Thoughts on Birth Plans

Have all of you guys been told to make a birth plan?

I see sample birth plans all of the time – on the internet, from childbirth classes and in books and I’ve decided that I’m not a huge fan of what is out there.  That is not to say that I think parents should show up to the hospital without something written down for the nurses and clinical staff letting them know what their priorities are for their birth, but the modern common birth plan is just not relevant, realistic or helpful in my honest opinion.

First of all, I hate the term “birth plan”.  You can’t plan for birth – there are unknowns in the process.  Instead, I recommend that my clients make a “birth preferences list” that outlines what their main priorities are for their birth experience.  Birth preferences gives the parents room to change their mind as the process unfolds and does not lend itself towards couples looking back on their “plan” and feeling upset that their birth did not happen exactly accordingly.

So what should be included in this birth preferences list?  I have seen so many birth plans over the years and too many of them come from pre-programmed layouts or classes listing out, in infinite detail, every single minute issue that might possibly come up on the day of baby’s birth.  Birth preferences lists should be simple, short and give the nurse that is assigned to work with you and any back up physicians, midwives, residents, or students that you don’t know an idea of what you are seeking from your experience.

My recommendation when creating a birth preferences list is to start with a discussion of your priorities with your partner.  These priorities will be different for each birthing couple.  Priorities might include things like being skin to skin with your baby after birth, freedom of movement during labor, avoiding unnecessary medical interventions, or wanting breastfeeding support while you are at the hospital.  Once you have your list of priorities, I recommend thinking about the things that might happen in a hospital environment that might get in the way of those priorities without medical need.  You can find out what those things are at your hospital or with your care provider by talking with your doula, childbirth educator, or friends who have recently delivered at that same location.  For your birth preferences, focus on those things you wish to avoid in order to obtain your most important priorities.  For example, if a big priority for you is to reduce your chances of tearing during birth, then you might want to include requests to be able to push spontaneously in the position of your choosing without time limits, deep perineal massage or episiotomy but with warm compresses and gentle perineal support.

A few more hints:

Focus on your most important priorities first.  We can all hope that every person that comes into contact with you will read through your whole list, but I imagine that the first few things get processed most by those reading over it.

Only include things that you would be discussing during labor and the immediate postpartum period.  This document is for your nurses and care providers at the hospital to look over.  Topics like induction or circumcision you will discuss with your care provider either before or after your baby’s birth, but not during the process, so they shouldn’t be included.  Some families make a separate postpartum preferences list for their postpartum nurses and pediatric care providers.

Make sure it is simple to read and legible.

Try to be positive.  For example: “I prefer to limit the number of people coming in and out of my room” instead of “Only one nurse, no residents or students”.

Make sure to thank the people who will be taking the time to read your preferences for their care and support.

And, most importantly, make sure it comes from the heart and really reflects what you are hoping to achieve during your birth experience.  Do not blindly copy a friend’s birth plan or one from a book or childbirth class.  Take the time to make your birth preferences list help your care providers understand what is special or unique about what you and your partner hope to experience during your baby’s birth.

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