When considering having a baby, most women think of how they would like the events to unfold. For some, this picture involves a birth as naturally as possible, with little to no intervention. For others, it’s a scheduled cesarean where everything is planned prior, and nothing is left to chance. Often, the reality is somewhere in between.

Guiding how your labor and delivery would go

While I didn’t write a formal birth plan for my first pregnancy, I had imagined a vaginal birth with epidural anesthesia and made all my plans accordingly. However, my body had other plans, and I had to quickly shift my expectations of what a good birth looked like as my daughter was born through an emergency cesarean section.

During my second pregnancy with my son, my imagination was less rigid. Although I had a written birth plan for a vaginal birth after my cesarean (VBAC), I found it much easier to accept the need for medical intervention and for a second cesarean after what had been a rather complicated pregnancy.

Whatever your idea of an “ideal” birth is, it’s useful to have a written guideline that notifies your healthcare professional, midwife, or doula what your wishes are. It’s also advisable to research the different birth types and prepare yourself regardless of how your baby’s birth unfolds.

What is a birth plan?

A birth plan is a written outline of your labor and delivery preferences. It includes details of;

• who you’d like to be present with you
• what pain relief you’d prefer (if you require it)
• what your desired birthing position is
• whether any special birthing equipment is needed (such as a birthing pool)
• if you have any special needs (for example, an interpreter)

If your plan is for a natural birth, you should also outline your wishes should additional intervention such as an assisted delivery or emergency cesarean be necessary.

Your birth plan doesn’t end at delivery. It should include how you’d like to feed your baby or whether you have any traditional customs you’d like to honor.

Why is it important to have a birth plan?

• It communicates your wishes to your care providers during labor and after birth.
• You become empowered in the birthing process and informed about all the options available to you.
• A birth plan is a conversation starter with your care providers and serves as a communication tool between yourself and your birth partner.
• Expressing your wishes and emotions for the birthing process will help you feel heard, supported, and empowered.

How to create a birth plan

Writing a birth plan doesn’t need to be a long or complicated process. In fact, the shorter and more concise the plan, the better. Nursing and other care staff often don’t have the time to read long and complex documents.

Try to avoid being too prescriptive, as birth isn’t always a simple process, and hoping to have complete control over the process can lead to frustration and additional anxiety.

Ensure that your birth partner is aware of your birth plan and your wishes to avoid any confusion as your labor progresses. While putting your wishes in writing, it’s a great idea to sit with your birth partner and talk about your hopes and expectations and hear what they have to say–they might have some insights or suggestions you haven’t considered.

Your childbirth educator, midwife, or doula has guided many expectant mothers through this process and may also offer a wealth of information. They usually know about processes and practices at your local hospital and labor ward, so talk to them.

Birth plan checklist: What should be in your birth plan?

If possible, create a basic birth plan checklist or a visual birth plan containing icons rather than a long wordy document. A bullet point checklist is easy to read and reference and can help avoid misunderstandings.

A visual birth plan uses icons in place of words to reflect your preferences. You can download these types of plans from various pregnancy websites. Browse and find one that suits your needs. You can also create your own visual birth plan, using images and colors to highlight the most important things.

There are several occasions during the process of labor and birth where decisions have to be made. A birth plan should communicate your preferences in these decision-making times. These can be as simple as whether to wear a hospital gown or your clothes or as huge as whether you’re willing to have your labor augmented if it’s not progressing well.

It would be best to consider what your wishes will be should your labor and delivery not go as expected.

Different types of birth plans

There are different types of childbirth and delivery methods, and each one has different aspects to keep in mind.

• Natural birth: Usually, vaginal delivery with no medicated pain relief or other medical intervention.
• Vaginal birth: A vaginal birth, while still often referred to as “natural,” may include pain relief or other medical intervention during the birthing process.
• Scheduled cesarean: A date for the cesarean is usually decided during the pregnancy. It’s an elective procedure, although it also includes cesareans done due to known medical complications that might affect the birth outcome.
• Unplanned cesarean: Also known as an emergency cesarean, it occurs when a medical complication arises during late pregnancy or during labor where the mother, baby, or both are at risk.
• Vaginal Birth after C-Section (VBAC): Some hospitals and doctors will encourage a mother who has already had a cesarean to attempt a vaginal birth. These cases are usually more closely monitored to ensure the well-being of both mother and baby. Most doctors will intervene and perform a c-section should the labor not progress smoothly or take too long.
• Scheduled induction: An induction is usually done when a baby is overdue. In this instance, the mother is given medication to start the labor process.

