Ahhhh birth plans. I feel like the pregnant population is somewhat divided on this topic. Some people would argue that the unpredictability of labour & birth renders a ‘plan’ useless. I wholeheartedly disagree and am here to share some of the reasons why I think writing a birth plan is a GREAT idea.
First off, what is a birth plan?
A birth plan is a written summary of preferences for labour & birth, the purpose of which is to communicate your goals and how you would like to be supported.
Writing one allows you to consider ahead of time how you might like to handle various situations and what your preferences would be during each phase of labour.
From this perspective, the magic of a birth plan is not looking back and saying “Yep! Every single thing went as expected”. It’s the process of learning about your options and really thinking, what is important to me? What are my non-negotiables? How do I want to be cared for and supported within this experience?
As a midwife who has supported many many Mums with birth plans, I think a great birth plan is two things:
There are many ‘birth plan’ templates available online, but to write an effective birth plan, you must first research your options. I urge you not to copy and paste a list of things from the internet that sound ‘nice’ without properly investigating them.
Who would I share my birth plan with?
I would encourage you to research and write your birth plan alongside your partner or support person. For a birth plan to be implemented, the people around you need to be aware of your preferences. Typically, your 36-week midwife or OB/GYN appointment is the best time to show your care provider. This is an opportunity for us to step through the plan with you, identify any obvious limitations ahead of time and get on the same page before the intensity of contractions make it all a little foggy.
Where do I begin?
If you’re reading thinking… What should I be putting on this birth plan? I don’t know what I don’t know?! Don’t stress! Consider this your comprehensive research guide. There are MANY topics listed here. If you begin feeling overwhelmed, take it slow. You might want to pick a couple of categories a week to read up on and just gradually make your way through.
Firstly, I would consider pain management strategies. Start by researching the benefits of non-pharmacological pain management strategies such as:
- Heat packs
- Hot shower/bath
- TENS machine
- Mindfulness and breathing techniques
- Movement and position changes
- Continuous support
- Sterile water injections
- Touch & massage
As well as the pro’s and con’s of pharmacological pain management, the common ones being:
- Morphine injection
- Nitrous oxide (gas & air)
- Epidural analgesia.
After considering these options, including the way each can impact your labour, write down what you would like to use and/or what you would like to avoid. If you are on the fence, for example, you think you want to avoid an epidural, but are not closed to the idea, you may like to say:
“Please do not offer the epidural unless I directly ask for it. I know it is an option but I would like to try TENS, hot shower…etc… prior to considering epidural”
This leaves the door open but lets your care provider know that you would prefer if it is not offered until you ask.
The labour & birth environment
Get familiar with the ways in which the physical environment influences your birth hormones. A basic understanding of oxytocin vs. adrenalin will likely shape how you feel about your birth space. In the context of a planned c-section, some of these things may also be accommodated and it is worth talking them through with your care provider:
- Who do you want there?
- Are you open to student midwives/doctors?
- Do you want music playing?
- Dim lighting?
- Minimal talking/distractions?
- Would you like photos?
Birthing your baby and your placenta
Topics worth exploring include:
- Physiological vs. directed pushing.
- Ways to reduce your risk of perineal tear such as: birth position & warm perineal compresses.
- Physiological vs. active management of the third stage (placenta).
- Skin to skin with your baby at birth.
- Would you like to breastfeed or formula feed? What are the pro’s/con’s of each?
- Have you brought expressed colostrum with you to hospital?
Particularly if you plan to birth in a hospital setting, it would be remiss to research birth options without addressing some of the most common interventions that are used in maternity care.
Hopefully, by first researching the above topics, you will have formed a base of knowledge that helps you to understand the benefits of avoiding unnecessary intervention. The keyword here is ‘unnecessary’, because while labouring and birthing as naturally as possible does yield benefit, intervention absolutely has its place and for some mums and babies, it can lead to a really positive outcome.
That said, acknowledging that one intervention often leads to another in a phenomenon known as the ‘cascade of intervention’ is important and crucially, parents must be given the opportunity to make informed decisions.
Some of the most common interventions include:
- Induction of labour
- Use of synthetic hormone commonly called ‘syntocinon’ in Australia/UK and ‘Pitocin’ in the US, which is given through an IV drip.
- Artificial rupture of membranes: Use of a hook-like instrument to break the sac of waters around baby.
- CTG monitoring.
- Episiotomy: A cut made to the perineum during birth to widen the vaginal opening.
- Instrumental birth: The use of forceps & vacuum.
- Caesarean section: This can be either scheduled ahead of time, or an emergency if problems are identified during labour.
I mentioned earlier that a willingness to be dynamic is so important. Sometimes, what is written in the birth plan may no longer be the best or safest approach. This is where the knowledge & skill of midwives & doctors needs to be heard with open ears. That is not to say you are expected to instantly consent to everything and anything. Rather, that there is value in being open to discussions and suggestions to help you make informed choices.
Sometimes we must be ready to say okay, this isn’t working…let’s work together, pivot and go in a more positive direction. We need to consider that a positive outcome is not necessarily an outcome that reflects what is written in the birth plan but one in which you feel supported, well cared for and that you and your baby are both well, physically and emotionally. Sometimes, birth takes random turns and no amount of planning can account for what happens on the day. This does not mean birth plans are useless, rather, they should be written with fluidity and flexibility in mind.
Where can I find all of this information?
Great question! Often your hospital/care provider will provide you with reading material or access to classes that cover these topics. Some reputable resources I would encourage you to engage with include:
https://midwifethinking.com/ by Dr. Rachel Reed.
https://www.thewomens.org.au/health-information/fact-sheets/ (Some resources available in multiple languages via this site)
@birthwithbeth_ On Instagram – Bite sized pieces of evidence-based birth information by yours truly.
@evidencebasedmidwife On Instagram – Another great midwife led page stepping you through various birth related topics.
Birth With Confidence – Rhea Dempsey
Why Induction Matters – Dr. Rachel Reed
Birth Without Fear – January Harshe
Spiritual Midwifery – Ina May Gaskin
Why Breastfeeding Matters – Charlotte Young
Juju Sundin’s Birth Skills with Sarah Murdoch.
The Australian Breastfeeding Podcast by Susie Prout
Australian Birth Stories with Sophie Walker
VBAC birth stories
The Midwives Cauldron with Katie James and Dr. Rachel Reed.
The Kick Pregnancy Pod with Dr Patrick Moloney & Bridget Moloney
Share this article with a soon to be mama preparing for birth.
Expert author: Beth Ryan
Beth Ryan is a registered midwife currently finishing a Masters degree in Public Health. You can find out more about her by following her on Instagram here.