A guide to helping you create a birth plan that will set you up for success.

A birth plan is a framework for your labor and the birth of your child. The idea behind birth plans is that they help you to make choices in a calm environment, ahead of time, so you can state exactly what you want and need.  A birth plan can also help you to better understand what questions you should be asking your provider at your prenatal appointments, in order to better understand what some of your options might be at the place you are delivering.  Most importantly, a birth plan allows you to have open dialogue with your provider, as well as the confidence and ability to ask and understand what your options are during labor.

There are a lot of good templates out there for creating your plan. What to Expect has one, as does The Bump. A good birth plan should be fluid and flexible, allowing room for what your options are when in labor. When you google or research birth plans, you’ll often find the topic primary subjects to be: delivery type (vaginal, c-section), pain management, things you want / don’t want during labor (i.e. people in the room, music, lighting), and things you want / don’t want to happen after the baby is born.  At NAPS, we like to dive deeper into this and include more on who your supports are, what your options are in your hospital for labor support, moving around, birthing balls and equipment that you have access to.  We also like to include postpartum recovery and your preferences for skin to skin, how you plan to feed your baby (breast or bottle, or both), as well as questions to ask when labor isn’t going according to your plan.

Birth plans are a great idea in theory; in reality, they can be a tricky business. Some people may find birth plans very comforting because they offer you a chance to make choices about what feels right for you. However, birth plans can also create trauma, because your plan doesn’t always turn out as you might expect. It can be hard to re-calibrate your thinking when things change. 

Still, knowing what you want ahead of time is a good idea. We recommend using a birth plan in two ways: one, a wish list of how you would like things to go; and two, a list of things that you are not ok with no matter what.  Regardless of what goes on there, you want to make it during your pregnancy and review it earlier on in pregnancy with your provider, to ensure what you're requesting is not only something that can be accommodated, but it really serves as a great tool for dialogue during your visits.

Here are some questions that can help you build a plan.

1. What kind of pain management is NOT comfortable for you? There should be a spot on your birth plan for you to note what you want. But you should also be able to make a list of pain options you do not want to use no matter what. For instance, if you have had poor reactions to certain narcotics in the past, you may not want those used. Remember that you may change your mind if you have never been through labor before, and that is ok! A birth plan is not set in stone; you are always allowed to change your mind.  Your pain management can also include methods that are not medical - such as acupressure or massage. 

2. Who do you want around you? This brings us to our title question. Your birth plan should include a list of friendly faces who are allowed to be around you while you labor. It should NOT read like a list of people who helped plan the baby shower. For some people, having loved ones in the room brings comfort. If that’s the case, and you are all right being vulnerable (read: pooping) around those people, then your birth plan should reflect it. But remember, you’re the one going through this; no one else. So if you don’t want your mother-in-law in the room, that’s your call.  We always tell our patients, labor and delivery is a place for “support people”, not visitors.  

3. How do you react to hospitals? Movies do a poor job talking about the process of actually going through labor. Usually someone’s water breaks, and the baby’s head is crowning before they’re out of the cab. It’s understandable, really, because labor can be a long and boring slog that wouldn’t be very entertaining to watch, but your labor might take some time. So ask yourself: how do you do with being in a hospital bed? If it’s hard for you to be hooked up to devices, you might want to consider adding something to your plan about walking around, or not being on an IV unless medically necessary. Fetal monitoring can be continuous or intermittent, so you can get up and move around. Some hospitals (and birth centers) are more amenable to pregnant people walking the halls than others, so it’s worth considering these things ahead of time.  Also, many hospitals or birthing centers have what you need when it comes to balls, showers, tubs or equipment. Find out ahead of time what is available to you, and what you might need to bring.

4. What matters to you most? As we said earlier, birth plans are tricky. You can say you don’t want a c-section, but it might be necessary. You can say you want to have a water birth, but it might not work out that way. So what matters to you more than anything else? What is it that you can’t do without? Keep this list short, but keep it close. Flexibility is critical for labor and delivery, but your thoughts and feelings matter, too.