccine
- Hearing screening
Postpartum hospital stay preferences
- I would like to be present for any and all of baby’s tests and procedures
- I’d like to delay baby’s first bath as long as possible
- I don’t have strong preferences surrounding baby’s first bath
- I would like baby to room in with me
- I’d like baby to stay primarily in the nursery and come in when they need to eat
- I’d like baby to room in during the day and use the nursery at night
- I’d like my hospital stay to be as brief as possible
- I’d like my hospital stay to be as long as insurance allows
- I would like to see the lactation consultant as soon as possible (depending on timing of the birth)
- My partner plans to sleep and be in my room for the entire stay
- Postpartum pain and comfort measures:
- Stool softener
- OTC pain meds
- Perineal ice packs
In the event that baby needs NICU care
- My partner will accompany baby if I cannot
- I would like to be discharged as quickly as possible to be with baby if they need to relocate to a different hospital
- I want to breastfeed/pump for baby during their NICU stay
- I would like to hold and be with baby as much as is possible and safe for baby
Giving birth during the COVID 19 Pandemic?
If this is you, I’m so glad you are researching and creating a birth plan! This is such a wonderful way to take control of your birth experience and spark dialogue with your provider about what to expect.
For more specific advice and tips related to pregnancy, prenatal care and birth in the pandemic, head on over to our article: Tips for Your COVID 19 Pregnancy.
Birth plans unpacked
As you can see, there is quite a bit to think through regarding birth! I think simply going through the different details of a birth plan gives mamas a better idea of how much there is to learn and think about.
A birth class can really help explain all of this!
The main reason I created my online childbirth class was to empower and educate mamas for a more positive birth – and I can assure you that we cover ALL the topics mentioned in the birth plan.
Have any questions related to your specific birth wishes or birth plan?
Do you prefer a traditional style birth plan or a visual birth plan? I’d love to hear from you ?
Happy birth planning!