Birth Plans
A birth plan states your personal preferences for how you as the parents would like your birth to progress. Your birth plan should always be respectful of the policies of your birthing facility. Keep in mind that a birth plan is a great way to let others know what your plans are but you need to be flexible and allow for the unexpected.
A good place to start on a birth plan would be to see if your birthing facility has a standard form that they use for birth plans. The advantages of using their form is that it is in a format they are familiar with and it is easy for them to find the answers they need. A majority of birthing facilities have a standard form. If they do not finding a generic form to use would probably still be preferable to providing a narrative type birth plan. If you choose to provide it in narrative form keep in mind the following guidelines.
A birth plan should not be too long or no one will want to read it. It should have an introduction that talks a little bit about you and your partner and why your birth plan is important to you. This would be a good place to let the staff know if you had a complicated pregnancy.
You should discuss your fears and concerns if you have any. This is where you might want to include any previous pregnancy losses.
Discuss your plans on how you see your birth going if there are no complications. Whether you plan to use pain medication or if you do not want them offered. Discuss your desires for fetal monitoring, IV’s, comfort techniques such as shower. Make known what position you would like to be in for pushing and if you want directed pushing or if you want to be able to push spontaneously.
A birth plan also discusses the care for your newborn. Do you want procedures such as immunizations to be delayed so you can bond with your baby, who will cut the cord, are you doing cord blood banking? You should also state your intent to breastfeed if that is your plan.
A birth plan also will lay out your plans in the event something unexpected happens such as a c-section or an unexpectedly ill baby. Who will stay with the baby, who will stay with mom in the event she has a c-section.
You also should give the providers an idea of who expect to be with you during the birth; partner, doula, parents, children, siblings.
Sample birth plan
Check all that apply
Environment:
___Dim lights
___Peace and Quiet
___Music
___Wear own clothing
___Other: (specify)
Mobility:
___I wish to be allowed to move around freely and change positions as much as possible throughout my labor
___Freedom to move and reposition in bed (up to bathroom only)
___Mobility is not important
Hydration/Nutrition: (some hospitals require access to a vein be established for in the event of an emergency)
___Heparin lock
___IV
___Clear fluids (jell-o, broth, juice, popsicles)
___Ice chips/sips of water
Monitoring:
___Intermittent monitoring
___Continuous external monitoring
Pain Relief:
___I would like to know what is available, but retain the option not to take any medications
___I am planning on minimizing my medication use, so would appreciate the staff not offering me pain medication, instead allowing me to request it if I feel it is needed.
___Offer medication if I appear uncomfortable
___Offer medication as soon as possible
___I would like to utilize tub or shower
Pain relief options:
___Non-medical: positioning, shower, heat or cold therapy, acupressure, aroma-therapy
___Hypnobirth
___IV medication
___Epidural
Labor augmentation:
___Natural methods
___Pitocin
___Amniotomy (breaking bag of water)
___Nipple stimulation
Pushing:
___Choice of positions for pushing and delivery
___Push as long as the baby and I are stable and making progress
___Spontaneous bearing down (push when your body tells you to bear down)
___Directed pushing (being told when to push and how long)
___I would like my coach and/or my nurse to support my legs as necessary for pushing
___I would like to use the foot pedals or stirrups for pushing
___I would like to use the squatting bar
Perineal care:
___Prefer to avoid an episiotomy (massage, compresses, positioning) if at all possible
___Prefer to tear rather than have an episiotomy
___Prefer episiotomy
___I would like a mirror available so I can see my baby’s head as it crowns
Cord cutting:
___Partner to cut cord
___I want to cut the cord
___Immediately cut the cord
___Delay cord cutting until pulsation stops
___I am a cord blood donor and have made arrangements
___I am planning on banking my cord blood and have made arrangements
Skin to skin contact:
___Place baby on my abdomen immediately as long we are both doing well
___Place baby on warmer and clean up before being brought to me
Eye care/newborn medications:
___Delayed for ___minutes
___Immediate application of the eye ointment
___I do want my baby to receive
___Vitamin K
___Hepatitis B vaccine
___I do not want my baby to receive
___Vitamin K
___Hepatitis B vaccine
Feeding baby:
___Breastfeeding
___Bottle feeding
___Combination of breast and bottle
___Pacifier
___No pacifier
Assisted vaginal or cesarean births:
___Spinal/epidural anesthesia
___Partner present
___Pictures/video of birth
___Screen lowered to view baby immediately after birth
___Description of surgery
___Touching the baby
___Breastfeeding as soon as possible in the recovery area