A birth plan is a one to two page list of preferences a woman has for giving birth. A pregnant woman may compose a birth plan to make her labor and delivery requests clear to her obstetrician (OB) or nurse-midwife, and the labor and delivery staff at the facility where she plans to give birth.

Birth plans should focus on three major areas, including:

• Wishes during a normal labor and delivery
• Preferences in the case of unexpected events
• Requests as to how the baby should be treated after delivery

A birth plan enables expectant mothers to have a role in the decisions that are made about their bodies and their babies. It also allows the mother’s partner to participate in the decision making for the baby. Although there is no guarantee that all the preferences listed in a birth plan will be met, having a simple list available makes it more likely.

Women choosing to develop a birth plan are encouraged to first research their labor and delivery options. They can then determine which factors are most important to them and include those requests in their plans. Women can learn about their labor and delivery options by talking to their OB or nurse-midwife, touring and speaking with the staff at the birthing facility and attending birth preparation classes. They also may gain some insight by talking to other mothers about their experiences. Birth plans should be reviewed by an OB or nurse-midwife about four to six months before a woman’s due date and again after the woman has attended birth preparation classes.

In addition to preparing a birth plan, pregnant women must make a number of additional preparations for labor and delivery. These range from making transportation plans to the birthing facility to arranging for childcare for any existing children. Women will also need to pack suitcases for their hospital stay. Items will need to be packed for the mother, the baby and the partner or birthing coach.  

During pregnancy expectant mothers may choose to create a birth plan. A birth plan is a written document that communicates a woman’s preferences concerning the types of care, procedures and management of the labor and delivery process as well as the management of the baby’s care following the birth. 

Although it is referred to as a plan, a birth plan is more like a list of requests. Though healthcare professionals may have an indication as to what an expectant mother wants, a birth plan helps communicate her ideas. It also eliminates the need for a woman to explain her preferences clearly at the actual time of labor and delivery when it may be difficult.

It is recommended that a birth plan be a simple, clearly written list of preferences. It should cover three major areas, including:

• Wishes during a normal labor and delivery
• Preferences in the case of unexpected events
• Requests as to how the baby should be treated after delivery

A birth plan can be used as a guideline for healthcare providers and the labor and delivery staff, and is not considered a binding agreement. Since it is not always possible for medical staff to accommodate each request, the preferences listed on a woman’s birth plan cannot be guaranteed. In addition, the events within any labor and delivery can never be fully anticipated or planned in advance. It is especially difficult when unexpected developments or complications arise during labor and delivery. As a result, a woman’s birth plan should be flexible because variations may be necessary. Emergency situations may require changes to the birth plan for the safety of the woman and/or her baby. Healthcare professionals will determine the best course of action based on the well-being of the mother and child.

When compiling a birth plan, a woman is encouraged to research her labor and delivery options. Many options are dependent on the facility she intends to use for giving birth (e.g., hospital, birthing center, own home). What may be possible at some facilities may not be possible at others. Before a woman makes decisions regarding her birth plan, parents should tour the hospital or birthing center where the mother plans to deliver. It is recommended that they also discuss the routine policies and procedures with the staff. For example, if a facility’s labor protocol has a policy requiring fetal monitoring, a woman will not benefit from stating “no fetal monitoring” in her birth plan. She may also choose to find another facility that may be more flexible in order to meet some of her requests.

In addition, a woman who finds that the routine care procedures of her facility are identical to her requests can then leave that information out of her birth plan. Some obstetricians (OB), nurse-midwives and birthing facilities have birth plan forms available.

Deciding which factors are most important to the individual is an essential part of the birth plan. Factors that are not important to the patient, and those that do not apply to her, should be left out of the plan. This makes it easier for the healthcare provider and labor and delivery staff to understand and follow the plan. Women are encouraged to keep the tone of their birth plan cooperative by using phrases such as “I would like,” “I prefer” and “I would hope to avoid.” The plan should also be limited to one or two pages. Some women choose to have one page of requests for a normal delivery and a second page addressing how to handle potential complications.

After compiling the first draft, it is recommended that a woman discuss her plan with her OB or nurse-midwife. This meeting should occur about four to six months before her due date. In some cases, certain factors in a woman’s pregnancy (e.g., age, health, problems during previous pregnancies) may prevent the provider from being able to fulfill certain requests. She can then modify the plan as necessary. She may choose to meet with her OB or nurse-midwife again after she attends birth preparation classes during the seventh or eighth month of pregnancy.

