At almost every prenatal meeting I’ve attended with a client, we’ve discussed her written birth plan. Clients ask what to include, how to edit, what format is appropriate, if it’s even necessary... the questions go on and on. For starters, yes, writing your birth plan is a good idea. Even if it’s just a short list of bulleted points, something is much better than nothing. The trick is to write something that’s concise, easy to follow, and details how you’d like things to go.
Clearly, if you’re birthing at home with a midwife your birth plan is already well known to your care team. Still, you may want to have a few ideas written down as reminders.
Do NOT Write a Novel
I’ve had clients include whole paragraphs about how they and their partners met, what they enjoy doing on the weekends, and how they told their families about their pregnancies. It’s not necessary. Skip the expository writing. In a hospital setting, your nurse doesn’t have time and she’ll be annoyed at you. If your plan looks longer than half a page, it’ll get lost in a pile of paperwork at the nurse’s station. All of your hard work and thoughtful preparation would be tossed aside.
“Jennifer doesn’t want an epidural because she’d really like to do things naturally. She might change her mind, but we’ll let you know if that’s the case. We have a code word, but hopefully we won’t use it.”
DO Keep It Concise
Introduce yourselves as minimally as possible, then go right into what you do and don’t want for your birth experience. Stick to bullet points and/or very short sentences. There’s no need to give reasoning for what you do or don’t want from your care team.
“Do not ask Jennifer if she wants an epidural.”
“Skin to skin contact immediately following delivery.”
“Dad wants to cut the cord.”
Do NOT Give an Overview of Your Healthy Pregnancy
If you’ve had an overwhelmingly healthy pregnancy, there’s no need to give your hospital nurses a play by play.
“Jennifer takes Rainbow prenatal vitamins and has been seeing Dr. Smith throughout her pregnancy. She had ultrasounds at 12 and 20 weeks. She began weekly visits at 34 weeks and set an induction date for 41 weeks, just in case.”
DO Tell Your Care Team Pertinent Health Information
Even though you will likely be delivering at a place that already has your health history on file, it’s a good idea to list the unique, important pieces on your birth plan. Allergies, recent test results, and trauma history are all things that are helpful for nurses and attending docs to know in a hospital.
“Jennifer has a history of sexual trauma. Only female RNs and/or OBs are to perform checks.”
“Allergies: penicillin, dairy, nuts.”
“Baby diagnosed IUGR (intrauterine growth restricted) at 32 weeks. Jennifer has received weekly non-stress tests and biophysical profiles since then.”
DO Include a C-Section... Section
Even the most well prepared, naturally minded birthing couples can end up in the operating room with a surprise surgical delivery. It’s always a good idea to include your desires should you end up in that situation. Include a section that begins with, “If a C-section is ultimately medically necessary...” and list your main concerns.
“... our doula will be allowed in the OR with us.”
“... we still want skin to skin contact immediately following delivery in the OR.”
“... our baby is NOT to be separated from us to be weighed or checked unless medically necessary.”
Do NOT Address Every Possible Scenario
Yes, birth is unpredictable. Your baby might turn at the last minute. You might deliver on all fours when you thought you’d want to be squatting. Your OB might not be on call when you go into labor and you might end up with the midwife on duty. Don’t waste your time and energy thinking about every possible scenario.
DO Focus On What’s Most Important to You
Narrow down your plan to 5-7 points that can be easily and concisely expressed to your care team. Nurses are busy and don’t have time to read pages and pages of desires, do’s, and don’ts for every single patient. Get organized with your partner and prioritize. For everything outside the written plan you print out and give to your care team, hire a doula.
DO Include Your Baby
With all the emphasis on the birth aspect of the birth plan, it’s easy to forget that there are decisions you’ll need to make, especially if you birth in a hospital, regarding your baby’s first few hours and days of life. Include a short section that addresses your baby’s needs once he or she is born.
“We want to HOLD BABY during vitamin K shot, erythromycin application, and any other standard procedures.”
“We are exclusively breastfeeding. Do NOT give our baby formula.”
“We will give our baby his first bath at home.”
A Note About “Plans” vs “Wishes”
I had a client not long ago who wrote “Our Birth Wishes” at the top of the page she handed her nurse upon checking into the hospital. Her nurse smiled and said something like, “I’m so glad you wrote “wishes” instead of “plan.” People who come in with a plan are often disappointed they don’t get what they want. Wishes are nicer.” Nicer for whom? Nicer for the nurses who don’t feel as threatened by people who have an idea of how their birth can and/or should go? Perhaps she was more well-meaning and I’m getting all worked up over semantics, but something in her tone told me she was relieved at not having to deal with another seemingly high maintenance patient with a birth plan.
I say, write down what’s important to you and make sure everyone who walks in the room knows what you do and don’t want. Repeat yourself, have a written copy, and be on the same page as your partner. Hire a doula who can reiterate your desires and nonstarters. There’s nothing high maintenance about advocating for yourself.
Sample Birth Plan A
Mom- Jennifer Johnson
Dad- Steve Johnson
Doula- Lindsey Tjernlund
Please Be Aware...
-Jennifer is on medication X for anxiety.
-We had 2 miscarriages before getting pregnant. This is our rainbow baby!
What We Want Today
-Time to make decisions.
-Freedom of movement.
-Unlimited eating and drinking.
-Minimal checks.
Once Our Baby Is Born
-Skin to skin ASAP
-Exclusive breastfeeding.
-Dad wants to cut the cord.
If a C-Section Is Medically Necessary...
-Our doula is to be allowed in the OR.
-We still want skin-to-skin and breastfeeding ASAP.
-Talk us through the surgery.
Sample Birth Plan B
Mom- Jennifer Johnson
Dad- Steve Johnson
YES
-epidural
-nitrous oxide
-push on my side if possible
-skin-to-skin asap
NO
-fentanyl
-episiotomy
-forceps/vacuum
For Baby
-we’re trying breastfeeding, lactation consultation would be helpful asap
If I Need a C-Section
-Skin-to-skin asap.
-Do NOT tell me what’s going on during the surgery until my baby is about to be born.