Birth Plan

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The Ultimate Birth Plan Checklist: Dos, Don'ts & What To Include

From pain management to cord clamping, options abound.

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Anyone who is pregnant these days gets asked the same question at some point: “So, what’s your birth plan?” Maybe you know exactly what you want your delivery to look like, or maybe your only goal is to show up and have a baby. While it is not a requirement of pregnancy by any means, writing a birth plan can help you and your providers get on the same page, and knowing what to consider, include, and even leave out, can help everyone get the most out of your plan. That said, if you’ve sat down to actually write your birth plan, or done a little Googling to figure out what goes into one, you can get overwhelmed quickly. There seem to be so many decisions to make, and it’s hard to know what choices are right for you. This comprehensive birth plan checklist can help you master the daunting world that is: Birth planning.

What to consider when writing your birth plan

Don’t feel like your birth plan has to be any one particular thing — birth plans are inherently personal and there’s no wrong way to write yours. There are many, many free birth plan templates out there, and those can be a really easy, no-brainer place to start. Your birth plan can be long and detailed or short and sweet. The whole point of making one is simply to make you feel a bit more comfortable and confident.

If you’re considering writing a birth plan, just be sure you’re coming from a place of awareness. All the planning in the world does not mean that your labor and delivery experience will go exactly the way you want it to. Writing a plan for an unpredictable experience is a delicate endeavor. “I’m all for an informed person with options, agency, and choice, but sometimes it’s coming from a place of fear, and that makes my heart hurt,” says Estela DiFranco Field, a certified nurse-midwife and associate medical director of the Duke Birthing Center. “As long as it can be a useful tool to people, then great. Sometimes it ends up feeling like…not that. I encourage people to have lots of these discussions ahead of time so they feel better informed (not that they have to make every choice the right way or they’ll have a bad experience).”

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When to write your birth plan

If you’re writing a birth plan, “the birth plan should be sent to the hospital along with your prenatal records, and you should also bring a copy with you to the hospital so that it can be shared with your care team,” says Monique De Four Jones, an OB-GYN and associate chief of Labor and Delivery at Long Island Jewish Medical Center.

Also, it’s good to note that not all hospitals and birth centers have the same anesthesia or pain management methods available, DiFranco Field reminds, and some allow you to eat and drink while in labor when others don’t. Before you set out to write your birth plan, talk with your providers about the specific labor and delivery options that will be available to you.

Include your support person in the process

Whether it’s your partner, a loved one, or friend, get specific about how they can help during labor. The process of planning together can also help you both think about what to expect on the day you have your baby.

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“Working through the birth plan, especially with my partner and support people has been really helpful in exploring what’s important to me,” says Fan Lee, an OB-GYN and assistant professor of obstetrics and gynecology at Duke Health, who is herself in her third trimester of pregnancy. “Talk through how you respond to stressful situations, pain or anxiety. How do you typically cope and relax with things like that, and how can your support people help you? Do you need more words of affirmation? Do you need them to listen closely to the doctor if you seem unable to?”

Take a tour

Some facilities have suspended in-person tours of labor and delivery rooms since the pandemic began, but many offer virtual tours at least. Take advantage of these opportunities, and talk to you provider about what is offered there.

“A lot of things you’ll see online are already offered, like delayed cord clamping and baby rooming in with mom. Then those may not be things you need to focus on in your birth plan,” says Lee. “Ask what things are available there, like, are there birthing balls? Post-Covid, how many people can be in the room?”

Include religious or cultural preferences

Many health care providers, like Monique De Four Jones, an OB-GYN at Long Island Jewish Medical Center, encourage patients to include any religious or cultural practices important to you in your birth plan. Discuss these with your doctor early on to make sure they’re aware of things that are absolutely essential to you, and that it’s possible for them to accommodate your needs.

Take any health conditions into account

When thinking about your birth plan, take into consideration any medical conditions you may have and how they may affect delivery. For example, some parents request intermittent fetal monitoring so they can move around the room more freely, says DiFranco Field, but people with high-risk pregnancies will likely need continuous fetal monitoring.

“While some patients may need very few interventions, some patients may have high-risk conditions like preeclampsia, or a hemorrhage that may occur during their labor and delivery, which needs to be treated immediately to save the life of the patient as well as their baby,” said De Four Jones. “Your provider should discuss the benefits, risks, and alternatives you may face during your labor and birthing process.”

Listing your medical and surgical history on your birth plan is another thing De Four Jones suggests.

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Birth plan checklist

There are so many choices you could make about your birth, and researching them all online can get confusing fast — what even is a gentle C-section, and why do I have to know all about fetal heart rate monitoring? First of all, you don’t have to know about these things if you’re not interested, or if going to deeply into all of the possibilities of labor and delivery is anxiety-producing. You do not need to have a birth plan at all, unless you want one.

These options appear on many birth plan templates and checklists online, and are worth discussing with your providers if you’re interested in them or curious to learn more.

Where are you giving birth, and is it right for you?

