Somewhere throughout your week-by-week pregnancy checklist, you’ll come to the birth plan assignment. This caught me off guard during my pregnancy as I didn’t know how to write a birth plan, let alone what that even meant. Could I plan and control my labor exactly to my wishes? How detailed did this plan need to be? And what sorts of information should I include?
Writing a birth plan can feel overwhelming, but it doesn’t have to be that difficult. All a birth plan does is give the hospital staff a general run-down on your ideal labor options, your wishes, and any specific concerns or fears you might have beforehand. It’s designed to help your nurses and birth team advocate for you when you can’t advocate for yourself, and it also serves as a jumping-off point for the deeper personal and philosophical conversations you should have with your doctors. A birth plan also forces you to do your homework and really think about which birthing options you’re most comfortable with.
Before you get started with the actual pen-to-paper birth plan writing, it’s important to note that labor rarely goes to plan. Just because you put something in writing — like “no episiotomy” or “drug-free labor” — that doesn’t mean the scenarios will play out according to your script; nor does it guarantee that your doctor’s practice will align with your wishes. That’s why an open dialogue about your birth plan is so crucial, as well as a general flexibility in your expectations. In fact, some practitioners are cautious about the birth plan process altogether. In her book Birthing From Within, nurse midwife and childbirth educator Pam England calls writing birth plans, “a ritual of modern pregnancy” that can act as, “a hidden reef on which your efforts toward deeper birth preparation may run aground.” She sees many birth plans written from a place of fear, anxiety, and mistrust, and a general lack of self-confidence. Again — a birth plan isn’t meant to control the outcome of your labor, and it’s not one more to-do to check from your list; it’s meant to get everyone on the same page as to what you would and wouldn’t like to happen during such a vulnerable experience.
And yet it’s still a good idea to write up a simple, well-researched, thoughtful birth plan that you can discuss with your birth team (including your partner).
1. Imagine Your Perfect Birth Scenario
What’s your ideal birthing situation? Would you prefer a home-y environment or a hospital stay? If you’ve had a previous C-section, are you hoping to try for a VBAC? Think about the ideal way you want your delivery to go, and write that out. But keep in mind that the chances of if being executed exactly as written are slim.
2. Think About Every Scenario That Could Happen
Let go of those expectations. Understand that a birth plan doesn’t guarantee that anything will go according to plan. When making a birth plan, it’s extremely important to be flexible in your wishes, acknowledging that a wide variety of outcomes are possible.
3. Research All Of Your Options
I chatted with Melissa Lawlor, a midwife in the Hudson Valley, who says a birth plan is individual to the woman’s past experiences, current belief systems (i.e. vaccines, pain medicine, etc.), and the medical practice she’s using. She suggests asking important questions like: Is the practice a hospital or birth center? Do you want a home birth? How many providers are in the practice? Do they offer midwives?
It’s also important to research all of your provider’s birthing procedures — before and after labor, too — and to know which medical interventions are optional. It’s natural to trust authority and assume that everything is mandatory, but you actually have a lot more options than you might think. Do you know what pitocin is? Erythromycin ointment? Episiotomies? Do you know about the different stages of labor, and what you might need in each stage? How do you really feel about circumcision? This is the step to gather as much research as possible, so pop on some Netflix documentaries, hit the library, and ask your friends for advice.
4. Talk To Your Birth Team
Once that the research is done, it’s time to bring your inevitable questions and concerns to your birth team — whoever that may be. Different practices have different procedures, and it’s important to feel comfortable with how your personal preferences align with the hospital or birth center’s long-standing routines and norms. To ease your concerns, consider hiring a doula or working with a trusted midwife who can help bridge the communication between you and your doctor, and better understand your options. It also helps to talk to other women who gave birth with your doctor, ask about their C-section rates, and take a hospital tour with your birth plan in hand.
5. Define Your Big Deal Breakers
After talking to your birth team, define what is and isn’t acceptable. Of course you can’t know if medical intervention will be necessary — much of your labor will be out of your control — but how safe do you feel in their hands? Which procedures are you most uncomfortable with? For me, it was very important to have control over my laboring positions (even though I couldn’t possibly know which positions would work best for me), to have the option of laboring in a birthing tub, and to have immediate skin-to-skin contact with my newborn if possible. I also insisted on delayed cord clamping and having a lactation consultant on hand immediately.
And if need be, find another provider who better aligns with your wishes. It’s not too late to assemble the right birth team. Now that you know what you want and don’t want, actively seek the right support system is key to a successful and stress-free delivery.
6. Write Up Your Plan, And Make It Simple
“If you want to make a birth plan, make it simple and direct,” Suzie D’Angelo, a doula at Hudson River Doulas in New York, says. “Something very easy for the staff to glance at. If it’s three pages of a birth novel, it’s asking a lot of the delivery nurses and doctors during their busy shift.” You can also check out pre-made birth plan templates that you can print and fill out with your partner.
A good basic outline is to section of your plan into different bolded sections: Before Labor, Induction, Pain Relief, First Stage, Second Stage, Delivery, After Birth, and Newborn Procedures. This way nurses can quickly glance at the stage you’re in. Underneath each headline, put a bulleted list of wishes and preferences, bolding where necessary. It’s also a good idea to include the people you’d like (and wouldn’t like) in the delivery room with you, and any medical diagnosis like group B strep or gestational diabetes.
7. Be Prepared To Throw The Plan Out The Window
Chaunie Brusie, a former labor and delivery nurse, says that she was always careful to honor birth plan requests that weren’t popular in her small hospital, but also stressed that first-time moms keep an open mind because it’s totally okay to change your mind. “A lot of women feared being judged if they ended up begging for the epidural at 1 cm, and honestly no nurse cares,” Brusie says, insisting that nurses just want their patients to be comfortable. “
I’ll never forget one couple who was arguing and crying because she made him swear not to let her get the epidural, and he was trying so hard to follow her wishes. I had to take him out in the hall and say it’s okay for her to change her mind — she makes the decisions, not him.” And as much as hospital staffs try to honor birth plans, not all requests are possible. Brusie also agrees with D’Angelo, saying, “It’s a long-standing joke that the more rigid your birth plan, the more likely you are to get cut. It’s true that there’s a link there. Labor is about going with the flow and listening to your body in that moment.”