“The birth plan is an ideal way to communicate her preferences, so the mother-to-be can fully focus on the amazing process of birthing a baby,” says Dr. Coral Slavin, doula and owner/director of Well-Rounded Maternity Center in Menomonee Falls, Wisconsin.
But navigating a birth plan can be daunting. Here’s an overview of each birth plan step.
This step includes choosing where to give birth, hospital, birthing center, or home, and who delivers the baby, an OB-GYN, family practitioner, or midwife.
Labor options, according to Dr. Slavin, also include educated preferences about the following:
- Being able to move around, use the rocking chair, birthing ball, or shower , and walk during labor, and whether that will impact fetal monitoring preferences.
- Setting the environment with low lights, music, aromatherapy, wearing your own clothing, and glasses/contacts, etc. Also preferences for no TV watching, doors to hallways closed or not, etc.
- Options such as frequency of vaginal exams, capped or running IVs, or attendance by nursing or medical students.
- Being able to eat and drink, and whether food from home is allowed.
- Having the partner, doula, family, etc., present for support, or limiting the number of people in the room.
Internal or external monitoring, continuous or intermittent, affects the way a woman labors. “Some women worry about their baby’s heart rate, especially through contractions, and would prefer to have continual monitoring despite the fact that they are bedridden,” says Jennifer Hunt, a labor and postpartum doula from Colorado Springs, Colorado. “Others prefer to have their freedom to move around.”
Induction/augmentation choices include stripping membranes; artificially rupturing membranes; medications including Pitocin®, prostaglandin gel, or Cytotec®; and natural methods, such as walking, nipple stimulation, castor oil, intercourse, herbs, etc.
“There may be restrictions to your requests, such as no food or drink, continuous monitoring, or confinement to bed, once you have pain medication or labor augmentation,” says Dr. Slavin, who advises women to consider delaying these choices as long as possible.
“There are three main choices in pain management during labor—natural pain management, narcotics, and epidurals,” Hunt says. “Most women will go into labor with a strong sense of what kind of pain management they plan to use.”
Narcotics lessen pain but may have side effects. Epidurals eliminate pain but confine Mom to bed. Consider this when making your choices. Remember, you don’t have to choose now. Mention on your birth plan that you’ll ask for pain relief when/if you desire some.
“With one in three women currently giving birth by Cesarean section, it is important for parents to consider what would make their birth experience more meaningful if they should have a C-section,” Dr. Slavin says.
According to Dr. Slavin, choices include the following:
- Being awake for surgery by having a spinal or epidural anesthesia.
- Having a mirror available to see the delivery.
- Setting the environment with music and asking the surgical staff to refrain from idle talk.
- Having more than one support person in the OR (e.g. father and doula) so one person can remain with the mother if and when her partner goes with the baby to the NICU.
- Having the baby placed on or near Mom’s chest after delivery (if Baby’s APGAR scores are good), or having Baby placed skin to skin with father.
Discuss episiotomies in advance so you know your physician’s practices. “It would be unfortunate for a couple to feel strongly that they would like to avoid an episiotomy only to learn in month nine that their provider does them routinely,” says Shelly Holbrook, former childbirth educator, labor and postpartum doula from Bellevue, Washington.
Remember, an episiotomy can become necessary if quick delivery is needed. “I had a really empowering birth that was exactly as I had envisioned it,” says Sarah Rose Evans of Portland, Oregon. “The only thing that didn’t go according to plan was that I had an episiotomy, but after 40 minutes of my baby being stuck in the same place, I told them, ‘Just cut me already!’ I was glad I’d made the decision, and that I wasn’t pressured into anything.”
This step involves delivery positioning and support. “The so-called ‘normal’ way to deliver—lying on your back—works against gravity, so many women prefer to deliver squatting, in the hands-and-knees position, or in a birthing pool,” Hunt says. “Mom can also choose who she wants to help during delivery and what type of help she wants, for example, holding her legs, supporting her while squatting, sitting behind her while in the pool, etc.”
Immediately After Delivery
Who cuts the umbilical cordand when is the first post-delivery choice. Then, where the baby will be placed comes next. “Some women prefer to have the baby handed directly to them while others like the baby to be placed on their belly,” Hunt says. You can also have the baby cleaned prior to contact.
Other options include cord blood banking, whether the mother wants to see or keep the placenta, and when to breastfeed.
Do you want to room in Baby (the baby stay in your room all the time) or use the nursery full or part-time? Hunt suggests moms remember they make the choices regarding their baby. “Sometimes the hospital personnel tend to make suggestions, which are misconstrued as orders,” she says.
If you plan to breastfeed exclusively, make sure you’re very specific about it in your birth plan. “If you would like to make sure that the nurses do not supplement the baby with anything other than your breast milk if you are unable to nurse right away, you should make sure that you include that on the plan,” Holbrook says.
Other choices related to breastfeeding are whether or not to allow your baby a pacifier and whether you’d like a lactation consultant to help you out.
If you’re having a boy, discuss your circumcision options with your pediatrician prior to the baby’s delivery. You may also want to confirm who will be doing the circumcision—the baby’s pediatrician or your OB. Aside from the decision for or against circumcision, there is also the option to have it performed while in hospital (if available) or having it performed as an outpatient at a later date. Whether the baby receives a local anesthetic for the procedure may also be an option.
“Most hospitals will allow cameras and video cameras in the delivery room,” Hunt says. “This is completely dependent on the comfort level of the mother.”
Some physicians do have restrictions about filming/photographing delivery for liability reasons, so verify ahead of time.
Other Miscellaneous Requests
This can include who you wish to be in the room with you during labor and after delivery (friends, family, other children, etc.) and anything else important to your plan.
Though her deliveries didn’t all go exactly according to her birth plan, Nicole Bovey, a mom from Anaheim, California, feels the birth plans benefited her and her providers. “The doctor would review the plan before she would decide on the next plan of action,” she says. “She consulted with me often and she would tell me, ‘I know you wanted to do xyz, but right now I think we should do xyz.'”
Remember, birth plans should be thought of as a request list. “Chances are, there will be a few twists and turns in there that you don’t expect,” Holbrook says. “As long as you can keep an open mind with those expectations, you will have a more satisfying experience.”