Making Your Birth Plans

Women often have strong feelings about what they do and don’t want to happen during their pregnancies. Whether we already have children or this is the first time, more specific hopes, wishes, and fears come up as baby’s arrival draws near. This is when a Birth Plan can be a helpful comunication tool.

A birth plan is a written outline that helps those caring for you to understand what you want and need in labor, birth and after your baby arrives. Ideally, it should be flexible since labor, birth, and babies are not always predictable. Birth plans work best when they build on a trusting relationship with your care provider established over the course of your pregnancy. All of the issues in your birth plan should be discussed well before your baby is due to ensure that both you and your midwife or doctor are comfortable with each other and have similar expectations of pregnancy, labor and birth. That way, when it comes time to write your birth plan, you can focus on things that are individual to you, not broad policies and procedures. Following are some issues you can address in your birth plan.

Who do I want with me when I am in labor?
The people with you should be supportive. Birth is not a spectator sport. It is hard work! You will need to rely on those around you for physical, psychological and spiritual support. You should feel at ease with whoever you choose. You may need to make special arrangements if you want more than two people with you or an older child present at the birth. Speak with your doctor or midwife about how to facilitate your wishes.

How do I cope with fear and pain?
Labor is hard work and can seem overwhelming at times. Think about how you respond best to challenges. Do you need reassurance or praise? Do you want to be touched or massaged, or should people just be nearby? Will music, dim lights, or a familiar pillow help? Ask about what you may bring with you to create an environment where you can feel confident and relaxed.

How do I want to labor?
Some women feel very strongly about natural labor, while others want pain relief at the very first contraction. Many are somewhere in between. Learn the benefits and risks of labor support and pain medications. Learn about fetal monitoring, intravenous lines, episiotomies and other procedures that you may need during labor and birth. Read about different positions for labor and pushing out your baby. With some reading and talking to others, you can make informed choices about how you want to labor.

Do I want a Doula?
A doula is a trained woman who will support you from the time you go into labor until after the baby is born.

Some doulas also provide assistance once you’ve returned home with your baby. A doula can be invaluable if you want to labor naturally and your provider will not be with you the entire time you are in the hospital. Ask your doctor or midwife to recommend a doula if you are interested or ask your childbirth educator for a referral.

What if I need a cesarean section?
Most cesarean sections are not dire emergencies and you can still address your wishes in your birth plan. For example, do you want to have one support person with you during the surgery? Do you want to see and hold your baby as soon as possible after surgery? Do you want help with breastfeeding in the recovery room? Sometimes in an emergency, your care providers will be acting quickly in your best interest and there will not be time to implement your birth plan.

When baby is born
Most babies are born without complications and make a smooth transition to breathing on their own. If this is true for your baby, make your wishes known for those precious moments when you first meet each other face-to-face. Do you want your baby placed on your belly right away? Do you want to nurse as soon as possible? Who do you want to cut the cord? Do you want the room quiet and the lights dimmed?

How do I want to feed my baby?
Do you want to breastfeed your baby? If so, early help from your midwife, doctor, nurse or doula can make a difference. Find out if your hospital has any help available for breastfeeding moms. Find out about any procedures that you might want to avoid, like giving a first bottle of sterile water. Most hospitals and all birth centers offer skilled help to breastfeeding moms.

Do I want rooming in?
Find out if you and your baby will be separated, and if so, for how long. If you don’t want this to happen, you may need to make arrangements ahead of time. You may also want to consider having a support person stay with you overnight in the hospital. Some hospitals are not able to accommodate support people overnight. Find out about visiting hours and make your preferences known.

When do I want to go home?
Do you want to stay in the hospital and take advantage of extra help and classes? Do you want to return to the comfort of home as soon as possible? Whatever you decide, think practically and arrange for help ahead of time. Discuss your wishes in advance with your doctor or midwife. If you choose early discharge, make sure you have a pediatrician well before your due date so that your baby can get needed checkups.

Depending on where you labor (hospital, birth center or home), your specific issues will vary. There are many excellent books available which your care provider or childbirth educator can recommend. Good luck as you make your birth plan for the satisfying birth experience you desire.

Editorial provided by Dana B. Perlman, CNM, MSN, of Pennsylvania Midwifery Associates at Pennsylvania Hospital in Philadelphia, Pennsylvania.