Writing a birth plan: 10 essential tips from a pediatrician and mom of 5

011110ATWhen a laboring mom arrives at the hospital with a birth plan, nurses often roll their eyes and smirk, especially if it is a check-off-the-boxes and fill-in-the-blanks birth plan off a web site.  Why?  Because 80-90% of moms on the unit where I work arrive with a plan for natural delivery, yet more than 90% end up with an epidural and toss aside the requests on their birth plans.  I’ve attended deliveries for more than a decade at five different hospitals, and I’m about to deliver my own 5th child.  Yes, I have a birth plan.  You should too.

Here are ten tips for writing an effective birth plan, plus an example birth plan based on my own.

1.       Write your own birth plan, don’t use a pre-printed form.

Pre-written check-off-the-boxes birth plans that are available on many web sites are good to use as worksheets while you are thinking about your birth plan.  But a personally written birth plan shows your health care providers that you are educated and serious about your wishes.  They are also far easier for your health care providers to use.  Your birth plan should be short and readable, preferably 1-2 pages.  I prefer bullet point format.  Be personal and polite in your writing, using “I” statements and the word “please.”  Tell short personal stories that explain your choices.  I’ve included an example birth plan below.

2.       Be very educated about your choices, especially regarding pain management and c-sections.

Be sure to complete a child-birth preparation program before attempting to write your birth plan.  If you are running out of time before delivery, consider reading a book on child birth preparation or watching a video course.  Take a tour of your birthing facility before you deliver and learn about options they offer for pain control, birthing positions and newborn care.

3.       Begin your birth plan with the names and phone numbers for all the key people involved in your delivery. 

Include your name, your baby’s name (if you know it!), your obstetrician or midwife, your pediatrician/baby’s doctor, the names of all those expected to be present at your delivery, and the names of anyone you don’t want at your delivery.

4.       Continue with a section about your own medical and obstetric history.

In this section, include your home medications, allergies, chronic medical conditions, and information about each of your prior pregnancies and deliveries.  Please see example below.  State whether you are positive or negative for Group B Strep and gestational diabetes.  If you have ever had herpes, HIV, hepatitis, or other sexually transmitted diseases, it is essential to include this.

5.       Discuss your wishes for labor, especially regarding pain control and labor augmentation.

If you are planning natural labor without epidural, explain how you have prepared for this and what your pain-management plan will be.  If your labor is augmented (sped-up) with Pitocin you will likely require an epidural for pain control.  If you have had past poor experiences with pain control during delivery, discuss what happened and how you would like to avoid these complications.

If you would like to use specific birthing positions or props, such as a birthing stool or bar, be clear about these choices in your birth plan and also tell your health care providers as soon as you arrive.  Be sure you are educated about how to use these positions/props and that your facility will support these options.  Most women who have epidural anesthesia don’t have the leg control or strength to use a sitting or squatting position, so be sure to include a contingency plan for your birthing position if you choose to have an epidural.

6.       Express your wishes for delivery, and include contingency planning in case you need a c-section.

Very few women want a C-section, but you need to be prepared for one anyway.  Every birth plan should include your wishes for c-section, such as choosing not to have your hands tied down, and avoiding medications that alter your level of consciousness.

No one wants an episiotomy, but sometimes they are better than a severe tear.  If you are declining episiotomy, discuss with your health care provider beforehand how you plan to avoid a severe tear and include this in your birth plan.

Delayed cord clamping is now recommended by most pediatricians, but you may have to request this procedure.  Delayed cord clamping may not be an option if your baby is not breathing or ill.

Include your choices for cord blood donation or private cord banking.

7.       Include a section with your choices about newborn care. 

Do you want to hold your baby skin-to-skin right after delivery, even if you have a c-section?  You need to be clear about this.  Also specify your plans regarding breastfeeding, antibiotic eye ointment, vitamin K, baby’s first bath, and the hepatitis vaccine.

8.       End with a section about your own post-partum care

What pain medications work or don’t work for you?  What laxatives/stool softeners do you prefer?  Do narcotics make you nauseated?  Tell your health care providers about it.

9.       Discuss your birth plan with your obstetrician or midwife during a routine appointment. 

A birth plan is useless if your health care provider doesn’t support your choices.  Discuss your choices before you go into labor.

10.   Know that no birth goes exactly as planned. 

Remember your ultimate goal—a healthy mom and baby.  Be flexible.  Every labor is different and no one can predict how it will go.

