How to make a birth plan

If your birth plan is to help you communicate your thinking to your healthcare provider, make sure it fits with where you are booked to have the baby. It’s no good stressing that your priority is maximum pain relief if you are booked for a home delivery’you won’t be able to have an epidural. Or that you want several children present if you are booked into hospital’they will not be allowed in the delivery room. Or to give birth in water if you are booked into a midwife-run unit with no birthing pool.

Once labour gets going, the best-laid labour plans can change and a lot of details get forgotten. The planning is still worthwhile though. Some of the issues that are worth addressing in a birth plan require you to do some research and talk to your healthcare provider before you write them in. Issues to think about for your birth plan include:

• Birthing pool: Do you want to use a birthing pool? If so, only for pain relief in labour or also to give birth in?
• Caesarean birth: Would you prefer to be asleep or awake? And if you were awake, would you want to see what was going on?
• Eating and drinking in labour: Talk to your doctor about what is recommended.
• Episiotomy: Of course nobody wants an episiotomy, but would you still want to avoid being surgically cut if you were warned that you were at risk of a tear?
• Induction: If your baby was overdue would you want to wait as long as possible before being induced?
• Massage: Do you want massage in labour? Would you like help with this from your healthcare provider?
• Monitoring/Mobility: How important to you is being free to move around in labour? Are you happy to accept monitoring that confines you to bed or would you prefer intermittent electronic monitoring, or only a handheld sonicaid device?
• Pain relief: Do you plan to use only self-help techniques such as breathing, positioning and massage? Do you want TENS (trancutaneous electrical nerve stimulation) and entonox (gas and air) available? Might you consider having pethidine or are you definitely against it? Would you like an epidural as soon as active labour is confirmed or would you prefer to do without one?
• Managing the third stage of labour (cutting the umbilical cord and delivery of the placenta): Active management is designed to reduce the possibility of bleeding (post-partum hemorrhage). It involves giving you
• (with your permission) an injection of syntometrin (or equivalent drug) as the baby is delivered and clamping and cutting the cord immediately. This encourages the uterus to clamp down quickly; the placenta is usually delivered within 20 minutes. A physiological third stage delays clamping and cutting the cord until it has stopped pulsing blood to the baby, and does nothing to hurry delivery of the placenta, which may take as much as an hour. Think about what you would prefer.
• Cutting the cord: Do you want to delay this? Does your partner want to be the one to cut the cord? Do you want the baby delivered directly onto your bare belly and to be helped to nurse within a few minutes?
• Vitamin K: Are you happy for your baby to have the recommended dose of Vitamin K administered by injection?
• Special care: If your baby needed to go to the hospital’s special care baby unit (SCBU), would you want your birth companion to accompany the baby or stay with you until you could go too?

Excerpted from The Essential First Year by Penelope Leach. Copyright 2010 DK Publishing.