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Preparing a Birth Plan

Osher Ben Or, Certified Midwife
22 June 2024

In a birth plan, you can write in advance your preferences related to the childbirth and the care for you and your baby. Before writing the plan, you should learn about childbirth and understand what is right for you. This way, the midwife and the rest of the delivery room staff can know your preferences in advance and may follow them as much as possible.

What a birth plan includes

  • Introduction: your personal information, a bit about yourself and any relevant medical history.
  • In the obstetric emergency room: what you want at this stage, what can provide you relief.
  • The latent stage: how would you like to cope with labor-related pain? Would you like an enema? You can mention the atmosphere, music, lighting, entry of staff members, fetal monitoring type, and so on.
  • The active stage: how would you like to cope with pain? Would you like a natural birth? It is also worth learning about interventions during childbirth and existing options.
  • The second stage of childbirth: which positions would you prefer at the pushing stage, would you want a perineal massage and compresses? Also try to understand your attitude to episiotomy, if needed.
  • After delivery: do you prefer laying the baby on you immediately after birth, delaying the cutting of the umbilical cord, having your partner cut the umbilical cord, breastfeeding immediately after birth and getting breastfeeding assistance?
  • Infant care: do you consent to your baby being given care after birth, including vitamin K administration, hepatitis B vaccination, hearing screening tests and a blood test? Also, would you like to breastfeed or provide infant formula, would you want lactation counseling, would you prefer the baby to be with you all the time or to be in the neonatology department some of the time?

Attention to posttraumatic stress: if you face a complex mental state – in most hospitals you can meet in advance with the midwife, or other professionals who can help you prepare for the childbirth.

When the moment arrives and you go into the delivery room, how would you like the delivery to be conducted? Would you prepare epidural anesthesia or a natural birth? Would you prefer a water birth? And what would you like to happen immediately after delivery? There are many questions related to the delivery process that women do not always pause to think about, but are of great importance. Consider them so that the delivery go in the way that best suits you, to the extent possible. This is why preparing a birth plan is a good idea.

What is a birth plan

A birth plan is a document in which you write in advance all of your preferences on birth and the care for you and your infant. It is important, so that you do not have to think about everything for the first time when you are already in the delivery room, experiencing the pain of labor and sometimes stress and confusion. It is also important for the staff to know your preferences in advance so that you will not have to try to explain what you want.

The plan may cover many issues related to childbirth, you and the newborn, and should be concise and clear.

The gynecologists and midwives in the delivery rooms have vast experience in reading birth plans and matching the process to the mother and her companions, so that you can give birth the way you choose. However, remember that sometimes it is not possible to follow the plan through, because of scenarios you cannot predict. Therefore, on the one hand, it is important to prepare a birth plan, and on the other hand, you should come to the delivery room with some sense of flexibility, with the main goal in mind: going through a safe, healthy delivery, at the end of which you and your baby will be safe and sound.

How to begin

  • Expanding your knowledge: often, just thinking about childbirth and the things that are important for you during delivery makes you want to read more and expand your knowledge about the process. Knowledge will give you strength and understanding about the choices that you will make. Read about the stages of childbirth, enroll in a birth preparation course, check what interventions are common during childbirth, what natural pain relief options are available and what the medicinal ones are, talk with women who have given birth in your area of residence and schedule visits to delivery rooms nearby so that you can feel the pulse of the venue and choose where you want to give birth.
  • Sharing with your partner: preparing the plan with your partner’s involvement will ensure that your partner is attentive to the things that are important to you during childbirth and while caring for your baby.
  • Dividing it into stages: it is a good idea to divide the plan into childbirth stages and the stages of your care from the time you arrive at the medical center until your discharge – going to the obstetric emergency room, entering the delivery room, the latent stage, the active stage, coping with pain in each stage, the second and third stages of childbirth, and finally the care for the newborn.

