The days of “knock ‘em out and drag ‘em out” childbirth is long past, and mothers are now exploring childbirth options with their care providers before the big day. Many mothers are choosing to write a birth plan in order to open up a discussion about preferences for labor, delivery and baby.

But, what to include? Here are some things to consider when discussing your birth preferences with your obstetrician or midwife.

Labor support

Decide beforehand who will be in the room during labor and birth. Indicate in your birth plan who is authorized to be in the room during labor, during pushing, and during any related exams throughout.

While birth is a family event, remember to be selective. First, hospital policy may restrict the number of visitors during labor and pushing. Second, conflicting personalities can add unnecessary stress to the situation. There will be plenty of time for visitation once the baby arrives and everyone settles.

Mobility

Certain interventions such as I.V. fluids and fetal monitoring keep the mother close to the bed with lines and cords. Talk to your obstetrician or midwife about any preferences you have about movement during labor, things that might restrict movement and what options the hospital offers.

Pain management

Indicate in the birth plan which, if any, pain relief options are agreeable to you, and at what point you would want to implement them. For example, you may choose to avoid pain medications, or just delay them until you have made substantial progress. You may prefer medications that allow the you to remain awake and aware, such as an epidural, or you may wish to avoid spinal medications and opt for narcotics.

It is best to have an idea of what your preferences are regarding pain relief before you are faced with making these decisions in between powerful contractions. Informed choices about pain relief preferences come much easier with a clear mind.

Welcoming baby

Once the baby arrives, the staff will perform newborn procedures such as weighing, assessing breathing, administering a vitamin K injection, Apgar testing, and dressing the baby. Some mothers want to take care of the medical aspect of the baby’s arrival as soon as possible to get it all out of the way. Other mothers have preferences about first moments, such as skin-to-skin care, when the cord is clamped and cut, and when the infant will initiate breastfeeding.

Postpartum stay

The birth plan covers the postpartum stay as well. Any preferences about visitation, exams and procedures, rooming in with the baby, how the baby will be fed, requests for breastfeeding support, and anything else involving the treatment of mother and baby in the days following birth should be indicated here.

Helpful hints

• Take a childbirth class before drafting a birth plan. That way, you have an idea what to expect, and you can have an informed discussion with your care provider about questions that arise.
• Discuss your birth plan with your doctor or midwife during a third-trimester prenatal appointment. That way, you can make sure your plans are compatible with hospital policy, and make adjustments as necessary.
• Keep your birth plan short and simple. For example, if you want dimmed lights, simply dim them on arrival. If you want to labor in your own nightgown instead of a hospital gown, just put it on. There is no need for line-items in the birth plan for things you can do in the moment. The staff are more likely to remember your wishes if kept to one page.
• Be flexible. Sometimes birth takes unexpected turns, and some requests cannot be honored because new risks arise. A plan is a plan, and plans must sometimes change. Your care providers are trained to assess the situation and steer the birth toward the best possible outcome. A healthy family takes priority.