Questions About Birth Plans? We’ve Got Answers
You may have been thinking about the type of birth you want from the moment you found out you were pregnant—or maybe you’ve only recently started envisioning the delivery. Either way, you’ll likely find it helpful to create a birth plan. And your doctor or midwife will probably find it useful, as well.
“In my view, birth plans are important because they can facilitate and assist me, as a provider, in understanding the values that are important to each individual patient,” explains Damali Campbell-Oparaji, M.D., a board-certified ob/gyn and assistant professor in the Department of Obstetrics, Gynecology and Reproductive Health at Rutgers New Jersey Medical School in Newark, New Jersey.
The process of preparing your birth plan can be just as valuable as the final draft itself. But it’s not always self-explanatory. Here are some common questions that arise when creating a birth plan, and answers from experts in labor and delivery.
What Is a Birth Plan?
“A birth plan is an individualized, formal document defining a mother’s wishes and plans for her birth and postpartum experience,” explains Lisa Gittens-Williams, M.D., a board-certified ob/gyn specializing in maternal-fetal medicine and professor in the Department of Obstetrics Gynecology and Reproductive Health at Rutgers New Jersey Medical School.
Having a plan in place can potentially provide an expectant parent with more control and ownership over the birth experience. This may be especially important for Black women and other people of color, whose wishes during birth have often been ignored, says Gittens-Williams. “Birth plans can be important in addressing health equity, agency, and voice,” she says.
One way to think about a birth plan, experts say, is as a communication tool. “To me, the goal of a birth plan is to engage in conversation during the pregnancy about what your wishes, plans, and desires are,” for your baby’s birth, says Joanne Motino Bailey, C.N.M., a certified nurse midwife and director of Nurse-Midwifery Service at the University of Michigan Health in Ann Arbor. Ideally, you can use it to initiate a conversation about your wants and needs with your provider before the delivery day.
What Should the Plan Include?
While the details of a birth plan can vary widely from person to person they often cover:
- The type of delivery you want (for example, a water birth)
- Your pain intervention preferences (Example: Are you open to an epidural?)
- Desired props (such as a birthing ball)
- Things you’d like to be able to do during labor, such as eat or walk around; this may even include music preferences.
- Other details that are important to you, like who’ll be in the room with you and whether you’ll breastfeed/chestfeed or bottle-feed.
A few things to consider as you’re creating your birth plan:
Learn what to expect at your hospital or birthing facility.
It’s a good idea to take a labor and/or birth class at the hospital where you plan to deliver. This will help you get educated on the facility’s policies and will also give you the information you need to draft your birth plan preferences.
Most helpful is when people share wishes that might not be part of the typical routine, says Bailey.
“I see birth plans that say things like, ‘no [unnecessary] episiotomy’ and ‘I want my baby to stay in the room with me the whole time,’ or, ‘I want skin-to-skin with my baby right at birth,’ or ‘I’d like delayed cord clamping,’” says Bailey. But all of these aren’t considered special requests where she practices—they’re all routine and therefore don’t necessarily need to be spelled out in a birth plan.
That said, going through this document with your provider may provide an excellent opportunity to talk through their typical care practices and those of the hospital or birth facility, so you’re familiar with them and know which things to leave in your plan and which may not be necessary.
Another way that birth plans can be particularly helpful for everyone involved, says Bailey, is when they include important personal details that your doctor might not be able to glean from your medical chart. Someone who has a history of trauma, for example, may want the delivery room lights turned down or prefer that people talk in low, calming voices. “That allows us to provide better care,” explains Bailey.
Include a birth plan for C-section delivery.
Because you can never predict exactly what will happen during the birth process, be sure to talk about your ideal Cesarean, even if you’re planning to deliver vaginally. Preferences could include having your support person stand by your side, says Daniel Roshan, M.D., a board-certified ob/gyn and medical director at Rosh Maternal & Fetal Medicine in New York City.
Different hospitals have different amenities, too, so it’s important to ask what options would be available to you. For example, some have clear surgical drapes that you can request to allow you to better view the baby being born. Or you may request specific music to be played in the operating room.
Remember that the birth experience doesn’t stop at the birth.
In your birth plan, include postpartum preferences, such as who’ll cut the umbilical cord, how you’ll feed the baby, and whether you’d like to have the baby circumcised.
It’s also important to include an emergency plan that includes what-ifs, such as what to do if you have a complication or need to go to the emergency room, says Gittens-Williams. Additionally, you’ll want to officially designate a health care proxy who can make decisions for you if you can’t, says Oparaji. “This health care proxy should be written down in accordance with state laws so that it can be properly recognized if needed,” she advises.
When and How Should I Write My Birth Plan?
A good place to start is with our birth plan template, which you can screenshot or print and fill in your preferences. For ideas and inspiration, you can look at birth plan examples from other parents.
Oparaji advises drafting your plan at around 28 weeks and reviewing it with your provider at least a month before your due date—sometime around the 36-week mark. This way, your clinician can make sure that what you’re asking for is feasible at the place where you’re delivering, says Oparaji. You want to give yourself time to make adjustments in case something isn’t possible.
In terms of structure, think simple and to the point—literally. “When I think of birth plans, my favorite is a one-page bullet-pointed list of things. Something that you can tape up in the room so that every person who walks in can see it,” says Bailey. It’s hard to get your medical team on the same page if your birth plan includes pages of notes that aren’t quickly or easily readable.
Birth Plan: Done! What Next?
The most important thing to do with your birth plan is to review the final version again with your provider during one of your appointments. This gives you and your provider a chance to discuss what happens when things don’t go exactly as planned.
“For example, a plan to designate a sister who lives out of town as a support person needs a contingency plan in the event that pregnancy complications occur,” says Gittens-Williams, since the sister might not be available on short notice. Or if you need IV fluids or medications during labor, you may be limited in how much you can walk around, even if that was in your initial plan.
As part of your discussion, be sure to cover the specific delivery-related risks you may face in your pregnancy—and how to account for this in your birth plan.
“Review your plan [with] a provider who is able to apply an equity lens to your desires and who can review your individual delivery risks,” says Gittens-Williams. “A multilevel approach is necessary since work, family, transportation, and finances can all impact plans. Women don’t often approach the plan from this perspective."
In other words, birth isn’t completely predictable. While plans are helpful, it’s not realistic that they’ll always be followed to the T, and your plan should reflect the most likely possibilities.
What If Birth Doesn’t Go as Planned?
Few—if any—deliveries go the way the pregnant person imagined they would, and that’s okay. The true power of the birth plan lies not in the piece of paper, but in the process of its creation: learning about the different situations that may arise, preparing for surprises, and talking through different scenarios with your provider. “The more informed you are before the birth, the easier it is to engage with the potential of things changing,” says Bailey.
Think of the birth plan as a set of guidelines rather than of commandments. “There should be room for the unexpected, because that is life,” says Oparaji. “Even if things didn’t go the way you planned, if you felt heard and listened to, and you and your baby are healthy, it is a win-win.”
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