Birth Plans

If you’re planning on giving birth anytime soon, have attended a childbirth class, or read a pregnancy preparedness book, chances are you’ve heard the term “birth plan.”

While it seems that everyone agrees that you need a birth plan, the information surrounding them can be at best unclear and at worst, overwhelming.

I’m here to address some common questions and misconceptions about birth plans, and help you make decisions about your own preferences for birth:

1) What is a birth plan, and why does everyone say you need one?

  • A birth plan is a document where you list all of your preferences for your ideal birth scenario. In fact, I think a more suitable name for it would be “List of Birth Preferences” instead of “birth plan.”

The conversation around birth plans can be really conflicting -  people like your yoga instructor, your doula, or your best friend will tell you that you need a birth plan so that the doctors/midwives/nurses will know your desires straight away and won’t try to push interventions that you don’t want. Care providers can sometimes be very supportive of the idea of a birth plan,  while others may be defensive or dismissive. Depending on where your doctors/midwives all on that spectrum, presenting a list of birth preferences can be a really great way to have a conversation with your care provider about how you’d like your birth to unfold and forge a more trusting and open relationship with them. They will be present for a pretty crucial moment in your life, after all.

If you don’t already have a positive relationship with your care provider, the reality is that a piece of paper with your plan on it (even if it’s laminated, which I’ve done before) likely isn’t going to be the thing that keeps you from being hounded with unwanted interventions.

However, what will help you stay in control of your labor and birth experience is knowing your options ahead of time and how you feel about them.

For some people, they may have never heard of pitocin, episiotomy, or the “golden hour” before deciding to write a birth plan. When you commit your preferences to paper, you are also equipping yourself with knowledge so that you can make informed decisions about the options with which you are presented. Will having a birth plan keep you from needing pitocin or deciding to have an epidural? Not necessarily. Birth is unpredictable. Birth plans, like all plans, can change. Still, I encourage all of my clients to write down their birth preferences, because it is important to consider what you want on what will undoubtedly be a monumental event in your life. People create elaborate plans for outdoor weddings every year knowing that there’s a chance it may rain. You are allowed to dream of your ideal birth and still be open to the possibility of change when the time comes.

2) What should be included in your birth plan?

There’s another misconception that the only people who really need birth plans are those who desire a completely unmedicated, intervention-free birth. In actuality, a birth plan usually covers several possibilities through the different stages of labor, including preferences for baby’s care for the duration of your stay at the hospital. (Also, if you know that you’d like to be offered pain management such as nitrous oxide or epidural as soon as you are obviously in pain, that’s a great thing for your nurses to know when you arrive!)

When I create birth plans with my clients, we typically play a game in which they lay out all of the possible options in three categories which are: “Yes, we absolutely do want this”, “We’re not sure”, and “No, we absolutely don’t want this.” Again, plans can change, but we’re planning for their ideal vision for birth. After we’ve discussed their preferences and gone over any topics they may have needed more information on, I take their answers and create a birth plan divided into the four stages of labor. I won’t list all of the options we go over in my game, but here are some that are important to consider when creating your own birth plan:

  • Do you want to be able to move freely while in labor? Your care provider’s approach to things like fetal monitoring, IVs, catheters, etc should be discussed depending on your preferences.

  • Do you want to be able to eat and drink while in labor? (I have many thoughts about this that I will likely discuss in another post)

  • Do you want to be offered any sort of pain management, or would you prefer to not be asked?

  • Do you want your provider to rupture your water, or would you like for it to break on its own?

  • Do you want baby taken to be cleaned, weighed, and given shots as soon as they are born, or do you want them to be put directly onto your chest? (barring any emergent medical issues, of course).

  • If you’re delivering at a teaching hospital (very common in NYC), do you want medical students assisting in all procedures, or would you prefer that some (cervical checks or vaginal repairs, for example) be done by the senior medical professional overseeing your care?

Growing up, many of us are taught that we should be polite and be good patients, to avoid bothering our doctors or ask too many questions. However, the incredible, intense, very physical event of bringing your baby or babies earthside is a time to throw all of that out the window; this is the moment to be clear about your needs and desires, without apology.

3) What should your birth plan look like?

There are a few different ways to structure a birth plan. Some people prefer to make a bulleted list, offers a printable worksheet, and on the rare occasion, I’ve seen expecting parents write more of a letter-style document to their provider.

When I’m assisting clients in creating a birth plan or “list of birth preferences”, I utilize a visual birth planner. This allows me to turn items commonly listen on a birth plan into simple, easy-to-read icons. As many of us know, doctors and nurses are often very busy. I believe that the visual birth plan is a great option because care providers don’t have to spend too much time reading it and are therefore more likely to actually, well, read it. Here’s an example:

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If you’d like to create your own visual birth plan, you can create an account at Visual Birth Planner and make one for free!

4) Who should see my birth plan?

The creation of your birth plan should take place with whoever will be supporting you during labor. If you’ll have the support of a partner, it’s important that they are intimately aware of your preferences, especially since they may be the only other person in the room capable of making medical decisions on your behalf. If you want your parent, sibling, cousin, or best friend to be there - they should also see your birth plan and understand how they can support you in achieving your desires and give you the space to make a decision if circumstances change.

Once you’ve completed your list of birth preferences, bring it to an appointment with your OBGYN or midwife (goodness knows we have plenty at the end of pregnancy). Be prepared to discuss with them why you’ve made certain choices and remain confident. Hopefully, you’ve chosen a provider who is well-matched to your standard of care and they will be thrilled that you’ve done all of this wonderful research! If they are dismissive or negative about anything on the birth plan or the fact that you brought one, it’s okay to ask them to explain. If the conversation feels contentious, this may also be a good indicator that you should reconsider giving birth under their care (this is a very difficult decision, and I don’t make that suggestion lightly).

Of course, your birth plan should also be discussed with your doula, as well as how you’re feeling about your care provider’s input. Your doula is trained to share with you the information you need to advocate for yourself. They can help you navigate conversations with care providers and feel confident that you’re receiving the care you deserve.

The choice to bring a piece of paper to your birth is ultimately yours and only yours.

At the very least, I hope you leave this post feeling encouraged to research your options and empowered to visualize the birth you desire, without fear. Whether you choose to put your preferences in a document, draw them, discuss them, or simply keep them in your heart - do yourself the favor of knowing your wants and needs and asking for them with confidence.

You are worthy.

Thank you for reading. Until next time -