Once a woman has created a final version of the birth plan, she should review it with her partner to be sure it is clear. It helps to have a family member or friend who may be present during labor and delivery familiar with the plan. She should also create several copies of it. A copy should be given to the physician or nurse-midwife, the birth attendant and the partner or birthing coach. In addition, copies should be put in her file at the designated place of birth and in the bag being packed for the hospital. It should be labeled with the patient’s identifying information, including:

• Her name
• Partner/birthing coach’s name
• Birth attendant’s name
• Name of birth facility
• Birth facility address and phone number
• Due date
• Name and contact information of physician or nurse-midwife

There are a number of factors women are encouraged to consider when compiling a birth plan. These include:

Atmosphere during labor and delivery

• Where does the expectant mother prefer to give birth (e.g., hospital, birthing center, own home)?
  
  
• Who would she like to have present at the birth (e.g., partner, friends, relatives, doula [birth assistant])?
  
  
• Would she prefer music to be played?
  
  
• Would she like the lights dimmed?
  
  
• Does she prefer to wear certain clothes during labor and delivery?
  
  
• Does she want to have the birth photographed or filmed?
  
  
• Are there certain amenities she would like to have in her room (e.g., DVD player, stereo)?

Preparation

• Does she prefer not to have the routine enema?
  
  
• If possible, would she like to wear her contact lenses during labor and delivery?
  
  
• Would she like to remain home until she reaches a certain point in labor?

First stage labor

• Who does she prefer to have assisting at the birth (obstetrician [OB], family practitioner, certified nurse-midwife, doula)?
  
  
• Does she prefer not to be separated from her partner at any point during labor or delivery?
  
  
• Does she want to be sent home if she is less than five centimeters dilated?
  
  
• Does she prefer to wait before inducing labor if her water breaks at the onset of labor or if she goes past her due date (if approved)?
  
  
• Does she have a preferred technique for inducing labor (e.g., oxytocin, stripping or breaking membranes, castor oil, enema)?
  
  
• Would she rather not undergo internal exams during labor (unless medically necessary)?
  
  
• Does she prefer to eat and drink during labor?
  
  
• How does she want to stay hydrated (e.g., drinking clear fluids, eating ice chips, IV)?
  
  
• If an IV is required, does she prefer to use a heparin or saline lock?
  
  
• Is she interested in using pain medication? If so, should it be offered to her or should it be given only when she asks for it? What drugs are preferred (e.g., epidural, sedatives, tranquilizers, narcotics)?
  
  
• Which alternatives to pain medication is she interested in using (e.g., acupressure, acupuncture, massage, hypnosis, breathing techniques, hot/cold therapy, bath/shower)?
  
  
• Does she prefer to walk and move around during labor?
  
  
• Does she want to have fetal monitoring? If so, does she have preferences as to how the baby is monitored (e.g., externally, Doppler, fetoscope)?
  
  
• Does she prefer to be free of time limits and not have her labor augmented (as long as it is not a health risk)?

Second stage labor

• Does she want to avoid an episiotomy (a surgical procedure that involves cutting a woman between her vagina and anus)? In what situation would she approve an episiotomy (e.g., risk of tearing, medical emergency)?
  
  
• If an episiotomy is performed, does she have a preference as to the type and degree of episiotomy (e.g., pressure episiotomy)?
  
  
• What positions are preferred for delivery (e.g., classic/semi-recline, side-lying position, squatting, hands and knees, standing upright, whatever feels right at the time)?
  
  
• Does she want to have certain birth equipment available to her (e.g., birthing bed, birthing stool, beanbag chair, squatting bar, birthing pool/tub)?
  
  
• Does she wish to view the birth using a mirror?
  
  
• Does she wish to touch the baby’s head as it crowns?
  
  
• Does she prefer not to have residents or students present at the birth?
  
  
• Does she want to push instinctively and not be told how or when to push?
  
  
• Would she prefer to be free of time limits on pushing (as long as there are no health risks)?
  
  
• If an assisted birth becomes medically necessary, does she prefer the use of forceps or vacuum extraction?
  
  
• How long does she wish to try vaginal delivery before having a C-section?

Caesarean sections

• Does she want to have her partner present during the entire operation?
  
  
• Does she wish to be conscious?
  
  
• Does she prefer to have the screen lowered so she can view the baby coming out?
  
  
• Does she wish to have one hand free so that she can touch the baby?
  
  
• Does she want to have the delivery photographed or filmed?
  
  
• Does she prefer to have immediate contact with the baby (if the infant’s health permits)?

Post-birth

• Does she prefer for her partner to catch the baby?
  
  
• Would she prefer for the baby to be cleaned off before it is handed to her?
  
  
• Does she want her partner to suction the baby?
  
  
• Does she prefer waiting for the umbilical cord to stop pulsating before it is clamped and cut?
  
  
• Does she want her partner to cut the umbilical cord?
  
  
• Does she wish to bank the baby’s umbilical cord blood?
  
  
• Does she prefer to deliver the placenta unassisted?
  
  
• Would she prefer not to have routine oxytocin after birth?
  
