As a birth doula, I have talked with so many expectant parents about their wishes for their birth experience. You’d be surprised how many people plan to “just wing it.” Many of them have even brought up their birth plan, or the idea of one, to their providers, only to be shot down because “you can’t plan for birth.”
And listen, I get it! In some sense, birth is a bit like Elsa following the mysterious and melodic voice “into the unknown.” (Sorry, not sorry for getting that stuck in your head.) If this is your first birth, you have no idea how it will feel. It is truly all in theory at this point. So what do we do? We turn to other people’s experiences of birth to create a framework for our own experience. We look to friends, family, books, social media, and podcasters to expose us to birth stories. You don’t have to look long or hard to find out that no birth is the same. There is not a formula or map every labor follows. This knowledge can be incredibly overwhelming! And it’s no wonder expectant parents just give up on preparing altogether. If you have no control over the experience, then what is the point of even trying? We might as well just defer to our providers to make the plan and call all the shots, right?
Here’s what I think. The unknown nature of birth is exactly why you should have a birth plan. When you are under the care of a medical provider, you have the right to informed consent. What is informed consent? It means you are told the nature of the intervention and why it is being suggested. You are given all of the pros and all of the cons. You are given potential alternatives. And you are given time to ask questions and think through your decision before making a choice. In order to truly have informed consent, you have to be informed! This right here is why I love a good birth plan.
Setting up a birth plan is a process. It takes time to research! And this research will help you form opinions and realize there are things you wanted for your birth that maybe you didn’t even know were an option before!
Here are some tips on how to create a good birth plan:
First of all, we’re going to keep it short and sweet. I promise you every nurse or provider that you work with will skim, at best, to get the gist of your plan. We don’t want a five-page essay here, because it just won’t be read. Stick to bullet points.
Start the plan with a short summary of what your goals are for the birth. The key is to include anything of note right here at the top. Here are a few examples:
- “I would like a vaginal birth without the use of pain medications, so I can labor and birth in any position that feels right to me.”
- “I would like a vaginal birth with the use of an epidural when I have reached active labor.”
- “I would like a vaginal birth with my partner catching the baby, assisted by our doctor. I am a survivor and request only female medical personnel during my labor and birth.”
- I always follow up the main goal statement with, “I understand I have the right to informed consent and refusal. Please consult me about any decisions so we can work collaboratively for my care.”
Next, you can include your preferences for early labor. Some examples of things to think about are:
- Are you open to an induction? If so, when? What methods of induction are you comfortable/not comfortable with?
- Do you prefer to go into labor on your own? How long are you willing to wait past the baby’s “estimated due date”?
- Would you like to labor at home as long as possible, or do you prefer to be at your place of birth before active labor is established?
After this, you can move on to active labor and transition. For this section, you might want to research:
- Methods of fetal monitoring and continuous vs. intermittent monitoring
- Artificial rupture of membranes vs. spontaneous rupture of membranes
- IV pain medications
- The epidural
- Frequency of cervical exams
- The use of Pitocin
After active labor and transition, comes pushing and birth! Definitely include these things in your research:
- Changing positions for pushing
- Coached pushing vs. intuitive pushing
- Episiotomy vs. natural tearing
- Cord clamping and cutting preferences
- The Golden Hour
- Newborn procedures
- Placenta delivery and what to do with it afterward
For the last part of the birth plan, I always recommend including a “Plan C.” This would be your preferences for a Cesarean delivery, if the need arises. Even if you’re planning a primary or repeat Cesarean, you still have so many choices available to you for a Cesarean birth! Think about the atmosphere of the room, a clear drape to see the birth, cord clamping preferences, and immediate skin-to-skin in the OR. A Cesarean birth is a birth, so don’t skimp on the birth planning!
I have a couple of go-to websites for researching all of these different topics.
- Evidence-Based Birth is awesome because they combine all of the available evidence in a format that is easy to understand and non-biased. You can search through their website for the topics that are relevant to you! They have also done a great job of compiling all of the available research we have surrounding COVID-19, the vaccines, and pregnancy.
- [M]otherboard Birth is an educational and birth planning tool you can use collaboratively with your partner/birth support people and providers. It takes you through the process of creating a birth plan and has all the research and evidence you need at your fingertips. You can weigh pros and cons and decide what to include in your birth plan all in one easy-to-use app!
Now that you’ve created your birth plan, it’s time to print some copies! I recommend taking your birth plan to one of your appointments with your care provider to discuss everything you’ve included. I also recommend sticking a couple of copies in your hospital bag and saving one to your email or phone in case you forget the copies when the big day comes! (Believe me, I’ve seen it!)
Of course, you can’t plan exactly how your birth will go, but the process of planning and realizing all of your options will empower you and help ensure your baby’s birth isn’t something that just happens to you, but it is something you’re an active participant in. No matter what direction your labor and birth journey takes, you can take comfort knowing that you have fully prepared yourself for the experience!