How to Create Your Birth Plan: A Checklist for Parents

By their second trimester, most expectant moms have researched childbirth, and they realize that delivery can be personalized in a myriad of ways. That's why they're often encouraged to write a formal birth plan—to record choices they may be in no position to articulate once labor rolls around. "It's tough to convey preferences in the middle of a contraction," observes Penny Simkin, a childbirth educator in Seattle. "A birth plan gives you a voice during labor."

What Is a Birth Plan?

A birth plan is a written document that helps mothers achieve the labor they've always envisioned. It's essentially a personal wish list for your ultimate birthing experience. The concept was introduced about 20 years ago as an outgrowth of the natural childbirth movement, but birth plans are by no means exclusive to women who expect to deliver vaginally.

"Even someone who has scheduled a C-section has a vision of what she wants her delivery to be like," Simkin says. A birth plan lets her specify that she wants her partner by her side throughout the procedure, for example, or that her baby should be placed on her chest immediately after birth.

Creating a birth plan doesn't have to be a complicated process—all you need is some time to reflect on some important questions pertaining to your birth experience. It lets you identify the issues that concern you most, and prepares you for discussing them with your health care provider or birth attendant.

Birth Plan Checklist

Every labor and delivery is different, so it helps to familiarize yourself with the possibilities. Remember that formulating a birth plan doesn't guarantee a seamless experience. No matter how you go about it, always bring a flexible attitude and a sense of adventure, especially when considering these six important items to add to your birth plan checklist.

1. Where would you like to give birth?

Moms-to-be can choose between three main locations for giving birth: a hospital, a birthing center, or their home.

Hospital: Ninety-nine percent of all births occur in a hospital. For a homier setting, look for a hospital with birthing rooms. These specially equipped facilities feel more like a bedroom than a traditional delivery room, and you can stay in them from labor through recovery.

Birthing Center: Certified nurse-midwives usually provide the bulk of care at a free-standing birthing center (also known as a maternity center). These facilities tend to emphasize low-tech approaches to childbirth and are best for low-risk pregnancies. If complications arise, you may have to be transported to a hospital (each center has a relationship with a specific hospital) for a different level of care or emergency care.

Home: A very small but growing number of couples opt to give birth at home, assisted by a qualified physician or certified nurse-midwife. This is a safe option only for women in excellent health who have had low-risk pregnancies, and optimally, who have already been through at least one complication-free childbirth. Back-up plans should be in place in case a transfer to a hospital is needed.

2. What's your ideal labor environment?

Describe what you'd like your labor experience to look like, including elements such as:

• I can walk around, try different positions, etc.
• The lights are dim.
• Our favorite music is playing.
• There's a TV.
• There's a bath or shower available.

3. Who do you want present during labor?

In the throes of labor, you might not have the energy to turn down an unwanted visitor in the delivery room. Specify who you'd like to be present during childbirth, such as a spouse or partner, labor couch, doula, or other family members and friends. Be sure to ask if your birthing site limits the number of people who can be in the room with you.

4. Is there a special birthing apparatus and/or position that appeals to you?

Some women want to deliver their baby on a birthing bed or chair.

Birthing bed: Many birthing sites now have special beds that are designed for both labor and delivery. The back can be raised or lowered to support different laboring positions. Options (which vary from one setting to another and should be discussed with healthcare providers) may include:

• Lying down: On your back, with your head flat or elevated, and your legs elevated
• Side-lying: With one leg elevated (this option is particularly good if you're tired or having trouble with your blood pressure level)
• Kneeling: On the lower part of bed with your arms or upper body resting on upper section (this posture eases backache)
• All fours: With your stomach facing down, supported by your hands and knees (this position takes advantage of gravity and eases backache)
• Squatting: On your feet, with support from bed or partner (this position takes advantage of gravity and shortens the depth of the birth canal)

Birthing chair: Some birthing sites have these special chairs or stools, designed to support a woman in a squatting or sitting position. They allow women to benefit from gravity and see more of the birth, but may cause increased tearing of the perineum (tissue between vagina and rectum).

5. What would be part of your ideal labor and childbirth?

There are many factors that make up someone's ideal delivery experience. Read the birth plan checklist below to figure out which options appeal to you.

