If you haven’t been following the Healthy Pregnancy Series so far, please check out the previous posts!
A birth plan is crucial in the delivery of your baby. A birth plan is your written wishes about how you would like the delivery and post-delivery experience to be, barring any unexpected complications. It covers things like who is in the room, how you would like decisions to be made, the environment (music? candles?), whether or not you want certain procedures (epidural? internal exams?), which newborn procedures you do/don’t want, where the baby should sleep, initial bonding, and more. It is critical to understand that if something does go wrong (which is not likely, but always possible) that your wishes may be impossible to follow. How to handle an emergency should be written into your plan, and it’s something you and your provider need to discuss. But in the event of a normal birth, the plan is what you would like to occur.
I’m including with this post a downloadable form you can fill out in case you, like many of us, need a template to get you started. Don’t feel like you need to use this; you can simply write your wishes down on your own. But this template can get you started and remind you of all the little details you may want to cover. I know when I was writing my first birth plan, I did use templates and there were many areas I hadn’t quite thought of!
So what exactly should be on a birth plan?
- Your name and your husband’s name
- Your doctor or midwife’s name (and doula, if you have one)
- The names of anyone else you wish to be present (include adult supervisors for any young children)
- Where you are planning to give birth
- Your estimated due date
- How you feel about induction
- When you would like to go to a hospital or birthing center, if applicable
- Comfort measures you would like to use in labor
- What procedures you do or don’t want (IVs, pitocin, the ability to eat/drink, etc.)
- Environmental concerns (music, lights, candles, etc.)
- How to handle problems that crop up
- Pushing positions you’d like to use (if known)
- Episiotomy/tearing preference
- Vacuum/forceps preference (or neither)
- C-section preference
- Pain medication preference
- Cord clamping/cutting (when and who)
- Initial bonding
- Cleaning/bathing of baby
- Newborn procedures (eye ointment, vit K, Hep B, etc.)
- Sleeping arrangements (nursery or room-in)
- Baby’s first exam (where? who should be there?)
- Visitors (allowed? who?)
- Breastfeeding/bottle feeding
- Pain relief after birth
- Length of stay (if in a hospital or birthing center)
- What to do if the baby/you has a problem after birth (where to transfer if necessary, who should go, etc.)
- Anything else that especially concerns you
There’s a lot to think about!
Ideally a birth plan should be completed early in your third trimester. Obviously, if are unfortunate and your baby is born rather prematurely (before about 35/36 weeks), many of your options will go out the window. Still, you want to write your birth plan far enough in advance that you can discuss it thoroughly with your doctor or midwife long before birth is imminent (any time after 37 weeks).
Write an outline of your birth plan — basically, what you would prefer under ideal circumstances. Bring it to your provider and say, “This is what we would like. Is this feasible?” You may find that certain hospitals will not allow or will require certain things (like forbidding eating during labor, or having to have an IV). Some doctors will require or forbid certain things, too. If issues crop up, you must decide if you need to find a new delivery site or a new doctor. It depends on how important the issues are to you. If, for example, the doctor says, “Well, they prefer that you don’t light candles in the delivery room,” that may not be a big deal. But if the doctor says, “You have to deliver lying on your back and we don’t hesitate to use forceps or a vacuum; no, we won’t allow you to change positions,” that may be a deal breaker. It depends on what is most important to you. In case you do need to make a switch, it’s good to talk these things through early!
Once you have talked through your plan and have come up with one that you and your health care provider both (hopefully) feel good about, both of you sign it. If you’re in a state or delivery location that has a habit of ignoring birth plans, get it notarized. Then make several copies. Every person who enters your room needs to have one (give your husband or another support person this job). That means your doctor, every nurse, any on-call doctors who check on you, any residents (if any attend your birth), etc. Don’t forget to keep it on hand after your baby is born and continue to pass it out to your baby’s nurses, too.
Hospitals unfortunately will often try to ignore birth plans if they can get away with it. They do not like deviating from their standard procedures. In their defense, they want to make sure that nothing that needs to get done gets skipped or done twice. However, it is your baby, and your right to choose. There are certain things that are mandated by law, but you can often opt out if you sign specific waivers. Ask to see these papers and agree to sign that you will not sue them because you have chosen to opt out (but read the fine print carefully!). Only a few states will make a huge fuss about certain procedures (in New York, they will not let you leave the hospital without eye ointment, for example, and are rather strict about most things).
It is also common for staff to simply “forget” (usually by accident, but sometimes on purpose) your birth plan. They won’t check for one before they go ahead and do the usual procedures, so it’s up to you to make sure your plan is being followed. Don’t let anyone do anything to you without explaining what and why (except in an emergency situation, of course). Don’t let anyone take your baby without knowing where they are going and why, and ideally, send someone with the baby. It is often true that babies are taken for brief procedures but then simply set in beds in the nursery and left for awhile, until a nurse is free to take the baby back. If you are insistent they will do most procedures that are necessary at your bedside. They will probably not like you very much, but your job is parent first, not popularity.
It is unfortunate that I have to say all this. But I’m sure many of you can chime in with horror stories like “We told them not to do X but they did it anyway while the baby was in the nursery!” Ideally, you should have an extra person with you (mother, sister, friend), or better yet, a doula, who will advocate for you. (Yes, a close friend or family member will provide more personal support to you, and I’m not discounting the need for that, but when you’re seeking an advocate, you want someone who’s done it before and knows how to talk so they will listen.) This advocate can make sure that your plan is followed as much as possible.
While you’re at it, you can download the birth plan template.
Did you write a birth plan? Why or why not? Was it followed?