Birth Plans

What is a birth plan? 

A birth plan is a simple way of communicating your wishes to your caregiver about the kind of labour you would like to have, what you want to happen in certain circumstances and what you definitely hope to avoid.  It enables you to make informed decisions about your body, your labour and your baby. They can be empowering and assist in reducing birth trauma and PTSD. The best birth plans acknowledge that things may not go according to plan and therefore some like to refer to them as ‘birth wishes’ or ‘intentions’ to convey this flexibility. 

Prior to writing your birth plan: 

• Get as much evidenced based information as you can find eg borrow a range of books from the library, look on parenting websites and look up any choices you don’t understand
• Go to antenatal classes – they are invaluable and you meet new people
• Talk to women you trust who have given birth 
• Talk to your partner or the person who will be your birth companion. What sort of labour and birth would they like you to have? How do they see their role? 

What to include in your plan: 

Birth companion /who is present 

• Who do you want to be with you in labour?
• Do you want this person to stay with you all the time, or are there certain procedures or stages in labour when you’d prefer them to leave the room? 
• Will you allow student midwives or doctors in the room if asked? It is well within your rights to refuse them entry into the birthing room 
• Do you want any family in the room?
• Is there anyone, under no circumstance, allowed in the room or hospital? 

Positions for labour and birth 

• Mention which positions you would like to use during labour and for your baby’s delivery, such as lying on the bed, kneeling, standing or squatting. Most midwives know the benefits of an active labour and will try to encourage you as much as possible but if there’s any previous injuries that would stop you from assuming some positions, please state them, so alternatives can be thought of 
• Would you like access to a birthing stool, fitball, or mattress on the floor?

Pain relief 

• State natural techniques you wish to use or be encouraged to use e.g. hypno/calm birthing, breathing techniques, music, low lighting, massage, water immersion , TENs, acupressure, aromatherapy, relaxation and visualization 
• What kinds of pain relief you want to use, if any, and in what order (sterile water injections, Nitrous oxide gas, morphine injections and epidural)
• Types of pain relief you wish to avoid 

Overdue/Inducing/Augmenting labour 

• Most women have given birth by 41 weeks, but if there are no signs of labour after this, doctor’s will usually suggest an induction or depending on circumstances, a c section.  Depending on dilatation, options may include a stretch and sweep, breaking your waters, insertion of prostaglandins gel or starting a synthetic oxytocin drip. Research which options you may be happy with or what you would really like to avoid. 
• Would you like to try natural induction techniques first? Such as nipple stimulation, acupuncture and sex  
• If your water’s break and you do not go into labour, how long do you want to wait before being induced? Will you be taking antibiotics? 
• If your labour slows down or is particularly long, do you want your caregiver to use interventions to speed it up (by artificially breaking waters or starting a synthetic oxytocin drip) ? Or would you prefer to wait and see what happens naturally? 

Water Birth 

• Would you like to use a bath during labour or deliver in the water if possible? Not everyone is suitable for a water birth, nor does every hospital allow them due to insurance reasons. 
• Have you hired your own birth pool ? Do the connections fit ? Will the hospital allow this? 

Third stage (delivery of the placenta) 

• Active third stage is an injection of synthetic oxytocin into your leg muscle to help detach and expel the placenta. It also reduced the risk of postpartum haemorrhage (PPH).  
• Physiological third stage is where the placenta is left to detach by itself, usually helped by gravity.  
• State any exceptions to your wishes you would like eg if placenta hasent detached after 30 mins, please start active management. If the caregiver determines you are at higher risk or currently having a PPH, they will strongly suggest you have an active third stage and any other medical management needed 

Baby’s umbilical cord 

• Do you have a strong preference for someone to cut the umbilical cord? You? Your birth partner? 
• Would you like delayed cord clamping? Delayed cord clamping is when your baby’s umbilical cord is left unclamped for more than one minute or until cord pulsation has ceased to ensure all the babies blood in the placenta is allowed to travel back to the baby. In 2012 WHO recommended that delayed umbilical cord clamping is to be performed for improved maternal and infant health and nutrition outcomes .
• Lotus birth?  The practice of keeping the placenta and cord attached to baby until it detaches itself, usually around day 7-10. 

Postnatal care of baby 

• Would you like immediate skin-to-skin contact with you? If this is not possible would you like your partner to have this. Skin to skin contact helps breastfeeding initiation and stabilises heart rate, breathing rate and the baby’s temperature. 
• Vitamin K and Hep B injections for baby – If you don’t want your baby to receive these you will need to make this clear before the birth. Vitamin K injection helps babies blood clot, this is particularly important if they have an instrumental birth. Hep B vaccination at birth is an additional vaccination that protects them from Hepatitis B until they have the first of 3 more injections at 6-8 weeks. 

Feeding the baby 

• Be clear about whether you want to breastfeed or bottle-feed. State what you wish to happen in the case you are unable to feed straight away due to a complication ( eg pre expressed colostrum, donor milk, bottle) 
• Would you like baby to “breast crawl’ and self attach for the first feed? 
• Use of dummies? Dummy use can interfere with establishing milk supply

Unexpected situations 

• You may want to write down what you want to happen if your baby has to go the neonatal unit, you need a c section, instrumental birth or either of you needs to be transferred. 
• Did you test positive for Group B strep ? Are you consenting to antibiotic therapy during labour

Special needs

• Disability- what kind of help you may need 
• Religion/Culture- what impact this may have 
• Diet – GF, Allergies 

Who needs to see your birth plan? 

Show your birth plan to your Midwife or Doctor at one of your antenatal appointments (ideally before 36 weeks) so you can discuss your choices and any changes that may need to be made. Although a birth plan is helpful,as you don’t have to keep repeating your wishes to each caregiver, labour and birth are unpredictable. Your OB/Midwife may need to recommend a course of action at any time that may not be what you had originally hoped for, but may be in the best interests of you and your baby.