• Intermittent external fetal monitoring ( allows for moving around) or continuous external fetal monitoring (usually requires you to stay in bed)
• Pain relief medication (such as epidurals and intravenous narcotics) or no pain relief medication
• Episiotomy (an incision in tissues of the perineum, beneath the vaginal opening, to enlarge the vaginal opening and to prevent tearing) or no episiotomy. Women who opt against an episiotomy may use local massage, warm compresses, etc., to lessen discomfort and reduce the chances of tearing.
• Your partner or the practitioner cutting the umbilical cord.

6. Which postpartum options interest you?

Birth plans often include postpartum decisions related to the umbilical cord, circumcision of a newborn boy, and "rooming" with your newborn. Read more about the birth plan options here to decide whether you want them.

Umbilical cord blood donation or banking:

The blood in a baby's umbilical cord was once routinely tossed away, but now it's seen as a valuable medical asset. Cord blood is enriched with stem cells, which can be used to treat over 50 life-threatening diseases. Drawing the blood is quick and risk-free—and it's definitely painless, since it's done when the cord is no longer attached. But you do need to arrange for a collection ahead of time, because cord blood banks, where the collected material can be stored, are not available in every community.

Some parents choose to bank the cord blood privately, so that they can have access to it later; this is seen as a sort of biological insurance against possible illness in their child's future. This is a costly option, though, and the American Academy of Pediatrics encourages donating the cord blood or blood stem cells to a public cord blood bank instead. Parents should consider privately banking the blood only if a family member has a current or potential need for a stem-cell transplant. Discuss the matter with your healthcare provider. For more information on cord blood donation, contact the National Marrow Donor Program.

Circumcision:

Circumcision is the surgical removal of the foreskin, which covers the end of the penis. The procedure is usually done in the first few days after birth. As of 2010, about 58.3 percent of baby boys in the U.S. were circumcised, according to the Centers for Disease Control and Prevention (CDC), but the practice is much less widespread in other parts of the world. Though medical research shows some medical benefits of circumcision, the American Academy of Pediatrics states that the benefits are not sufficient to recommend the procedure as routine for all boys.

Some parents may want their sons circumcised for religious, social, and cultural reasons. Others are concerned that circumcision desensitizes the tip of the penis, causing a decrease in sexual pleasure. Since circumcision is not essential to a boy's health, parents should choose what is best for their son by talking it through and exploring the benefits and risks.

Rooming In:

Some hospitals allow parents to keep their newborn with them in their room, rather than in the hospital nursery. You can state your feelings about this before birth, but feel free to change your mind later on. Here are your options:

• Rooming in at all times from birth on
• Delayed (baby with you after an initial recovery period)
• Partial rooming-in (baby with you during the day, but not at night)
• Nursery (baby brought to you according to your schedule and baby's needs)

Format for Creating a Birth Plan

As you gather your ideas, be open to the unpredictable nature of labor, suggests Kathleen Slone, a certified nurse-midwife in Baltimore. You may have firm ideas about holding your baby right away, for example, but you should avoid sounding adversarial or overly demanding. Always preface each statement with "All things being normal, I'd prefer . . . "

Pam Cass, a certified doula from Warrenton, Virginia, suggests opening with a statement like "I realize that any birth may take unexpected turns. These goals reflect my idea of a model birth, and I thank you for your support in helping me achieve as many of them as possible."

Then emphasize one or two of your most important objectives, she suggests. (You might underline them or put them at the top of your list.) Focusing on the issues that mean most to you can help you feel good about your labor — no matter what happens. "I attended a birth in which the mother needed several interventions that she had wanted to avoid," Cass says. "But because she wasn't separated from her baby after delivery—her top priority—she felt everything was great."

A good birth plan, however, should be more than a list of preferences; it should convey a sense of who you are. For instance, you might write, "I've never been in a hospital before except when my grandmother was dying, so I'm a little fearful" or "It took us nine years to get pregnant, so we want every bit of technology you've got to ensure that our baby is born healthy."

"Disclosing a little personal information can make the hospital staff more likely to rally around your plan, because they'll see you as a person, not just a patient," Simkin says.

When Should I Write a Birth Plan?

You should start thinking about what to include in your plan as early as your second trimester, though you needn't put it down on paper until the 32nd through the 36th week of pregnancy. Bring up your questions with your obstetrician or midwife, and negotiate any areas in which you might have different viewpoints, suggests Slone.

Once you've written your plan, give a copy to your doctor and schedule an appointment that will be slightly longer than usual to discuss it. Make sure the plan is part of your medical records, which are automatically sent to your birthing site.