What is a birth plan and why do you need one?

Many pregnant couples have heard of a birth plan, but feel unsure whether this is something applicable to them in their setting? Surely that is why you are birthing with a medical team?

But remember that this is your body and your baby. No matter what type of birth you are planning to have, a birth plan is useful. It forces you to do some research and to decide on what you want for your body and your baby. It helps you to clarify your expectations of yourself and those around you.

A birth plan can help to reduce any anxiety you may be feeling about your birth, because you can identify your concerns and find practical ways of dealing with them. It documents your hopes and plans for the day.

You should share your birth plan with your midwife, doctor and/or the nursing staff who will care for you on the day. When choosing a doctor, you should find out if they are willing to discuss a birth plan, give their input and opinions, and to accommodate your wishes where possible.

The important thing to remember though, is that a birth plan is not set in stone. Labour is unpredictable and you need to be prepared for the unexpected. Your birth plan should also include your wishes if things do not work out the way you wanted them to.

Before you write down your birth plan, do a bit of research on what options are available to you. Talk to your midwife or gynae about any concerns you may have as well as what their opinions are.

What should you include in your birth plan?

Your type of birth, practitioner and venue. In the private sector, you can firstly choose between an independent midwife or a gynaecologist. Midwifery care is the best option for low-risk women who want to have a natural birth without intervention. They facilitate birth at a hospital birth unit, a birth centre (not attached to a hospital) or at home, with a gynae on standby in case of complications. If you choose to birth with a gynaecologist, you will receive care in a hospital and can choose between a vaginal delivery or a Caesarean section. If there are any complications or high-risk factors you will need to be under the care of a gynae.

Your due date. If you want a vaginal birth going into labour on your own will give you the highest chance of success. Discuss with your practitioner how they will deal with you going overdue and decide how you would like to handle it if baby decides to take his time. If you are planning on an elective Caesarean section, hear from your doctor when he suggests this should be done? For low-risk, healthy pregnancies it would always be better for the babies to do a Caesar as close to the due date as possible.

Your plans for early labour. Do you want to stay at home, or be admitted? Early labour may progress better if you are at home, but some mothers may not feel comfortable with this idea.

Your birth partner/partners. Included in this section is instructions on who you would like to be in the delivery room or theatre with you. Are there times you would prefer them not to be in the room? Make sure your birth partner is aware of your wishes. You may need to check the protocols of the facility where you are giving birth, especially if you want more than one person with you. For example, a doula is an incredibly valuable addition to a birth team, but not all hospitals allow doulas.

Pain Relief. Research the different medical and non-medical pain relief options. Medical options would include nitrous oxide gas, pain relief injections and epidural anaesthesia. Non-medical options include massage, pressure points, water (a birth pool), breathing techniques and different labour positions. You should check if the facility has what you need, for example a birth pool and enough birth balls (otherwise take you own). Be clear about when you would like pain relief and discuss this with your caregiver. Some doctors have protocols they insist on using.

Speeding up (augmenting) labour. If your labour is not progressing as you would like, do you want to be given medication to speed up the birth of your baby? Do you want your water to break spontaneously or are you willing to let the doctor break your water to speed things up.

Positions you would like for the birth. Use this to specify how you would like to be positioned for your labour. Upright positions make more sense for pushing, as you are pushing with gravity (and not against it) and you have more space in your pelvis when upright. But not all doctors will allow this.

The third stage of labour. This stage takes place from the time that baby is born, until the placenta is delivered. You should research active versus natural management delivery of the placenta, and immediate versus delayed cord clamping. Do you want to take the placenta home for religious or cultural reasons, or do you want it to be send away for incineration.

Skin-to-skin between mom and baby. Ideally your baby should be placed on your chest immediately after delivery. Skin-to-skin is encouraged as it carries many advantages for mom and baby, but it is still worth including in your birth plan.

Feeding your baby. You should be very clear in this section on what your wishes are for your baby. Do you want to exclusively breastfeed? Or may formula be given? Make sure everyone is aware of what you would like to happen.

Unexpected situations.

A birth plan gives you the opportunity to inform yourself and to state what you would like to have, but you should also acknowledge that sometimes an intervention may be necessary for the safety of mom and baby. If this is the case, being better informed will make it a lot easier for you to cope with. Read about artificial rupture of membranes, induction of labour, episiotomies, Caesarean section and admission of baby in NICU. Think about these situations and if there is anything you would like to happen in the event of an unexpected situation, write it down here.

Once you have written your birth plan, discuss it with your doctor or midwife. Ask any questions you may have and allow them to also voice their concerns and requests.

Lastly, remember that a birth plan is not an act of defiance against a system. It is meant to make things easier for healthcare professionals and to ensure that mothers feel satisfied with their birth experiences.

For more information and guidance on the birth process, consider joining Parentwood’s monthly Antenatal Labour and Birth Workshop.