do you have a written birth plan?

We are well aware that birth rarely goes to plan, so why bother writing it down?

Maybe it’s part of The Secret, I don’t know but on every admission to the labor unit where I work we have to ask, “do you have a written birth plan?”

Overwhelmingly the answer is no. But when it’s yes, oh boy!


Verdict is still out on its legitimacy, but one study found the longer a woman’s birth plan was, the greater the likelihood of her going for an urgent or emergent cesarean section.

Authors of the study recommended if you do decide to write a birth plan keep it simple, one page or less seemed okay but beyond that the odds of unplanned C-section dramatically increase: 10-fold for every extra page. In fact, if you come to the hospital with a long intricate birth plan, the safest thing you can do for you and your baby is to throw it in the trash can on the way in.

I kid of course. But why am I so cynical? Probably because where I work I’ve seen every OB textbook emergency: a prolapsed cord, placental abruption, shoulder dystocia, flash pulmonary edema, eclamptic seizure, postpartum hemorrhage, even neonatal death. Birth does not go to plan. And these aren’t one-off events, I don’t even work full time!

Birth is beautiful but it is serious and can turn dangerous, even deadly very quickly.

Thinking you do need a birth plan? Before you start penning it let’s think for a moment why you decided to give birth in the first place. Was it to bring a healthy child into this world? Or was it to prove that you can learn more in a 10 minute google search than your doctor did during medical school and residency? Okay, I promise that’s mostly the end of the snide remarks. Now I, a mother/nurse/baby message board reader am actually going to help you make your birth plan.



Things you do not need to write on your birth plan:

  • C-section only if medically necessary

    • Yes. That is the reason for a c-section, medical necessity. Your doctor or midwife has determined your baby will not come out safely through your vagina.

  • Prefer a natural birth

  • Are you giving birth to a baby human or a baby shark? One of those is natural, the other is not.

  • Do not offer me any pain medication!

    • Fine, but why? No one is going to throw you a parade for enduring this unmedicated. And sorry but if you do request something I’m going to have to remind you of what you wrote on this birth plan. Kidding

  • Would like to eat and drink freely during labor

    • Sis, those rules are dictated by hospital policy. If you get an epidural, the po rules are set by the anesthesia department. But if you come to the hospital in active labor you won’t care about eating anyways.

  • Immediate skin to skin

  • Where do you think the baby is going to go exactly? The broom closet? As long at the baby is breathing on its own we’d rather you have it.

  • Routine cares delayed until after bonding has been established.

  • And when might that be? Was the 40 weeks inside of you not enough? It’s your child, you will bond.

What to think about before your arrival:

  • Pick a pediatrician. You don’t need to know their name, just pick an effing clinic. The hospital needs to know where to send your baby’s records after discharge and the nurse needs to know who to contact if your baby starts acting a fool.

  • To doula or not. Some are great, some are just incredible scam artists.

  • What are you doing with that placenta? WE WILL BE HAPPY TO THROW IT AWAY FOR YOU.

  • If your child requires supplementation do you prefer formula or banked breastmilk?

  • Circumcision preference? Your options: no. yes, in the hospital. yes, as an outpatient after discharge.

  • In the event of a C-birth do you want to see what’s happening at the time of delivery? A clear-drape is usually available that is designed to be lowered for you to witness the baby’s birth.

  • Vacuum/forceps birth: in the moment you will consent to these procedures, however it might not feel like you have any choice but to say yes. You can elect at this point to have a c-section. And you will need to have a c-section if the vacuum or forceps fail.

What you should plan:

  • Bring your own pillow. Hospital pillows are gross. And from an energy standpoint, like someone might have legit died on that pillow.

  • Make sure to pack comfy clothes and sandals for your birth support person. Lord knows they won’t be prepared and it’s really weird (not to mention gross) to see a full grown adult walking around the hospital with no shirt and no shoes. No shirt, no shoes, no service, K?

  • Plan to get no sleep. Welcome to parenthood.

  • Plan for your family to not respect your wishes regarding your time after birth. They waited in the lobby for 18 hours, they’re not leaving until they see this kiddo. They couldn’t give two shits about your immediate skin-to-skin bonding/golden hour. To avoid this awkward situation just keep the labor a secret, invite everyone to visit on postpartum day one.

  • How are you going to care for yourself once baby comes home? You will receive a flurry of visitors in the hours/days after birth and then silence, it’s just you. The difference can be shocking. Set clear boundaries ahead of time for visitors. Like this, “yes, we would love to have you come over! You can visit between the hours of and . Please bring us to eat. It would be great if you could hold the baby while I take a nap/shower/do laundry/scroll Instagram. Love you, thanks!”

  • You will never want to have sex again. Nor will your partner. But it’s fine, those feelings pass. Might take months or years but they pass.

Still think you need a written birth plan? You might if you have special circumstances you don’t want to explain again and again. I had a patient whose partner served in Iraq and he was very nervous that seeing his wife’s blood or hearing his wife in pain would trigger his PTSD. And I was really thankful to know that. Hypnobirthers are very aware of the power of words and prefer that things like contraction and pain not be spoken of in the labor room. This is really common labor language so again, essential for your care providers to know, go ahead and write that shit down!


How to improve your chances of birth going to plan:

Prepare

Really want a vaginal birth? Keep yourself healthy, do that prenatal yoga, and practice Spinning Babies techniques. Make regular visits to a chiropractor that specializes in pregnancy care. Mentally prepare yourself and your birth partner. Stay at home during early labor.

Determined to give birth without pain medication? Hypnobabies is a great program.

Go with the flow

A lot of those OB emergencies mentioned above happened to healthy, low-risk mamas to be. And where are they now? Probs at home snuggling their baby. Cannot emphasize enough that labor is unpredictable.

Focus on the end goal

Again, why are we here? To birth a healthy baby. Put trust in your care providers or find different care providers.


Sample Birth Plan that will not induce any eye-rolls:

  • Prefer vaginal delivery

  • Epidural for pain control when pain becomes too intense

  • Stay flexible if issues develop

  • Listen to OB/GYNs and labor nurses for recommendations

Christine Hicks