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Birth Plans

  • Dana Sullivan
  • Posted March 11, 2013

A birth plan is simply a document that outlines the kind of birth experience you wish to have. Creating one will help you talk with your physician or midwife about your baby's birth. Perhaps some of your requests can't be granted due to hospital policy, but at least you can start the discussion with hospital staff and see if your physician can work out some compromises.

There are three important things to keep in mind when researching and writing a birth plan: Learn about your options, keep it short, and, most important, stay flexible.

Learn about your options

A birth plan outlines the kind of care you get during delivery, from the painkillers you receive to the brightness of the lights in the delivery room. If you've never had a baby before, it's a good opportunity to learn about your choices. There are many places to look for information, but here are some of the most helpful sources:

  • Books and trusted Web sites where you can learn the basic options for labor, delivery, postpartum recovery, and newborn care.
  • Other women who have recently had babies. They usually have plenty to say about their own birth experiences and may have some suggestions about what you might want to include in yours. Often, hearing about circumstances others have encountered brings up issues you may not have considered before.
  • A childbirth education class. At these labor-preparation courses you will learn what to expect from labor. Your instructor should go over in detail the pros and cons of the various pain-relief options and give you a general idea of what your time in the hospital or birthing center will be like. There are also many other types of classes you can take before the baby gets here -- classes on breastfeeding, on infant CPR, even on writing a birth plan.
  • A tour of the hospital or birth facility where you plan to deliver. This will give you a sense of the staff's philosophy and level of expertise. If you anticipate a health problem with your baby, how does the neonatal intensive care unit rate? If it isn't a level III nursery (one that can provide the highest level care for newborns), would your baby be transferred to another hospital? What kind of breastfeeding support is offered? Is a c-section baby allowed to stay in the room with the mother? Are lactation consultants or nurses trained in lactation support available to help you breastfeed? Do private postpartum rooms cost extra, and if so, will your insurance cover the cost?

Next, ask your doctor or midwife about what they would normally do in various scenarios. Ideally, you know going into your baby's birth that your philosophies are similar, but now that the big day is looming you'll have more specific questions. For example, will your doctor let you labor as long as you wish, or set time limits?

Even if you're planning a natural or drug-free birth, think through all your options for pain or interventions in case you need them, especially if this is your first child. And if there are complications, let your doctor know if you would prefer only drugs to hasten labor, for example, that have been approved by the Food and Drug Administration for that purpose.

Keep it short and simple

Ideally, your write-up should be one page or shorter. Your birth plan should include the name of your physician, family member(s) to contact in case of an emergency, and any food or drug allergies.

Dispense with a long essay on your birth philosophy. If you feel the need to mention it, distill it down to a sentence or two and list any childbirth preparation courses you might have taken.

Don't forget to list any preferences for postpartum care (like a private room, special food) and newborn care (no bottle, for instance). However, you should discuss with your doctor in advance anything out of the ordinary that you would like, such as delaying standard tests, so there are no surprises for you or your doctor immediately after delivery. When you've finished your plan, leave a copy with your doctor or midwife. Make more copies and keep several in the bag you're going to take to the birth center or hospital.

Make sure your birth partner or coach knows about your preferences, because even if you're conscious, you may be too overwhelmed by labor to make your wishes known (whether you're on pain meds or not).

Once you're in labor

Once you arrive at the hospital and have been admitted, ask your nurse to read your plan and include it in your chart.

Stay flexible. You may have misjudged your capacity to handle pain, or the pain of an induced labor may be more than you can handle. On the other hand, if you said you wanted an epidural but your labor progressed quickly, don't get too stressed about not having had one. Similarly, there might be an unforeseen problem with your labor and you may need to be prepped for a c-section. Depending on the circumstances, you will be given an epidural or be put under general anesthesia for your baby's birth.

Remember, it's okay to change your mind about some of the things in the birth plan once you are in labor and in the hospital. Following your birth plan to the letter isn't a badge of honor. The purpose of the birth plan is to convey to those who will care for you what your concerns and preferences are and to allow you to have input into important health decisions.

If things don't go as you imagined, remember that childbirth is unpredictable from start to finish, and all you can do is try to ensure you make informed choices under the circumstances. Many women find that if they are treated respectfully, the ups and downs of the labor itself pale in comparison to having a healthy baby at the end.

References

Nemours Foundation. Birth Plans. http://kidshealth.org/parent/pregnancy_newborn/pregnancy/birth_plans.html

American Pregnancy Association. Creating Your Birth Plan. http://www.americanpregnancy.org/labornbirth/birthplan.htm

University of Illinois, McKinley Health Center. Choosing an Obstetrical Care Provider and Hospital. http://www.mckinley.uiuc.edu/health-info/womenhlt/choosemd.html

Cleveland Clinic Health System. Fairview Hospital Expects the Unexpected. http://www.cchs.net/news/article.asp?storyID=1679

Dr. Spock. Your Birth Preferences. http://www.drspock.com/article/0,1510,24310,00.html#bf

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