Writing a 'birth plan' may be simpler than you think

writingabirthplan_large

The first thing to know about a birth plan is that it probably shouldn’t be called a plan at all.

What many call “birth plans,” I like to call “birth preference lists,” because, let’s face it: No one has complete control over the birth process.

The TL;DR ‘birth plan’

Some pregnant people love writing wishes for delivery that include music preferences and back-up plans for every possible contingency. Some people don’t.

Already overwhelmed and want a “too long; didn’t read” version? 

  1. Ask your healthcare provider what their standard of care is for labor and delivery.
  2. Have them walk you through their typical methods of action for various scenarios (e.g., When and how might you need to be induced? If the preference is a vaginal delivery, at what point do they decide to move to a C-section, and what does that process look like? What birthing positions are typically available? What pain relief options are available?)
  3. Once you have an understanding of your provider’s standard of care, communicate at what points you might prefer something different from their norm.

Talk with your provider so that you’re on the same page, write down those preferences and make sure your labor support person is also aware of your wishes. You may find that your provider already does what you’d like in each scenario, making it easy to write a birth plan.

Making a more detailed preference list 

I always tell patients at the Ohio State Maternity Center that it’s best to hit the highlights — keep your list to one page, if possible, and use bullet points to make it easy for the whole care team to read and keep track of your wishes.

When I talk to pregnant patients about their wishes for delivery, common topics are:

  • Whether they want to be able to labor and/or birth in certain positions
  • Whether they want pain medication, and what types they’re interested in
  • Whether they may want hydrotherapy during labor (being able to labor in a shower or tub)
  • Preferences for fetal monitoring (e.g., intermittent versus continuous, or whether they’d want internal monitoring)
  • Preferences for hydration (using an IV versus drinking water)

Many patients also like to include preferences for baby care, such as:

  • What they think about the standard medications for baby in the delivery room, such as the erythromycin eye ointment
  • If they plan to have their male baby circumcised
  • Feeding preferences (exclusive breastfeeding or formula-feeding, or some combination)
  • If they’d like to delay umbilical cord clamping, and for how long (for a minute, until the cord stops pulsing, etc.)

If you have strong preferences for any point of delivery, it’s important to review those with your provider well ahead of time to make sure your preference is available. For example, if you want a water birth, you’ll need to make sure your provider offers it. Here at the Ohio State Wexner Medical Center, water births are available through our midwifery team at the Ohio State Maternity Center. 

What to know about ‘birth plan’ templates online

Feel free to look for online templates that get you started with questions. Keep in mind, though, that many of these lists mention practices that may no longer be the standard of care in evidence-based medicine.

For example, I sometimes see preferences like “I don’t want to be shaved” or “I prefer not to have an enema.” Those aren’t typically performed anymore during labor and delivery, so there’s little need to address those issues. These days, most providers avoid routine episiotomies.

Talk with your provider about any topic that causes you concern or that you’re not sure about, but know that these templates and questionnaires could bring up topics that are no longer relevant.

New options available in labor and delivery

If you’ve already had a baby but it was a few years ago, there may already be newer developments available to you to make labor and delivery safer and more comfortable.

Many U.S. medical centers, including Ohio State, now have nitrous oxide available as a pain relief method. There are different fetal monitor options now that are more portable, allowing laboring patients to walk freely or even get into the shower while still being monitored. Water-birthing tubs are becoming more common.

Ask your provider about new options available to you and in what circumstances you could take advantage of them.

Avoiding disappointment and creating happier outcomes

Studies have shown that, after delivering a baby, patients are happiest when they feel empowered as a member of the care team who knows the risks and benefits of different options. So ask questions, consider different scenarios and remember that you have a voice.

Talk openly and realistically with your provider and labor partner about what labor and delivery will look like if things don’t go as expected. Acknowledge that a C-section could be needed, and talk about the choices you have in that scenario.

If something doesn’t go exactly the way you’d prefer, that doesn’t mean you have to throw out your whole wish list. Perhaps you have to be induced when you preferred not to, or you didn’t plan on getting an epidural but get one because you’re so exhausted that you need a rest. You can still stick to many other preferences, such as delayed cord clamping, or immediate skin-to-skin contact with the baby after delivery.

There are many routes to healthy deliveries and healthy babies — you don’t have to commit to just one.

 

Emily Neiman is a certified nurse midwife at The Ohio State University Wexner Medical Center.