Birth Plans: Creating

Creating a Birth Plan

So how do you create a birth preferences list? First of all, avoid calling it a plan. Because birth is unpredictable, you cannot control how it unfolds (so you can’t really “plan” the important parts).¬† Many moms and couples start with a brief, positive statement of their overall goals for the birth and a request for help in achieving them.

Next, list your preferences briefly and in chronological order (early labor, active labor, pushing, immediate postpartum period, the rest of your stay). You can include variations and complications in the chronology or add them afterwards (for example, your preferences about induction).

Stating your wishes positively comes across better than stating them negatively: “I will not let you put in a routine IV” sounds very argumentative and will put readers on their guard against the dreaded “non-compliant patient.” Something like this is more likely to get you the consideration and help you need: “I want to avoid an IV unless medically necessary for dehydration. I will be sure to drink frequently during my labor so as not to get dehydrated.”

Sometimes, as above, it helps to explain what you will do or have been doing to make your preference a reality, as well as asking your provider(s)/nursing staff for help:”Please do not do an episiotomy unless there is a danger to my baby and you have my explicit permission. I would rather risk a tear than have a routine episiotomy. Please cue me to push gently when the baby is crowning so that I will stretch.”

Try not to list things that you already know are common and accepted at your chosen birth place (for example, keeping the lights dim in the room during labor, playing music, having your partner with you). Make sure you do list anything that you know is an exception to the usual routine. If your care provider has agreed that he/she/the birth place can make an exception for you, note that agreement in your preferences list.

Avoid the pitfall of sounding too inflexible. “I will not have a cesarean under any circumstances” sounds awfully rigid and unrealistic to providers who have occasionally had to save a life this way. Since you can’t prefer any complications away, use your birth preferences list to request what would make handling those complications easier for you — for example, clear explanations from your providers, time to talk in private if possible, and the chance to ask questions before procedures are begun. (These are features of “informed consent,” which is actually required of care providers before doing any procedures at all.)

Try to keep it short. Most birth preferences lists end up, after discussion with providers, about a page or a page and a half long. Remember–your readers will not have much time to read your list, so make the most of it. A long, long list of detailed preferences may signal that you are too focused on controlling the birth — an approach that actually gets in the way of the awesome journey that is labor.

My list is done. Now what do I do with it?

Discuss the points in your list with your provider(s) at prenatal visits; if you see more than one provider, discuss the most important points on your list with each one. Simplify, add to, or change your preferences based on these conversations and the information you gain from them.

Once your list is complete, make copies and:

  • Give your provider a copy for your chart (typed, not handwritten) and have it signed if necessary.
  • Give a copy to your doula and talk with her about it, if you haven’t had her help in refining it already.
  • Put an extra copy in your birth bag, to take along with you to the birth place. Your list might not have made it into your chart, so ask any nurse assigned to you whether she has read your preferences. If not, you can provide your copy on the spot. In addition, having a concise list at hand may be helpful to you, your partner, or your doula in negotiating for the surroundings and the care you want during your labor and birth.

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About Birth Plans