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Nine Months : Birth Plan

What is a birth plan?

A birth plan is an outline of how you want your labour and birth to be managed. Once you've written down your wishes, you feel more confident and in control of the situation.

Some hospitals provide the birth plan format as part of the other documents in your hospital file which is given to you at your first antenatal visit. Even if the hospital does not provide one, you must write one of your own. Although not an essential document, it is definitely advisable to write one (especially if this is your first pregnancy).

When is it written?

Although a birth plan can be written at any time in pregnancy, it is best to write it in the third trimester because then you would have looked at all the various issues of childbirth and labour more closely. Whenever you write the plan, your midwife will discuss and sign the birth plan sometime between week 32-34.

It is a good idea to write the plan after attending ante-natal/parentcraft classes since these classes discuss labour and childbirth in quite detail.

Who writes it?

Your birth plan is written by you and signed by your midwife. However, you can take help from various people in completing the plan. You may wish to discuss it with your partner, midwife or even other mothers-to-be. Remember that it is your birth plan and you have complete say in it.

What all does a birth plan outline?

A birth plan may contain some or all questions similar to the ones detailed below:

Whom do you want to have with you as your birth partner during labour? It could be your partner, friend or relative. For safety reasons, you may be asked to restrict the number of birth partners to two only. (However, the hospital policy determines how many are allowed as some may allow only one.) You could also mention whether you want your birth partner to be present if you get stiches or undergo a caesarean.

Do you want to be as mobile as possible during labour?

What type of positions would you prefer to be in during labour and delivery? You can choose to be sitting upright, squatting or anything that keeps you active and comfortable. You may even leave the option open and decide at the time what feels comfortable.

What type of environment would you prefer? You could have dim lights, music, cushions, bean bag, birth pool etc.

If you are planning to use bean bags, birth pool etc., it is best to check with the hospital if these facilities are available.

What are your feelings about being induced if you go past your due date?

How do you feel about foetal monitoring?

Would you agree to an enema, if required? Although bowels are not emptied artificially nowadays during labour, it may be a policy in certain hospitals. However, you can state your wish on the plan.

Would you want your pubic hair to be shaved? Again, most hospitals don't shave hair for routine delivery but it may be required for a caesarean. It is best to write your views.

How would you feel about speeding up labour artificially, if required? Sometimes, contractions may stop in the first stage. They may need to be speeded up either by breaking waters artificially first (if not already broken)or by giving a drip of a hormone called syntocinon.

Would you like to make use of breathing and relaxation techniques learnt in your ante-natal classes?

Would you mind if medical students are present during your labour and delivery along with doctors and midwives?

Would you want to be cared by women professionals only?

Do you need any interpreters?

Would you be using any pain relief during labour?

If using pain relief, what preferences do you have? You can choose from gas and air, pethidine, TENS, epidural or alternative methods. If using TENS, remember that you may need to hire your own machine.

If an epidural is required, what is the hospital's policy? As an epidural can be administered by an anaesthetist only, it may be useful to know if one is available at all times.

What are your feelings about assisted delivery (using forceps or ventouse)?

Would you prefer an episiotomy as opposed to tearing naturally?

Would you want to see your baby's head being delivered?

Would you want your birth partner to cut the umbilical cord?

Would you like the baby to be delivered straight onto your abdomen or cleaned before being handed over to you?

How do you plan to feed your baby (breast or bottle)?

If breastfeeding, do you want the baby to be put to the breast straightaway?

How would you like the placenta to be delivered? (Naturally or through the use of syntometrine which speeds up the delivery of the placenta)

Do you want your baby to have vitamin K? Although you can choose between an injection and by mouth, an injection is more effective than the other route.

Things to remember

The way you want to have your labour and childbirth depends not just on your birth plan but also on your medical condition and what is available in the hospital.

A birth plan is not written in stone. You can change it anytime you want if something you wrote before does not make sense anymore.

Keep a copy of the birth plan with you and use it once you are admitted in the hospital.

It is best to be flexible at all times so that you and the baby are not at risk at any point.

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