How To Write a Birth Plan

I remember telling someone about my birth plan when I was pregnant, and their response included a laugh and something like, “childbirth never goes to plan.” Whether you are someone who believes that nothing goes to plan or that everything goes to plan is a subject for another day. But, I can tell you that having a plan in place when it comes to childbirth is beneficial to both types of individuals. 

Why Create a Birth Plan?

Having no plan leaves your childbirth experience out of your control. I’m not suggesting you can control childbirth, but having a plan EMPOWERS you! It allows you to make educated decisions that impact how your labor goes. It also helps make your labor as close to the experience YOU want for you and your baby as possible, as opposed to the preferences of your medical provider.

Creating a plan requires you to be knowledgeable about what’s going in the plan. That usually means you’re aware of all the options available and have chosen the ones that are best for you. 

It also means that if something in your plan doesn’t go to plan, you know what alternative route you’d like to take. If you have no plan in place, and you end up having to make a last-minute decision, you risk not being prepared. If you’re stressed and your emotions are flying, the decision you make might be different than if you had thought about it in a more objective frame of mind. 

Creating Your Birth Plan

I encourage you to start working on your birth plan as early in your pregnancy as possible and here’s why:

• There is a lot to learn and you want to give yourself ample time to determine your preferences. If you wait until later in your pregnancy, you may feel overwhelmed and scattered in your decision-making.

• Your birth preferences may require a change in medical provider or birth location. Once you’ve created your birth plan, you’ll want to discuss it with your medical provider and make sure they support it. Depending on your preferences, your current provider may not be comfortable with them. You’ll want to hear their reasoning of course, in case it changes your mind on your preferences. Also, some locations simply don’t allow certain things (e.g. if you’re hoping for a water birth, your hospital may allow you to labor in a tub, but may not allow the baby being born in one). I decided to switch medical providers at 33 weeks in my pregnancy to better support my preferences. Do I wish I had made the switch sooner? Absolutely. The sooner you start determining your preferences, the sooner you can make changes if needed. 

• Your preferences may influence which childbirth preparation class you choose. If you’re giving birth in a hospital, your hospital likely offers childbirth classes, but those aren’t your only option. There are lots of additional options offered by third parties and some tailor to specific birth preferences (e.g. planning for a “natural” unmedicated birth). You’ll likely want to research which option is best for you and ensure you have ample time to sign up for a course (since many courses are 1-2 months long).

• You will feel greater confidence and comfort about childbirth once you have your birth plan set. And, you can enjoy the rest of your pregnancy, focusing on you and your baby. After I determined my birth plan, I felt so much more excited about my baby’s birth! I knew what I had to look forward to and it helped me visualize it better (more on that below!)

What Things Should I Include in My Plan?

I mentioned above that there is a lot to learn about options and interventions during childbirth. As you work on your birth plan, below are the things I encourage you to become educated on and determine your preferences around. I also included the things you should be educated about related to your baby’s care following birth.

You will need to do your own research on these items, so break the list into chunks and research a little bit at a time. This is why starting early is helpful – it allows you to take your time learning about and deciding your preferences on these things.

Even if you think you already have your preferences decided, I’d suggest learning about any alternative options you may not know much about – you could end up changing your mind. I went into my pregnancy assuming I knew what I wanted for my labor preferences, and ended up with an entirely different plan after l learned about my options.

As I wrote this post, it occurred to me that someone reading it might think, “do I really need to learn about ALL of this?” No, of course not! But knowledge gives you power and awareness. When your medical care provider talks to you about their typical approach or asks your opinion on something, you’ll be able to respond confidently. You’ll be able to make choices about your baby’s birth that are the best fit for YOU and YOUR baby. I am not suggesting one preference over another. I am instead encouraging you to become informed through learning, determine your preferences for your ideal childbirth experience, and then get excited about the main event!

