Why have a Birth Plan?

The article below was written by Cara Terreri for Giving Birth With Confidence.  It details nicely why it is very important to create a written birth plan before labor begins.

Don’t Just Hope for the Best — Plan for it: How to Write a Good Birth Plan

If writing a birth plan seems like a frivolous step to birthing your baby, you may want to reconsider. It is true that your baby will come whether or not you “plan” (or write a plan) for his entrance, but the act of writing about your upcoming birth can help you learn more about the care you’ll receive and the needs you may have during labor and birth. Writing a simple, informed and succinct birth plan helps you: consider and research the many choices available surrounding labor and birth; open a discussion with your care provider that can sometimes reveal surprising differences in your “vision” for birth; and provides useful information to your birth team.

While there’s no right or wrong in creating a birth plan, there are some things to consider to help you get the most out of the process and make it more likely that your care providers will read your plan.

A Birth Plan is Not a Script — or a “Plan”

You can plan your wedding day, you can plan a vacation, you can even make plans to build a house. The idea that you can “plan” a physiological event like birth is a bit of a misnomer. You can’t plan — or predict — exactly how labor and birth will unfold, but you can request preferences for you and your baby’s care during birth. With that in mind, it’s important to understand as you create your birth plan that birth is unpredictable and flexiblity is key. While certain birth plan requests, like allowing the baby’s cord to stop pulsing before being cut or delaying (or refusing) the Heb B newborn vaccine, should be observed regardless of the birth situation, other preferences may have to be amended depending on the health of both mom and baby.

Rixa Freeze, MA, PhD, a well-known birth advocacy blogger at Stand and Deliver who has written at length about birth plans, has this to say:

“…planning for birth is like preparing proactively for breastfeeding. There are the individual choices you make and have control over during pregnancy, such as provider or place of birth. There are the institutional protocols and provider preferences that will influence what happens to you during labor and birth. And then there are the unpredictable, uncontrollable events that may throw you a curveball during labor. Birth plans are primarily for the second category of events–navigating institutional routines and employee protocols that may or may not be what you want, and may or not be beneficial for you or your baby.

Involve Your Partner and Your Provider

Writing your birth plan is not a one-woman-show, but rather a group effort. Talk to you care provider about your birth plan preferences — are they in line with your care provider’s philosophy or what she will even allow? Are they in line with typical hospital protocols? If your birth plan is chock full of requests that go against standard hospital protocols or ask for tools (bath tub, wireless fetal monitoring, birth stool, nitrous oxide) that aren’t available, you might be disappointed on the big day. Involving your providers in your birth planning process will help you understand alternative options to achieve the care you desire or perhaps, seek a different care provider or place of birth.

Write an Outline, Not an Essay

Remember the “succinct” part I mentioned above? There’s good reason to keep birth plans short and sweet. For one, your care providers and birth team have will have limited time, especially on the day of your birth. If they are presented with a two and-a-half page, text-heavy document to read, it will most likely not happen. Create a birth plan that is easy-to-read and short (one side of a one 8.5 x 11 page is great!), with bulleted text and only the necessary details. For example, I didn’t include on my birth plan that I wanted to eat and drink as necessary — I just did it.

The Specifics

To help you get started, use the following questions as a prompt for writing your birth plan.

What message would you like for your care providers to read first? Here’s a sample of an opening message:

Thank you for taking the time in advance to read our birth preferences. We realize that unexpected circumstances do arise and do not intend this as a “script” for our birth. We hope you will be able to keep us informed and aware of our options. Thank you!

What would you like for pain relief during labor (narcotic or non-narcotic)?

What routine interventions do you want to avoid (IV, continuous fetal monitoring, etc.)

How would you like to be able to push? As you feel the urge? In a position that feels most comfortable to you?

Who would you like to announce baby’s gender (if you don’t already know)?

Would you like baby’s cord to stop pulsing before being cut? Who would you like to cut the cord?

Unless there is an emergency situation, would you like immediate, uninterrupted skin-to-skin contact with your baby?

Would you like the staff to delay routine newborn procedures (weighing, washing) until after your baby has breastfed?

What routine newborn procedures would you like to avoid or include (eye ointment, Hep B vaccine, vitamin K shot, baby bath)?

How will you feed your baby? Do you wish to avoid bottles or pacifiers?

Even if you don’t “plan” on a cesarean, it’s important to include cesarean preferences, just in case. The following are examples of those preferences:

  • Please allow partner/dad to be present at all times.
  • Please allow doula to be present. (This is sometimes against hospital policy, but it doesn’t hurt to ask.)
  • Please allow dad to announce baby’s gender.
  • Please allow baby’s cord to stop pulsing before cutting. Dad would like to cut cord.
  • Please allow mom to have skin-to-skin contact with the baby in the OR. (Skin-to-skin in the operating room after a cesarean surgery is not standard, though it is starting to happen in a few locations across the United States. When mom is not under general anesthesia for a cesarean, this should be a reasonable request and will help with the initial mother-baby bonding that might have otherwise been missed.)