Written by: Kathleen Berchelmann, M.D.
When a laboring mom arrives at the hospital with a birth plan, nurses often roll their eyes and smirk, especially if it is a check-off-the-boxes and fill-in-the-blanks birth plan off a web site. Why? Because 80-90% of moms on the unit where I work arrive with a plan for natural delivery, yet more than 90% end up with an epidural and toss aside the requests on their birth plans. I’ve attended deliveries for more than a decade at five different hospitals, and I’m about to deliver my own 5thchild. Yes, I have a birth plan. You should too.
Here are ten tips for writing an effective birth plan, plus an example birth plan based on my own.
1. Write your own birth plan, don’t use a pre-printed form.
Pre-written check-off-the-boxes birth plans that are available on many web sites are good to use as worksheets while you are thinking about your birth plan. But a personally written birth plan shows your health care providers that you are educated and serious about your wishes. They are also far easier for your health care providers to use. Your birth plan should be short and readable, preferably 1-2 pages. I prefer bullet point format. Be personal and polite in your writing, using “I” statements and the word “please.” Tell short personal stories that explain your choices. I’ve included an example birth plan below.
2. Be very educated about your choices, especially regarding pain management and c-sections.
Be sure to complete a child-birth preparation program before attempting to write your birth plan. If you are running out of time before delivery, consider reading a book on child birth preparation or watching a video course. Take a tour of your birthing facility before you deliver and learn about options they offer for pain control, birthing positions and newborn care.
3. Begin your birth plan with the names and phone numbers for all the key people involved in your delivery.
Include your name, your baby’s name (if you know it!), your obstetrician or midwife, your pediatrician/baby’s doctor, the names of all those expected to be present at your delivery, and the names of anyone you don’t want at your delivery.
4. Continue with a section about your own medical and obstetric history.
In this section, include your home medications, allergies, chronic medical conditions, and information about each of your prior pregnancies and deliveries. Please see example below. State whether you are positive or negative for Group B Strep and gestational diabetes. If you have ever had herpes, HIV, hepatitis, or other sexually transmitted diseases, it is essential to include this.
5. Discuss your wishes for labor, especially regarding pain control and labor augmentation.
If you are planning natural labor without epidural, explain how you have prepared for this and what your pain-management plan will be. If your labor is augmented (sped-up) with Pitocin you will likely require an epidural for pain control. If you have had past poor experiences with pain control during delivery, discuss what happened and how you would like to avoid these complications.
If you would like to use specific birthing positions or props, such as a birthing stool or bar, be clear about these choices in your birth plan and also tell your health care providers as soon as you arrive. Be sure you are educated about how to use these positions/props and that your facility will support these options. Most women who have epidural anesthesia don’t have the leg control or strength to use a sitting or squatting position, so be sure to include a contingency plan for your birthing position if you choose to have an epidural.
6. Express your wishes for delivery, and include contingency planning in case you need a c-section.
Very few women want a C-section, but you need to be prepared for one anyway. Every birth plan should include your wishes for c-section, such as choosing not to have your hands tied down, and avoiding medications that alter your level of consciousness.
No one wants an episiotomy, but sometimes they are better than a severe tear. If you are declining episiotomy, discuss with your health care provider beforehand how you plan to avoid a severe tear and include this in your birth plan.
Delayed cord clamping is now recommended by most pediatricians, but you may have to request this procedure. Delayed cord clamping may not be an option if your baby is not breathing or ill.
Include your choices for cord blood donation or private cord banking.
7. Include a section with your choices about newborn care.
Do you want to hold your baby skin-to-skin right after delivery, even if you have a c-section? You need to be clear about this. Also specify your plans regarding breastfeeding, antibiotic eye ointment, vitamin K, baby’s first bath, and the hepatitis vaccine.
8. End with a section about your own post-partum care
What pain medications work or don’t work for you? What laxatives/stool softeners do you prefer? Do narcotics make you nauseated? Tell your health care providers about it.
9. Discuss your birth plan with your obstetrician or midwife during a routine appointment.
A birth plan is useless if your health care provider doesn’t support your choices. Discuss your choices before you go into labor.
10. Know that no birth goes exactly as planned.
Remember your ultimate goal—a healthy mom and baby. Be flexible. Every labor is different and no one can predict how it will go.