Birth Preferences: General

1. Your medical provider and birth location
   1. Your provider
      1. The medical provider you’ve been seeing for annual care may not be the best provider for your baby’s birth. You will have to share your preferences with them and hear their reasoning for any that they’re not supportive of and then make this decision.
      2. If seeking a new provider, understand the differences between an OB-GYN and a midwife.
   2. Birth location. There are many places you can have your baby and it’s important to know the pros and cons of each based on your goals:
      1. Hospital labor & delivery ward
      2. Birth center (hospital attached)
      3. Birth center (stand alone)
      4. Home birth (not legal in every state)
      5. Water birth – if you desire a water birth, this will likely impact your birthing location (not all hospitals allow water births)
2. Induction
   1. When and why they’re typically done
   2. Pros
   3. Cons
      1. Potential risks of being induced (cascade of interventions)
      2. Potential risks of not being induced
   4. Types of induction methods available
      1. Pros and cons of each 
3. Laboring clothing – you don’t necessarily have to wear the hospital gown!
4. What type of environment do you want?
   1. Do you prefer a quiet, dimly lit environment or do you want music playing and natural light if possible?
   2. Do you want access to a tub?
5. Desired length of hospital or facility stay
6. Who will be in the birth room with you and what role with they play?
   1. Are you interested in hiring a doula? A doula can be a wonderful addition to your labor experience. A qualified doula builds a relationship with you prior to giving birth. During labor, they help you with pain management and calming techniques. They will be a liaison and advocate for your birth plan preferences when medical staff are in the room. This can be extremely helpful when you and your spouse are focused on YOU. They will work together with you and your spouse to provide you with the support you need for a great labor experience.
   2. Are you okay with medical students in the room if asked?

Birth Preferences: First Stage of Labor

1. Fetal monitoring options and your preference
2. IV and fluids 
   1. Pros
   2. Cons
3. Ability to labor at home as long as possible
4. Freedom to eat and drink during labor
5. Freedom of movement (an IV, Pitocin and wired fetal monitoring will all impact freedom of movement somewhat, and an epidural will prohibit movement once it’s administered)
6. Frequency and allowance of vaginal exams / checks
7. Pain management 
   1. The various options available to you (there are additional options besides an epidural)
      1. Pros
      2. Cons/potential risks (cascade of interventions)
   1. Do you want any pain meds?
      1. If so, which one(s)?
      2. If not, what is your strategy for naturally dealing with pain? (you don’t necessarily need to put this info in your birth plan, but if you are doing hypnobirthing or any special pain management technique, it may be helpful for your providers to be aware so they can help support it)
8. Methods for progressing labor if needed
   1. Natural methods available
   2. Medical augmentation (Pitocin)
   3. Artificial rupture of membranes (AROM)
      1. When and why it’s done
      2. Pros
      3. Cons

Birth Preferences: Second Stage of Labor

1. Pushing
   1. Coached vs. mother-directed pushing
   2. Pushing positions
      1. If you plan to have an epidural, you will likely be pushing while lying on your back.
      2. If you are planning an unmedicated birth, you will have more choice in your pushing position. Research the different pushing positions and the pros and cons of each. Then, ask your medical provider their comfort level with the different ones you’re considering. Some providers are used to women delivering babies while lying on their backs and aren’t as comfortable with other positions, but it doesn’t mean they won’t be open to others.
   3. Methods for preventing perineal tearing
      1. Warm compresses
      2. Gentle massage
      3. Episiotomy
2. Who will announce the baby’s gender (if applicable)?

Birth Preferences: Third Stage of Labor

1. Umbilical cord & placenta care
   1. Do you want to delay cord clamping?
   2. Who will cut the cord?
   3. Do you want active management of delivering the placenta?
   4. Will you encapsulate your placenta?
2. Skin-to-skin contact – many hospitals are moving toward skin-to-skin time as a normally followed practice but it’s good to check with your provider on their approach
3. Breastfeeding
   1. State your expectations to breastfeed
   2. Handling low blood sugar – are you okay with baby being given sugar water or do you wish to encourage more frequent nursing? 
4. When will guests be allowed in to meet baby (if at all)

Birth Preferences: Cesarean Section (C-section)

It’s helpful to know your preferences for a C-section regardless of whether you’re planning a vaginal birth or not. Of course in an emergency situation, the medical providers may not be able to meet all your preferences. Still, it’s preferable to be educated about the standard process and procedures, and alternative options available so that you can identify your preferences in the chance that you are able to meet them. I encourage you to research the following when determining your birth preferences in the case of a C-section:

1. Attributes of a traditional cesarean
2. Attributes of a “gentle cesarean” or “family centered cesarean”
3. Options for skin-to-skin contact – especially important for establishing breastfeeding!!