  
• Does she wish to postpone newborn procedures (e.g., vitamin K injection, heel prick for blood test, eye medication) until she has had a chance to bond with the baby?
  
  
• Does she prefer for all newborn procedures to take place in her presence? If she cannot be with her baby for newborn procedures, does she prefer that her partner stay with the baby at all times?
  
  
• Does she want to breastfeed? If so, does she prefer that no water or formula be fed to the baby?
  
  
• Does she prefer to feed the baby immediately after birth?
  
  
• Would she prefer that pacifiers not be provided to the baby?
  
  
• Does she want the baby to be fed on demand instead of on a schedule?
  
  
• Does she prefer 24-hour rooming-in with the baby?
  
  
• Would she want her male baby to be circumcised?
  
  
• Does she prefer to stay in a private room?
  
  
• Does she want her partner to spend the night in her room with her?
  
  
• Does she prefer to stay in the hospital for as long as possible?
  
  
• Does she wish for her older children to visit her and her baby?
  
  
• Does she want any special diet after the delivery?

In addition to making choices about labor and delivery, pregnant women will need to make a number of other plans before going into labor. These include:

• Determining transportation (e.g., personal car, friend’s car, taxi). Those planning on using their own car should keep the gas tank full.
  
  
• Choosing a driver or support person.
  
  
• Determining the best entrance to use at the hospital or birthing facility. Find out if there is a special entrance to use after hours.
  
  
• Researching the hospital or birthing facility’s regular and after hours parking policies. If money is required to park, be sure to have it handy.
  
  
• Completing all required medical and insurance forms.
  
  
• Compiling a list of physicians and contact numbers, including the baby’s chosen pediatrician.
  
  
• Making required arrangements for child and pet care.
  
  
• Having backup arrangements for necessary transportation and care.

Women are encouraged to begin packing a suitcase for the hospital several weeks before their estimated due date. Everyday items (e.g., toiletries) that will also be taken to the hospital should be kept handy as well.

Items for the mother include:

• A nightgown or oversized T-shirt to wear during delivery
  
  
• A few pajamas (lose-fitting T-shirts and nursing gowns may be comfortable for breastfeeding mothers)
  
  
• A robe
  
  
• Socks and slippers
  
  
• Several pairs of underwear
  
  
• Nursing supplies (e.g., bra, pads, pillow)
  
  
• Clothes to wear home (items that fit during the sixth month of pregnancy)
  
  
• Sanitary napkins (pads)
  
  
• Toiletries (e.g., deodorant, toothbrush, toothpaste, shampoo, soap)
  
  
• Hairbrush and comb
  
  
• A prepaid phone card or cell phone and charger
  
  
• Camera and/or videocamera, film, memory cards and batteries
  
  
• Pregnancy/childcare books
  
  
• Copies of birth plan
  
  
• Prescribed medication
  
  
• Address for the hospital and directions on how to get there
  
  
• Phone numbers of partner, hospital, ambulance, insurance company, family and friends
  
  
• Insurance card

An expectant mother may also wish to pack:

• Hair clip, elastic or headband
• Moisturizing oils or lotions
• Massaging devices (e.g., tennis balls, rolling pin)
• Personal music system (e.g., MP3 or disc player and headphones)
• Pillow
• Favorite photographs (e.g., her other children, pets)
• Magazines and books
• Note cards or stationary
• Address book
• Snacks
• Lip balm
• Mouthwash and breath fresheners
• Makeup
• Hair dryer
• Extra bag/suitcase for carrying home gifts

Items for the baby include:

• Receiving blankets
• Infant tee shirts/onesies
• Clothes to wear home
• Hat or cap
• Booties or socks
• Disposable diapers
• Bunting or a warm blanket (during cold weather)
• A car seat
• Bottles, formula and bottle brush (for women who plan to feed their babies formula)
• Pacifier (optional)
• Toiletries (e.g., baby brush, baby lotion)
• Baby book

Items for the partner or birthing coach include:

• Personal grooming items
• Change of clothes
• Swimsuit (optional for sharing tub/shower during labor)
• Pillow and sleeping bag/comforter
• Snacks
• Magazines and books
• Cell phone

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about birth plans:

1. When should I start compiling my birth plan?
   
   
2. Does your office or the hospital have birth plan forms?
   
   
3. Does my hospital have a reputation for following a mother’s birth plan?
   
   
4. How can I learn about the hospital’s policies and procedures regarding birth plans?
   
   
5. Are there certain requests that cannot be honored?
   
   
6. What is the most important information that should be included in a birth plan?
   
   
7. Who should receive copies of my plan?
   
   
8. If another doctor delivers my baby, will he/she be informed of my birth plan?
   
   
9. How can I be sure the facility reviews my birth plan?
   
   
10. What do you recommend I bring to make my labor and delivery more comfortable?