A birth plan is your plan of how you envision your birth and what happens directly following the birth of your baby. A birth plan is much more than a piece of paper you hand to your care provider. It is the process you go through to prepare for the birth experience you want. This process will lay the foundation for you to be prepared for the scenario in which everything goes exactly as planned and for what should happen in the event things do not go as planned.
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Article and Resources
Quick Links to Resources:
- Get a copy of Vanessa’s birth plan
- Your Birth Plan book
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What is a Birth Plan
A birth plan is your plan of how you envision your birth and what happens directly following the birth of your baby. A birth plan is much more than a piece of paper you hand to your care provider. It is the process you go through to prepare for the birth experience you want. This process will lay the foundation for you to be prepared for the scenario in which everything goes exactly as planned and for what should happen in the event things do not go as planned. The value of a birth plan has a lot more to do with the process of creating it than it does with the finished product.
When to Start Your Birth Plan
You start creating your birth plan the minute you start educating yourself about labor and birth. This is a work in progress throughout your pregnancy. Every prenatal appointment is an opportunity to discuss some aspect of the labor and birth experience you want. Your plan may evolve as you learn more and explore your options. Ideally, you finish your birth plan by the end of week 36. You can always make changes or revise it until you go into labor.
Ten Steps to Creating Your Birth Plan
As promised, let’s go through 10 simple steps to creating and writing your birth plan.
Step 1: Get Educated
To make an informed decision about anything, you need to educate yourself and know your options. Education about birth comes from listening to the Pregnancy Podcast, reading books, doing online research, and talking to your care provider. Please utilize your visits with your doctor or midwife to learn about aspects of labor and birth. Your care provider is your expert resource. The Pregnancy Podcast has episodes that examine the evidence of every intervention during labor and birth. To browse by topic, check out the episode guide. Premium members have access to the entire back catalog of episodes ad-free.
Step 2: Make a List
Make a list of everything you want to include for your labor, birth, and baby. You can use a pen and paper, a note app on your phone, or a document on your computer. Start putting down the things that are important to you and that you know you want to include in your plan. Don’t worry about details at this point. The goal is to have everything that comes to mind documented in one place.
Step 3: Find Out the Policies and Procedures You Need to Work With
Once you have your initial list, you need to find out what the policies are of your care provider or the venue where you plan to have your baby. If there is a conflict between policies or laws and your requests, you want to know upfront to plan accordingly. One example is that some states mandate the use of erythromycin eye ointment for newborns. If you live in a state that requires erythromycin, you may not be able to opt out of this procedure. As you are working with your care provider throughout your pregnancy, you will learn the policies and practices you need to take into account. While it may be frustrating to have to alter your requests, the best time to make changes to your birth plan is well before you are in labor.
Step 4: Create Your First Draft
To create the first draft, you need to write out your preferences in an organized format. Typically, you write your birth plan as a letter addressed to your doctor, midwife, or the hospital or birth center staff. It is crucial you craft your plan in a respectful tone rather than a list of demands. This is helpful when you provide copies to staff with which you do not already have an existing relationship. For example, imagine you want to avoid cesarean birth. To make that clear, you could state, “I plan a vaginal birth and do not want a c-section.” An alternative way to state that would be, “I would like to exhaust all options for a successful vaginal birth before resorting to a C-section.”
If you want to see a sample of a birth plan to see how it could be structured or worded, you can get a free copy of the birth plan I used for my son’s birth. Although my preferences may not be right for you, you can use them as an example of how yours can be structured and worded. Click here to get a copy of Vanessa’s birth plan.
If you have a preference that is in line with your care provider’s routine practice, you may be able to take it out of your birth plan. For example, if your doctor routinely uses electronic fetal monitoring and you are comfortable with that, then you do not need to include it. On the other hand, if you wish to do something outside of your care provider’s routine practice, you will want to leave it in your birth plan to make sure they know your preference. Using the same example above, if you prefer intermittent monitoring, you may want to put that in your birth plan.
Your first draft is a draft. Don’t worry about making this perfect the first time around. You will have an opportunity to edit and make changes as you complete this step-by-step process.
