How to Create a Birth Plan

While you’re stocking your baby’s nappy bag in preparation for their birth, you may want to start planning for how you imagine that birth to take place. You may have heard many people saying that a “birth plan” should rather be thought of as a “birth wish list”, and it’s true, as the birth of a baby cannot be accurately predicted. Things can change at any point in the lead-up to your baby’s birth so having set expectations may lead to disappointments. 

Is it even necessary to have a birth plan? “Women don’t need to create a birth plan, but I would highly advise it,” says Crystal Esau, a Cape Town-based midwife at Midwife by Nature. 

“Birth plans are becoming more popular, especially among women who choose to have an out-of-hospital birth or a home birth. It is, however, important for women to know their rights and that they have the right to take part in the decision-making process during pregnancy and birth, regardless of where they give birth,” says Esau. 

As you learn more about your pregnancy and the upcoming birth of your baby, remember that your medical team are there to help you, so share your concerns and wishes with them. If you have any questions, ask them directly so you can better understand what is happening, and be well prepared for what’s to come. 

What exactly is a birth plan?

Esau explains that a birth plan is a written record of what you would like to happen during your labour, birth, and the period after the birth. “It is personal to you and depends on your circumstances, medical history, what is available at your maternity service, and what is important to you,” she says. 

Esau says your birth plan can include the following information:

·      Your healthcare provider and institute: OB-GYN (obstetrician-gynaecologist) and/or a midwife; public or private hospital, or a home birth or birth centre, if your healthcare provider approves it. 

·      Birth companion(s): Ask your provider how many companions are allowed in the room with you and list your preferred companions. If you’d like a doula present, ask if the facility allows it.

·      Environment: This includes how would you like the environment to be – dim lights, music playing or aromatherapy, for instance. Also ask if you or your partner/birth companion may take pictures and videos.

·      Pain relief options: Would you like natural pain relief methods such as massages and moving around? And which of the available medical pain relief options are you open to using? 

·      Positions during labour and birth: List your preferred birthing positions (standing, kneeling, squatting, side laying) and note any equipment, such as a birth ball or birthing stool, you’d like to use.

·      Procedures you would like to avoid: These might include artificial rupture of membranes, episiotomy or assisted delivery with forceps/vacuum.

·      Cultural factors: This could include having no men in your room during labour or keeping your placenta after birth, for instance. 

·      Birth of the placenta: Do you want natural, physiological birth of the placenta or are you fine with active management?

·      Care of the umbilical cord: Do you want delayed cord clamping and if so, how long do you want it to be delayed? And do you have a specific person in mind to cut the cord?

·      Postnatal care: Ask your provider what their policy is for the immediate care of your baby after birth – do you want immediate skin-to-skin, and so checks and tests are delayed (where safely possible)?

·      Feeding your baby: Be very clear whether you want to breastfeed or formula-feed your baby. Breastfeeding is always preferred, if it’s possible. Raise any concerns you may have with your doctor. 

·      Backup plan: It is important to remember that births don't always go according to plan. Be open to last-minute changes and know that it is ok to change your mind. You can change your mind at any time during labour and birth. 

“If, at any time, your plan might pose a risk to you or baby, your healthcare should discuss it with you,” says Esau. 

Who needs to see your birth plan?

Discuss your wishes with your partner and do as much research as you can. When you feel confident that you know what your options are, talk to your healthcare provider.

“By discussing your birth plan with your care provider, you will understand your options, including the risks and benefits. This also gives you the chance to ask questions and communicate with your care provider,” says Esau. Bear in mind that hospitals and birth centres may have their own policies in place regarding certain things so finding a facility that suits your needs and desires.

When should I create my birth plan?

There’s no need to rush your birth plan. Take your time to do your own research on the various pre- and post-birth factors and know that you might change your mind on certain points as your pregnancy progresses. 

“There must be enough time to discuss the plan with your care provider before the birth,” says Esau. She says a good guideline would be to start early in your third trimester, and to discuss it with your doctor and/or midwife when you’re around 34 weeks pregnant. 

Do I need a birth plan if I’m planning a C-section?

Birth plans are not reserved for those having a vaginal birth. Esau says women can develop a birth plan for a C-section – you can discuss these points with your doctor:

·       What pre-operative medication you prefer

·       Who you want in the operating room with you

·       Whether your partner can cut the umbilical cord

·       Whether you can immediately engage in skin-to-skin with your baby 

·       Whether it would be possible to have a birth photographer present

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