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Cheat Sheet

Birth Plans For Dummies

From Birth Plans For Dummies by Rachel Gurevich, Sharon Perkins, RN

A birth plan is a document you create to communicate your wishes and requests to your medical practitioner, the birth team, and your support team. How do you put your hopes and dreams for a perfect birth down on paper? Pinpointing what kind of labor and delivery you want isn’t as overwhelming a task as it may first seem. Here are some ideas to help you get started.

Essential Topics to Cover in Your Birth Plan

Keeping in mind all the topics you want to cover in your birth plan can be overwhelming. Having a reference list of the most common issues of labor and delivery can help. Use this list of birth-plan topics to help guide you as you write your own. Remember that you should only include issues that are important to you, and if something essential for your plan isn’t on this list, go ahead and include it in your birth plan.

  • The important people: At the top of your birth plan, include your name, your partner’s name, your medical practitioner’s name, and any essential birth guests, like your doula or your children (if they are attending).

  • Your ideal birth vision: If you’re planning a natural childbirth — or, alternatively, planning to use an epidural at your birth — say so at the very top of your birth plan. Your ideal birth vision sets the tone for the entire birth, so it belongs front and center.

  • Birth-environment requests: You may want to dim the lights, control noise in the room, limit (or include) guests, close the door to the hallway, play music, or use aromatherapy.

  • Food, drink, and IV: Indicate in your birth plan if you want to accept routine IV fluids or an IV saline lock. If your medical practitioner or birth location approve, you may include requests to drink or eat light foods during labor.

  • Cervical checks: You can request to limit cervical checks or to ask that no nursing or medical students perform them.

  • Fetal monitoring: You may write in your birth plan that you consent to continuous monitoring or prefer intermittent monitoring (best for when you plan on staying active during labor). Depending on your medical practitioner’s willingness, you may request that fetal heart tones be checked by Doppler, a telemetry monitoring unit, or a fetoscope.

  • Induction and speeding along labor: You may request that labor be allowed to progress naturally. You can ask that natural ways of speeding up labor — like nipple stimulation or movement — be tried before oxytocin (Pitocin).

  • Episiotomy: Your birth plan should note whether you want an episiotomy or prefer to tear naturally. You can also include how you intend to prevent tearing, like by use of certain pushing positions or with perineal support or compresses.

  • Cesarean section: If you’re planning a vaginal birth, your birth plan should address what you want in the case of a C-section, including whether you want to try alternative options before surgery in a non-emergency situation. Your birth plan may also want to include what you want if a C-section is required, like who will be with you during surgery, whether you want the drape lowered so you can watch the birth, or if you want to try breast-feeding on the surgical table.

  • Pushing preferences: You can include in your birth plan pushing positions you hope to try. You can also indicate whether you prefer coached pushing or instinctive pushing.

  • Cutting the cord: Note if you want to let the cord finish pulsing before it’s clamped and cut. You can also include who you want to cut the cord.

  • Placenta: Your birth plan may ask that control cord traction not be used and that the placenta be allowed to be delivered naturally. You can ask to see the placenta or take it home.

  • Receiving your baby: You can request in your birth plan that the baby be placed on your chest right after birth. You can also request that initial evaluations occur while the baby is in your arms.

  • Washing and weighing your baby: You can ask that weighing and washing your baby wait until after you’ve had time to bond. You can also request that the baby not be washed at all.

  • Shots and drops: Your birth plan should discuss which shots and tests you want your baby to have, including your preferences for vitamin K, antibiotic eye drops, hepatitis-B vaccination, and PKU testing.

  • Circumcision: Indicate in your birth plan whether you want your baby circumcised by the hospital.

  • Feeding your baby: Your birth plan should say whether you plan to breast-feed, bottle-feed, or do a little of both. You may also include a request to avoid unnecessary formula supplementations.

  • Partial versus full rooming-in: Your birth plan should say whether you want your baby with you around the clock (full rooming-in) or if you prefer the baby to sleep in the nursery (partial rooming-in).

  • Taking photos and video: Your birth plan can indicate your plans for taking photos or video during birth, including whether you’ve signed any necessary paper work required by the hospital for liability issues.

Drug Choices in Labor

Medication options can make up a big part of your birth plan. Maybe you plan to go natural and don’t want hospital staff to even mention pain medication. Or maybe you want your epidural put in during the last few weeks of pregnancy so it’s ready to go! (Sorry, that’s not really an option.) Either way, knowing your options ahead of time makes writing your birth plan easier.

Choosing an epidural

If you’ve already decided you want an epidural, you’re in good company — between 50 and 70 percent of women in the United States get an epidural for labor pain, and in some hospitals, the rate is closer to 90 percent. Epidural issues to consider adding to your birth plan include:

  • When you would like to get an epidural (keeping in mind that if you get it too early, it can slow labor)

  • The option to lie on your side rather than sitting up during the epidural placement

  • Whether to have your partner or other support person stay with you during the epidural placement

  • The option to not have a Foley catheter (for urination) placed automatically after epidural placement (you can ask to be catheterized intermittently instead)

Choosing intravenous sedation

Intravenous sedation includes medications such as meperidine (Demerol), butorphanol (Stadol), and nalbuphine hydrochloride (Nubain). These medications work rapidly and last for several hours. Sedatives take the edge off labor pain, but they do have disadvantages:

  • If given too close to the time the baby’s born, they can make your baby very sleepy and interfere with spontaneous breathing.

  • They can slow labor if given very early.

Labor Positions and Movements for Your Birth Plan

Staying active and in upright positions during childbirth can help labor progress. Including the option to keep moving during labor is a great addition to your birth plan, and having a list of common labor positions and movements can be helpful as a reminder to you and notification for your doctor, nurses, or midwife. Here are some labor positions and movements to include in your birth plans:

  • Walking: Walking around is a great way to keep labor moving along and distract you from discomfort.

  • Standing: Try leaning against someone (or something) or standing self-supported. You may stand during a contraction.

  • Squatting: When your baby is engaged in your pelvis, squatting can really intensify the contractions — too much to handle, for some.

  • Lunges: You can lunge standing up, by placing a sturdy chair in front and just to the side of you, putting the lunging leg up on the chair, or you can lunge while kneeling on the bed or on the floor. Be sure to be supported by your labor partner when lunging.

  • Climbing stairs: Walking up and down stairs combines the benefits of walking with the benefits of lunging. Be sure to have someone with you, and don’t overexert yourself.

  • Rocking: You can try rocking in a rocking chair, while sitting on a birth ball, or while sitting on the edge of the bed.

  • Slow dancing: A slow sway of the hips, especially when combined with a labor partner to lean on, can be comforting during labor.

  • Sitting upright: Sitting is a restful position that still gives you a gravity advantage by being upright.

  • Semi-upright sitting: This labor position is somewhere between lying down and sitting up. You get some gravity advantage in a restful pose, but remaining in this position too long may increase the chances of a posterior positioned baby.

  • Sitting on the toilet: Trying this position may help you instinctively let go of tension in the pelvic area.

  • Hands and knees: This labor position is good for labor felt mostly in your back. A chest-and-knees position can be especially good for when contractions are very intense.

  • Lying on your side: You may try this position when you really need to rest. Remember to turn from side to side frequently

  • Lying on your back: This position is rarely good for labor, because it can cause dizziness by limiting blood flow. It can also decrease blood flow to your baby. It may be used during medical examinations, though your practitioner should place a rolled blanket or other prop beneath your left hip.

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