Step 5: Check for Conflicts
Once you have your first draft, you want to read through it and check for conflicts. You make sure that everything makes sense and that all of the pieces fit together. For example, you may not be able to avoid IV fluids if you are choosing to have your labor induced with Pitocin. If you are planning to delay the clamping of your baby’s umbilical cord, you cannot also bank cord blood. Knowing which interventions conflict with each other comes from knowing your options and how one intervention could affect another. Make sure everything in your plan works together.
Step 6: Review Your Plan with Your Partner
The next step is to review your birth plan with your partner. Whether or not they have been involved in the process up to this point, they can be an excellent sounding board. Ask them if it makes sense and if there is anything important to them you are leaving anything out. Your partner plays a significant role in your birth. Having them read through it and getting their feedback is a great way to get them involved. Your partner can be an invaluable advocate for you during labor and birth. They can only be an effective advocate if they know your birth plan and understand your requests.
Step 7: Discuss it with Your Care Provider
At this point, you should have a solid draft of your birth plan, and the next step is to discuss it with your doctor or midwife. This step is mandatory and is in addition to working with your care provider throughout the planning process. The number one reason birth plans fail is that expecting parents do not involve their care provider. Your doctor or midwife is an excellent resource to pinpoint problems with your plan or conflicts they see as a potential issues.
If you aren’t 100% clear on anything about your birth, now is the time to bring it up. Make sure your care provider is clear on what you want and that they support your wishes. If there is anything you do not see eye to eye on, talk about it. If you have concerns, bring them up. You and your care provider are on the same team, and you will not get the birth experience you want if you plan without them.
Step 8: Final Edits
After you have reviewed your birth plan with your doctor or midwife, you are ready to make your final edits. An essential part of this step is editing down your birth plan to a maximum of one page, printed on one side. While you can decrease the font size or reduce margins, you want a concise birth plan. The goal of your final draft is to have a brief, well-thought-out plan that is clear, easy to read, and free of any typos.
Step 9: Know Your Birth Plan Inside and Out
Once your final draft is complete, you need to know precisely what is in your birth plan. Understanding interventions and your preferences allow you to be confident in your decisions and what to expect. You should have a thorough understanding of every item in your plan and why you included it. This is also true for your partner. They need to know your birth plan well to advocate for you. If you are working with a doula, make sure they have a copy and will be supportive of your choices. You do not have to memorize the entire plan word for word, but you should know precisely what you want and do not want.
Step 10: Have it Ready
Save your birth plan and have it accessible via email if you need to forward it to anyone electronically. Provide your partner with a copy and your doula, if applicable. Print out several copies and pack them in your hospital or birth center bag, or have it on hand for your home birth. As new nurses, doctors, or support staff meet you during your labor, let them know you have a birth plan and get them a copy to review.
It is the Journey, Not the Destination
At the end of this process, you have a concise sheet of paper with your requests, but everything you did leading up to that final printed piece of paper is what will set you up for success. Some of these steps will take less time than others, and I encourage you not to skip any steps in this process.
What if birth Doesn’t Go as Planned?
I wish I could assure you that your birth will go exactly as planned, and it will be magical and perfect. I genuinely hope it does. There are always unknowns. Many factors can impact your labor and birth, and many of those are out of your control.
A simple way to illustrate how some births do not go as planned is to look at the rate of cesarean births. According to CDC data, in 2020, in the United States, the overall cesarean rate was 31.8%. Some mothers who had their baby via cesarean would be at high risk or need a cesarean for medical reasons. Some of those mothers may schedule an elective cesarean. If you look at the low-risk cesarean rate, it is 25.9%. Low-risk mothers are at least 37 weeks, first-time mothers, with a baby in the vertex (head down) position. One in four low-risk women is giving birth via cesarean. Do one in four women plan on a cesarean for birth? Or is it possible that their birth did not go as planned?
One study of over 38,000 women who had their babies via cesarean found the biggest reason for cesarean was a failure to progress. 35.4% of mothers in this study had a cesarean because labor was not progressing. The following most prominent reason for cesarean was non-reassuring fetal heart rate, which accounted for 27.3%. Examining this data tells us that 62% of women who had a C-section in this study didn’t go into labor planning on a cesarean. These were births that did not go as planned.
