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What is a birth plan?
A birth plan is a document that lets your medical team know your preferences for things such as how to manage labor pain. Keep in mind that you can't control every aspect of labor and delivery, and you'll need to stay flexible in case something comes up that requires your birth team to depart from your plan. But a printed document gives you a place to make your wishes clear.
A birth plan also helps refresh your healthcare provider's memory when you're in labor. And it informs new members of your medical team – such as your labor and delivery nurse – about your preferences when you're in active labor.
Most hospitals and birth centers provide a birth plan worksheet or brochure to explain their policies and philosophy of childbirth, and to let you know what your birth options might be. That information can help guide you and your provider in a discussion about your labor and delivery preferences.
In the "Labor" and "After delivery" sections below, we explain what typically happens at the hospital and what alternatives you may have. Not all the options will be available in every setting or make sense for your situation, especially if your pregnancy is high risk. But this should give you a place to start your discussion. It can be wise to consider your preference in all situations, in case you are faced with an unexpected choice.
Birth plan worksheet
Here's a checklist to note your preferences and guide your discussion with your provider. Give a completed copy to your provider well before your due date, and bring another to the hospital when you go into labor.
A printable birth plan worksheet to fill out before labor
- When you arrive at the hospital, a health practitioner evaluates you to see how far your labor has progressed. You may be asked to walk around a bit or even to return home for a while before being admitted.
- Once you're admitted, the hospital may allow you to invite family and friends to be with you, bring in comfort objects (such as photographs, flowers, or pillows) or food and drink for your support team, play music, dim the lights, and move around as you need to for comfort. If you plan to have the birth photographed or filmed, ask ahead of time what the hospital's policy is. Not all hospitals allow it.
- To enable your ability to move around freely during labor, most hospitals won't routinely start an IV when you're admitted. (You'll be encouraged to drink clear liquids to stay hydrated.)
- Most hospitals no longer order enemas or shave you before delivery.
- You may want to ask about the hospital's policy on fetal monitoring. Your baby will likely be monitored externally for 20 or 30 minutes when you're admitted. If your baby's heart rate is reassuring, you might only need to be intermittently monitored after that. Not being tied to a monitor allows you to move around more easily during labor. (And some hospitals have wireless monitors, so patients can walk around while being continuously monitored.)
- Discuss your preferences for pain management with your healthcare provider. If you're trying for an unmedicated birth, you might plan to work with a support team or use various labor props, such as a shower, tub, birthing ball, birthing stool, squatting bar, and so on. (You may want to ask your provider what kinds of props you're allowed to bring with you and which ones the hospital can provide.) If you prefer to use pain medication or have an epidural, it's a good idea to discuss your options ahead of time.
- If your labor stops progressing, your medical team may recommend interventions such as breaking your amniotic sac (if your water hasn't already broken) or augmenting your labor with Pitocin.
- When it's time to push, your medical team can coach you on when and how to bear down. Another option might be to follow your body's natural urges and push when and how you feel is right for you.
- You may be able to choose the position you deliver in, such as squatting, semi-sitting, lying on your side, or on your hands and knees.
- Most hospitals don't routinely perform episiotomies, so you probably won't need to communicate your preference. But be aware that your provider may recommend one in some situations.
- If an assisted delivery is required, your provider will use a vacuum device or forceps to help your baby out of the birth canal.
- If you end up having a c-section, it's likely that you'll be awake and your support person will be able stay with you. In rare cases, you'll need general anesthesia, and your support person will be asked to wait outside the operating room.
- You may want to ask your practitioner if you can view your c-section delivery through a clear plastic drape or have the drape lowered and have your baby placed directly on your chest afterward.
- After a vaginal delivery, the baby is usually placed on you and covered with a warm blanket. You can let your provider know if you prefer to hold your baby skin to skin immediately after delivery or if want your baby dried off or bathed first.
- Unless your baby needs special medical care, you can usually ask for all procedures and tests to be done while your baby is in the room with you. Some procedures (such as bathing and measuring) can be delayed for an hour to give you a chance to feed and bond with your baby. If your baby does need to be taken from you for special medical care, your partner or attendant can usually go along.
- The umbilical cord is clamped in two places and cut between the two clamps. Let your provider know if your support person wants to cut the cord.
- You may want to ask your caregiver about delaying the clamping and cutting of the umbilical cord. Recent research shows that waiting a few minutes allows extra blood to flow from the placenta to the baby and reduces the risk of newborn anemia and iron deficiency.
- If you've chosen to bank your baby's cord blood, the blood will be collected at this time. (You'll need to arrange for the process well in advance.)
- Whether you choose to breastfeed or formula-feed, you can begin whenever you and your baby are ready. If you're nursing, let your medical team know if you'd like a lactation consultant to help you get started.
- Consider whether you want your baby to have a pacifier, and let the hospital staff know your preferences.
- Most hospitals encourage you to be with your baby as much as possible during your stay. They tend to support "rooming in" – rather than keeping the baby in the nursery – to promote bonding. Ask about your hospital's policy on this if you have any questions.