Birth Plans

Birth Plans have been around for many years. Birth Plans originated to assist women to inform their midwife or doctor of their wishes during labour, particularly if they wanted to avoid routine interventions. Birth Plans have evolved since their humble beginnings. Birth Plans now may be comprised of many things, including thoughts and expectations of what you would like for the birth of your baby. I must say from the out set, that I personally dislike the term ‘Birth Plan’. The term ‘Birth Plan’ implies that there is some control over birth and that you are able to plan for it. The reality is that you have little control over labour and birth, making it very difficult to formulate any sort of plan. Perhaps it would be better to think in terms of listing ‘Birth Preferences’ or compiling a ‘Wish List’.

The concept of a Birth Plan however, can be very valuable in acting as a tool of communication between your self and your midwife or doctor. Birth Plans can be used to help people around you know about your preferences before labour starts. As a tool to help you to explore different issues surrounding labour, birth and afterwards, Birth plans can help you formulate ideas on what you would like or not like to happen. You may find it very helpful to work on your birth plan with your partner, so they can be part of the decision making process and be able to assist you in implementing your plan.
Birth Plans can be quite varied, they can be short and to the point or extensive and cover every possible contingency you can think of, right through to caesarean birth to caring for the baby after the birth. There is no right or wrong way to write a birth plan. You can gather ideas for writing your Birth Plan from friends, books, childbirth educators, midwives, doctors, hospitals or the Internet (see the reference list for some online help).

I am thinking of writing a birth plan. What sorts of issues should I include on my birth plan?

This is a really difficult question. Every birth plan is very different and the sorts of issues that are important vary from woman to woman. A good way to start working on your birth plan is by undertaking the following five-step process:

  • Explore your options
  • Examine your feelings
  • Evaluate your priorities
  • Examine your person situation
  • Discuss issues with your midwife or doctor
  • This will give you a good basis on which to start formulating your birth plan.

The following is a large list of issues that you may or may not want to include on your birth plan:

1st Stage of Labour

  • Choice of birth place
  • Clothing during labour (own or hospital gown)
  • Monitoring of the baby
  • Activity during labour
  • Eating and drinking in labour
  • Students during labour
  • Vaginal exams
  • Pain medication
  • Positions during the first stage of labour
  • Use of water
  • Use of heat
  • Self help techniques
  • Caesarean birth options

2nd and 3rd Stage of labour

  • Positions during the second stage of labour
  • Pushing during the 2nd stage
  • People present during the birth
  • Natural or managed 3rd stage of labour
  • Episiotomy and tears
  • Immediate contact after birth
  • Cutting of the baby’s cord after birth
  • Baby’s first breastfeed

Postnatal Care

  • Vitamin K
  • Hepatitis B Immunisation
  • Rooming in with mother during the postnatal stay
  • Newborn Screening Test
  • Breastfeeding/bottlefeeding
  • Preferences if baby has complications

This list is by no means exhaustive. There are many other issues that can be considered. Use this list just as a guide.

Who should have copies of my birth plan?

When writing a birth plan it is ideal to make copies for each person who is going to be present during labour. This may include your partner, support people, midwife or doctor. A copy can also be made for your hospital records. Some women choose to have a meeting their support people and discuss the issues raised on the birth plan. You will also need to discuss the contents of your birth plan with your midwife or doctor. You may like to have your midwife or doctor sign your birth plan when it has been finalised – this can be helpful when presenting your birth plan to the hospital, particularly if some of your wishes are different to hospital policy.

I am currently working on my Birth Plan. How do I present my Birth Plan to my doctor, without offending her?

The ideal time to present your birth plan to your midwife or doctor is around 32-36 weeks of pregnancy. This way you have had time to research your options, but there is still time left discuss any issues with your midwife or doctor and make changes to your Birth Plan if necessary. One of the positive aspects of Birth Plans is that they help ensure that there are no surprises for you or your caregiver. Birth Plans are also a great tool for fully informing your midwife or doctor of your preferences, though you may need to negotiate on some points. Overall Birth Plans are generally well accepted. Though some health care practitioners do not like Birth Plans as they feel they are being told what to do. So when presenting your Birth Plan to your midwife or doctor, try being open and acknowledge their concerns, maintain eye contact and be assertive (but not aggressive).
Very occasionally a midwife or doctor may be unhappy with a woman’s choices for labour and birth. In an ideal world it would be great to be able to negotiate a mutually acceptable outcome. However this may not always be possible. A woman several options here:
Take a stand against the procedure or intervention – in some cases this may result in the woman needing to choose a different midwife or doctor for their care.

  • Negotiate a compromise
  • Accept the midwife or doctors preference
  • It is important to remember that every woman has the right to make informed decisions.

There are so many things that can happen in labour, how can I account for all of them on my birth plan?

Birth plans should be written in a way that is flexible. As you have already identified, labour and birth does not always follow a predictable path.  You will not be able to account for every possible variation of labour on your birth plan.
To help make your birth plan more flexible it is better to use words like ‘I would prefer’ or ‘if possible’.  This helps prevent the birth plan as been seen as a list of do’s and don’ts that must be followed. Birth Plans indicate the preferences of the woman in labour and provides an outline of how she would like the birth to be.
Some women do include contingency plans within their Birth Plan. For example some plans include preferences if a caesarean birth becomes necessary or preferences if the baby needs to be transferred to Intensive Care or Special Care Nursery.

Reference List

  • Interactive birth plan
  • Create your own birth plan
  • A birth plan
  • (website no longer available)
  • (website no longer available)
  • (website no longer available)
  • (website no longer available)

(26th April 2001)

Jane Palmer is a mother, birth activist and midwife in private practice located in Sydney, Australia. With additional qualifications as a childbirth educator and lactation consultant, Jane works to improve pregnancy, birth and parenting options for families.

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