A cesarean can be a lifesaving procedure for both mothers and babies. I am thankful we have access to that medical advancement when we need it. The takeaway from these figures is that statistically, not everyone will have their birth go as they plan.
Why You Should Have a Backup Plan
Should you plan for the birth you want? Absolutely. Should you also have a backup plan? Yes! Labor is an intense experience. Many factors can require quick decisions or change the trajectory of your birth plan. During labor, there may not be adequate time for your doctor or midwife to educate you about all of your options and go in-depth through each procedure’s pros and cons.
Creating a backup plan allows you to educate yourself ahead of time and make informed decisions for alternate birth scenarios. By creating a backup plan, you will not be caught off guard if circumstances arise that change the course of your plan. Depending on your ideal birth plan, there are several circumstances you may want to explore when creating your backup birth plan.
Changing Preferences for Interventions
In the course of your labor, you may change your mind on the interventions to which you opt in or out. If you plan a natural or unmedicated birth, you could decide that you want an epidural or other pain management options. Even if you plan on intermittent rather than continuous electronic fetal monitoring, you should know about both. In any case, it would be good to understand what your options are. Plus, educating yourself about these procedures ahead of time will give you more confidence in discussing them with your doctor or midwife, even when quick decisions are needed. You can always change your preferences and deviate from your birth plan during labor. Please do not feel obligated to stick with your plan if you want to change it during labor.
Every expecting mother should be knowledgeable about cesarean birth. Looking back at the statistics we already covered, nearly one in three mothers in the United States has their baby via cesarean. Even if you think a cesarean is unlikely for you, one in four low-risk women is giving birth via cesarean. If you plan for a vaginal birth, a cesarean may not be ideal. The good news is you have many options in a cesarean birth. The caveat is that if you do not know what your choices are, then you don’t have any. The more you know, the better you will be able to navigate your options. There are episodes of the Pregnancy Podcast on cesarean birth and gentle cesarean and vaginal seeding.
If you are planning for a home or birth center birth, you need a backup plan in the event you need to transfer to a hospital. The majority of these transfers are not emergency 911 calls. You may decide you want an epidural to rest. Something may come up that makes your midwife recommend you transfer to a hospital. You should have answers to the following questions when exploring the possibility of a transfer to a hospital. These questions will be helpful when creating a backup plan if you transfer from your home or birth center.
What hospital would you transfer to? If your preferred hospital is not the nearest, you should also know where the nearest facility is in the event you need to transfer quickly. If possible, it would be nice to have a doctor whom you know your care would transfer to if required. Some birth centers and home birth midwives have OBGYNs they work with regularly and they may be able to assist in connecting you with an OBGYN.
Who can accompany you to the hospital? Hospitals tend to have stricter policies on who can be with you during labor. Your partner should be with you, but your midwife or doula may not be able to accompany you. You should know what capacity your midwife can continue your care. This depends on the circumstances and the laws where you live. Some midwives will be able to stay with you in the capacity of a doula. Others would have to hand over your care completely. Ask your midwife to walk you through what a hospital transfer would look like and how they can or cannot continue to support you. This support could be in person, virtual, or postpartum.
COVID-19 brought some of the most drastic changes to prenatal care and birth policies in decades. Hospitals required masks during labor, limited visitors, and partners and doulas could not attend births in extreme cases. Changes in hospital policies affected many mothers who had babies during the pandemic, and not all mothers prepared for these changes.
An analysis of birth plan alterations in response to COVID-19 found overall, 45.2% of participants reported changing some aspect of their birth plans because of COVID-19. Hopefully, we don’t have another global pandemic. If there is an event that changes hospital policies and procedures, you need to consider that when planning your birth. In the case of COVID-19, policies changed often. It would be worth discussing whether you will take a COVID-19 test and how a positive result could alter your options. You should also ask whether your partner would take a COVID-19 test and if a positive test would prevent them from being able to be with you. If you ever have questions about the policies of your care provider or the venue where you plan to give birth, please discuss them ahead of time with your care provider.
Creating a Backup Birth Plan
Creating a backup plan is the same process as creating your ideal birth plan. At a minimum, if you are planning a vaginal birth, you should have a backup plan if you need a cesarean. This allows you to maintain autonomy in your choices and confidence in handling either scenario. Once you write your primary birth plan, repeat the steps to write a backup plan. You may never need your backup plan. You will be more confident going into labor knowing that you have prepared for multiple scenarios.
