Why plan for birth?

Written By Emily Moncada

The point of this post is to discuss birth plans: their purpose, a healthy birth plan approach, tips on writing a birth plan, common topics for birth plans, and what happens when our birth plan goes out the window. As a doula, I believe that most women benefit during the birthing process when they have completed and shared a written birth plan. It’s possible that you may be thinking that a birth plan is not for you, or you may be struggling to decide on what to include in your birth plan. I hope after reading this blog post, you may know where to start. Read all the way to the end to find a link to my recent birth plan for my May 2023 baby.

A birth plan is a document made by the mother to communicate her wishes and desires for her upcoming birth and immediate postpartum care. Its main purpose is to inform medical providers on what medical practices we prefer and already consent to. Keep in mind, that birth plans are for all types of birth! It is not just for the mom planning an unmedicated, vaginal birth. They are helpful for planned inductions, someone who wants all the pain meds, and planned Cesareans. There are choices that come with each type of birth, and your birth plan will lay out your preferences either way.

Most providers see many patients. So even if you discuss your birth preferences with them verbally at an appointment, they may not remember at the time of your birth. (Side note: Midwives who work outside of the hospital setting are more able to remember your birth plan). An official birth plan will remind the provider what your wishes are so that they can best adhere to them. If anything happens during labor and the provider sees it in your or baby's best interest to complete a medical procedure that you do not prefer, the provider then knows to have a more in-depth conversation with you about the intervention. If there was no birth plan, the provider might assume you were already consenting to the procedure, or they may resort to their routine practice without asking for consent. The birth plan allows the provider to realize what you are already informed about or not and will hopefully help them understand what areas you may or may not be consenting to. In the end, it is always the provider’s responsibility to seek your consent for ANY procedure or intervention.

When it comes to birth plans, it is important to have a healthy approach. I usually call my birth plan my "birth preferences" for this reason. Some people don’t like that phrase, so use whatever floats your boat. Anything can happen before or during labor that may change our birth plans or preferences. It is always okay to change your mind for whatever reason you deem appropriate! For example, my birth plan says that I would prefer to go into spontaneous labor. However, if a complication arises later on in pregnancy that usually requires an induction, I will be having a conversation with my provider. If your hospital has a policy that you do not agree with (ex. mandatory IV), bring it up with your provider. Ask what their reasoning is for the policy and if there is any wiggle room. It is then up to you if you want to adjust your birth plan in consideration of your provider’s response. As a patient, you are not required to follow hospital policy. A common compromise many women will take for a recommended IV is to ask for a saline lock instead. This is a compromise, and if you do not wish to compromise, you do not have to.

Now onto writing your birth plan. It is important to remember that you and your birth team (medical provider, nurses, doula, partners, etc.) are working together (ideally)! A birth plan is written from your perspective and with you in mind, but it is to be read by everyone else. Consider what will be easy for everyone on your team to read and understand. Spend time to make your birth plan as thorough and precise as possible. I know, seems like a contradictory statement! Some people write a long birth plan for themselves, but a condensed version for their providers, which is totally acceptable. Discuss your wishes out loud and verbally with each person of your birth team (if possible) before you begin writing. You can write out your plan by yourself, with your partner, or with the help of your doula. Doulas LOVE helping moms write out and finetune their birth plans. Once it is written, provide each person time to read your birth plan before labor. Bring it to an appointment and ask your midwife or OB to review it asking for honest feedback on if it seems doable based on your pregnancy and medical history so far. Once the big day arrives, bring a few copies to the facility with you. Provide copies to your nurses and OB and keep one copy on you (this is a great job for Dad!).

With all of that being said, it is entirely possible that your birth plan changes before or during labor/birth. And if it does, that is okay! Most birth plans are written with consideration to emergent situations in place, which is a healthy mindset. It is entirely possible you may change your mind on medicinal pain management during labor as well. No one on your birth team will judge you for that. Your birth plan won't perfectly work for me, and mine won't perfectly work for you. If your birth plan goes out the window for any reason (emergency or personal change of preferences), it is okay to later feel grieved by the loss of this perfect birth you previously envisioned. It's also normal and healthy to envision your birth in the most ideal way for you! So I wouldn't avoid that mindset to begin with. However, balancing that with remembering that birth is unique and unpredictable may ease some of those feelings later on.

