Creating a Personalized Birth Plan

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There are a lot of differing opinions about birth plans out there. While many OBs and L&D nurses out there may laugh at the notion of having a "plan" for birth, there is importance to the act of writing a birth plan. In my opinion, creating a personalized birth plan is something that every expectant mother should do well before the big day. There are a few reasons for this. While your birth may not go as you "plan", the so-called birth plan is a way for you and your partner to get a clear picture of what your expectations for labor, of your health care provider and of your hospital/birthing center/home are. 

A birth plan is best utilized when you have a chance to review it with your provider sometime in month 6 or 7. This gives you a) enough time to mentally adjust to what is and is not possible at your given birthing location and with your particular provider and b) the chance to change providers if the gap between what you want and what they are willing to provide is too far apart. If your provider is really honest with you, it's likely you'll have a little editing to do. 

Once you've reviewed your birth plan with your provider (if you have a practice with multiple partners be sure to have each one read it when you meet them so that everyone is on the same page) print out the edited version and have them put it in your file. Have another one to bring with you to the hospital or birthing center. Having your wishes written down clearly can help you later if you are put in a tough situation and feeling pressure from nurses or an on-call doctor who may be trying to manage your labor when you're in no position to form a complete sentence much less give informed consent. Some key elements of your plan should be:

• Who will be present in your labor room and who should not be.
• Mood/Setting for your L&D room
• Your choice of pain management options and order of preference
• Who will catch the baby, how you'd like to be situated 
• Immediate postpartum care: managed placental birth (cord traction or pitocin) vs. naturally birthing the placenta, breastfeeding, infant exam/vaccinations/bathing
• Rooming in vs. Nursery care (or what you'd like in the case baby needs to be in the NICU or you are in need of medical recovery time)
• The C-Section: be open that there may be a need for this and be prepared and educated about what will/can happen during this surgery. Will you partner be present? Who will stay with you after? Who with baby? Can you have your arms free for holding baby after? Can routine infant exam happen with you there? Specify breastfeeding or bottle feeding and rooming-in if possible. 
• Breech birth
• Expectations/Plans for Postpartum Depression Support & Care

Once you have a long version, make a short half-page or less version for the nurses and other staff at your hospital or birthing center. Tape this one to the door or your L&D room. It's always nice to have chocolates or some other sweets on hand for the lovely (or not so lovely, but you want them to leave you alone) nurses who are working so hard for you. 
Here's our plan for Baby #2. After going through our first birth I edited ours to reflect the things I wanted to do differently. Like, before I never thought I'd want to see the baby coming out of me, but now I know I TOTALLY want to see that! Childbirth is amazing however it happens, so get educated, talk to your health care provider openly about your expectations, and then learn to let go...


Birth Plan(Short Version) 
Dear Midwives & Nurses: This is our second birth and we lookforward to one of you watching over us as we labor to ensure we area healthyand strong and helping us catch our baby. We would like to have our labor andbirth be as intimate and hands-off as possible in the hospital. When the babyis born we would like to be the ones to catch him/her with you there to guideusThe following is more detail about more specific wishes for our time in thehospital and what we would like to happen in the case of an emergency duringour labor/birth. Thank you in advance for being with us for such a wonderfulevent.            -Us
Birth Plan (Long Version)
Attendants at Birth:The HusbandThe Best Friend (who also happens to be an ER nurse, and attended our first birth)
Once I'madmitted and in my delivery room, I'd like:

•      Only my practitioner, nurse, and specified guests to bepresent (please no residents, medical students, extra nurses or other hospitalpersonnel)
•       To keep the lightsdimmed
•       To listen to quietmusic from my iPod
•       Use of the bathtuband shower for pain relief
•       Please keep theroom quiet and calm
•       I’d like to eatand drink as I feel hungry or thirsty, I am aware that my hypoglycemia may makemy blood sugar levels drop so I would like for a birth attendant to help medrink or eat small bites of nourishing food between contractions.
•       For my partner to be allowed to stay with me at all times
•       To wear my glasses/contact lenses, as long as I don't need ac-section

