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A Birth Plan template and tips on how to write one

a birth plan template and tips on how to write one


Birth Preferences, more commonly known as Birth Plans, are a wonderful way to communicate your wishes with your support team and a great way to dive in, learn more about what your birthing options are, and to clarify what is most important to you during birth. Any uncertainties you have will make great talking points with your medical providers and with your doula. Birth Preference Sheets can be brought to one of your prenatal appointments to make sure that you and your midwife/OBGYN are on the same page about setting expectations for your birth. If, after a discussion with your provider about your Birth Plan or Birth Preferences, you feel like your provider or place of birth does not fit with your wishes, you may want to consider hiring a new midwife or OBGYN. 

How to write a birth plan? 

Birth Preferences should be written in a way that is concise and to the point. Think 1 page of bulleted lists or quick sentences. You want anyone who comes across your Birth Preferences (for example a care provider in the practice you haven’t met yet, a new nurse on shift, or your backup doula) to be able to quickly understand your wishes and how to best support you. A birth plan or birth preferences sheet always makes room for flexibility in case your situation becomes more clinical. 

How to begin your birth plan? 

To begin your preferences, start with basic but necessary information like your name, your partner’s name, and both your phone numbers. Include your estimated due date, location of where you intend to give birth, and your doctor or midwife’s name. Indicate if you are planning a vaginal birth or a cesarean birth and whether you hope to have an unmedicated or medicated birth. Keep in mind, no matter which kind of birth you plan, many of the same options are available to you.

What birth plan example should I use? 

Use the following questions to help form the rest of your preferences. Check out our sample plan here. You’ll see it begins with an acknowledgment that “These are our preferences in an ideal scenario. We appreciate being consulted about all procedures, choices and options in any non-emergency situation and understand that some of our preferences may shift under certain circumstances.” Make it your own!


How labor begins

I would like my labor:
[  ] To begin spontaneously
[  ] To be medically induced
[  ] To be medically induced, only if necessary for health
Example: “I’d like my labor to begin spontaneously. I’d prefer to avoid induction, unless medically necessary.” 

Who will be present at your birth

During labor, I’d like the presence of:
[  ] Partner
[  ] Doula
[  ] Parents
[  ] Other children
[  ] Other: ___________________________________

The birth ambiance

I would like my birthing ambiance to have the following:
[  ] The lights dimmed
[  ] The room as quiet as possible
[  ] Music playing 
[  ] Aromatherapy (oil diffuser, scented sprays, incense etc)
[  ] Other: ___________________________________

For hydration and nourishment:

During labor, I would prefer:
[  ] To eat and drink as I wish
[  ] To receive hydration through an IV
Example: I’d prefer to avoid IV fluids, unless medically necessary. 

Pain Relief

For pain relief, I’d like to use:
[  ] Various positions (walking, squat/squat bar, on hands and knees, standing, dancing, leaning on my partner, birth/peanut ball, laying down on my back or side)
[  ] Hypnobirthing or hypnosis for labor
[  ] Meditation
[  ] Affirmations
[  ] Visualizations
[  ] Distractions
[  ] Hot/cold therapy (ice, heat packs, fan etc)
[  ] Counter pressure
[  ] Hydrotherapy: Shower or bath
[  ] Massage
[  ] Tens Machine
[  ] Sterile Water Injections
[  ] IV medicines
[  ] Epidural
[  ] Nitrous Oxide (laughing gas)
[  ] Other ___________________________________

Other considerations during labor

Vaginal Exams
[  ] I prefer vaginal exams to be kept to a minimum
*Many practices offer routine vaginal exams every 1-2 hours.

Monitoring
[  ] Auscultation
    *typically only available in home or birth center birth and for low-risk people only
[  ] Intermittent Electronic Fetal Monitoring (EFM)
    *appropriate for low-risk people with baby doing well throughout labor
[  ] Continuous EFM
    *appropriate for high-risk people, when baby needs closer monitoring, or when any medicine is used during labor
[  ] Wireless EFM
    *only available at certain hospitals. You’ll still need to discuss continuous vs. intermittent. 

Amniotomy (breaking the bag of waters)
[  ] I would prefer to avoid amniotomy unless clinically indicated

2nd Stage (Pushing)
[  ] Before beginning to push, I would like to wait until I feel an urge to push 

While pushing, I would like to:
[  ] I would like to push spontaneously by following my body’s urges and rhythms
[  ] I would prefer to follow my providers’ instructions and push as directed
[  ] Avoid episiotomy unless medically necessary
[  ] Try various positions
[  ] Squat (with the squatting bar, if available)
[  ] Lay on my side
[  ] Lay on my back
[  ] Be on my hands and knees
[  ] Stand up
[  ] Use a mirror to see my baby’s head
[  ] Touch my baby’s head as it crowns
[  ] Help catch the baby
[  ] Let my partner help catch the baby

In the event of a planned or unplanned cesarean birth, I would like:
[  ] The drape lowered so that I can view the birth (Gentle/Family Centered Cesarean)
[  ] The opportunity to have my baby in skin to skin contact if all is well (Gentle/Family Centered Cesarean)
[  ] To have my baby with me in the recovery room (Gentle/Family Centered Cesarean)

After my baby is born and if all is well, I would like:
[  ] Immediate skin to skin contact until after lactation initiation
[  ] Delay post-birth procedures (weighing, bathing, measuring, eye ointment)
*If you don’t discuss, these are often done immediately, but delaying is recommended by the AAP to increase success of initial lactation
[  ] All post-birth procedures to be done with my baby on my chest
[  ] Delayed Cord Clamping 
[  ] My partner to cut the cord
[  ] Cord blood banking (some locations provide cord blood donation).
[  ] Breastfeed/Bodyfeed exclusively
[  ] Pump and bottle or spoon-feed colostrum
[  ] Formula feed
[  ] Meet with a lactation consultant 
[  ] Avoid pacifier or bottle, unless discussed first. 
[  ] To have my baby circumcised
    *circumcision is no longer routine

If baby must be separated for clinical reasons:
[  ] My partner will join baby
[  ] Please have staff member or my partner help me express my colostrum and deliver and feed it to my baby
[  ] I’d like the ability to join and stay with my baby, when possible, in the NICU as soon as possible

Birth Preferences are a helpful guide for you and your support team, but because births can sometimes go in ways that are unplanned, it’s a good idea to leave some room for flexibility on your birth plans. Always remember that you can change your mind about any of the decisions you’ve made. Lean on your support team to go over your options, ahead of time and also while in labor, so that you are making decisions that feel informed and empowered.

Laura Max is a birth and postpartum doula, available on the boober platform, having served clients in both the Tri-State Metro area and in Michigan. She is a wife and the mother of two, a teenager and an 8 month old. When Laura is not supporting new families (or her own), you can find her out in nature, listening to R&B and enjoying a cup of tea. Laura is available on the boober platform for matches. 

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