Discuss episiotomies in advance so you know your physician's practices. "It would be unfortunate for a couple to feel strongly that they would like to avoid an episiotomy only to learn in month nine that their provider does them routinely," says Shelly Holbrook, former childbirth educator, labor and postpartum doula from Bellevue, Washington.
Remember, an episiotomy can become necessary if quick delivery is needed. "I had a really empowering birth that was exactly as I had envisioned it," says Sarah Rose Evans of Portland, Oregon. "The only thing that didn't go according to plan was that I had an episiotomy, but after 40 minutes of my baby being stuck in the same place, I told them, 'Just cut me already!' I was glad I'd made the decision, and that I wasn't pressured into anything."
This step involves delivery positioning and support. "The so-called 'normal' way to deliver—lying on your back—works against gravity, so many women prefer to deliver squatting, in the hands-and-knees position, or in a birthing pool," Hunt says. "Mom can also choose who she wants to help during delivery and what type of help she wants, for example, holding her legs, supporting her while squatting, sitting behind her while in the pool, etc."
Immediately After DeliveryWho cuts the umbilical cord and when is the first post-delivery choice. Then, where the baby will be placed comes next. "Some women prefer to have the baby handed directly to them while others like the baby to be placed on their belly," Hunt says. You can also have the baby cleaned prior to contact.
PostpartumDo you want to room in Baby (the baby stay in your room all the time) or use the nursery full or part-time? Hunt suggests moms remember they make the choices regarding their baby. "Sometimes the hospital personnel tend to make suggestions, which are misconstrued as orders," she says.
BreastfeedingIf you plan to breastfeed exclusively, make sure you're very specific about it in your birth plan. "If you would like to make sure that the nurses do not supplement the baby with anything other than your breast milk if you are unable to nurse right away, you should make sure that you include that on the plan," Holbrook says.
Circumcision PreferencesIf you're having a boy, discuss your circumcision options with your pediatrician prior to the baby's delivery. You may also want to confirm who will be doing the circumcision—the baby's pediatrician or your OB. Aside from the decision for or against circumcision, there is also the option to have it performed while in hospital (if available) or having it performed as an outpatient at a later date. Whether the baby receives a local anesthetic for the procedure may also be an option.
Photo/Video Preferences"Most hospitals will allow cameras and video cameras in the delivery room," Hunt says. "This is completely dependent on the comfort level of the mother."
Some physicians do have restrictions about filming/photographing delivery for liability reasons, so verify ahead of time.
Other Miscellaneous RequestsThis can include who you wish to be in the room with you during labor and after delivery (friends, family, other children, etc.) and anything else important to your plan.
Though her deliveries didn't all go exactly according to her birth plan, Nicole Bovey, a mom from Anaheim, California, feels the birth plans benefited her and her providers. "The doctor would review the plan before she would decide on the next plan of action," she says. "She consulted with me often and she would tell me, 'I know you wanted to do xyz, but right now I think we should do xyz.'"
Remember, birth plans should be thought of as a request list. "Chances are, there will be a few twists and turns in there that you don't expect," Holbrook says. "As long as you can keep an open mind with those expectations, you will have a more satisfying experience."