THE FULLEST Guide to Your Birth Plan

It’s so exciting to be pregnant, especially if you’ve been trying to conceive for a while. Your body is growing an entire human being, eyebrows and all, without any conscious input from you. Even though you likely feel a little absentminded (pregnancy brain, anyone?), your cells know just what to do. Your part as your baby grows is to eat the healthiest, freshest foods you can; get lots of movement and sunlight throughout the day; rest when you need to; and practice your best mindfulness and relaxation techniques so you don’t get overwhelmed by stress.All this gestating — which likely includes some not-so-fun nausea; sleepless nights while Baby is doing cha-cha kicks in your belly; mood swings; and maybe even some varicose veins — is leading up to the prize: giving birth.But the labor and delivery process can feel scary for a first-time mom. You don’t know what the pain will feel like. You don’t know how many hours your birth will last. And, if you are receiving prenatal care from a large practice, you may not even know which doctor or doctors will attend your birth.

While there are a lot of uncertainties and unknowns, you can set your intentions with a detailed birth plan. Writing a birth plan is fun, and it’s a process that will help you figure out in advance what you want to happen during your labor and what you want to avoid.

So how do you make a birth plan? Read on!

Deciding Where to Give Birth

The first thing to consider before writing your birth plan is where you want to give birth. You have three choices:Home BirthOver 45,600 babies are born at home in the United States each year. Currently, home birth accounts for about 1.2 percent of all births. In the Netherlands, home birth is much more common, with almost a third of Dutch babies born at home.Many moms find home birth to be the most empowering and satisfying way to have a baby. If you have a home birth with a homebirth midwife, you likely won’t need a written birth plan. That’s because your midwife-led prenatal appointments will last an hour or even longer, and you will have plenty of time to talk through how you want your birth to go, what techniques you want to use together to support your birth, and what you will do in case of an emergency. Unless you have a precipitous birth, which is rare with a first-time mama, you will also know exactly who will be there with you in your home.Birth Center BirthSome hospitals have birthing centers that are integrated into their maternity wards. These birth centers have protocols that are dictated by the hospital administration. There are also stand-alone birth centers that are not affiliated with hospitals, which gives the midwives who run them more leeway to do things their own way. If you give birth at a larger stand-alone birth center, you may have a main midwife who does your prenatal care but a different midwife who attends your birth. Birthing at an independently owned birth center is more like home birth than hospital birth. For a birth center birth, whether inside a hospital or stand-alone, it’s a good idea to write out your birth plan.Hospital BirthThough home birth has been gaining in popularity since 2020, the majority of first-time mamas in America still choose to birth in the hospital. Often hospitals are beholden to administrative and medical protocols, which means that the staff may be more resistant to doing things your way. Still, you are in charge of your birth and you can go full out mama bear if you need to (or have your birth attendants help with this) so you have the birth experience that you want.For your hospital birth, make sure to print out at least seven copies of your birth plan, preferably on brightly colored paper. You will want to tape one copy to the outside of the door of your labor and delivery room and another to the white board in your hospital room (which the nurses will check every time there is a shift change). When you get to the hospital, also ask the clerk who checks you in to put a copy of your birth plan in your medical file. You will also want to give a copy of the plan to your doctor, as well as to the labor and delivery nurses who come into your room.You may get the best labor and delivery nurses in the world. But you may also end up with some who want to do your birth their way. So don’t be surprised if a nurse rolls their eyes at you when you hand them a copy of your birth plan. Their preconceived notions don’t matter. It’s your baby, and you get to do things your way (even if you need your advocates to help you do so in a hospital setting.)

Who Will Attend Your Birth?

The next thing you need to do before you write your birth plan is decide who you want to attend your birth. Keep in mind that studies show that doulas (that is, professional birth attendants) are shockingly effective at lowering your risk of both birth complications and unneeded medical interventions and even at shortening your labor and lowering your perception of pain. Still, depending on where you give birth, there may be a limit on who is allowed to be there.Birth can be messy, smelly, and emotional. So anyone at your birth should be someone you are comfortable with and you don’t mind seeing you naked. Choose people to be at your birth who will be helpful, encouraging, and lend positive energy to your experience. And don’t feel bad if you don’t want people there, even if the people who aren’t on the invitation list include your husband, partner, parents, or in-laws. For some, birth is a spectator sport. For others, birth is a deeply private affair.That said, people to consider having at your birth include:

• Your spouse, partner, or baby daddy
• Your mom or dad
• Your partner’s mom or dad
• Your best friend or a close friend who has already had a baby
• A doula or other experienced birth attendant
• Your older children
• A birth photographer

What to Include in Your Birth Plan

Now that you know where you’re giving birth and who will be with you, you’re ready to write your birth plan.The most effective plan is one that is easy-to-read and just one page, since hospital staff likely won’t take the time to read anything longer.Start With Your Basic InfoPut your name, age, and birthday at the top of the plan, along with how you’d like to be addressed (if you have a preferred nickname), and the name of the support people who will be with you in the birthing room. Include a phone number for a person to contact in case of an emergency.Next, Outline Your Labor Plan1. During Labor I Plan To (include the things that apply to your wishes):

