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Making a Birth Plan

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At one of my regular OB-GYN visits late in pregnancy, my doctor inquired about my birth plan. Uh… My plan was to trust that she knew what she was doing and to let her do it. Apparently, that particular plan wasn’t what she had in mind. She insisted that I create a birth plan, even though I had no idea what would even go into one beyond 1) go into labor, 2) go to the hospital, 3) have the baby. However, I am nothing if not a good patient, so I did some research and came up with a plan. What was in it? Well, here’s what you need to think about when you’re making a birth plan.

Know what’s possible. Be aware of policies and procedures at the location you’ve chosen for your birth. If you want a party in your delivery room but you’re giving birth at hospital that only allows one person to be with you, that’s obviously not going to work.

Keep it simple. This is going to seem like really silly advice when you see the big old list of questions below, but what I mean is: you don’t have to go into a ton of detail.

What does your health care provider usually do? Remember how I said I wanted to leave it in my doctor’s capable hands? Ask your health care provider to describe their procedure for an uncomplicated delivery (or the type of delivery you’ll be having if you know in advance of special circumstances around your pregnancy and delivery). You can look over what they do and see what you if anything you’d want to do differently.

Now for the fun part!

Questions to answer. Here are some questions to think about—and yes, this is a long list. Don’t get freaked out. You may find that not all of these are important to you. You may find that the standard procedures at your birthing location and/or your health care provider’s standard routine both answer all or most of these questions and meet your needs—that’s fine! It still doesn’t hurt to have the answers written down.

  • Where do you want to give birth? If you are giving birth at home or at a birthing center, what are your transportation plans to get a hospital in the event of an emergency?
  • Who do you want to be present? Is there anyone you don’t want present? Any special instructions for those who are there (like everyone should stand above your waist)?
  • Who is your birth coach? Do you have/want a doula?
  • Will someone be taking photos or recording the birth? Does your birthing location allow this?
  • Do you plan to bring anything from home (your own clothes, blankets, music, etc.)?
  • How do you feel about induction? Do you feel differently about natural methods to try to bring on labor versus medical inductions?
  • What are your preferences regarding a C-section? If you have one that is planned or otherwise done with local anesthetic, do you want to have the drape removed or do want a clear drape used so you can view the birth?
  • How do you feel about fetal monitoring during labor?
  • Do you want to use pain medications? What types of pain medications do you want to consider/use? Do you want them right away, or do you want to try to labor without medication first?
  • Do you wish to employ other methods of pain relief instead of, or in addition to, pain medication? If so, what kinds (breathing exercises, massage, ice/heat, etc.)?
  • During labor, do you want to move around, or do you want to stay in bed? If you want to move, what activities (walking, dancing, balancing on a stability ball, etc.) or positions (squatting, hands and knees, etc.) do you want to use?
  • What are your preferences for food and drink during labor?
  • If you have other children, what is your plan for their care? Will they be present? Does your birthing location allow this?
  • Is there a certain position you prefer to give birth?
  • How do you feel about episiotomies?
  • Do you want to delay cord clamping? Do you want someone other than medical staff to cut the umbilical cord? Will you bank the cord blood?
  • Do you want immediate skin-to-skin contact, or do you want to wait until the baby has been cleaned up?
  • Will you nurse, bottle-feed, or both? When will baby’s first feeding happen? If you are in a Baby-Friendly accredited hospital, the hospital may have specific rules or guidelines around this question.
  • Where will the baby sleep (in a nursery, rooming in with you)? As with feeding, if you are in a Baby-Friendly accredited hospital, there may be specific rules or guidelines around this question.
  • If you give birth to a boy, will you have him circumcised? If so, when?

Whew. That was a lot to think about!

Have multiple copies. Discuss your birth plan with your health care provider, and make sure they have a copy. Keep a copy in your hospital bag, and make sure your labor coach and/or doula—whoever your support person is—has a copy, too. I’m not saying that the delivery room is a battle between you and your health care team, or anything, but it’s nice to know that everyone is on the same page—especially at a time when you many not be able to communicate your wants as clearly as you would usually do.

Consider having a back-up plan in case of complications. Make a plan for your ideal uncomplicated delivery (or, if you already know that you’ve got a less than ideal situation ahead, for that reality), and then consider making a plan for potential complications. For example, if you’re hoping for a standard non-induced delivery with an epidural, also consider what you might want if you need to be induced, or if you have to have a C-section. If you’re planning on an unmedicated home birth, also create a birth plan for a birth in a hospital setting. That way, you’re still able to have some say in how things go, even if they don’t go exactly as you’d envisioned.

Oh. And one more thing. Remember how I had my birth plan? Well, you know what ended up happening? Exactly the opposite of everything I wanted to have happen. As a matter of fact, the end of my (wonderfully complication-free until then) high-risk pregnancy ended in a few weeks of bed-rest topped off by untreatable PUPPP, all capped off by a birth story of the variety that can’t be told to anyone who hasn’t already given birth because it’s considered unnecessarily cruel to scare them by sharing it. So the most important thing to remember when preparing your birth plan is to be prepared to roll with punches. All the stars may align, and things might go exactly according to your plan, or there may be an emergency that throws your whole plan right out the window. Know what you want, be an advocate, and surround yourself with advocates, but be prepared for the unexpected, too. No matter whether this is your first child or your last, this birth is a moment that has never been and never will be again—and there’s no telling what it’s going to be like.

PS: Still feeling overwhelmed? Here’s a worksheet, here’s a worksheet, and here’s a birth plan generator.

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