Here’s my birth plan for my 5th child:

Birth plan for: Kathleen Berchelmann

Husband: [name and phone]

Baby:  [name and gender, if known]

Obstetrician: [name and phone]

Pediatrician: [name and phone]

Patient History:

  • Prenatal labs may be obtained from [Obstetrician’s name and phone] .  I am a X year-old mother who has been pregnant 5 times and delivered 4 prior children.  I am otherwise healthy and have no history of STDs or blood born diseases.
  • My four other children are living and healthy:
    • Baby #1: Normal spontaneous vaginal delivery of [insert weight] healthy male.
    • Baby #2: C-section for breech at 38 weeks and 1 day.  We had attempted version and induced labor, but after 12 hours of augmented labor baby flipped over to breech again.  [insert weight] healthy female.
    • Baby #3: VBAC delivery with minor shoulder dystocia at 39 weeks 6 days, [insert weight] healthy male.
    • Baby #4: C-section at 39 weeks 4 days for unstable lie.  [insert weight] healthy female.
    • I have had a healthy 5th pregnancy without gestational diabetes, hypertension or other complications.  Prenatal testing was all normal.
    • Medications: [insert list]
    • Allergies: none

Requests for this labor and delivery:

  • I am planning a VBAC delivery.  I will transition to c-section as necessary. 
  • My husband, Greg, will be present during delivery.  I have no restrictions on visitors.
  • Please use IV fluids only if medically necessary.  I am fine with a saline-locked IV.
  • Please do not augment labor with Pitocin.  I have had two prior c-sections and Pitocin increases risk for uterine rupture during VBAC. 
  • Please do not strip or artificially rupture membranes. 
  • For pain I would like a walking epidural (ie: a true epidural and not a spinal) after labor pain becomes too intense.  Lidocaine or local anesthetic for episiotomy if needed.  Prior to epidural I like to walk, use an exercise/birthing ball, and hold onto the handrail on the wall.  I presented in precipitous delivery with my 3rd child and I almost delivered him while hanging on the handrail in the triage bathroom.  A better plan would be to use a birthing bar with the head of the bed up and the foot of the bed down.  
  • I am requesting delayed cord clamping for about 2 minutes after delivery or until cord has stopped pulsating.
  • We are planning private cord blood and cord tissue banking.  Please see the kit that I will provide.
  • Please no methergine without my consent.  I had breast feeding failure with my 3rd child after 2 doses of IM methergine. 

If I have a C-section:

  • Please don’t forget to invite my husband into the OR.  This happened with our second child.
  • Please don’t tie down my hands. 
  • For the anesthesiologist:
  • Please do not give me any medications without my consent.  Please no drugs that alter my level of consciousness unless I need general anesthesia for a medical emergency. 
  • I am requesting delayed cord clamping for about 2 minutes after delivery or until cord has stopped pulsating, even if C-section, as long as I am not hemorrhaging.
  • We are planning private cord blood and cord tissue banking.  Please see the kit that I will provide.
  • I’d like to do skin-to-skin with my newborn in the OR immediately after delivery and any necessary resuscitation.  Please see “Requests for after baby is born” below. 

Requests for newborn care:

  • After any necessary resuscitation, please delay routine care (including antibiotic eye ointment, vitamin K, weight, measurements, footprints, bath and full assessment) until after infant is breastfed, my husband has held the baby, and I am ready to rest.  
  • Please do a pulse-ox congenital heart disease screen.
  • Our baby will stay in our room with us at night.  Please do her nursing assessment in our room. 
  • Pacifiers are fine unless baby is having trouble with latch, in which case I will request no pacifier. 
  • Please give me a copy of results of baby’s hearing screen, blood work, and any other tests/studies. 

Requests for my postpartum care:

  • For a stool softener, I like…
  • If vaginal delivery, I would like ibuprofen scheduled every 4 hours for pain/cramping.
Kathleen Berchelmann, M.D. About Kathleen Berchelmann, M.D.

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children's Hospital and Washington University School of Medicine, director of the St. Louis Children's Hospital Social Media Team, and co-founder of the ChildrensMD hospital physician blog. Her work has been featured in print and online publications including the St. Louis Post-Dispatch, the Chicago Tribune, and TIME magazine. She is a frequent contributor to Fox2 News STL Moms. Kathleen and her husband are raising five children.

Follow Dr. Kathleen Berchelmann on Facebook: ChildrensMomDocs Twitter: @MomDocKathleen and connect with her on .

Comments

  1. I am curious what hospital you will be delivering at.

  2. I was told I could not bank cord blood if I do delayed cord clamping. Is this not true?

  3. Dear Liz,

    It is indeed possible to cord blood bank AND have delayed cord clamping. Delayed cord clamping may reduce the quantity of blood available for banking, but unless you have a premature baby or unusually short umbilical cord, you should still be able to get a sufficiently sized cord blood sample to bank.

    We were able to successfully bank cord blood and cord tissue with our 5th child, despite waiting about 2 minutes after birth before clamping the cord. You can read my article on cord blood banking here: http://childrensmd.org/browse-by-age-group/newborn-infants/cord-blood-banking-why-i-changed-my-mind/#comment-7232

  4. Thank you so much for this incredibly helpful article. I am giving birth in about two months at Barnes, and I couldn’t have found a better resource.

  5. This is great! I’m a first time mom. I have been doing research on what I do and don’t want as far as medical procedures and labor/delivery go. This has given me so much help in writing up my birthplan.

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