“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.
1st Stage (Labour):
- Support Team and their Roles
- Room set up preferences
- Pain Relief Options – natural or medical. Which one/s?
- Foetal Monitoring preferences – nil, intermittent Doppler (how often?), continuous CTG or baby scalp monitor?
- Vaginal exams – no or yes, and if yes, how often?
2nd Stage (Birth of Baby):
- Pushing –instinctive or guided?
- Who catches the baby? Mum, Dad or Midwife/Ob?
- Who announces sex of baby?
- Cord clamping and cutting: Who cuts the cord? How long to wait: Before or after birth of placenta, or lotus birth?
3rd Stage (Birth of Placenta):
- Physiological (ie. natural) or Active Management (syntocinon injection, palpation 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?
- Vitamin K –nil, oral, or injection?
- Breastfeeding or bottle feeding?
- Hep B Vaccine: No, Yes, or delay until future GP visit?
Complications and the Unexpected:
- Transfer from homebirth to hospital, or from birth centre to labour ward
- Induction and Augmentation
- Emergency Caesarean
[Example of a Natural Birth Plan]
Birth Plan for [Mother’s Name]: E.D.D 1/04/2020
Birthing Partners: [Partner’s Name] (Spouse) and [Doula] (Doula)
My intention is to have a normal, physiological birth with the guidance and support of my partner, my doula and midwife for working with pain. Please respect my preferences below…
- Do not offer medical pain relief!
- Please inform me if my baby is posterior so that I may try different techniques to help baby turn.
- Intermittent hand-held foetal monitoring only – no more often than once every half hour, unless medically necessary such as heartrate abnormalities or during pushing. No foetal scalp monitor – please show me what gets attached to baby’s head if you feel that it is required.
- No vaginal exams unless I request one.
- No giving me a stretch and sweep or breaking my waters without my consent!
- I would like complete silence or quiet encouragement by my support team during contractions.
- If medical interventions are warranted, please explain the pros and cons to me in between contractions without coercion, 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, nipple stimulation, acupressure, herbs etc. before being offered syntocinon augmentation.
- Water birth preferred.
- I prefer to push instinctively, but if I do need direction, please only 1 person to speak at a time.
- Remind me to pant during crowning to avoid tearing.
- No episiotomy unless absolutely necessary (ie. to get baby out quickly in an emergency).
- Baby to take its first breaths unassisted (no suction unless medically necessary).
- We do not consent to clamping and cutting the cord until after the birth of the placenta. If resuscitation is necessary please ask for our consent before cutting the cord, otherwise [Partner] to cut the cord, when we are ready.
- Natural / physiological delivery of the placenta preferred and no touching the cord. Please give us 1 hour with no distractions or pressure before offering syntocinon injection, unless there is heavy bleeding.
- I want to find out for myself what sex my baby is, or [Partner] to tell me only.
- Skin to skin contact with baby immediately after birth, and baby to breastfeed when he/she is ready.
- I wish for my breasts to be treated gently and only touched with permission.
- I would like to my placenta refrigerated or packaged with ice to be taken home/picked up for encapsulation.
- I would like to make an informed decision on both the vitamin K and the hep B vaccine, and be given the package inserts (not the promotional material) and time alone to view and discuss them
- 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, unless in the NICU.
- 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.
- I would like a lactation consultant if I have difficulties breastfeeding.
- I would like to do “vaginal seeding” so that my baby is given the best chance at colonising his/her gut with optimal microflora.
- I would like [Partner] and [Doula] present in the theatre.
- We request that my right arm be free of an IV line and is free to move about so that I can hold [Partner’s] hand and cuddle my baby.
- Please turn the volume down on the heart monitor
- Please allow [Partner] to announce the baby’s gender (or allow me to see for myself)
- Please hold baby up for me to see as soon as he/she born.
- No cutting the cord as I would like to have a lotus birth.*
- If baby is well, I would like skin to skin contact ASAP. Delay weighing and measuring procedures until breastfeeding is established, and these are only to be done in my presence.
- If I am separated from my baby, I would like [Partner] 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 [Partner] and I would like some time to be totally alone for at least an hour to celebrate with our baby. No outside visitors are to be allowed in until we indicate that we are ready.
- I would like to make an informed decision on both the vitamin K and the hep B vaccine, and be given the package inserts (not the promotional material) and time alone to view and discuss them between [Partner] and I.
*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 its placental blood. Delete this paragraph for your official copy.
**Other points for [support people]**
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.