Creating Birth Plans

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Writing a birth plan often feels like a rite of passage for any expecting parent. There are endless outlines online and scores of suggestions in books and childbirth education classes. As a midwife for over a decade, I have seen more than my fair share of birth plans; the good, the bad and the outrageous. Over the years I have come up with some suggestions to help families use the birth plan as an effective communication tool.

Birth plans should be reviewed extensively with your health care provider before you get to labor and delivery. This fact is backed up by a randomized controlled trial. That may not mean much to you, but it means a lot to your provider. This is the most important step in writing a birth plan. I suggest that between 34 to 36 weeks in your pregnancy you go to an appointment with your provider, birth plan in hand, to review all of the particulars.

Reviewing the birth plan together is a great opportunity to ask questions about hospital practice and protocols. It is also a chance to review any details that you are not sure about, and to gain more information about why and when certain recommendations are in place.

Be aware that planning any big event is fraught with unexpected struggles. Have you ever hosted a party and had everything go exactly as planned? Of course not. Birth is the same way. There will be unpredicted hiccups along the way. What is most important is having the right ingredients and having a solid sense of your overall goal.

There is evidence showing that women who wrote birth plans are often LESS satisfied by their birth experience. This should NOT stop you from writing one. In many cases this dissatisfaction comes from holding on to specific decisions instead of larger concepts.

For example, Instead of focusing on avoiding an IV I recommend focusing on the ability to move around. Not having an IV may be part of this, but the bigger picture includes more than the small detail.

As for the nitty gritty of writing a birth plan, here are some simple steps:

1. Keep it short. everything should fit on a single page. Providers and nurses will be able to retain the information better if it is concise.
2. Keep it positive. Instead of saying “Don’t offer me an epidural” you could say “I intend to birth without an epidural and would appreciate your help with this.”
3. Keep it realistic. Knowing what the hospital has to offer and what is absolutely off limits is important. For example, most hospitals cannot allow live flames, so real candles are absolutely off limits.
4. Keep it organized. Divide the birth plan into sections based on the labor process. i.e. a labor section that includes the ways you would like to be supported in labor, a birth section with the ways you would like to be supported in birth, a postpartum section and a baby section.
5. Keep it goal oriented. Start the birth plan with whatever is most important to you and ask your providers to help obtain this goal. For example, if the thing that is most important to you is avoiding surgery then say that. If the most important thing is that you feel empowered to make your own decisions then say that.
6. Keep it personal. This is not a cookie cutter form, it should be an expression of who you are, your hopes and even in some cases your fears.

Once you have created this birth plan bring a first draft in to your provider to review it. Have your provider sign it and ask them to scan it into your chart. You should also bring multiple signed copies to your birth to post them in your room.

Happy Birth Planning!

Becca Amirault has been a Certified Nurse Midwife since 2007. She currently works in clinical practice at UCSF where she is also an Associate Professor of Obstetrics in the School of Medicine. Becca is a proud San Francisco native and the mother of two energetic and passionate girls.

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