Birth Preferences: What to Consider & Example Birth Preference Plan
Birth Plan Considerations:
Labor and delivery can be unpredictable, but there are some things that you will probably have control over. Most doctors and nurses try to be as accommodating of your wishes as possible, while still putting the health of you and your baby first, so it’s worth taking the time to write down your thoughts in the form of a birth preference plan.
You can have a written birth preference even if it’s not super-detailed. Writing your ideas down now is one less thing you or your birth partner will have to remember or explain while you’re in labor. Just remember, a checklist is better than an essay and short is better than long. Include the things that are most important to you, and be flexible about the rest. Here are questions you may want to consider thinking about:
During Labor
Who would you like to be present in the room?
Do you want your water broken if it doesn’t break on its own?
Do you have preferences about lighting? Music? Scents?
Would you like to be as mobile as possible?
Would you like to wear your own clothing, if possible?
How would you prefer to labor? (Options include taking a bath or shower, using a birthing ball, walking around, trying different positions, etc.)
What are your pain management options and preferences?
Do you want to try for a natural birth?
Do you want an epidural? If so, when? Do you want other medications other than an epidural? If so, what?
Electronic Fetal Monitoring - continuous or intermittent?
Freedom of movement - Would you like to be up and walking around during labor? Permitted the use of a birthing ball, bar or stool? Would you like to choose the position in which you deliver?
Eating and drinking - Would you like the option to snack during labor? Administered IV fluids? Would you prefer to avoid getting a routine IV?
Pain medication - Would you like pain medications to be made available only upon request? Would you like to be notified as soon as you are eligible for an epidural?
Induction and labor augmentation - Would you prefer to avoid the use of Pitocin, if possible? Have your bag of waters artificially broken or allowed to rupture naturally?
Photos and video - Do you plan to hire a photographer or videographer?
Method of delivery - Vaginal, Cesarean, VBAC or water birth?
During Delivery
Who would you like to be present during the birth? What if a c-section is needed?
Do you mind having student nurses or doctors present?
Are you allowing photos/video? Who can take them? Anything you don’t want photos of?
Are you opposed to the use of forceps or a vacuum? What about an episiotomy?
How involved would you like your spouse or significant other to be?
Who will cut the cord?
What position would you like to give birth in, if possible?
After Delivery
Mama-Baby Bonding - Is immediate skin-to-skin contact important to you? Would you like to delay routine newborn exams other than the APGAR?
Breastfeeding - Would you like to initiate breastfeeding ASAP? Would you like to meet with a lactation consultant (assuming the hospital employs any)? Would you like to avoid pacifiers, formula, artificial nipples, and supplementation?
Umbilical cord - Would you like to delay clamping of the umbilical cord? Do you plan to bank or donate the cord blood?
Placenta - Do you intend to save the placenta?
Routine Newborn Exams - Would you like to delay or decline any of the following routine newborn exams: heel prick, eye ointment, vitamin K shot, hepatitis B?
Newborn bathing - Would you like to specify that baby’s first bath be delayed? Performed only by you or your partner?
Planned or Unexpected C-Section
Visitors - partner or doula present?
Surgical drape - Clear surgical drape or a mirror to watch baby being delivered? Do you prefer drape to be lowered so you can catch a glimpse as soon as possible?
Style of incision and suturing - Low traverse incision? Single or double layer uterine suturing?
Vaginal Swab - Collected and wiped on baby’s skin following delivery?
Mama-baby bonding - EKG or monitoring devices placed in areas that won’t infringe on ability to bond with baby? Immediate skin-to-skin contact? If you are under general anesthesia, would you prefer that your partner be allowed to hold baby skin-to-skin immediately after birth, barring any medical complications?
Breastfeeding - Would you like to initiate breastfeeding immediately, while still in the operating room?
Post-Birth
Do you want to hold the baby right away, if possible?
Would you prefer to delay cord-clamping?
Will you bank the cord blood?
Will you allow visitors? Who, and how soon after the birth?
If you are having a boy, will you have him circumcised?
Do you want your baby to stay in your room with you, or would you prefer to have him/her in a nursery so you can get some sleep?