Your childbirth educator, doula, midwife, or doctor should give you all the information you need about each procedure to help you make informed choices for the birth of your child.

Natural birth plan

The birth plan outline for a natural birth can include the following:

• An introduction: There is a good chance that the labor ward staff and doctor on call may not know you. A brief introduction is a good starting point. It should include any health conditions you have, including chronic diseases, gestational diabetes, or possible Rhesus incompatibility with your baby. Also, mention whether you have had any previous deliveries, especially if by cesarean.
• Birthing partner: Who is your birthing partner? Is it your spouse, partner, family member or friend, or doula, and what is their role in this process?
• Access: Who can be present in the room? Can various people come and go, or do you only want your birth partner present? Do you have a birth photographer, and if so, is there anything they should not have access to?
• Atmosphere: What do you imagine the room to be like? Would you like music? Soft lighting? Do you need access to a bath or shower? Do you prefer physical touch or are you more hands-off?
• Pain management: Do you plan to make use of pain medication during your labor? Do you want the freedom to move around? Have you practiced any other pain relief techniques, such as breathing or meditation? If you want an epidural, at what point?
• Labor augmentation (assistance in speeding up the labor process): Under which circumstances would you want the labor hurried up?
• If plans change: If you are having a VBAC, have you discussed with your doctor at what point they would step in and insist on a cesarean?
• Birthing positions: Do you have a preference concerning a birthing position? Would you prefer to squat rather than lie down? If an assisted delivery is required, how do you feel about forceps or a vacuum?
• Birth: Have you thought about an episiotomy if required? Who would you like to cut the cord? Do you want skin on skin contact directly after delivery?
• Newborn: Do you intend to breastfeed or bottle-feed? What are your requests regarding any interventions such as Vitamin K shots, PKU, and other post-natal infant screenings? Does your baby boy need to be circumcised? Is your baby going to be rooming with you or in the nursery? Can your partner room with you?
• In the event of emergencies: Remember to include your wishes in the event of an emergency cesarean section or if your baby needs to go to the newborn intensive care unit (NICU). It is better to have both a surgical and natural plan rather than need one and not have it.

Even if you plan to have a home birth, a birth plan is a good idea to provide a sense of control and outline what you have agreed with your birth partners should happen if an emergency arises.

Cesarean birth plan

Although you may feel as if a cesarean is a procedure beyond your control, there are still many aspects where you can have a say in ensuring that the experience is a positive one.

• Pre-surgery: When you arrive at the labor ward or enter the operating room, a brief introduction is essential. Although it should appear on your medical file, you can mention any health conditions you have.
• The surgery: Would you like preoperative medication? Do you want your birth partner present during the administering of the spinal anesthesia? Should your birth partner be there at all times? Are videos and pictures allowed–is anything “off-limits”? Is a “gentle cesarean” where the atmosphere more closely mimics that of natural birth allowed? Would you like a mirror to view the delivery? Who will cut the cord? Can your baby have skin to skin time in the operating room? Would you like to breastfeed immediately in the recovery room? Who will go with your baby if they need special care immediately after?
• Post-surgery: What pain relief would you like? What are your feeding wishes? Can your baby have a pacifier or glucose water? Can your baby get Vitamin K shots and post-natal screenings as required? Do you want to be present for all pediatric exams? Who will give your baby their first bath? Which visitors are allowed immediately following the birth? Can your partner room with you?
• In the event of emergency care: Must your baby’s father accompany them to the NICU? Do you want to express milk in this case? How often do you want to be able to see your baby (circumstances permitting)?

Once you have written your birth plan, have your childbirth educator or doula look it over to make sure you’ve remembered everything. Give a copy to your doctor, birth partner, and the hospital, and keep an extra copy or two in your hospital bag.

When plan A becomes plan B (or even C)

A birth plan usually communicates our wishes around labor, delivery, and after birth. Sometimes, however, even the best plans can go awry, and as vital as it is to have a birth plan, it’s equally important to understand that there may be times when your wishes can’t be honored.

Perhaps your medical facility has certain restrictions, or the doctor believes that it’s necessary to make a decision or choice that goes against what you have stipulated in your birth plan. Maybe your health or the well-being of your baby is at risk. It is wise to remember that a birth plan is a guideline, not an inflexible document in these instances.

Be willing to listen to the experts’ advice–after all, they have attended many, many births. Still, don’t be afraid to ask questions, discuss your options with your birth partner, or even ask for a second expert opinion. The ideal outcome is a healthy baby and a healthy mommy, and sometimes a degree of compromise is necessary to ensure that. Good luck, mama!