What to include in a birth plan

There's a lot to talk about as you prepare for your little one's arrival, and your birth plan is bound to come up. Just by the name, it's pretty clear what it is, but what should a birth plan include? Here's what I talk about with my patients and their families.

It's about having a conversation

The best thing you can do is have a conversation with your provider. It's talking through what type of pregnancy you're having, labor and delivery options, and different scenarios that may occur. This gives everyone an understanding of your preferences and expectations before the big day arrives. Capturing the details on paper may be helpful to you too, but it's not a must. When you check in to deliver, sharing the birth plan with your nurse by having a conversation is the most helpful; and be sure to provide any plan you've captured on paper. You can use our birth plan template to get started.

Before birth

• Delivery location: Make sure you know where your provider delivers babies so you can register at the Birth Center and plan for when the big day arrives.
• Special concerns: This goes without saying, but you should feel comfortable bringing these up at any time in your prenatal appointments. This could include: personal or cultural requests; childcare issues and transportation concerns.
• Delivery scenarios: Your labor and delivery may not go as expected. Sometimes this means having an unplanned Cesarean delivery (c-section), or other interventions you thought would not be needed. Discussing with your provider about the type of pregnancy you are having and potential scenarios that could happen is a must.

Labor and delivery

• Who do you want to be present? Do you prefer only your partner or support person there, or are you OK with having other people present? This often gets overlooked but making your preferences known in your birth plan will lessen confusion and increase your satisfaction. Your provider may have recommendations for how many people to have in the room. And please note that you may be limited to only one support person due to COVID-19.
• Pain management: Almost all women want to know how to control or manage pain. There are many options including different labor positions, birthing tools, laboring in a tub, nitrous oxide ("laughing gas"), integrative services such as aromatherapy, and medications like IV pain medication or an epidural. With so many options, talking through them is helpful.
• Atmosphere: Think about what brings you joy or helps you feel comfortable—from room lighting to music to noise levels.
• Cervical checks: During labor, your provider may check your cervix (vaginal exam) to feel for positioning of the baby and assess how dilated the cervix is. If you are concerned about the frequency of cervical checks, you can request to only have them when medically necessary.
• Episiotomy: Episiotomy (a surgical cut in the skin tissue and muscle between vagina and rectum) is a lot less common than it used to be, but it is still used in certain situations. If you have concerns about episiotomy you can discuss this with your provider.

After birth and newborn care

• Skin-to-skin contact. Sometimes called “kangaroo care,” this is when babies are placed skin to skin after birth on their mom’s bare chest. This simple technique has huge benefits including regulating the baby’s heart rate, reducing stress levels, easing digestion, and stimulating mom’s hormones to support breastfeeding.
• Delayed cord clamping. This means waiting one or a few minutes after birth before clamping and cutting the umbilical cord. It allows the baby to receive extra oxygen-rich blood from the placenta. There are potential risks to delayed cord clamping, including jaundice or polycythemia, which is a high red blood cell count, so you should discuss this with your doctor.
• Placenta. The placenta is usually discarded after birth, but you may choose to save for placenta encapsulation (where the placenta is dried, ground and used to make capsules for consumption) or donate it—the tissue can be used in reconstructive procedures, for example.
• Umbilical cord blood. Since cord blood is rich with stem cells that can be used to treat life-threatening diseases, many parents choose cord blood banking—but you need to prepare for this in advance. Drawing the blood is done when the cord is no longer attached, so it’s a painless procedure.
• Vaccinations and medications. A vitamin K injection and anti-bacterial eye drops are normally administered in the first couple hours after birth. Hepatitis B (HepB) vaccination usually happens within the first 12 hours. If you have vaccination preferences or special requests, it’s important to discuss them ahead of time.
• Screening, testing and results. Newborns receive multiple tests, usually at 24 hours of age, including blood oxygen measurement, congenital heart disease screening, hearing, and a newborn screening blood test that screens for over 50 hidden disorders. Plan ahead so you’re aware of which tests are performed at your birth center and how you can access the results.
• Breast feeding preferences. Make your preferences known when it comes to lactation consultant support, whether to use bottles, pacifiers, formula, and more.
• Receiving visitors. Think about your instructions for visitors such as hand washing or avoiding scents such as perfume. This is also the time to decide who’s allowed to visit. Note that visitors may be limited by COVID-19 policies.
• Choose your baby doctor. Think about setting a designated time to meet with your baby’s doctor and ask questions about procedures, feeding, health and more.
• Bathing the baby. Most babies get a bath during the first few hours of life to remove the vernix, the white substance that coats their skin after birth. Discuss with your provider if you have any special requests about this.
• Circumcision. Yes or no? While there are potential benefits of a circumcision, there are also potential risks. The decision whether to circumcise is a personal decision affected by your values and beliefs and should be made after a discussion of the benefits and risks.
• Rooming with your baby. Rooming in with your baby promotes attachment and early and sustained breastfeeding. Discuss where you want baby to sleep and the schedule you prefer.

Tips and advice for creating a birth plan

• Third trimester: A good time to start talking about the birth plan is in the third trimester if you haven't already.
• Questions welcomed:Bring up any questions or concerns—this is your birth plan!
• Shorter is better:Try to keep a written plan relatively short and to the point, otherwise the most important aspects may get lost in the details.
• It's a goal, meant to be flexible: The birth plan is really a birth goal or guideline for what we hope to happen. I think it's important everyone has a realistic understanding of what may or may not happen while being open to changes if needed. It can help alleviate stress when unexpected delivery scenarios have already been discussed, causing less disruption.
• Change is OK: It's OK to change your mind on something, like pain management options. We never know how long labor and delivery will take and the goal of this journey is to have a healthy mom and baby.
• Self-care for the support person: Eat and stay hydrated if you are supporting mom through labor and delivery. Life will be wonderfully different after baby has come, so make sure you are taking care of yourself leading up to the little one's arrival.