Creating a Personalized Birth Plan

There are a lot of differing opinions about birth plans out there. While many OBs and L&D nurses out there may laugh at the notion of having a "plan" for birth, there is importance to the act of writing a birth plan. In my opinion, creating a personalized birth plan is something that every expectant mother should do well before the big day. There are a few reasons for this. While your birth may not go as you "plan", the so-called birth plan is a way for you and your partner to get a clear picture of what your expectations for labor, of your health care provider and of your hospital/birthing center/home are. 

A birth plan is best utilized when you have a chance to review it with your provider sometime in month 6 or 7. This gives you a) enough time to mentally adjust to what is and is not possible at your given birthing location and with your particular provider and b) the chance to change providers if the gap between what you want and what they are willing to provide is too far apart. If your provider is really honest with you, it's likely you'll have a little editing to do. 

Once you've reviewed your birth plan with your provider (if you have a practice with multiple partners be sure to have each one read it when you meet them so that everyone is on the same page) print out the edited version and have them put it in your file. Have another one to bring with you to the hospital or birthing center. Having your wishes written down clearly can help you later if you are put in a tough situation and feeling pressure from nurses or an on-call doctor who may be trying to manage your labor when you're in no position to form a complete sentence much less give informed consent. Some key elements of your plan should be:

• Who will be present in your labor room and who should not be.
• Mood/Setting for your L&D room
• Your choice of pain management options and order of preference
• Who will catch the baby, how you'd like to be situated 
• Immediate postpartum care: managed placental birth (cord traction or pitocin) vs. naturally birthing the placenta, breastfeeding, infant exam/vaccinations/bathing
• Rooming in vs. Nursery care (or what you'd like in the case baby needs to be in the NICU or you are in need of medical recovery time)
• The C-Section: be open that there may be a need for this and be prepared and educated about what will/can happen during this surgery. Will you partner be present? Who will stay with you after? Who with baby? Can you have your arms free for holding baby after? Can routine infant exam happen with you there? Specify breastfeeding or bottle feeding and rooming-in if possible. 
• Breech birth
• Expectations/Plans for Postpartum Depression Support & Care

Once you have a long version, make a short half-page or less version for the nurses and other staff at your hospital or birthing center. Tape this one to the door or your L&D room. It's always nice to have chocolates or some other sweets on hand for the lovely (or not so lovely, but you want them to leave you alone) nurses who are working so hard for you. 

Here's our plan for Baby #2. After going through our first birth I edited ours to reflect the things I wanted to do differently. Like, before I never thought I'd want to see the baby coming out of me, but now I know I TOTALLY want to see that! Childbirth is amazing however it happens, so get educated, talk to your health care provider openly about your expectations, and then learn to let go...

Birth Plan

(Short Version) 

Dear Midwives & Nurses: This is our second birth and we look forward to one of you watching over us as we labor to ensure we area healthy and strong and helping us catch our baby. We would like to have our labor and birth be as intimate and hands-off as possible in the hospital. When the baby is born we would like to be the ones to catch him/her with you there to guide usThe following is more detail about more specific wishes for our time in the hospital and what we would like to happen in the case of an emergency during our labor/birth. Thank you in advance for being with us for such a wonderful event.

            -Us

Birth Plan

 (Long Version)

Attendants at Birth:

The Husband

The Best Friend (who also happens to be an ER nurse, and attended our first birth)

Once I'm admitted and in my delivery room, I'd like:

•      Only my practitioner, nurse, and specified guests to be present (please no residents, medical students, extra nurses or other hospital personnel)
•       To keep the lights dimmed
•       To listen to quiet music from my iPod
•       Use of the bathtub and shower for pain relief
•       Please keep the room quiet and calm
•       I’d like to eat and drink as I feel hungry or thirsty, I am aware that my hypoglycemia may make my blood sugar levels drop so I would like for a birth attendant to help me drink or eat small bites of nourishing food between contractions.
•       For my partner to be allowed to stay with me at all times
•       To wear my glasses/contact lenses, as long as I don't need a c-section

