A birth plan is a way for you to communicate your birth preferences to the midwives and doctors who care for you during your labour and birth. It tells them about the type of labour and birth you would like to have, what you want to happen, and what you want to avoid.

You don’t have to write a birth plan, but if you do, below are some questions you might like to ask yourself as you prepare for the birth of your baby. The questions will help you get started. In addition you may have a birth plan template in your notes or you can download a template from the NHS website.

During your antenatal course you will have the opportunity to explore and find out more information on the options available to you, (i.e. positions for labour and birth, pain management, induction and augmentation of labour, natural/instrumental or caesarean delivery of your baby, birthing your placenta, care and feeding your baby). Please don’t sit in silence – I would encourage you and your birth partner to raise any questions or issues you may have during the course or on a one-on-one basis with me.        

I would encourage you to include your birth partner in writing your birth plan. Discussing and understanding your birth plan can help you and your birth partner to feel more confident as the birth approaches. It is important that your birth partner is aware of your feelings, because when it comes to the labour, you may be more focused on the task at hand than discussing niceties. As the hormonal changes of labour progress, you may stop talking as you concentrate on what your body needs to do. If there are complications, the midwife or doctor may want to speak to birth partner first in order to not break your concentration.

Write as much or as little as you like. Your birth plan is personal to you and should reflect your wishes – things that are important to you. You may want to add details about your medical history, but your midwife/doctor will have your maternity notes, so will be aware of your circumstances. It’s worth taking into account what’s available at your chosen place of birth.

Remember: A birth plan is not set in stone. Birth is unpredictable and things do not always follow a plan! So try to be flexible and think about preparing for the other labour and birth of it as birth preferences rather than anything fixed.


 

Place of birth and Birth partners

• Where would you like to give birth?

Options include:

• Home
• Birth centre/ Midwifery led unit within a hospital
• Hospital in a consultancy (maternity team of doctors and midwives) led unit

Whatever you have already arranged, it is never too late to change your mind or consider other options like having your baby at home. Even if you book for a homebirth you can transfer to hospital at any time (including during your labour).

• Who would you like with you at the birth?

For example (but this is not an exhaustive list):

• Partner
• Relative(s)
• Friend(s)
• Birth champion/doula

Research shows that continuous support from a birth partner can significantly reduce the need for pain relieving drugs and increase satisfaction in the birth. Most places of birth allow you to have more than one birth partner so consider your options, but do check with your chosen birth place as to how many supporters you can have and when.

It is also worth considering whether or not you would like to have and how your birth partner(s) feel about accompany you during medical procedures such as instrumental delivery (forceps or ventouse) and caesarean section.

Birth Positions and Environment

• Would you like to move around and use different positions during labour and birth?

Research shows that adopting upright, forward-leaning, open (UFO) positions and movement can significantly shorten the length of your labour and make the birth of the baby easier. So move and change positions as often as you like and feels comfortable.

Putting this in your birth plan may remind medical staff to encourage you to move and try different positions.

For ideas of positions to take, see:

• ‘Positions for labour and birth’  NCT Leaflet
• My leaflet – ‘Working together with…. ….for a harmonious labour and birth’
• The Royal College of Midwives, Campaign for Normal Birth – org.uk This contains clips demonstrating positions to take during labour and birth.

• Do you want to use any equipment (i.e. birth ball, bean bag, wall bar etc) during labour and/or want the lighting dimmed and music playing as the baby is born?

It is important to think about your birth environment and the facilities available during the first stage (latent phase) of labour when you are likely to be at home and in the later stages if you are not having your baby at home.

Check the facilities available at your chosen birth place and don’t forget to pack any music and other equipment in your labour bag.

• Do you want to use a bath, shower or the birthing pool during labour?

Even if you do not want to give birth in water, you may want to use a bath, shower or pool during labour. This can help ease pain, support you, help you move more easily and make you feel more relaxed and in control.

• Would you like your baby to be born in water?

Research shows that there is no real difference in safety between waterbirths and those on “dry land” and many women report waterbirths as an enjoyable and calming birth experience.

Check your birth place facilities and policies with your midwife. Hiring a pool for use at home is often an option.

Monitoring during labour

• How do you want your baby to be monitored during labour?