• Be massaged by my partner
• Be on my hands and knees, as needed
• Dance
• Do breathing exercises
• Eat and drink as needed
• Have my support team help me labor in different positions
• Have my support team do perineal massage to help me not tear
• Keep the lights low or off
• Labor on the toilet
• Labor in the shower
• Labor in the bathtub
• Labor in a birthing pool
• Laugh
• Meditate
• Move freely – I do not plan to be hooked up to monitors, except if absolutely necessary
• Play music (soothing, inspirational, religious, jazz)
• Pray
• Sing
• Use a rebozo, exercise ball, and birthing stool, as needed
• Use hypnobirthing techniques
• Vocalize as needed – I may get loud!

Next, Specify What You Want to Avoid2. During Labor I Would Like to AVOID:

• A hep lock IV: I do not want an IV or a hep lock “just in case”
• Artificial rupture of membranes: I would like my labor to progress naturally
• Catheter
• Continuous fetal monitoring: I would prefer only intermittent monitoring
• Clocks: I will be covering all of the clocks in the room so as not to feel pressured to birth more quickly
• Internal fetal monitoring: Please use only a doppler
• Enema
• Epidural
• Episiotomy
• Forceps
• Narcotic pain relief
• Pitocin
• Vacuum extraction

If You Want Medical Interventions, Include These in Your Plan3. During Labor I May Request the Following Medical Interventions: List any medical interventions from the list above that you feel you may want.Next, Include Your Preferred Pain Management Techniques4. If I Feel Intense Plan, I Would Like to Try (list the techniques you desire in the order you would like to try them):

• Acupuncture
• Changing positions, laboring upright
• Hydrotherapy
• Massage
• Nitrous oxide
• Oral pain medication
• Epidural anesthesia

5. During the Delivery, I Would Like (list everything you want here):

• The nurses and doctors to pay attention to me, not the monitors
• To use a mirror to watch the baby emerging from the birth canal
• To be upright or on all fours while pushing
• For my birth attendants to be by my side, holding my hands
• For no one to yell at me to “PUSH!” – a gentle suggestion is all I need
• To keep the lights low
• For no one to call out the baby’s gender – we would like to find out for ourselves
• For my spouse/mom/friend to catch the baby
• For the baby to be given to me, skin-to-skin, as soon as it is born

6. After the Baby is Born, We Would Like:

• Everyone at the birth to recognize that this is a sacred time for us to meet our new baby. Please don’t talk or text during this bonding time
• Delayed cord clamping: Please wait until the cord stops pulsating, even if this takes a while
• The newborn exam to be done with the baby on my chest
• To keep the placenta, as we plan to bury it in the yard

Special Requests for Newborn Care

In addition to your birth plan, you may want to prepare a separate half-page document with your requests for newborn care. This is especially important if you plan to opt out of certain standard hospital interventions, like the vitamin K injections, hepatitis B vaccine, eye ointment, and routine infant circumcision. You should also include these requests in your birth plan, under the section, “After the Baby is Born.”Your special requests might include:

• No bath
• No circumcision, if the baby is a boy
• No eye ointment
• No formula under any circumstances, I will breastfeed
• No hepatitis B vaccine
• No plastic diapers, we have brought our own and will be using cloth
• No vitamin K shot
• No suctioning of the baby’s nose and throat

In addition to writing down your birth plan, it is important to talk to your obstetrician, midwife, and pediatrician before the baby is born to make sure they support your wishes for a less medical, more natural childbirth.If you get a lot of push back from your providers, find medical professionals who share your values and will honor your plans.Print your Newborn Care plan on cardstock or heavy paper and tape it to the front and back of the baby’s hospital bassinet, so the hospital staff does not mistakenly give your baby something you didn’t want or need for your baby. You can also display a copy of it close to your hospital bed as well.

What If Things Don’t Go as Planned?

If you end up needing a C-section, you can make a plan to have a gentle, family-centered abdominal birth. Click here for our guide to show you how to prepare.

Birth is unpredictable. Every birth is different. First-time births can actually be much easier or much harder than expected. The best laid plans can change. Many factors influence your birth experience: your frame of mind when you go into labor, the hospital or birth center attendants interacting with you, the attitude of the family in the room with you, your feelings about having a baby, and issues outside of this birth that you are having in your life.

Many of these things are outside your control but that’s okay. In many ways, birth is a process of letting go. Have fun writing your birth plan. Don’t forget to pack some tape. And remember, your real job is to allow your body to do what it was designed to do, and to try to be present for every moment.Jennifer Margulis, Ph.D., is an investigative health journalist and science writer based in Oregon. She is the author of Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family (Scribner, 2015). She’s also a guest on THE FULLEST Podcast and regular contributor to THE FULLEST. Learn more and sign up for her free newsletter at www.JenniferMargulis.net.