So, you’re writing a birth plan! Or maybe you’re wondering what choices you’re likely to face while you have your baby. Or maybe you’re a fellow birth nerd with no practical application for this info. Welcome all, let’s get started!
In this post, I’ll be covering some very common choices that parents have during a typical uncomplicated birth. If you have pregnancy complications or anticipate complications during your birth, bear with me, because I have a few blog entries in the queue for you, and take the following with a grain of salt.
These preferences may apply to the entire birthing experience, or just apply at certain times:
Where will the baby be born?
Lighting – many mothers prefer dim lighting, similar to candlelight.
Music – some parents like to have a playlist including calm, soothing tracks and high-energy, motivating tracks for pushing
Nourishment– nourishment is a physiological need during labor, most easily met by drinking water and eating healthy meals. Sometimes, nausea during labor can make this challenging. Also, some hospitals do not allow eating depending on pain management expectations or anticipated complications. Find out your options in advance by discussing this with your provider, and plan accordingly.
Special focus objects, comfort objects, rituals, etc – every family has their own unique needs to feel safe, secure, whole, and supported. Objects of emotional or religious significance, favorite works or art or articles of clothing, photographs, and more can all be used to enhance the birthing environment.
Preferences for Early Labor
Early labor is clinically defined as the period of time during which the pregnant parent’s cervix dilates (opens) from 0 to 6 centimeters. It can last anywhere from hours to days or even weeks, and the pregnant person may be acutely aware of it or totally oblivious. If they are aware, they might have some preferences around the following:
“Getting checked” – this refers to an internal examination done by a medical professional to assess how far open the cervix is. Some folks find a lot of security in knowing exactly how far they’ve progressed, and others prefer not to know.
Contacting your medical providers and doula – Believe it or not, this is optional during early labor. You may feel secure knowing that everyone has been notified or you may want to wait until you feel more “sure.” Either preference is valid, and your providers want you to do what makes you feel best.
Focusing on labor – this may or may not be a choice, but if you’re not experiencing a lot of sensation, it’s valid to simply ignore what you’re feeling and go about your day.
Timing Contractions – you may wish to start timing contractions, if you notice them, during early labor. It’s not necessary but can be fun, interesting, and good practice for later.
Preferences for Active Labor and Transition
Active labor is clinically defined as the time when the cervix dilates from 6-10 centimeters. It can last a few to several hours. During active labor, you should contact your care team and doula and get to your birth location. Transition is the final phase of active labor when contractions come quickly and may last longer.
Getting checked – this is still optional, though medical staff may treat it as routine. Some hospitals have policies requiring a certain amount of dilation before they will admit you for delivery; this is a good thing to discuss with your provider well before you go into labor, especially if you do not want to be checked.
Getting prepped for an IV or hooked up to an IV – another option that may be treated as routine. If you have questions or reservations about having an IV during labor, this is another good thing to discuss with your provider in advance.
Fetal monitoring – each birth location will have its own options for checking the baby’s heart tones and monitoring your contractions. These options may include listening periodically with a stethoscope, intermittent electronic monitoring via sensors placed on the parent’s belly, continuous monitoring using the same equipment, and internal monitoring using a sensor attached to the baby’s scalp. Again, discuss these options with your provider in advance to be sure you are on the same page.
Breaking your water – a pregnant person’s water can break at any time during labor. Sometimes, providers routinely break parents’ water as a way to help labor progress. This is done with a medical instrument that resembles a crochet hook. The pregnant person cannot feel the water bag being pierced, but may well feel discomfort or pressure during the procedure. After the water is broken, labor is likely to intensify. It’s wise to consider what circumstances would make you comfortable having your water broken. Often, the main motivator is to speed labor up.
Walking – your birth facility may or may not encourage you to walk between contractions in active labor. You should know that this is your choice.
Positioning – during labor, you will find what position feels best for you. It may be difficult to advocate for yourself when you are doing the hard work of labor, so discuss this with your partner and doula in advance so that they can help provide you with what you prefer – perhaps a birthing ball, peanut ball, pile of pillows, etc.
