“The power of a birth plan isn’t the actual plan, it’s the process of becoming educated about your options!” ~ Jen McLellan (plussizebirth.com)
“If you don’t know your options, you don’t have any!” ~ D. Korte
Writing a birth plan (or you may wish to call it “birth preferences”) is a great way to be clear about your intentions for how you envision the birth of your baby. It is not meant to give you unrealistic expectations but rather to open up communication and bring the birthing team to a closer understanding as to what each other hopes for. It is also helpful for your support team to know ahead of time what your wishes are, so that important decisions need not be discussed in detail on the day, when the vulnerability of the labouring woman can make decision-making difficult. Give your care provider a copy and discuss your wishes ahead of time, but always bring an extra copy on the day, as it may have been forgotten or lost, or you may have different staff on, on your big day!
Some Points To Consider
Keep it short, concise and in point form with decent text size that is easy to read, as the midwives and medical staff may be very busy and do not want to read an essay (1 page only to be given to the staff). [Below is an example of a natural birth plan]
Don’t state the obvious such as what may be standard procedures anyway (it may be worth discussing standard procedures with your care-giver or doula), but be clear about your wishes in areas of choice and in unexpected situations such as in the event of transfer from the birth centre to the labour ward.
Do not be rigid, as things often go outside of your plans and expectations, so be open to the possibility that your best laid plans can go out the window in the intensity of labour or in the event of an emergency, so give alternatives for such situations.
The statistics in Australia show that approximately 1/3 of women will end up having a caesarean birth (WHO recommends that only 10-15% should be necessary!). So write a caesarean birth plan on a separate page, to be pulled out in case of emergency.
You may want to write an extra page for your partner and/or doula which is separate to what you give the midwife/obstetrician.
- Support Team and their Roles
- Comfort Measures and Pain Relief Options
- Foetal Monitoring Options
- Room set up
2nd Stage (Birth of Baby):
- Gender announcement
- Cord clamping and cutting – Before or after birth of placenta? Who cuts the cord? Or lotus birth (leave cord and placenta attached until it naturally drops off)?
- Cord blood donation?
3rd Stage (Birth of Placenta):
- Physiological (ie. natural) or Active Management (syntocinon injection and cord traction)?
- Placenta to be taken and incinerated as waste by the hospital? Taken home to bury? Encapsulated? Or left alone for lotus birth?
- Skin to skin contact.
- Routine newborn measurements and their timing.
- Vitamin K – injection, oral or nil?
- Vaccinations? Which, if any, and when?
Complications and the Unexpected:
- Transfer from homebirth to hospital, or from birth centre to labour ward
- Induction and Augmentation
[Example of a Natural Birth Plan]
Birth Plan for Jacqui Smith: E.D.D 1/10/2014
Birthing Partners: Adam Smith (Spouse) and Virginia Maddock (Doula)
- Natural pain relief: massage, hot packs, TENS, shower, bath, (gas if requested).
- Do not offer medical pain relief!
- Intermittent hand-held foetal monitoring only, unless medically necessary such as baby in distress. No foetal scalp monitor.
- No vaginal exams unless I request one.
- I would like my membranes to rupture naturally – no breaking the waters!
- I would like complete silence during contractions.
- Water birth preferred.
- Remind me to pant during crowning to avoid tearing.
- No episiotomy unless absolutely necessary (ie. to get baby out quickly in an emergency if it is in distress).
- We would like our baby to take its first breaths unassisted (no suction unless medically necessary)
- Delayed cord clamping (cut cord only after it stops pulsating). Adam to cut the cord after the placenta is out.
- No cord blood donation.
- Natural / physiological delivery of the placenta preferred and no cord traction. Syntocinon injection only if absolutely necessary such as delayed 3rd stage after 60 minutes, or heavy bleeding.
- I want to find out for myself what sex my baby is, or Adam to tell me only.
- Skin to skin contact with baby immediately after birth.
- I would like to breastfeed soon after birth, whenever baby is ready.
- I would like my placenta packaged with ice to be taken home/picked up for encapsulation.
- I wish for my breasts to be treated gently and only touched with permission.
- No Vitamin K unless medically necessary (such as birth trauma with bruising).
- No hep B vaccine as I will be discussing vaccinations with my GP.
