The golden rule of writing an effective birth plan is to to include only non-routine preferences or those that are of great importance to you. This is your opportunity to get educated on your options, determine the path to a positive birth experience, and to communicate your wishes with your medical care team.
Topics this article will cover:
- What to include in your birth plan
- Understanding your options for birth
- How to best communicate your preferences
- How to ensure your birth plan is read and respected
- When to share with your provider
What to call it?
First off, let’s reconsider the use 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; 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 “Birth Preferences” or “Birth Wishes” 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.
First, do your research and get educated!
Before drafting your birth plan, you’ll need to do your research and determine what you’d like for your birthing and how you’d like to welcome your baby into the world. There is so much value in this process: becoming aware of your choices (there are many), taking the reigns of your care, and educating yourself so that all of your choices are informed. Knowledge is power, particularly when it comes to such a high-stake event in your life.
Take a childbirth education class (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? These are the questions your Birth Wishes should seek to answer!
What to include?
Your Birth Wishes will have a greater chance of actually being read, and read carefully and therefore honored, if it is short & sweet. 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, such as having a Hep-lock.
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).
It’s also a good idea to have in writing that which is really important to you, even if it is hospital policy (like optimal cord clamping, for example).
How to communicate your preferences?
Start with an 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:
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:
I suggest breaking your preferences into two categories: “YES, PLEASE” and “NO, THANK YOU”. 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, dimly-lit birthing environment
—Intermittent fetal monitoring
—Limited vaginal exams
—To eat and drink throughout labor
—To be an active participant in informed decision-making regarding my care and/or my baby’s care
—Should an epidural be necessary/requested, I would prefer to start with a combined-spinal epidural (CSE), “walking epidural”
—Allow mother to follow body’s natural urges during second stage without pushing prompts (unless requested)
—Delay cord clamping until the cord stops pulsating; please seek parental consent to clamp
—To have immediate, uninterrupted 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
—In the event of a c-section: for all family-centered cesarean procedures to be followed (including, partner and doula in the OR, clear drape, delayed cord clamping, mother’s hands free, immediate mother-baby skin-to-skin contact, breastfeeding in the OR)
— Delay ALL newborn procedures for at least 2 hours or until parents are ready
—Lactation consult with IBCLC
NO, THANK YOU:
—Sweeping of membranes
–Any talk of “pain” or offer of pain-relief
–Frequent vaginal exams
—HEP lock / IV Fluids
—AROM (artificial rupture of membranes)
—Pitocin, epidural, episiotomy, and vacuum / forcep delivery
—Hepatitis B Vaccine
—Erythromycin eye ointment
—Hands-on breastfeeding help from nurse (unless requested)
—Separation of baby from mother or father for any reason
When to share with your provider?
Ideally, you will review your Birth Wishes with your provider prior to labor at a prenatal appointment. This will give time for the two of you to discuss, ask questions, and come to a common understanding. Bring several copies to the birth; be sure the nurse has a copy.
Good luck! My hope is that your Birth Wishes 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).
Want to learn more? Get in touch!