Your midwife (and/or doctor) will want to monitor your baby during your labour. There are different ways of monitoring your baby, ranging from continuous electronic fetal monitoring to less intrusive and restrictive methods such as using either a small ultrasound device called a ‘Doppler’ or the little trumpet-like tube called a Pinard’s stethoscope to listen to the baby’s heartbeat. Which method is preferred by your midwife/doctor will normally depend on the circumstances of your labour.

Listening in at regular intervals using less intrusive methods is just as safe for you and your baby if you have a low-risk straightforward pregnancy. With continuous electronic fetal monitoring your movement may be restricted and this may affect your labour. Research has shown that continuous electronic fetal monitoring can lead to an increased risk of an instrumental birth/caesarean and a greater need for pain relief.

For more information about monitoring methods during labour, see ‘Monitoring your baby during labour’ by BabyCentre UK (Available from http://www.babycentre.co.uk).

You should be given an opportunity to discuss monitoring of your baby with the midwife/doctor. When faced with choices, remember to use BRAINS (or ask Bridget or Brian).

Coping strategies and pain management

• Do you want to avoid drugs, or would you prefer to use drugs to be as pain-free as possible?

What type of pain relief do you think you would prefer? It is a good idea to consider the options beforehand and have an idea of your preferences, but it is also important to keep an open mind. Remember every labour is different and you don’t know beforehand how you will cope in labour. When faced with choices, remember to use BRAINS (see page 6).

• Do you want to be kept informed and involved in all decision making?

Some parents are happy to leave decisions to the medical staff, others feel happier being involved in the decision making. Staff should always consult you but if this is important then write this on your birth plan.

Medical Interventions

• How do you feel about induction and augmentation (acceleration of labour)?

Sometimes induction or augmentation is suggested for a number of reasons, i.e. if you go past your due date or if your labour slows down/stops.

• How do you feel about assisted birth (instrumental delivery)?

About one birth in eight is an assisted birth. An assisted birth is when your baby needs help to be born with instruments (forceps and ventouse) that attach to his/her head.

• How do you feel about caesarean section?

The birth of your baby

• Would you like to discover your baby’s sex yourselves?

Whatever type of birth you have this is a preference you can state this on your birth plan.

• Do you want to be the first to hold your baby?

 

• Would you like your baby to be delivered straight onto your tummy?

Skin to skin contact, especially at the breast, has been shown to have great benefits for the baby. These include reassurance and calming, temperature regulation, bonding and helping towards successful breastfeeding. Think about what might be right for you in the first moments after your baby is born.

 

• Do you want your baby to be cleaned and wrapped before you hold them?

 

• When would you like the cord to be clamped and cut?

• Would you or your birth support like to cut the cord?

Birthing your placenta

• Would you prefer a natural or managed third stage?

Most hospitals do not do a natural third stage by default, so if this is important to you then discuss it beforehand and write it down. We will be looking at the two types of managing the third stage of labour during the course. It is useful to find out what each method may involve beforehand and use BRAINs to help you decide what which one is right for you.

Feeding and caring for your baby

• Would you like your baby to be given vitamin K?

• How would you like to feed your baby?

• Do you want to put your baby to the breast as soon as possible?

Midwives, nurses and doctors in training

• Are you happy to have midwives, nurses and doctors in training to observe your labour and/or birth?

Observing women in labour is part of a midwives, nurses and doctors training. They are always supervised by a senior health profession and it is entirely up to you if you are happy to allow them to be present during your labour and birth.

Making INFORMED DECISIONS

“Bridget or Brian/Brain” is a useful technique to help you ask questions when faced with a choice.

It stands for:

what are the Benefits?                                                         what are the Benefits?

what are the Risks?                                                             what are the Risks?

what does my Instinct say?                                                 what does my Instinct say?

what if we Do Nothing, at least for now?                            what Alternatives are there?

Give me Alternatives are there?                                          what if we do Nothing, at least for now?

Express yourself

Time to think

….. and Smile!

      

Remember – a birth plan is simply a way of stating what you think your preferences are – any and all of this can be changed at any time.

It is the birth of your baby so do what is and feels right for you.

Further information on writing a birth plan

NCT – http://www.nct.org.uk/pregnancy/dad%E2%80%99s-view-birth-plan-and-pain-relief

NHS – http://www.nhs.uk/Planners/pregnancycareplanner/Documents/BirthPlan-blankform.pdf

BabyCentre – http://www.babycentre.co.uk/a544479/writing-a-birth-plan