Birth Plan?! Do you really need one?

Birth plan, birth preference, care plan, what ever you call it, you need one at your next birth! WHY you ask? Read on to find out! We will explore 10 reasons/tips for birth plans. 

#1: Your care provider (midwife or OB) needs to know what it is you want and don't want during labor. I haven't met with many OB's in the Antelope Valley who will ask YOU, "What kind of birth are you envisioning?". Hopefully you've already got a good idea of how your care provider feels about natural birth, VBAC, Family Centered C-section, through your previous months of care. So when you give your birth plan to your OB or Midwife, they are not surprised to see, "I prefer to deliver in an alternate pushing position". Having the birth plan has all of your preferences in writing, so you don't have to remember each and every thing when it comes time to talk with your care provider. Have them sign and acknowledge your plan. If there are certain things they are not comfortable with, ask WHY. Explain why YOU want this, and tell them the evidence based research that backs up this information. (Evidence Based Birth is a great resource for this!)

#2: Once you go the the hospital, give the signed copy of the birth plan to your L&D nurses. Watch them read it! Or have your partner watch them read it, and ask them to assign a nurse to you that has experience with your preferences. Have a few extra copies in your bag in case they misplace this birth plan. When ever a new nurse is assigned to you, ask if they have read through your birth plan. Now, because they have read your preferences, they shouldn't be asking (or telling you) every 2 hours, "lets check your cervix now!". You specifically stated on your plan, "I'd choose to bypass routine vaginal exams".

#3: Assign a member of your birth team (partner, sister, mother) to protect your plan. It can be difficult for a woman in labor to speak up for herself while she is in the midst of transition. The laboring moms focus shouldn't be on weather or not staff is following her plan. It should be on her body and her baby. Before labor, choose someone you trust, someone who agrees with your plan, and someone who isn't afraid to speak up, to make sure the staff stays on track with your plan. Example: a well meaning nurse comes into the room and sees you EATING WHILE IN LABOR, she tells you that you're not allowed to do that. Your "birth plan protector" can kindly say "her birth plan states she would like to eat and drink as she pleases during labor, Doctor Smith has already given her the okay for this". For whatever reason the laboring mother couldn't at the moment voice this herself, so her loyal partner, mother, or sister, has stepped up and protected her wishes.
This is also another GREAT REASON TO HIRE A DOULA! It's my job to give couples a gentle reminder about their rights, and to use their voice when a wish isn't being respected.

#4: You end up at a different hospital. What happens if you planning a home birth, and end up transferring to a hospital? Or your place of birth is an hour away, but baby has decided that he/she is coming RIGHT NOW, so you now are going to the nearest L&D hospital. This new and unplanned place of birth can still benefit from seeing your birth plan. Sure, if you get to the hospital and your baby is crowning, there isn't much time for a birth plan to be read, but you or your partner can quickly tell them "we want XYZ" to happen. If you have transferred from home to hospital, the same thing applies, the staff needs to see what your preferences are. What if when you call your planned birth place they tell you they have NO open beds and you must go to a different hospital, with a new OB? BIRTH PLAN, here you go guys, this is my plan for this labor and delivery!

#5: When writing your birth plan, use words like; "we strongly prefer", "I would love to", "I choose", "Please DO NOT". These words are kind, and to the point. Going down the list of  "I want, I want, I want, I want", can be off putting to a nurse. Your extra kindness and respect will be returned back to you!

#6: This is a PREFERENCE. At the top of you "Birth Preferences" sheet, acknowledge that you understand labor and delivery have unexpected road bumps. These are your preferences for a NORMAL labor and delivery. If things should change course, you still want as many wishes to still take place as possible, and you would like all procedures or interventions explained to you, including the BENEFITS AND RISKS. State you will need informed consent to each intervention. When an intervention may be necessary you  would like the least invasive and most minimal procedure possible.

#7: have your birth plan separated into different sections and keep it to one page! A section for LABOR, DELIVERY, BABY CARE, AND CESAREAN. List your preferences under each section with a bullet point. Start your bullet points with what will likely happen first when you get to the hospital or birth center. You'll be assessed, assigned a room, sign paperwork, etc. Your fist bullet points can address vaginal exams, what kind of room you want (one with a tub or shower), how you want to be monitored, and what you'll be trying for comfort measures (dim lights, music playing, aromatherapy, pain medications). Your first bullet point shouldn't be, delayed cord clamping and skin to skin. That comes AFTER your preferences during la

#8: I encourage everyone to have a short section on cesarean birth. Most of us do not plan on having a cesarean, but there are times when the need arises. Just because you are having a cesarean doesn't mean that your who plan goes out the window! You can still have, delayed cord clamping, skin to skin, no separation from baby, breastfeeding immediately, etc. Look into "Family Centered Cesarean" and ask their care providers if they have done this. Before going into the OR, make sure your nurses know that you want skin to skin, remind them several times if needed. For a scheduled C-section, it's just as important to have you're wishes on a piece of paper to show to your care provider before you deliver.  

#9: This is YOUR birth! YOU will remember this for the rest of your life. How you are treated during labor and delivery has an impact on you and your postpartum period. Do not try to be a "good patient". Be yourself. Know that just because someone says you cannot do something, doesn't mean that you CAN'T. Always ask yourself, or have your partner ask, is the health and well being my my baby and myself at risk if I do this? A great example is laboring out of bed. Most L&D nurses are wonderfully supportive of moms walking around, using the toilet, and laboring out of bed. However, many of you will probably report that you were told to STAY IN BED! Most of the time there isn't a medical reason to stay in bed. In fact, staying in bed can likely lead to other interventions! Be FLEXIBLE! Childbirth doesn't always go as planned. You might envision wanting to eat throughout labor, but then you become nauseous. Go with the flow. 

#10 REASON: Writing a birth plan explores what is important to you and your partner. There might be things you have never even thought of until you sit down to write out your preferences. Maybe you and your partner don't agree on some points and you need to do more research. You have 9 months to think about what kind of birth you want! Even if you want a "traditional hospital birth", which usually involves continual fetal monitoring, IV fluids, Epidural anesthesia, directed pushing, immediate cord clamping, and only ice chips as your nutrition and hydration during the course of labor, there is likely SOMETHING you have a preference about! Maybe you are a survivor of sexual abuse, and only want a female nurse to preform vaginal exams or maybe you want your partner to cut the umbilical cord. This should be stated and talked about before labor and delivery, and but onto a birth plan!!

DISCLAIMER: Birth is unpredictable. I've often heard nurses refer to birth plans as a c-section ticket. I cringe at this!! I'm screaming inside just writing that out. Birth plans are not a ticket to a c-section. It's simple a list of what's important to you! It's NOT a way to control birth (you can't control birth, if you do, you'll just get REALLY tired!). It's a way to tell your birth team what you envision for this spectacular birth day of your baby. Birth plans are not legally binding. So if your care provider signs it, it's not binding anyone to follow it. 

There you have it folks. You need a birth plan. If it's your 5th baby or your 1st, it's a good idea. I hope this helps you write your next birth plan. Birth plan writing is apart of my doula services. I go through an extensive list for each couple to find out what's important to them, then write it all up, and give them the final couple. PHEW, one less thing you have to do in order to prepare for this epic event!


Rachel Ivison,
Birth Doula, Placenta Encapsulator, Birth Plan Advocate

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