I hope all of this information has helped you as you begin to prepare to write out your birth plan. If you’re still unsure, I offer a birth planning session available to anyone! This can be in person or virtually. The quality of service will be the same. You do not have to hire me as your birth doula to utilize this service. Below you will find some of the most common topics included in birth plans, as well as a simplified version of my own birth plan.

BIRTH PLANNING TOPICS

  • who is allowed in the room

  • where your partner goes if there is an emergency with you or baby

  • induction preferences (ex. cytotec vs pitocin)

  • pain management (ex epidural vs no epidural)

  • freedom to move around or be in water

  • set up of the environment (ex dimmed lighting, music, oils, etc)

  • intermittent monitoring

  • pushing positions

  • tearing vs episiotomy

  • assisted delivery preferences

  • in case of emergent c-section and how you would prefer to be approached about the possibility of an emergency c-section

  • c-section preferences (ex. clear drape, pain medication, and when you want to see baby)

  • cord clamping and who cuts cord

  • what to do with placenta

  • golden hour preference

  • delayed newborn procedures and bath until after golden hour or not

  • if you prefer to room in with baby or send to nursery

  • newborn procedures in your room

  • whether you plan to breastfeed or formula feed

  • if pacifiers are allowed

  • circumcision plans for a male child

  • who you want to announce sex if you are team green

  • in case of NICU stay

MY BIRTH PREFERENCES (EXAMPLE)

Patient: Emily  DOB:

Husband and father of baby:

Additional support persons allowed in labor and delivery room:

 

Labor

·       Preference for Saline/Hep Lock to IV

·       Dim lighting

·       My own music

·       Intermittent fetal monitoring

·       Minimal cervical checks – I consent to one cervical check upon admission, checks if intervention decisions need to be made, and a cervical check to see if I am ready to push.

·       Natural rupture of waters

·       Free movement during labor

·       Access to water/ice

·       Access to birthing ball and peanut ball

·       Access to shower

·       I will try natural pain relief techniques before considering medication or an epidural.

·       I would like to avoid the use of Pitocin.

Delivery

·       Freedom to choose delivery position.

·       Avoid coaching me how to push.

·       I would like to catch my baby if I am in an appropriate position and there are no complications like shoulder dystocia.

·       I would prefer to tear naturally rather than receive an episiotomy.

·       In case of ER assisted delivery, I would prefer a vacuum extraction vs. forceps delivery.

·       In case of ER c-section, my main support person allowed in the room is: Additional people also allowed if permitted by staff:

·       In case of ER c-section, I would prefer any and all gentle cesarean methods. 

 

Immediately Afterwards

·       In case of ER with the baby or NICU admission, my husband will go with the baby.

·       In case of maternal ER, my husband will stay with me.

·       Immediate skin to skin. Minimal towels between mom and baby post birth. Do not rub off vernix. Not excessive external stimulation unless baby is struggling to breathe or failing APGAR scores.

·       Delayed cord clamping of 2 minutes or until cord stop pulsing, whichever occurs first.

·       I would prefer for the placenta to be born spontaneously without the use of Pitocin, and/or controlled traction on the umbilical cord.

·       I would like to delay routine Pitocin after the placenta is born unless there are any signs of hemorrhaging.

·       The father will cut the cord.

·       WE WILL BE KEEPING THE PLACENTA – Placenta will go into the provided cooler and be removed by my support team within an hour of delivery.

 

Newborn Procedures, Golden Hour, and Recovery

·       Delayed newborn procedures and all newborn procedures to be in the room.

·       Delayed newborn bath of 24hrs post birth. Parents will perform the newborn bath.

·       Baby boy Moncada will not be circumcised – do not circumcise or retract foreskin.

·       Observance of the golden hour, skin to skin, and breastfeeding within the first hour.

·       We do NOT consent to Erythromycin eye ointment unless the baby is showing signs of infection.

·       We DO consent to Hep B vaccine, Vitamin K injection, and the heel prick test.

·       Baby boy will be exclusively breastfed.

·       If he is admitted to NICU, I will provide pre-pumped colostrum for him, and I would like to have a breast pump provided so that I can continue providing breastmilk and encourage my mature milk to come in.

·       No pacifiers even in NICU.

·       Baby will room in with me in the postpartum room unless he is admitted to NICU.

·       We prefer as few check-ins as possible during postpartum recovery.

·       We prefer as early of a discharge as possible.

Emily Moncada