Whether you’re delivering at home, in a birth center, or at a hospital can impact what options are available to you for your birth plan. It’s important to talk to your providers about your preferences early so you can make sure you’re planning to deliver in the right place for you.

During labor, you may want to consider the following:

  • Asking for fewer (or more frequent) cervical exams to check for dilation. Some people want frequent updates, and other people prefer fewer exams.
  • Requesting to eat and drink during labor. Every hospital or birth center has their own policies around this, says DiFranco Field. Some do not allow food or drink during labor, as some consider all birthing people as potential surgical patients in case they need a C-section.
  • How to create a comforting environment for labor. Perhaps you’d like to have music playing, keep the lights dim, or have aromatherapy.
  • Who is listed as a support person for you during labor? List the support people you want present throughout your labor and delivery.
  • Would you like your water to break on its own or have it ruptured?
  • Would you prefer intermittent fetal heart rate monitoring, or a portable monitor so you can walk around?

Pain management

Even on the most bare-bones birth plans, most people include pain management preferences. Some birthers want their epidural as soon as possible, and others want to wait or try not to have one at all. Describing your goals can help your providers know how to help you meet your goals and keep you comfortable.

Not all facilities have the same pain management options, so consider what types you want to use. Pain management options often include:

  • Epidural
  • Hypnobirthing
  • Nitrous oxide
  • Patient-controlled pain medication
  • Massage
  • Using water or a shower
  • Moving during labor, like using an exercise ball

During active labor, or while pushing

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TV shows and movies almost always depict people giving birth lying on their backs, feet in stirrups, but there are many labor positions that you’re likely to cycle through.

Things to consider including on your birth plan during active labor include:

  • Alternate pushing positions, like pushing while squatting, on all fours, lying on your side, etc.
  • Perineal massage.
  • Using a mirror to see your baby crowning, or touching their head during crowning.
  • In what cases you’re comfortable with episiotomy, forceps, or vacuum assistance.

Even with preferences in mind, though, parents-to-be to make this section of their birth plan more about preferences than hard-and-fast rules says DiFranco Field. “Preferences about episiotomy, forceps, and vacuum — these are the conversations that are hard to put in a checklist. Most people, including providers, would prefer a birth with no interventions, but your decision may come down to a forceps delivery or a C-section.”

When your baby is born

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Once you’ve delivered your new baby, things can happen pretty quickly. If you have any preferences about this stage of birth, it’s best to let everyone know beforehand.

What are your choices here? You may want to talk with your health care provider about:

  • Delayed cord clamping
  • When you want skin-to-skin contact to start (right away, or after baby has had a wipe down)
  • Banking or donating cord blood
  • Your facility’s policies around keeping your placenta, if that’s something you’re interested in.
  • Whether you want an IUD placed after you deliver your placenta

Baby’s care after birth

Whether you’re staying at the birth center for a few hours or in the hospital for a few days, you’ll want your care team to know your plans for your newborn.

Consider adding these preferences to your birth plan:

  • Do you want your baby to stay in your room, or spend time in the nursery? (Many hospitals don’t have nurseries anymore, but some still do.)
  • Do you want to give your baby their first bath, or have the nurses bathe them?
  • Do you want your baby circumcised?
  • Will you be breastfeeding, formula feeding, or using both?

C-section birth plans

Both experts agreed that what birth plan accommodations are possible during a C-section depends on hospital policies and procedures. That said, you can definitely have a C-section and a birth plan.

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If you know that you’re having a C-section, talk to your health care provider about:

  • Starting skin-to-skin and/or breastfeeding in the OR versus in your recovery room.
  • Using a clear drape so you can see your baby being born, if you’re interested in that.
  • Whether a doula can join you and your partner in the operating room.
  • Any options to make the environment more comfortable, like playing music.
  • Pain management options, like an epidural versus a pudendal block.

“The desire is for all patients to have a healthy delivery. When a Cesarean is necessary, your preference should still matter,” says De Four Jones. “However, there are emergency situations where a quick conversation regarding the risks and benefits needs to be had [so we can] proceed with delivery.”

Rather than thinking of your birth plan as set in stone, Lee encourages pregnant people to treat it like a goal sheet. Use writing it as a chance to learn about your options, but talk to your OB-GYN or midwife early on in the birth plan creation process, so you know what’s likely going to be possible for you.

“Keep an open mind,” Lee says. “Every journey and birth is different. Realize that yes, these are my preferences and things that would make me feel good during this process, but things change and emergencies happen. You might feel differently in labor than you thought you would; leave space for that and be open-minded to exploring things you didn’t think you would.”

Sources interviewed:

Estela DiFranco Field, BSN, certified nurse-midwife and associate medical director of the Duke Birthing Center

Monique De Four Jones, M.D., MBA, OB-GYN and associate chief of Labor and Delivery at Long Island Jewish Medical Center, and associate professor of Obstetrics and Gynecology at the Zucker School of Medicine

Fan Lee, M.D., OB-GYN and assistant professor of obstetrics and gynecology at Duke Health

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