- Weighing and measuring baby must be done in my presence, and only after first breastfeed. We will bath our baby at home.
- Baby to room in with me at all times.
- I would like a lactation consultant if I have difficulties breastfeeding.
- If baby needs to be fed expressed milk, we would like it to be fed via a syringe, spoon or cup. No dummies or formula.
- No induction unless there is a valid medical reason. (If I go overdue I am happy to come in for monitoring and a bio physical profile to assess baby’s health and wellbeing.)
- Please explain every intervention to me and then allow me PRIVATE time with my support team to discuss my options before I make a decision.
- If labour stalls, I would like to try walking, homoeopathics / herbs before being offered syntocinon augmentation.
- I would like my husband and birth photographer* present.
- We request that my left arm be free of an IV line and is free to move about so that I can hold Adam’s hand and cuddle my baby.
- No cutting the cord as I would like to have a lotus birth**.
- If my baby needs resuscitation, I prefer that this be done while still attached to it’s cord and placenta so that it still receives oxygenated blood.
- If baby is well, I would like skin to skin contact ASAP. Delay weighing and measuring procedures until breastfeeding is established.
- If I am separated from my baby, I would like Adam to have skin to skin contact with the baby and my doula to be present with me. If necessary to feed the baby in my absence, I would like it to be fed via syringe, spoon or cup with my expressed colostrum / breast milk rather than fed with formula in a bottle. No dummies.
- I would like my baby to join me in recovery, if he/she is well enough.
- Once out of recovery Adam and I would like some time to be totally alone for at least an hour to celebrate with our baby. No visitors are to be allowed in until we indicate that we are ready.
- We would not like our baby to have any injections within the first 24hr after birth. Please discuss with us the oral administration of Vitamin K.
*Due to hospital policy, it is rare for anyone but the husband/partner to be allowed into theatre but if the doula takes photos as the “birth photographer” then there is a slightly increased chance she may be allowed in. No guarantees but no harm in trying!
**Lotus birth is a practice whereby the cord is left attached to the placenta until it naturally dries and falls off itself, which some people believe is a more gentle transition for the baby. Requesting delayed cord cutting may not be honoured during a caesarean but if you ask for a lotus birth due to spiritual beliefs then your request may be more likely to be respected.Then you can cut the cord in your own time, well after the baby has received all of it’s placental blood!
**Other points for Adam and Virginia**
Transfer to hospital > hospital room set-up
- Put baby capsule in the boot, so I have room to lay in the backseat on the way to the hospital. Get it fitted after baby is born.
- Make car comfortable with cushions (+ bucket & plastic sheet in case I vomit).
- Set up tea light candles / lamp.
- Dim lights in the room
- Cover or hide clock.
- Burn essential oils in burner.
- Play iPod with my chosen playlist.
- Offer snacks (in early labour) and cold drinks in between contractions.
- Remind me to urinate every hour.
- Massage shoulders, hot packs on belly, and TENS on lower back
- Ice cold cloths on face and neck as needed (especially when in a hot bath).
- Help me to try different positions. If baby is posterior, lift belly during contractions to encourage baby to turn.
- If I ask for medical pain relief please discourage me and remind of me of my desire for a drug-free birth and help keep me going. If I ask for it [ X ] times or say the code word [ ___ ] then please get it for me. I prefer gas initially then epidural if absolutely needed (before 7cm!). No pethidine or morphine!
- Labour kit (homoeopathics, essential oils, flower essences and herbs as needed).
- No idle chit chat or talking on mobile phone unless out of ear shot. I prefer complete silence during contractions, unless in need of direction – then do so quietly.
- Use quiet praise, affirmation, reassurances & words of encouragement when I am losing it – remind me that I can do it and that I will soon meet my baby. Remind me of my visualisations: contractions like a wave, cervix like a flower opening, baby coming down.
- Do a body check on me to see if I’m tensing up and quietly guide me to relax: “Soften your mouth / shoulders / lips…”. Use words like “release”, “surrender” and “let go”.
- *Don’t forget to take turns resting and keep yourselves energised and well-hydrated with snacks and fluids.
- Please do not allow any visitors to pick up and hold my baby for at least the first 48 hrs after birth so we can establish bonding.