Pain management (nonmedical) – your pain management options depend to some degree on your birth location. No matter what, if your doula is with you you will have options like massage, counter-pressure, position changes, guided breathing, and focus exercises. You may also prepare ahead of time and bring tools like hypnotherapy, a TENS unit, herbal remedies, or aromatherapy. Hydrotherapy (getting in the shower or tub) is an option in any birth location that allows it; some providers do not allow getting in a tub after your water has broken.
Pain management (medical) – in a hospital setting, you will also have medical pain management options. These vary by location and may include nitrous oxide, a gas you inhale through a handheld mask, narcotic pain relievers, an epidural injection, and anesthesia if needed for a cesarean birth. Each type of treatment has a different impact on pain and different effects on the baby. This is a subject well-worth some research and discussion with your provider and doula to empower you to make an informed decision. Note that some hospitals have policies governing when an epidural can be given, specially how dilated the cervix must be. Ask your provider so that you aren’t taken by surprise on birthing day.
Pitocin – this is a synthetic hormone that’s chemically identical to oxytocin, our bodies’ hormone responsible for labor contractions. If you give birth at a hospital, Pitocin may be given routinely to speed labor by producing stronger contractions. This has both advantages and disadvantages, and is yet another good subject for discussion BEFORE your labor starts.
Preferences for pushing
Position – medical providers may have routine recommendations for pushing positions, but it’s up to you to choose the position you feel is most effective and comfortable. If you’re birthing with medical pain relief, you may need help getting into/staying in the position of your choice. Effective birthing positions include squatting, side-lying, kneeling on hands and knees, and many more.
Perineal care – you may want perineal massage or a warm compress to help support your perineum during pushing, and potentially minimize tearing. Ask your provider before your labor begins whether they are experienced with these techniques.
Breathing – you may be advised to breathe or vocalize a certain way during pushing, but this is ultimately up to you. You may find it useful to practice some breathing techniques in advance with your doula.
Vocalizing – many parents find that they make sounds during labor that they have never made, or even heard, before. This is natural and powerful! If you feel you might be embarrassed by making certain sounds, discuss it with your doula/provider, and make unapologetic vocalization a part of your birth plan.
Water birth – some facilities do not allow babies to be delivered in the water, so if water birth is important to you, make sure you know your options.
Who catches the baby – this is a choice many parents may not be aware of. In an uncomplicated delivery, even in a hospital setting, it may be possible for either parent to catch the baby, under the supervision of a qualified healthcare provider.
Before the birthing day, it may seem like all the planning has to do with the labor and delivery. But the immediate postpartum period of just 30-90 minutes following the birth is a crucial part of the experience for both baby and parents. I urge all parents to consider their preferences for this period and communicate them in advance to their healthcare team.
Pitocin – even when it’s not administered during labor, Pitocin is often given immediately postpartum to strengthen uterine contractions and slow the birthing parent’s bleeding. This routine practice may be something you need to opt out of explicitly, if you wish to forgo it.
Immediate skin to skin contact – many parents plan for immediate skin to skin when baby is born. Some birthing facilities have routine policies that delay skin to skin for measuring the baby, cleaning the baby, and soforth. If you want immediate skin to skin, be sure your provider knows before birthing day and remind them on birthing day.
Cord clamping – the baby’s umbilical cord can be clamped promptly or clamping can be delayed, which allows all the of baby’s blood to flow into his/her body before separation from the placenta
Who cuts the cord – again, can be a family member supervised by a qualified healthcare provider
The golden hour – refers to 60 minutes of more of uninterrupted skin to skin contact between baby and birthing parent, during which baby will latch and nurse for the first time. You may want to discuss this with your provider to understand whether routine policy includes immediately washing/swaddling the baby or relocating family to another room
Placental encapsulation – some parents wish to save and encapsulate the placenta. Your provider will need to know if this is your preference so that they do not discard it.
There is so much to consider, and this list is just for the most uncomplicated births! If it feels overwhelming, I encourage you to work through your birth plan just a little bit at a time. And remember, the most important part of any birth plan is the flexibility to adjust it based on what you need on birthing day. Let me know in the comments what the most important parts of your birth plan are.