Newborn Care Plan

1. Rooming in – most hospitals are moving towards this as a normal practice, but again, good to confirm
2. Will you allow the use of a pacifier?
3. Initial exam – are you okay with it happening soon after birth or do you wish to wait until breastfeeding has happened successfully and time for bonding has been allowed?
   1. Do you want to be in the room?
4. Vernix – do you wish to leave it or wipe it off?
5. Bath – will you give baby a bath at the facility or wait until home? If at the facility, do you want to do it or have a medical provider do it (or have them do it while you watch/learn)?
6. Hepatitis B shot – will the baby get this?
7. Vitamin K shot – will the baby get this?
8. Eye drops (erythromycin) – will the baby get them?
9. Circumcision plans (if applicable)
   1. If you plan to give birth in a birth center attached to a hospital, you may not be able to do a circumcision at the hospital due to a shorter hospital stay

Formatting Your Preferences

Similar to a resume, your birth plan should be as short and succinct as possible. Think single line sentences to get your preferences across – not paragraphs of text. Try to keep your birth preferences to one page in length, with your C-section preferences on a separate page that your support person can grab from your bag if needed (and hopefully they won’t be). You can also list your newborn care preferences on a separate page and ask your support person to handle getting them to the medical staff.

You can search “sample birth plans” to see examples others have used, or you can also download our free sample birth plan here. It’s a modified version of the plan I used for my son’s birth that you can edit to list your preferences instead. It is an EXAMPLE and is not meant to suggest what your birth preferences should be! Your preferences will be unique to you.

Some people like to use icons or graphics to represent their preferences. This is a nice, clean look, so long as your medical care providers can easily tell what they mean.

Sharing Your Birth Plan

Q: Who should be aware of your birth plan?

A: Your medical provider and anyone else who will be in the birthing room with you. Ensure that you have talked through each element of your birth plan with the main support person attending your birth – whether that’s your spouse or someone else – so they know your wishes and can help support them.

I also like to keep my birth preferences in a cloud storage solution (like Google Drive). If something were to happen to my paper copies, I could easily access information from any mobile device. I can also easily share it with my husband or anyone else.

When others ask about your birth plans, realize they may share their own opinions about the choices you’ve made and/or stories about childbirth. It’s okay to objectively listen and take whatever information you want to from their sharing. Let go of any other info they shared that doesn’t serve your goals. This is your baby and your labor and you are making the decisions that are best for you.

Visualizing Your Baby’s Birth

Now that you have your birth plan set, begin visualizing your amazing, beautiful birth. Think through every single detail and paint as vivid a picture as you can. Think through each of the five senses – what are you seeing, hearing, smelling, touching, tasting? How are you feeling? Picture yourself throughout every stage of labor – when it first begins, when you’re in active labor, when you’re pushing your baby out and then after your baby is born.

Mental actions activate the same neural pathways as physical actions. Repetition of pathways creates new patterns. This means that every time you replay your baby’s birth in your mind, your priming your body and mind to recreate it in the physical sense. That’s why you want to visualize it positively and exactly as you’d like to experience it. Think about how you’ll work through each contraction (even if you’re planning to have an epidural, you will still feel early contractions in labor), what the physical environment will be like, how it will feel when you hold your baby for the first time, etc. 

Plan for your baby’s birth to go as planned. But if it doesn’t, feel confident knowing you’re prepared with the backup course of action.

Your baby’s birth will be wonderful! Expect it and then do the mental preparation to make it so!

Brianna