During Labor:

•      I would like the nurse and/or midwife to use intermittent monitoring using a doppler or fetoscope. I do not want to use continuous fetal monitoring either internal or external.
•       I would prefer not to have internal exams once in labor unless medically necessary.
•       I would like to labor free of external interventions to augment my labor, including but not limited to pitocin or cytotec.
•       For pain relief I would like to use: acupressure, bath/shower, deep breathing techniques, massage, freedom of movement, vocalization, or any other non-medication based methods. I would like to labor without pain medication and do not want to receive narcotics or an epidural, please do not offer them to me unless it is medically necessary due to the need for an emergency cesarean.

Pushing & Delivery:

•      When it becomes time to push I would like to do so instinctively and to be allowed to progress free of stringent time limits as long as my baby and I are doing fine.
•       I would like to be free to push in whatever position feels comfortable and safe at that moment.
•       I would like to see the birth with the help of a mirror if possible.
•       I would like to have the midwife massage and support my perineum during the pushing stage to minimize the risk of tearing. I would rather tear naturally than have an episiotomy cut.
•       As the baby is born I would like to have him/her placed on my abdomen and allow my husband and I to discover his/her sex.
•       I would like to birth the placenta without use of pitocin. I would prefer fundal massage if necessary. I do understand that pitocin may be necessary if there is a large amount of bleeding, in which case I would like it to be used to help stop a possible hemorrhage.
•       We want to wait until the cord stops pulsing before cutting it. We will not be banking the cord blood.
•       After the baby is born I would like him/her to stay with me in bed for all newborn procedures, to eat, and to sleep.
•       We will not be consenting to eye drops or Hep B immunizations after the birth. We will discuss the need for Vit. K dependent upon the birth.
•       The baby should not be removed from our care at any time without discussing it with us first.
•       I would like to breastfeed as soon as the baby is interested. Please DO NOT feed the baby formula or sugar water, or give any artificial nipples.
•       We would like to give our baby its first bath after we feel he/she is ready, not immediately following birth.

Cesarean Section: If there becomes a need for an emergency c-section I would like:

•  To have my husband with me at all times during the procedure.
•   To have the baby placed on my abdomen above the curtain as soon as it is born. If this is not possible I would like for my husband to be given the baby as soon as his/her Apgar score and other newborn procedures are complete.
• After the baby is born I would like him/her to stay with me in bed for all other newborn procedures, to eat, and to sleep. We would like to wait until the baby has begun bonding and breastfeeding to give him/her eye drops.
•  The baby should not be removed from our care at any time without discussing it with us first.
• I would like to breastfeed as soon as the baby is interested. Please DO NOT feed the baby formula or sugar water, or give any artificial nipples.
• If I am medically unable to breastfeed due to serious illness I would like my baby to receive breast milk from a milk bank or donation via cup feeding or finger feeding with a feeding tube. I do not want my baby to be given formula unless banked or dontaed breast milk is unavailable. There is a breast milk bank at the University of Minnesota Children's Hospital or my husband will find donor milk.
• If there is a medical problem and our baby needs warming or specialized care we would like to use Kangaroo Mother Care instead of a warmer or incubator. We would like unlimited access to our baby if he/she needs to stay in the NICU for any period of time.

Breech Birth:

• In the event that our baby is not engaged in the pelvis head down and in is a breech position I would like to deliver vaginally. I DO NOT consider this an emergency or a reason for a c-section unless the fetal heartbeat is low and not recovering after each contraction. I would like the midwife to deliver the baby using the hands-off approach allowing the baby to guide him/herself out and having the midwife catch him/her as he/she emerges.  

Post Partum Depression:

• I suffered from PPD after the birth of my daughter in 2011 and would like to be watched for recurrence this time around. Please have a proscription of My Preferred Drug ready for me after delivery in case I need to fill it prior to my 6-week check up. 

Thank you again for helping us bring a new baby into the world!