How to write a birth plan

It is always worth writing a birth plan, it helps the professionals understand how well prepared you are. Christine Hill guides you through the process

Making a Birth Plan

Many hospitals (but not all) ask you to write a birth plan before you have your baby.

What's the point?

Your midwife is not only anxious to make sure your baby is safely delivered, she wants you to have as good an experience as possible. A birth plan gives her an indication of how well prepared you are, and what sort of birth you would like. It also helps her to know if she is caring for a woman with realistic expectations, or one with romantic or impractical ideas that may jeopardise her baby's well-being. Through making a birth plan you will find information that helps you to understand and prepare for the birthing process.

Drawbacks?

The paradoxical problem with a birth plan is that you can't plan the birth. Be very wary of any antenatal teacher who says that you can. A healthy baby is more important than a particular type of delivery.

You must be flexible. You can plan the type of birth you would like to have but, as Fiona Gibson says in her article 'Birth Plan? You're joking', things don't always work out the way you hoped.

What should I write down?

There are two issues that are relevant to everybody:

I would like to keep an open mind about pain relief.

In saying this, you are acknowledging that you can't accurately predict how your labour will go or what effect the pain will have on you.

I would like to see a doctor after about an hour's pushing.

Most obstetricians and obstetric physiotherapists agree that it is not in the interests of a woman's long-term health to push for too long. An obstetrician will be able to check that your pelvic floor muscles are not becoming overstretched or damaged.

Other issues to think about:

Use of the birthing pool

If the hospital has one, it is a perfectly reasonable request to put on your birth plan but it is worth prefixing it with a question mark - however sure you may be before you go into labour. Contrary to what you might have read or been told, you really will not know if water will suit you during labour until you actually try it. You don't want the embarrassment of insisting that you want a water birth and then finding you don't find water at all helpful.

Do you want your baby delivered straight onto your tummy, or not?

Some women feel strongly that they want to receive their baby immediately, and some women don't even want to hold their baby until he/she is all wrapped up in a blanket. From your baby's point of view it's irrelevant. Whatever you feel you want will be the right thing to do.

Does your partner want to cut the cord?

Again, it doesn't matter, but if your partner has strong feelings one way or another mention it to your midwife.

Birth plan issues that women feel strongly about:

  • Episiotomies The decision to do an episiotomy, or to let you tear, is made by the person who delivers you and it is important to trust their judgement. Some people mistakenly believe that it is terribly important to avoid an episiotomy at all costs. But a third degree tear (which involves the anal sphincter muscle) is bad news. An episiotomy should avoid this happening.

  • Staying mobile during labour

    Most hospitals monitor the woman for about 40 minutes when she is first admitted to hospital. This is so the midwife can record the baby's heart rate during contractions and thus check that the baby is well. During this initial monitoring, you are likely to be propped up in bed, with a belt round your tummy, which is hooked up to a computer screen. It is certainly not the most comfortable position to be in during early labour. However, as soon as the midwife is happy that your baby's heart rate is normal, the monitor will come off, and your midwife will encourage you to adopt any position you find comfortable during a contraction. If the midwife insists that you have to stay on a monitor, it is likely to be because she is concerned about your baby's heartbeat. You won't want to ignore that.

  • Having a 'mobile' rather than a full epidural

    Whether you are offered a mobile epidural depends on which hospital you are in and which anaesthetist you have. You may not be able to choose. In any case, the best way to use the pain-relief benefits of an epidural is to rest and re-charge your batteries for the birth.

  • Avoiding forceps or Ventouse

    This is another decision for the professionals. If your baby needs an assisted delivery, it is usually because he or she needs to be delivered quickly or is stuck.

  • Syntometrine

  • This is a combination of drugs that is usually given routinely after your baby is born and before the placenta is delivered. It stimulates the uterus so the placenta can be delivered quickly. This helps prevent the risk of a post partum haemorrhage (PPH), which is dangerous. Some people (no-one who is medical) have a view that it is not 'natural' and is therefore unnecessary. But studies have shown that you are three times more likely to have a PPH if you do not have Syntometrine.