there are occasions when i popped random questions at my gynae when they come to my mind, such as "can episiotomy be performed if i opt for natural delivery without epidural?", but never gotten down to write my birth plan till now at 36 weeks. will discuss with her during my next visit at 37 weeks to ensure that we are on the same page and make necessary changes if needed.
What Is A Birth Plan?
A birth plan is a sheet communicating your concerns and wishes for the nurses, midwives and doctors caring for you in labour and birth. It describes how you would like labour and birth to be managed, the kind of support you would like, such as a doula, and your preferences for comfort measures and interventions. It also includes your wishes if things do not go as expected, and for breastfeeding and postpartum care.
Why Write A Birth Plan?
You may feel that you do not really know what to expect in labour. Even so, there is value in creating your birth preference sheet.
- When crafting your birth plan in pregnancy, you find out about options for labour and birth. This reflection and information gathering prepares you to make considered decisions in labour and birth. You also feel more confident as birth approaches!
- A birth plan is more than a checklist; it is a vehicle of discussion with your doctor. As you and your doctor go over the draft, you are able to discuss specific wishes; your doctor gains insight into your concerns and gives feedback.
- Your birth plan allows you to communicate with the labour ward staff, enabling them to support you in the way you want.
- In labour, you would not want to be answering questions. Having a birth plan ensures that those around you know your preferences.
- This is especially true if you have less common wishes for your birth such as allowing your baby to descend gently without prolonged periods of pushing or ‘cheerleader-style’ coaching from those caring for you in the crowning stage. Other requests may include your desire to give birth in an upright position or skin-to-skin contact with your baby immediately after a C-section.
How Do You Create A Birth Plan?
① Research & Reflect - Become informed about all available forms of comfort measures and pain relief. Find out about the benefits and drawbacks of each alternative. Read about routine procedures and when these are medically necessary. Take independent childbirth classes, learn new skills. Use your new found knowledge to work out your philosophy towards your birth. All the requests in your birth plan need to be consistent with the kind of birth you want. For instance, if you would like minimal interventions, think about how this can be achieved and what you would need to do to reach this outcome.
② Draft - Write a draft.
③ Dialogue With Your Doctor - Discuss the draft with your doctor. During these discussions, you will learn how compatible your wishes are with your doctor’s and hospital’s practices. Stay flexible, but aware of your goals for your birth.
④ Your Final Birth Plan - Towards the end of your pregnancy, you will arrive at a final version, a product of your research, reflection, and dialogue with your doctor.
Consider these dos and don’ts
① Layout - Organise your plan as a chart or using bullet points. Use short paragraphs and clear sub-headings.
② Language & Choice of words - A long list of demands for your doctor and his staff may be frustrating for them. Opt for an easy-to-read style and use words that are neither passive (“if it is possible, could I have…”) nor aggressive (“do not perform unnecessary vaginal exams…”). Go for a friendly, respectful tone. Keep a copy in your patient file, pass one to labour staff, and keep a copy handy for yourself.
③ Sample Birth Plan - Point-Form Birth Plan
- Introduction about you and your partner, your feelings, your background – state strong feelings for example, about having an unmedicated birth.
- Your goals, wishes and other concerns – mention any fears or past experiences.
- Your preferences for managing labour pain – think of your preferences as being on a scale, with one end being ‘feeling no discomfort at all’ and the other end being ‘no medical pain relief, only comfort measures such as using a birth ball’.
- Interventions – when labour progresses normally, are interventions necessary for safety? What are your views on monitoring the baby/contractions, using drugs to speed up labour, intravenous fluids, having an episiotomy, vacuum or forceps birth or coached pushing as the baby emerges?
- Preferences for unexpected events – consider how you can still meet many of your goals for example, in a C-section or with kangaroo care.
- Postpartum care – mention rooming-in or dietary needs.
- Newborn care & breastfeeding – mention your wishes for skin-to-skin contact after birth, plans for newborn procedures and breastfeeding.
Show your birth plan to your gynae and ask her to go through it with you during one of your antenatal appointments, ideally before you are 36 weeks pregnant. Discussing your plan with your gynae will give you the chance to ask questions and find out more about what will happen when you go into labour. Also, by listening to your preferences, your gynae will get to know you better and understand what is important to you
Though a birth plan is helpful, labour and birth are
unpredictable. Your midwife may need to recommend a course of action at any
time which is not what you had originally hoped for. But this will always be in
the best interests of you and your baby.
You may choose not to write a birth plan or defer birth decisions to your doctor. Even so, you already have some beliefs and expectations regarding your birth and writing your birth plan on paper is merely a way of communicating those goals to your birth team. The information-gathering, self-awareness and reflection you go through in creating your birth plan are all as vital to having a fulfilling birth as the birth plan itself!