Somewhere in your third trimester, typically, you will begin hearing the words “birth plan” from your provider. This little piece of paper is incredibly intimidating for many Moms, especially first time Mom’s! How can you possibly know what will be important to you in labor, if you never experienced it before? Fortunately, there are a few ways to simplify the process if you’ve never created a birth plan before.
But first, let’s talk about your Patient Bill of Right’s (for U.S. Moms)
When creating your birth plan, it is important to know that nothing safe or reasonable is off limits to you. Be empowered and know that the law is on your side! Many birth workers will tell you upon admission what they require of you. This can include things that may make you uncomfortable, like a hep lock or saline lock, birthing in a specific position, routine cervical checks, or even things like epidurals for all first time mom’s! It’s important to understand, the your bill of rights, will always supercede hospital policy. This is important information to have, because sometimes staff at hospitals may not be fully trained in your rights. It is ok to respectfully use the words “I understand, and I refuse.” If you are bullied or told that something is not your choice, immediately ask for a patient care advocate to come visit you and discuss your issue with them!
Now that you understand your rights, we can start creating your birth plan!
Vaginal, or Cesarean?
Perhaps the easiest decision you will make on your birth plan is the type of delivery you are aiming for. Are you planning on having a vaginal delivery, or is a planned c-section in your future? It’s important to understand that this could always change in the event of an emergency, however, birth staff will usually work hard to honor your initial desires. It is important to add a note if you are planning a vaginal birth after cesarean, or if you have had any abdominal surgeries in the past.
It’s important to know that cervical checks though standard, are still optional. You can decline all cervical checks in labor if you are planning an unmedicated delivery. Your body will tell you when it is time to push. If you know you do not consent to cervical checks, make note of this on your birth plan.
Delivery Room Preferences
Dim Lighting or No preference?
It is the natural instinct of most mammals to find a private, safe, dark space to birth in. Human’s are no different, many mom’s feel inhibited by bright lighting. Do you want nurses to be mindful of this as you labor? LED Fairy Lights add a relaxing pretty touch to your birth environment.
Music (provided by you), or minimal sound?
Many mother’s seem split between having the comfort of familiar music, or complete silence. As a musically inclined person, I was really surprised to find myself desiring complete silence around me in labor. I suggest requesting minimal sound on your birth plan, but bringing your own soundtrack in case you find the distraction helpful.
Access to a Birthing Stool or Ball?
Not all hospitals or birth centers will offer these options, so it may be up to you to provide them yourself. It’s a good idea to include these possible preferences in your birth plan to discuss with your provider ahead of time! The CUB is a new birthing stool that inflates and has a similar feeling to a birthing ball, many women I know personally have loved this stool in labor it’s a great 2-in-1 option!
Blankets, photos, or aromatherapy from home?
It is not uncommon to experience hot and cold flashes throughout labor. In case you weren’t aware, most hospitals and birth centers provide blankets that are practical but uncomfortable with stiff fabric. If you are practicing mindful birthing, you may desire familiar photo’s or birth affirmations be placed in plain sight as focal points. Aromatherapy in the form of a diffuser, is usually allowed at most birth centers and hospitals. Some women find this comforting, and others prefer minimal scents and perfumes so they can better enjoy newborn baby smell! Note these preferences on your birth plan.
This is an important point to discuss in advance with your provider. Some hospitals have policies that restrict the number of people present for delivery. If this is the case, it is best to know ahead of time to avoid disappointment. Include your birth partner, a photographer and doula (if you hired either), any older siblings attending, as well as any friends. Keep in mind high risk women to be asked to limit guests further.
This includes a variety of options, it’s a good idea to list out specific ones you may want to try. If you are undecided about certain methods, keep it on your list in case! Popular options are: bathing, showering, hypnobirthing, breathing techniques, applying counter pressure, a rebozo, and massage. Some lesser known options may include: peanut balls, rebozos, and birth balls.
This is by far the most popular method used in hospitals today to manage pain. If you understand the risks and benefits, and you already know you don’t want an unmedicated delivery, list this on your birth plan so your nurses are aware in advance.
If you are giving birth in a hospital, additional IV medications may be administered. Most are focused on relaxing you as opposed to numbing pain and help reduce stress. It is important to research these options in advance so you can choose a medication with few side effects. Many women like using laughing gas in place of an IV.
No Pain Medications
When labor pains intensify, it can be hard to stick with the plan to birth unmedicated. Especially when helpful nurses are offering it to you! For this reason, I recommend noting on your birth plan, if you do not want hospital staff to offer medication. You can always change your mind if needed. But nurses will appreciate knowing if you do not want pain medication in advance.
Many women love to employee the help of alternative methods, such as chiropractic adjustments, accupressure, and even accupuncture. If these options are available to you, and you wish to use them – make a note of it on your birth plan!