What a birth plan includes

In the introduction of the birth plan, state your name and identity number, write a briefing in which you ask that your requests be considered. Describe yourself briefly and state any medical background. State who your companions during the delivery are and what your relation to them is. If you have had a bad experience during a previous delivery, state what made it like that and how it is possible to change the experience this time.

Is there anything you would like to ask for in the emergency room? For example, if you have difficulty with a vaginal examination, what can help you?

At this stage, labor intensifies, until the progression to the active stage of childbirth. This process may be lengthy, and it is worth thinking about how to get through it:

  • Would you like to play music?
  • Would you like the lights to be dimmed?
  • Would you prefer to maintain an intimate atmosphere - keeping the door shut, keeping the room quiet, talking calmly, avoiding letting staff members in, except for your direct care (such as trainees, students, auxiliaries, housekeeping staff, and so on)?
  • Would you like an enema to be done?
  • Would you prefer to be left with a branula needle in your arm or to have blood taken from you with butterfly needle scalp only?
  • Would you prefer intermittent fetal monitoring (if possible)?
  • Would you prefer wireless fetal monitoring (if present)?
  • How would you wish to cope with pain – walk around, stand in the shower under the water flow, sit on a physio ball, use a TENS device (pain relief using minor electric currents)? Would you prefer laughing gas or epidural anesthesia?

  • How would you wish to cope with the pain at this stage (according to the existing options in your delivery room)?
  • Do you want a natural birth? It ןs important to choose this option in advance but also know that sometimes, at the moment of truth, the labor hurts a lot and the delivery process takes a long time. In such case, it is worth consulting the midwife – her experience can help you decide.
  • Interventions during childbirth: read and learn about medical interventions during childbirth and why they are needed. In a birth plan, you can ask to be provided an explanation about each necessary intervention and existing options.

  • Position: in which positions would you prefer to be at the pushing stage?
  • Perineal massage and compresses: would you like a perineal massage at the stage of contractions? Would you like warm compresses to be placed on your perineal area?
  • Episiotomy: the episiotomy (perineal region cutting) procedure requires your consent. Usually, an episiotomy is done to shorten the second stage of childbirth because of improper fetal monitoring and when the midwife knows that after the episiotomy, the infant’s head will emerge, or when she feels that the tissue is very taut and an episiotomy will help relieve the pressure from the emerging head. Find out in advance in what conditions you would like an episiotomy to be done, try to understand what your position is on the matter.

  • Would you like the infant to be laid on you immediately after birth, “skin to skin”?
  • Would you prefer to delay the cutting of the umbilical cord?
  • Would your partner like to cut the umbilical cord?
  • Would you like cord blood to be collected?
  • Do you want to breastfeed?
  • Would you like assistance in breastfeeding just after the delivery?

Before you discuss this subject in the birth plan, it is a good idea to get familiar with the routine treatments for the newborn that the Ministry of Health recommends.

  • When you are admitted to the delivery room, you will be asked to declare whether you consent to or decline each treatment provided to the newborn after birth, including vitamin K administration, hepatitis B vaccination, hearing screening tests, a blood test. Do you consent?
  • Do you wish to breastfeed? If not, what infant formula would you prefer?
  • Would you like the baby to be with you in zero separation (with you all the time), or would you like the baby to be in the neonatology department for some of the time?
  • Would you like to get lactation counseling?

Attention to posttraumatic stress

There are cases in which hospitals provide an even closer suite of services. If you were sexually abused in the past, if you have been diagnosed with posttraumatic stress disorder (PTSD), or if you are coping with trauma from a previous childbirth or another complex mental state, most hospitals have a program that allows you to meet a midwife or other professionals who can help you prepare for the childbirth. If you need such assistance, call the delivery room you are planning to give birth in and ask for the service.

The birth plan can also be a basis for a talk with a midwife and other delivery room staff members. If there are things that can be problematic during a certain delivery, the midwife can give you an explanation on the matter. Because the childbirth process can develop in unpredictable ways and is subject to change, some parts of the plan may prove unfeasible. However, the staff can act in the spirit of your wishes as much as possible.

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