Frequently Asked Questions
In helping thousands of expecting parents create birth plans, several questions frequently arise.
Does Your Birth Plan Have to be Written?
There are several reasons why you should have a written physical birth plan. When you can see all of your preferences in one place, you can make sure everything fits together, and there are no conflicts. Having a plan in writing ensures that when you review it with your care provider, you go over every aspect of it. A written plan gives your partner or anyone else attending your birth a cliff notes version of what you want. Support during labor can be from nurses, doctors, or other support staff. You will have support staff present with whom you have not built a relationship, and they will not know your preferences. Rather than explaining everything and risking leaving out essential details, you can hand them a physical copy of your plan.
Can Your Birth Plan be Longer than One Page?
You will provide copies of your birth plan to support staff present during your labor. Nurses, doctors, and hospital staff are busy and have many other patients. No one wants to spend a long time sifting through several pages of requests. Not only will they miss some of the things you have listed. They may miss the items that are really important to you. You may be able to fill up five pages with things you want during your birth, but spreading your attention over that many things isn’t as effective as narrowing your focus to a shorter list.
Unfortunately, some providers are not big fans of you having a birth plan. It is easier for someone who may not be thrilled about being handed a birth plan just to have one page to read.
You can shorten long-winded birth plans by taking out duplicate information and information or requests that are not necessary. I understand it can be challenging to cut your birth plan down to one page. Are there some things that align with your care provider’s routine practice that you do not need to mention? For example, if you want delayed cord clamping and it is your doctor or midwife’s practice to delay and not clamp the cord immediately, can you take that part out? The flip side of this is that if another doctor or midwife ends up attending your birth, this could be something that you want to make sure they are aware of.
Read through your plan and see if there are things mentioned that may not be necessary. An example of this will be if you want to have access to a birthing ball during your labor. This is something that will come up early in your labor. It is a quick request to a nurse to ask for a birthing ball, which is probably something you do not need to include in your birth plan. You can also condense related items into one sentence or paragraph. For example, if you mention erythromycin and vitamin K, you may be able to combine those two things into one sentence rather than two separate sentences. Creating a backup plan also allows you to move many items to a separate birth plan and keep both short.
Altering margins and spacing may fix your issue if you are just barely over one page. If you condense the font size and margins too much, it will be evident that you are squeezing more than one page of text onto a single page. If your birth plan is more than one page after going through these tips and you cannot make it shorter, move the more critical items to the top.
There are many resources from the Pregnancy Podcast to assist you in creating and writing your birth plan. The Pregnancy Podcast has episodes that examine the evidence of every intervention during labor and birth that you can include in your birth plan. To browse by topic, check out the episode guide. Premium members have access to the entire back catalog of episodes ad-free.
Sample Birth Plan
If you want to see my birth plan, I am more than happy to send it to you. You can request a copy here. This is the birth plan I created for my first birth planned at a birth center. I will also send you the backup plan I wrote if I needed to transfer to a hospital.
Your Birth Plan Book
The Your Birth Plan book walks you step-by-step, showing you exactly how to create a birth plan. You will find short sections with evidence-based information to help you decide your preferences from starting labor until you are home with your baby. There are sample plans for everything from home birth to a planned cesarean and everything in between. This book has you covered no matter what type of birth you are planning. Plus, the master template includes everything you could include, and it is quick and easy to customize to your preferences. Premium Members receive a free copy of the Your Birth Plan book. It is also available on Amazon, Kindle, or as an instantly downloadable PDF.
Talking to Your Doctor or Midwife
You must work with your doctor or midwife when creating your birth plan. The number one reason birth plans fail is that expecting mothers do not collaborate with their care providers when creating their birth plans. It is not enough to hand your doctor your birth plan when you arrive at the hospital in labor.
It will be challenging to achieve the birth experience you want without the support of your doctor or midwife. They are your trusted partner during pregnancy and birth. You want their input and expertise as you are crafting your birth plan. Please do not skip the steps of discussing and reviewing your birth plan with your doctor or midwife.
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