Coached Pushing or Not?
Some women find coached pushing to be helpful, particularly with first babies. However, some evidence suggests that coached pushing leads to higher instances of tearing and intervention. If you prefer no coached pushing – make this preference clear on your plan.
Who Catches Baby?
In labor, there are countless options for who gets to touch baby first. Some women take a DIY approach and love to catch their own baby, others prefer to share this special moment with their partner. If you are ok with your provider catching your baby at delivery, you can leave this off your birth plan.
Compresses or Perineal Support?
While pushing, some providers are happy to offer additional support to help prevent tearing. Some use warm wash cloth compresses, others use oil. Both techniques can be helpful. Research risks versus benefits of both and notate if you would like additional support on your birth plan.
Mirrors to view delivery?
If you are interested in seeing your baby being delivered, you can ask for a support person or nurse to hold a mirror for you. In the heat of the moment, it can be hard for you to express this. Noting this preference on your birth plan can help ensure that birth attendees remember your preference and accommodate it without you needing to ask!
Cord Clamping Preference
There are countless options for cord clamping. Do you want a lotus birth, where baby remains attached to placenta without any clamp, until the cord falls off naturally? Or maybe delayed cord clamping is more your style… Many providers now offer delayed clamping as the routine, however, some traditional doctors may still rush to clamp the cord. Another consideration is, who would you like to do the honors and clamp the cord when it is time. Your birth plan should include all of this information.
Delivery of Placenta
You may be surprised to know that there are multiple approaches to delivering your placenta after birth. My personal favorite is natural. Though occasionally, some women do require the assistance of pitocin in helping their uterus to contract and deliver the placenta, most don’t. If you do not want pitocin to be administered to you as a matter of routine – it’s important to note this in your birth plan.
Newborn Examination and Medical Treatment
In a natural, uncomplicated delivery, you can request undisturbed time with your baby. If you want, you can note a preference for routine newborn exams to be performed on your chest. Or only after the first hour of bonding. Or only after baby has latched to the breast first! It’s also important to notate immunization preferences if you are in a state that allows you to decline. Is baby going to receive a Vitamin K shot, liquid vitamin K, or nothing? Do you consent to your newborn baby receiving the Hep B vaccine? Is there a need for erythromycin eye ointment administration, or would you prefer to keep babies vision clear? It’s extremely important to state all of these preferences on your birth plan. Do not assume the doctors or nurses will ask you before administering routine treatment.
Feeding and Soothing Preferences
Are you planning to exclusively breastfeed? If so, it is important to request that baby not be given formula or a bottle. Most studies also suggest that breastfed babies should not be given pacifiers or other soothers until they are 6 weeks old. Notate these preferences on your birth plan. If you already know you do not want to, or will be unable to breastfeed – it’s ok to note that on your birth plan as well as specific feeding preference, like formula type.
If you are in a hospital for delivery. It is a good idea to notate if you want baby taken to the nursery for rest, or if baby will be rooming in with you. You can also notate if a spouse, or friend is going to be staying with you both in your room.
It’s important to realize that your care team will do their best to keep you comfortable, however, they cannot always keep visitors away. If you know you do not want any visitors for a set period of time after delivery – it is a good idea to refrain from announcing birth until that time is up. You can also refrain from announcing where you are delivering so excited guests don’t disturb your rest and recovery. If there are specific people you do not want visiting while you recover – do not be shy about including these names on your birth plan and asking to be removed from the hospital directory.
Emergency Back-Up Plan
In the event of an emergency
Birth is a normal, every day process, and it is unlikely you will hemorrhage or require an emergency cesarean, or any other emergency treatment. However, it is important to have a plan in place in case of the unexpected. If you are not alert and able to care for baby, who would you like baby to go to first? You can notate preferences for immediate skin to skin with Dad, or any other labor partner. You can also include alternative feeding options for baby if you do require some additional time to recover.
In the even of an induction
Most women don’t plan on being induced, it is really wise to understand what the options and possibilities are just in case. If you need to be induced, or labor needs to be augmented, which methods are you comfortable with? Nipple stimulation, orgasm, and walking are all natural ways to augment labor. However, it’s possible your provider may urge you to consider options like pitocin, artificial rupture of membranes, or cervical ripening medications like cytotec. Familiarize yourself with the possibilities so you can notate any you know you are unwilling to try.
Additional Things to Consider
When creating your birth plan, there are a few things to consider. The process itself is not complicated, but it can be helpful to discuss in advance with your provider. Most Mom’s creating their first birth plan, provide a lot of detail with each request. Most providers prefer a short, quick, to the point plan. No explanation is necessary. Ask them if they prefer bullet points, pictures, or a detailed plan. Then create what they request to ensure your plan is honored and no details are missed!