On Writing a Birth Plan

When I was pregnant with my first, I had an idea of what I wanted and though I had heard of writing a birth plan, I didn't think it was necessary because I knew what I wanted. It turns out I didn't get what I wanted. I'm not sure if that was actually related to not having a written birth plan, but I figured writing it down the second time around was something I wanted to do. After the birth of my first son, I felt I had a pretty good experience, however, I still wanted things a bit different. First, I didn't want medical augmentation of the labor. I really felt I fell victim to a snowball effect and that one intervention lead to another. I wanted the second time around to be different.

I did more research and reading on natural childbirth, focusing most of my time reading "HypnoBirthing" and learning relaxation techniques. The book also covers a decent amount about writing up your "birth preferences," known colloquially as a birth plan. The book offered several suggestions that I found useful and I incorporated some things into my birth plan that I had not even known about prior to reading the book.

I did run into a snag though. When I actually went to put on paper what I wanted, I was a bit unsure of what to add. Sure, there were a few things I knew I wanted, no drugs, rooming in with the baby, etc. There were a few things that I learned about in the book like the benefits of letting the umbilical cord finish pulsing prior to clamping and cutting it. But what I was still confused about was how to write it all up and how to phrase my birth plan. I turned to the internet as we do for many things and tried to look for some templates and while I found some things here and there or forms specific to breastfeeding after the birth, I didn't really find what I was looking for and I couldn't even find much in the way of other birth plans that people had written up (I think I found one). I felt a bit on my own, but taking from the form I found, the book, and the one birth plan I had found online and a few other things here and there, I came up with what I wanted. In discussing with an expectant mom today about labor plans and expectations we came across a few things that she hadn't thought of that she may have wanted to include in her birth plan. I am adding mine below so that perhaps another expectant mom can find some use for it and maybe having one more available online will help other moms to put together their own and possibly identify some things that she may have not thought about previously.

One thing I found disappointing, sort of after the fact, was that one of the nursery nurses mentioned that when they see that a mom has a birth plan, they worry. She said that a birth plan usually means a c-section. I'm not sure why this phenomenon is the case, but in my situation, I got what I wanted. I firmly believe that most moms can get what they want, but having a supportive nurse and staff when in labor is a good way to go about getting what you want. I added that to my birth plan too.

In any case, here is the list of my "birth preferences" for my second son:

Birth Preferences for B. E. (April/May 2011)

Howdy! Thank you for being a part of my birthing experience to welcome my newest little one into the world. I am looking forward to a natural birth with limited to no medical intervention, therefore, if there is a nurse who is partial to natural birth, I would enjoy working with him or her. I have listed several items which are important to me for my baby's birth and I greatly appreciate your cooperation in these matters.

Fluids – I prefer only a heparin block.

I am well aware of the importance of hydration during labor as well as the advantages of having a vein readily accessible should medication need to be administered. I am not anticipating needing medication and I would like the freedom to move around while I labor, therefore, I appreciate being free of a fluid pump and line.

Monitoring – I prefer intermittent monitoring if at all possible.

As mentioned above, because I would like freedom of movement during my labor, I prefer intermittent fetal monitoring if it is available. I am happy to comply with hospital regulations for minimum monitoring times and appreciate the opportunity to have the freedom to move around and change positions at will.

Environment – I would like a calm, quiet, dim environment to labor and birth in.

I understand that nurses and doctors are an integral part in ensuring the safety and health of me and my baby. I believe that a calm, quiet, minimally interrupted environment is also an integral part in ensuring the healthy natural progression of my labor. Therefore, please limit monitoring, checks, and traffic to the minimum. Should visitors arrive, please consult me or my husband before directing them to our room. Please limit lighting if at all possible during the birth as well, so my baby can be born into a welcoming environment.

Pain medication – I would like to avoid medications which can lessen the experience for me and my baby.

I am well aware of the systemic and anesthetic medications that are available to me for labor. I do not wish to be offered any medications. Please do not ask me to rate my pain level as I will respectfully decline to answer. If I feel medication is necessary, I or my husband will request it.

Assistance with labor progression – I do not wish to receive artificial forms of labor assistance.

If for some reason my labor stalls or slows for an unreasonable amount of time, as some pauses are the body's natural way of resting, I would like to try natural ways of helping the labor to progress. I would like to discuss any artificial interventions with my doctor and be allowed adequate time to discuss and decide on a course of action prior to proceeding.

Episiotomy – I do not wish to receive an episiotomy.

My doctor has let me know that this procedure is not typically performed in most cases, however, I want to express my preference again. I prefer a tear to an episiotomy.

After the birth

– I would like to have my baby placed on my stomach or chest immediately following the birth.

• Please allow the cord to stop pulsing before cutting it.
• Please perform initial evaluations, suctioning, only necessary cleaning, etc. with the baby on my chest. Please check weight and other measurements as quickly as possible and return the baby to me.
• I would like to initiate breastfeeding as soon as the baby is ready after birth and holding him skin-to-skin is the best way for me to know when he is ready.

Placenta – I would like to deliver the placenta naturally if possible.

I plan to donate my placenta and have discussed it with my doctor. Because of this, I would like the placenta to be free from damage of artificial delivery if avoidable. All portions of the umbilical cord that are separated from the baby will also be donated with the placenta. Please wrap the placenta and all portions of the detached umbilical cord in a biohazard bag and place it in the freezer bag and cooler I will provide.

Recovery

• I wish the baby to room in with me and only be removed or taken to the nursery for procedures that absolutely can not be performed in my room.
• For the short time(s) that my baby must be separated from me, do not offer him any pacifiers, bottles, or formula as he will be learning to breastfeed.
• I am expecting a boy and will have him circumcised. Again, I do not wish for him to be given a pacifier. Please use a finger or other way to administer the glucose water during the procedure.
• Please allow the room lights to remain dim for any procedures or checks of me or the baby as I would like him to be comfortable.