Do you want your baby to get a pacifier?
Are you planning to breastfeed or formula feed? If you’re breastfeeding, will you allow supplemental formula?
Birth Preference Plan Example
Birth Preference: Natural Birth
Name: [YOUR NAME]
Place: [LOCATION OF BIRTH]
Labor Partners
My husband, [NAME]
Please can the number of people in the room and talking be kept to a minimum
Objective
Natural birth (water for pain relief and water birth if all is ok) with the least amount of medical intervention whenever possible. Get baby and mum discharged alive and healthy. I prefer to not be induced, but induction is preferred over c-section.
Injections / Tests
Prefer to not have IV inserted during labor or in our baby after birth unless there’s a strong clinical reason
No needles and tests immediately after birth please
No injections (only 1 anti-sick injection if mum is vomiting)
Students
I don't want any students present, please. I am happy to have a student midwife
Monitoring Baby and Me
I am happy to have a vaginal exam every 4 hours
Please keep monitoring to a minimum unless I request it or there is cause for concern
Comfort Measures
Hypnobirthing
Acupressure
Active Labor
Visualizations / Massage
Essential oils
Homeopathic remedies
Birth Pool/Bath/Shower
T.E.N.S. machine
Gas and Air (Entonox)
Please do not offer me pain relief (epidural). If I would like some, I will ask
If I do have an epidural I prefer to be left in a lateral position
Rupturing of the Amniotic Sac
Please do not break my water
2nd & 3rd Stages of Labour
I am open to suggestions about different positions (all 4s)
Dim lights, calm environment
I would like to be as mobile as possible, walk around during labor
I want to progress free of any stringent time limits
Immediately after birth I’d like one hour skin-to-skin with our baby (even while placenta is being delivered). If I am unable to do this, I would like my partner to have skin-to-skin with our baby
Once our baby is born please keep the room as quiet as possible
Please delay cord clamping until it has stopped pulsing (keeping in mind we are doing stem cell collecting)
Please ask [HUSBAND] if he would like to cut the cord
I would like a physiological third stage, as long as labour progresses normally
If pre-37 weeks, allow vernix to soak in
Episiotomy
I would prefer to tear naturally than to be cut
Please use a warm compress when baby is crowning if I am not in the birth pool
No catheter
Vitamin K
I would like the baby to be given Vitamin K by injection
Placenta
I do not want to keep my placenta
Only if it’s not coming naturally would I want any injection
Breastfeeding
I am planning to breastfeed as soon as baby is born. Please support me with this and have a lactation consultant present
Thank you for respecting our birth intentions and helping us during this special time.
‘Natural Caesarean’ Preferences
Dear Ms/Mr...,
We realise that because of recent complications it has become necessary to have a C-section. We request to have as natural a C-section as possible following the guidelines presented below, as demonstrated by Professor Phillip Bennet, Consultant Obstetrician to Imperial Healthcare NHS Trust at Queen Charlottes and Hammersmith Hospitals.
Without compromising health and safety we would like a ‘family centered/ natural caesarean-section’
Yours sincerely,
To accomplish as natural a Caesarean section as possible we would like:
Mum will be relaxed and ‘within her birthing body’ so in the first instance any questions to go to Partner
Partner to be present
Mum’s relaxation music playing, ideally on a player but can do head-phones
Lights. We realize the need for bright lights around the area of operation but we ask for lights to be dimmed or darker when baby is passed to Mum
The drip in the non-dominant arm so that Mum can hold baby as soon as delivered
ECG dots away from front of chest so baby can be placed there after delivery. ECG dots to be placed on the back of shoulders and sides.
Delivery of baby to be slowed to allow lung fluid to be squeezed out of baby’s lungs.
Delayed cord clamping
Immediate skin to skin
All midwifery jobs to be done without separation of baby from Mum
If no medical problems baby not to be taken from Mum for at least an hour so she can have undisturbed skin to skin to really allow the oxytocin to flow
Support with breastfeeding
References:
Smith J, Plaat F, Fisk NM 2008 The natural caesarean: a woman-centred tech- nique by J Obst Gynaecol 115(8):1037-42