During Labor:

•      I would like thenurse and/or midwife to use intermittent monitoring using a doppler orfetoscope. I do not want to use continuous fetal monitoring either internal orexternal.
•       I would prefernot to have internal exams once in labor unless medically necessary.
•       I would like tolabor free of external interventions to augment my labor, including but notlimited to pitocin or cytotec.
•       For pain reliefI would like to use: acupressure, bath/shower, deep breathing techniques,massage, freedom of movement, vocalization, or any other non-medication basedmethods. I would like to labor withoutpain medication and do not want to receive narcotics or an epidural, please do not offer them to me unless it ismedically necessary due to the need for an emergency cesarean.

Pushing & Delivery:

•      When it becomestime to push I would like to do so instinctively and to be allowed toprogress free of stringent time limits as long as my baby and I are doing fine.
•       I would like to be free to push in whatever position feelscomfortable and safe at that moment.
•       I would like to see the birth with the help of a mirror ifpossible.
•       I would like to have the midwife massage and support myperineum during the pushing stage to minimize the risk of tearing. I wouldrather tear naturally than have an episiotomy cut.
•       As the baby is born I would like to have him/her placed onmy abdomen and allow my husband and I to discover his/her sex.
•       I would like to birth the placenta without use of pitocin. Iwould prefer fundal massage if necessary. I do understand that pitocin may benecessary if there is a large amount of bleeding, in which case I would like itto be used to help stop a possible hemorrhage.
•       We want to wait until the cord stops pulsing before cuttingit. We will not be banking the cord blood.
•       After the baby is born I would like him/her to stay with mein bed for all newborn procedures, to eat, and to sleep.
•       We will not be consenting to eye drops or Hep Bimmunizations after the birth. We will discuss the need for Vit. K dependentupon the birth.
•       The baby should notbe removed from our care at any time without discussing it with us first.
•       I would like to breastfeed as soon as the baby isinterested. Please DO NOT feed the baby formula or sugar water, or give anyartificial nipples.
•       We would like to give our baby its first bath after we feelhe/she is ready, not immediately following birth.

CesareanSection: If there becomes a need for an emergency c-section I wouldlike:

•  To have my husband with me at all times during theprocedure.
•   To have the baby placed on my abdomen above the curtain assoon as it is born. If this is not possible I would like for my husband to begiven the baby as soon as his/her Apgar score and other newborn procedures arecomplete.
• After the baby is born I would like him/her to stay with mein bed for all other newborn procedures, to eat, and to sleep. We would like towait until the baby has begun bonding and breastfeeding to give him/her eyedrops.
•  The baby should not be removed from our care at any timewithout discussing it with us first.
• I would like to breastfeed as soon as the baby isinterested. Please DO NOT feed the baby formula or sugar water, or give anyartificial nipples.
• If I am medically unable to breastfeed due to serious illnessI would like my baby to receive breast milk from a milk bank or donation viacup feeding or finger feeding with a feeding tube. I do not want my baby to begiven formula unless banked or dontaed breast milk is unavailable. There is abreast milk bank at the University of Minnesota Children's Hospital or myhusband will find donor milk.
• If there is a medical problem and our baby needs warming orspecialized care we would like to use Kangaroo Mother Care instead of a warmeror incubator. We would like unlimited access to our baby if he/she needs tostay in the NICU for any period of time.

BreechBirth:

• In the event that our baby is notengaged in the pelvis head down and in is a breech position I would like todeliver vaginally. I DO NOT consider thisan emergency or a reason for a c-section unless the fetal heartbeat is low andnot recovering after each contraction. I would like the midwife to deliverthe baby using the hands-off approach allowing the baby to guide him/herselfout and having the midwife catch him/her as he/she emerges.  

Post Partum Depression:

• I suffered from PPD after the birth of my daughter in 2011 and would like to be watched for recurrence this time around. Please have a proscription of My Preferred Drug ready for me after delivery in case I need to fill it prior to my 6-week check up. 

Thank you again for helping us bring a new baby into the world!