Your Birth Plan: Things To Consider

Reviewed by Dr. Elisa Ross in July 2010

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These days it's common to include a birth plan in your pre-baby preparations. A birth plan allows you to make choices about labor and delivery while you are still able to participate in the decision making—before the only thing on your mind is the next contraction.

"The birth plan is an ideal way to communicate her preferences, so the mother-to-be can fully focus on the amazing process of birthing a baby," says Dr. Coral Slavin, doula and owner/director of Well-Rounded Maternity Center in Menomonee Falls, Wisconsin.

But navigating a birth plan can be daunting. Here's an overview of each birth plan step.

Labor Preferences

This step includes choosing where to give birth, hospital, birthing center, or home, and who delivers the baby, an OB-GYN, family practitioner, or midwife.

Labor options, according to Dr. Slavin, also include educated preferences about the following:

• Being able to move around, use the rocking chair, birthing ball, or shower , and walk during labor, and whether that will impact fetal monitoring preferences.
• Setting the environment with low lights, music, aromatherapy, wearing your own clothing, and glasses/contacts, etc. Also preferences for no TV watching, doors to hallways closed or not, etc.
• Options such as frequency of vaginal exams, capped or running IVs, or attendance by nursing or medical students.
• Being able to eat and drink, and whether food from home is allowed.
• Having the partner, doula, family, etc., present for support, or limiting the number of people in the room.

Monitoring Preferences

Internal or external monitoring, continuous or intermittent, affects the way a woman labors. "Some women worry about their baby's heart rate, especially through contractions, and would prefer to have continual monitoring despite the fact that they are bedridden," says Jennifer Hunt, a labor and postpartum doula from Colorado Springs, Colorado. "Others prefer to have their freedom to move around."

Labor Augmentation/Induction

Induction/augmentation choices include stripping membranes; artificially rupturing membranes; medications including Pitocin, prostaglandin gel, or Cytotec; and natural methods, such as walking, nipple stimulation, castor oil, intercourse, herbs, etc.

"There may be restrictions to your requests, such as no food or drink, continuous monitoring, or confinement to bed, once you have pain medication or labor augmentation," says Dr. Slavin, who advises women to consider delaying these choices as long as possible.

Anesthesia/Pain Medication

"There are three main choices in pain management during labor—natural pain management, narcotics, and epidurals," Hunt says. "Most women will go into labor with a strong sense of what kind of pain management they plan to use."

Narcotics lessen pain but may have side effects. Epidurals eliminate pain but confine Mom to bed. Consider this when making your choices. Remember, you don't have to choose now. Mention on your birth plan that you'll ask for pain relief when/if you desire some.

Cesarean Preferences

"With one in three women currently giving birth by Cesarean section, it is important for parents to consider what would make their birth experience more meaningful if they should have a C-section," Dr. Slavin says. According to Dr. Slavin, choices include the following:

• Being awake for surgery by having a spinal or epidural anesthesia.
• Having a mirror available to see the delivery.
• Setting the environment with music and asking the surgical staff to refrain from idle talk.
• Having more than one support person in the OR (e.g. father and doula) so one person can remain with the mother if and when her partner goes with the baby to the NICU.
• Having the baby placed on or near Mom's chest after delivery (if Baby's APGAR scores are good), or having Baby placed skin to skin with father.