Confession time: I didn’t even write a birth plan for my first birth. I know, shocking considering the fact that I’m extremely Type A and like to be in control of things. But I was skeptical that anyone would even read it. I was also acutely sensitive to being that mom who was dismissed & made fun of by the nurses for having too prescriptive a plan. I thought that maybe having it all written out would set us off on the wrong foot. And I naively thought I’d be able to remember and communicate my preferences at the time each step came up (I couldn’t. Labor requires focus).
But now, I’m not afraid of that anymore. I don’t care what the nurses think. Well, that’s a lie, I do. I want them to think – okay, I’m not going to mess with this momma, she has an opinion, and won’t be pushed around. I demand evidence-based decisions and informed consent, and I’m not going to apologize for that. And actually, the nurse on my hospital tour specifically mentioned that during admission, they’d review our birth plan with us. And then the nurses decide which cases they want to be on, they’re not just randomly assigned. So theoretically, going in with a well-laid plan means I’ll get a nurse who wants to be a part of that plan.
So, this time around, I wrote a birth plan that requires minimal reading. I also separated it into stages so that it’s more digestible.
I posted my plan in a local birth group that I’m in, and everyone immediately wanted a copy that they could use. So, to help other mommas out, I’m providing the plan here so you can edit it to fit your needs.
*I recommend printing and cutting out the postpartum newborn care plan and taping it to the inside of the bassinet, so that every nurse can see it. Note that the plan does not contain items that would be pediatrician-related. These things are more likely to be a direct conversation with your pediatrician the morning after your birth.
Everyone has different needs for their birth – so it won’t offend me in the least if you just use my format and completely change all of the content because your plan is the opposite of mine. It’s a good idea to run your plan by your provider and make sure that they support it, and that you haven’t put conflicting information on there. It’s also a good opportunity to find out if you’re going to butt heads with your hospital… and might make you re-think where you give birth.
In case you’re interested at all, and doing the research for your own birth plan, here are links to just a fraction of the evidence I’ve used along the way to make my decisions. Note that a lot of these links have more supporting evidence and links cited at the end of the articles; I’ve read many of them.
My particular plan includes things that are concerns for me based on my last birth. For example, most might not think it’s important to put reminders on there about emptying your bladder before pushing & slowing down when crowning, since these are technically things that you’re doing. But you might forget, and your delivery team might let you down.
Obviously, much of your birth plan will flow from how you plan to manage labor pain, and it’s obviously a decision each individual has to make based on weighing the effectiveness vs. safety of each option. My goal is to avoid anything that could result in a further cascade of intervention, like an epidural or artificial induction or acceleration of labor. This can be tricky, as I know that an epidural can sometimes prevent a c-section, or sometimes be the cause of it. For example, my own mother received an epidural after she had already been pushing for 2 hours with me, because I was stuck (apparently my family just grows big babies), and if she didn’t get help, she wasn’t going to have the energy to be able to push me out on her own (and they ended up needing to use forceps on me). In that case, it prevented a c-section. On the other hand, an epidural can cause a drop in blood pressure that puts stress on the baby, and can result in a totally unnecessary and avoidable c-section. It’s a slippery slope, and every woman has to make the choice that’s right for them in the moment – and if things don’t go according to your plan, you are not a failure. Don’t even think like that. Birth is unpredictable – it’s okay to have a plan, and even more okay to adjust that plan if you need to (but it’s NOT okay if you’re being coerced to change your plan without informed consent).
Ina May’s Guide to Childbirth: Seriously, this book is amazing. I’ve read it at least 6 times, and it taught me so much. Even if you’re not planning on having an un-medicated birth, I think it’s an important read to understand how birth works, and what types of things can interfere with the process. A little confidence can go a long way for everyone.
At my last hospital, they forced me to be in the bed while I was having back labor so that I could get my initial fetal monitoring strip – being in the bed on my back was painful. Most hospitals are going to require a strip upon admission. But I’ve cleared it with my new hospital that I’ll be able to do it on a ball, and not on the bed. After that, intermittent monitoring will be used every 4 hours. Thankfully, no continuous monitoring like my previous hospital required during the 2nd stage of labor.
During my last birth, a hep-lock was a compromise I had to make; it was just in case I needed it. My new midwife says there’s no reason for needing one, as I can receive intramuscular pitocin in the case of postpartum hemorrhage. This was not provided as an option to me previously, so I’m super excited about not needing a needle in my hand, and having another way to manage bleeding.
Since I declined IV fluids, I had to bring my own food & drink to the hospital for my last labor. I’m pumped that my new hospital actually provides food & drink to women during labor! Seriously, how are you supposed to keep your energy up without it?
I plan on at least laboring in water, as taking several showers while I labored at home last time helped immensely. It may or may not end in a waterbirth, depending on how I feel at the time, but I’m glad it’s an option for me.
Last time I waited until I was 10 cm before allowing my doctor to break my water – and unfortunately, I did discover a small scratch on my daughter’s head from the amnihook. This time, I’m just going to let it happen it when it happens, to avoid any of the risks.
The plan for placental delivery and postpartum hemorrhage is fairly fluid for me, given the fact that I had a major one during my last birth. The main reason cited for this was the fact that I had a large baby; this means it’s harder for the uterus to clamp down fast enough. I also think it wasn’t helped by the fact that my daughter wasn’t able to breastfeed right after birth – without enough oxytocin release, the placenta may not be delivered easily. I’ve learned that my full bladder was also probably a factor, which is why it’s explicitly on my birth plan (women with epidurals have catheters in, and I think my birth team just forgot that I didn’t have one). We’re prepared for what might happen again, but are not going to preemptively interrupt the natural process of the 3rd stage until and unless it becomes necessary – in which case, most things are fair game. At that point, my baby’s out, so I’m not concerned about the effects of pitocin on him.
Regarding newborn care, the World Health Organization has pretty clear guidelines (that many hospitals don’t follow). All of the measurements can wait until after the golden hour. We are going to give the Vitamin K Shot, but are declining eye ointment. We’ll give the Hep B vaccine, but are just delaying it to happen at the pediatrician’s office instead of at the hospital; all other vaccines we do on schedule. And I’m a huge believer in protecting a baby’s microbiome at birth, so we will be delaying baby’s first bath. If for some reason I had an emergency c-section, I’d totally be jumping on board to seed my baby’s microbiome in this new way.
My biggest surprise after doing all of my research was that very few maternity providers and hospitals practice evidence-based care. Just another example of how you have to be your own advocate. As long as you put more research into your birth than you do the fancy stroller you registered for, you’ll be on the right track. You’ve got this, momma.
“If you don’t know your options, you don’t have any.” -Diane Korte