How to Write an Effective Birth "Plan"

First off, let’s get rid of the word “plan”. After all, it’s not really a plan… you can certainly dream about your perfect birth, but you cannot plan your perfect birth, for every woman, every baby, and every birth is unique and often presents certain scenarios that are impossible to anticipate. So, I much prefer to call it your “Birth Preferences” or, even better, your “Birth Wish-List”, for these terms acknowledge that you understand that there are elements of birthing that are essentially out of your control but that you have certain hopes and preferences that you would like to be honored and respected. Titling your document in this way will help to set the right tone in communicating your preferences to your care providers.

Here are my tips to crafting an effective Birth Wish-List (remember, the goal is to have the care providers— doctors, midwives, and nurses— actually take the time to READ your birth preferences):

Do Your Research: Before drafting your list, you’ll need to do your research and determine the way you’d like for your birthing to go and how you’d like to welcome your baby into the world. Take a childbirth education course (my favorite is HypnoBirthing®)— one that is comprehensive and ideally not taught by hospital staff. Hire a doula and pick her brain. Read some books. Check out evidencedbasedbirth.com. Then, determine what is most important to you in your birthing experience: what do you want to experience? how do you want your birthing to go? how do you want to spend those first few minutes and hours with your newborn?

Short & Sweet: Your Birth Wish List will have a greater chance of actually being read, and read carefully and therefore honored, if it is nice and concise. Limit yourself to ONE page only, ideally less.

Include Non-Routine Preferences Only: There is no reason to include preferences for things that are standard procedure. For example, nowadays at most hospitals, being able to walk while in labor is standard. Therefore, there is no need to say, “I would like to be able to walk while in labor”. This is a given. Think instead of preferences that are really unique to you and that may be against routine procedure / standard policy. Here’s where your doula can really be helpful. Ask her about the standard procedures for your hospital or birth center (typically, standard procedure includes: vaginal exams, Hep-lock / IV, fetal monitoring (intermittent or continuous), offer of epidural, and Pitocin injection immediately following delivery; and then for the baby, Hep B vaccine, Vitamin K injection, and Erythromycin Eye Ointment).

Introduction: Including a brief introduction is a nice way to set the tone and express gratitude. Something as simple as this can work really well (feel free to use this language verbatim):

“Dear Care Providers,

We have chosen you to be our care providers and we thank you in advance for honoring our wishes and assisting us in achieving the birthing experience we desire. These wishes are forwarded with the understanding that should a complication arise, you will have our full cooperation after opportunity for informed consent.”

Two Categories: For readability’s sake, I suggest breaking your preferences into two categories: “Things We Would Like…” and “Things We Hope to Avoid…” This keeps it simple for you and makes it very clear to your care providers. Here’s what it might look like (these preferences are geared toward a client seeking a natural birthing experience… make it your own!):

YES, PLEASE: 

— Quiet, calm birthing environment

—Intermittent fetal monitoring

—Limited vaginal exams

—Follow body’s natural urges to bear down without prompts from hospital staff (unless requested)

—To delay cord clamping until cord stops pulsing

—To have immediate skin-to-skin contact with the baby

—Allow the baby to initiate breastfeeding and successfully nurse before separation from mother, understanding this may take 1-2 hours

–Delay all newborn procedures until baby is finished the first feeding (up to 2 hours)

—In the event of a C-section, for our doula to be present in the operating room

 

NO, THANK YOU: 

—Any talk of “pain” or offer of pain-relief

–Frequent vaginal exams

—HEP lock / IV

​—AROM (artificial rupture of membranes)

—Pitocin, epidural, episiotomy, and vacuum / forcep delivery

—Heb B Vaccine

–Eyrthromycin eye ointment

–Hands-on breastfeeding help from nurse (unless requested

–Separation of baby from mother or father for any reason

Print & Deliver: Print your one-page Birth Wish List on brightly colored paper, make sure the font is big, and be sure to review it carefully with your care provider prior to labor. Bring several copies to the birth and personally hand to every care provider (doctors, nurses, and midwives) who oversees your care. Some women will even post their Birth Wish List in a prominent place in the labor and delivery room.

Good luck! My hope is that your Birth Wish-List will enable you to have a positive, empowering, birthing experience. My dream is that every woman can experience labor and delivery in her own, unique way, with her preferences honored and respected. Remember, if you don’t make any decisions, you have no decision (standard practice, whatever that means for your care provider and hospital, will make the decisions for you).

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