Once you become pregnant there are a lot of things you will learn about and a lot of new terms that you will hear from your doctor. One of the things you will have to learn about is a birth plan and you will have to decide if you want one.
What is a birth plan?
A birth plan is just that, a plan for your birth. It is a document that tells your healthcare team what you are looking for during your delivery in terms of how you want to control your pain, what interventions you want done, and so on. It can also include your plans for after the delivery such as breastfeeding and kangaroo care.
A birth plan is not a legal document, it is just something that you give to those caring for you during your labor so they know what you would like to happen. Keep in mind that every pregnancy is different and you cannot control everything that happens during your labor. The number one priority of the healthcare team is to keep you and your baby safe, no matter what, even if that means you don’t get to have the perfect drug-free vaginal delivery that you hoped for.
What things are included in a birth plan?
You can include anything you want in your birth plan, but you want to check with the hospital you will be delivering at for their policies. The hospital policies will determine which of these you can control and which ones you can’t.
- Induction. Some doctors will start talking about induction by the time you are 38 weeks, while others won’t even mention it until you are a week overdue. If you have a strong preference one way or the other, make it known to your doctor.
- Eating. You may or may not be able to eat while in labor, but you may be able to munch on some ice chips or popsicles. If this is something you are interested in, you can put it in your birth plan so your caregivers know you may be interested in having something so they can offer it to you.
- Starting an IV. Some hospitals will still routinely start an IV once it is determined that you are in labor in case of an emergency, while other hospitals will delay starting an IV until it is necessary. Not having an IV gives you a little more freedom with moving, but at the same time, most hospitals will not let you have an epidural without an IV. Not having an IV limits your options for pain management.
- Walking in the halls. Again, this will depend on the hospital, their policies, and their equipment. Every labor and delivery nurse knows that being up and moving will help progress your labor, but not every hospital allows this. You are also often more limited after your water has broken because you are more at risk for serious complications.
- Fetal monitoring. There are a lot of different options for fetal monitoring. Some hospitals offer intermittent monitoring that will allow you to move more freely, while other hospitals require continuous monitoring. This will also be determined by any complications you had during your pregnancy, for example if you had serious complications you may have to be monitored continuously for your baby’s safety. Another form of fetal monitoring is internal monitoring where they place a probe on the baby’s scalp. This increases the risk of infection to you and your baby and if this is something you want to avoid, make sure to put this in your birth plan. However, if they cannot externally monitor your baby’s heartrate, they may have to use an internal monitor.
- Pain management. You have several options for pain management, from nothing to an epidural and everything in between. When writing up your birth plan make sure you spell out what you want, but also make sure you do your research. For example, if you don’t have an epidural and you require an emergency c-section, you may not be able to be awake for the surgery.
- Labor augmentation. If your labor seems to stall after several hours, your doctor may start talking about augmenting your labor, or doing things to make your labor start progressing again. There are a couple of things they may decided to do. One is to start pitocin, which is a synthetic form of oxytocin, the natural hormone that stimulates contractions. The pitocin will be gradually increased to make your contractions come closer together and stronger. The other thing they may talk about doing is breaking your bag of waters. With this they take a hook, called an amnio hook which looks like a crochet hook, insert it into your vagina, past your cervix, and hook the amniotic sac, breaking your water. If you decide that you do not want either of these, your labor may, or may not, last longer.
- Pushing. We all think we know how pushing goes. We have see it on TV. The woman is on her back with her knees pulled up and she is coached as to when to push. This doesn’t always have to happen though. Your body knows what it is doing and nature will take over when it is time. If you have an epidural you may need to be coached because you cannot feel when to push, but if you don’t have an epidural you can push when your body says to push. You also don’t have to lay on your back. If you have an epidural you are limited here because your legs will not be able to support you, but there is nothing saying you can’t push on your side if you are more comfortable. If you don’t have an epidural you can even get on your hands and knees.
- Episiotomies. Most doctors do not routinely perform episiotomies any more, they usually just let your tear unless they think it is going to be a large tear. This is because tearing heals faster than a cut.
- Assisted deliveries. Sometimes a doctor will feel there is a need to help the baby’s head pass through the birth canal. This can be done with forceps or a vacuum that attaches to the baby’s scalp.
- C-sections. If you are having a scheduled c-section there is no reason you still can’t have a say in how your birth goes. You will more limited in what you can choose, for example you will have to have an IV, but you can still see your baby right after birth and have skin-to-skin contact if you want. You should even get to have a support person next to you if you are awake. If you have to have an emergency c-section you will not have much of a choice and things will happen very quickly around you. You can be prepared for this by having an alternative birth plan to change routes if it starts to look like you may end up needing a c-section. For example, you can say that you don’t want an epidural, but if the baby starts to have some dips in the heart rate, you want an epidural so you can remain awake should you need an c-section.
- Kangaroo care. Kangaroo care is when the baby is skin-to-skin on your chest after delivery. Some mothers want kangaroo care, while others prefer the baby to be cleaned up first. This is completely up to you, but, as with everything, you should do your research before making a decision. If your baby is having difficulty breathing or other medical problems after delivery though, you will have to delay kangaroo care.
- Medical care. Once a baby is born they are evaluated to determine how they are transitioning to life outside the womb. If your baby is not having any problems there is no reason this evaluation cannot be done on your chest or in your room.
- Cutting the umbilical cord. Most of the time doctors don’t have a problem with someone else cutting the umbilical cord.The cord is clamped in 2 places and it is cut in the middle of the 2 clamps. If you want someone else, or even if you want to do it, make sure you let them know. The opposite is true as well, some people don’t want to cut the cord and the thought makes them queasy.
- Delayed clamping. There is something known as delayed cord clamping, meaning that the cord is not clamped until it stops pulsating. Some research shows that this allows extra blood to flow from the placenta reducing the risk of newborn anemia and iron deficiency.
- Cord blood banking. If you have decided to bank your baby’s cord blood it is important to let your doctor and nurse know before hand so they know they need to collect the blood. If you wait until after delivery it may be too late.
- Feeding preference. Many moms know how they want to feed their baby before the deliver, but you have to make this known before hand. You don’t want the nurses to give your baby a bottle if you want to breastfeed and you don’t want them to assume you are breastfeeding if you want to bottle feed.
- Pacifiers. Along with how you want to feed your baby, you should make it known if you want your baby to have a pacifier. Many breastfeeding moms avoid pacifiers because of nipple confusion. Again, this is up to you and it is a personal preference.
- “Rooming in”. Many hospitals offer the option of rooming in now, where the baby stays in your room all night. Some moms like this because it helps them get ready for what it will be like at home, while others prefer to get a little extra sleep before going home. Again, this is up to you.
Do I need a birth plan?
There is nothing saying you have to have a birth plan. The option is there to help you spell out everything you want or don’t want, but having a birth plan is completely optional. Almost every woman has some form of a birth plan though, even if she doesn’t write it down.
Did you have a birth plan? Were you able to follow your birth plan?