Things to consider when writing a birth plan including information on planning your labour, your baby's delivery and your care.
A birth plan is a written record of how you'd ideally like your labour, delivery and care afterwards to proceed. It can include anything you feel strongly about.
Your birth plan - points to consider including:
Where do you want to have your baby?
Most women choose to give birth at hospital. However home deliveries are much more common these days, but even so, women over 35, under 18 or under five feet tall are generally advised against a home delivery. Your previous childbearing history and health during this pregnancy will also be taken into account. Possibly because there is no way of knowing whether or not first pregnancies are going to result in an uncomplicated delivery, many GPs and midwives prefer first-time mums to have their babies in hospital.
What type of pain relief do you want?
What is available and what do you want in the labour suite?
- Entonox - Breathed in as a contraction starts, this 5O-5O mixture of oxygen and nitrous oxide reduces pain but can make you light-headed, nauseous or sleepy.
- TENS - There may be a charge for using this machine, which uses electric currents to interfere with the pain signals being sent to your brain. Some women find this very effective while others find it only helps during the early stages of labour.
- Pethidine - Takes about 20 minutes to work but the relaxing, pain relieving effects last for up to four hours. However, it can make some women nauseous and it can affect your baby's breathing when it is born, in which case an antidote is given.
- Epidural - A nerve-numbing injection which usually gives complete pain relief. It can only be administered by an anaesthetist so, if you think you might opt for this form of pain relief, check that there is always one available at the hospital where you would like to give birth. It can only be given once labour has progressed to a certain stage and, as the anaesthetic has to flow into the spine through a special tube, it takes about 40 minutes to take effect. However, after that, the anaesthetic can simply be topped up as required. The down side is that you have to stay in bed during labour, you and your baby will need to be monitored and you won't be able to get out of bed for several hours after your baby has been born.
- Alternative pain relief - There are other ways of relieving pain. A warm bath can be helpful in the early stages of labour. If you are considering using complementary therapies, such as acupuncture, reflexology, homeopathy, hypnosis or aromatherapy during labour, discuss this with your GP or midwife and check that the practitioner you choose is properly trained and experienced in providing this therapy during childbirth.
Check if yours has the following:
- Birthing pool
- CD or cassette player
- Tea or coffee making facilities
- TENS machine
- Beanbag, foam wedges and pillows
If certain things you require aren't available, ask if you can bring your own.
How do you want to give birth?
What do you think about walking about? - If you want to be able to move around freely during labour, say so, as this will influence the way your baby's heartbeat is monitored. A monitor strapped across your tummy or attached to your baby's head will restrict your movements.
Which position? - Although most women choose to have their baby in a semi-sitting position in bed, there are other positions you can adopt during labour. Walking can speed up contractions and dilation of the cervix but even standing helps, especially if you rock your pelvis from side to side. Kneeling on all fours is a position many women instinctively want to get into during childbirth. In the second stage of labour, leading up to the actual birth, some women find an urge to kneel against their partner, a beanbag or the edge of the bed while others choose to squat. This is a good, if tiring, position as it widens the pelvis and allows gravity to speed up the process.
What do you think about being induced? - If your baby still hasn't arrived a week or two after your estimated date of delivery, do you want the birth to be induced? Either a hormone pessary is inserted into the vagina, which may be enough to start everything off, or a drip containing a stronger hormone is put into your arm.
What do you think about having your waters broken? - Artificially rupturing the sac of amniotic fluid surrounding your baby can speed up labour, with some hospitals carrying out this procedure as a matter of course. However, as well as increasing the frequency of the contractions, it can also make them more painful. If you would prefer your waters to break naturally, mention this in your birth plan.
What do you think about having an episiotomy? - Sometimes it is necessary for a small cut to be made to the vagina to help your baby to be born. This is done with a local anaesthetic and is stitched after the birth.
What do you think about having an assisted delivery? - If pushing alone isn't going to get your baby out, ventouse or forceps may be used. A forceps delivery involves the doctor pulling the baby out, while you are pushing, with a piece of equipment not unlike a pair of large metal spoons. In a ventouse delivery, a soft cup is attached to your baby's head using suction so he can be pulled out by the doctor as you push.
What do you think about having a Caesarean? - Although some women choose in advance to have a Caesarean, sometimes an emergency Caesarean is required so your baby can be born as quickly as possible. There are various reasons for this, including the baby being in breech position (feet first), pre-eclampsia, or the mother and baby may be exhausted. Women who are to undergo a Caesarean are usually given the choice of an epidural or spinal block (which means you are awake during the operation) or a general anaesthetic.
Who will help you have your baby? - Mention in your birth plan if you would like to be looked after only by female midwives and doctors. You should also state if you do not want medical students present.
Other points to consider when giving birth:
Who do you want as your birth partner?
- Do you want your partner to cut the umbilical cord?
- Do you want to be told the sex of your baby or do you want to make the discovery yourself?
- Do you want your baby cleaned before he is given to you or do you want him put into your arms immediately?
- Do you want an injection to help contract your womb and speed up the delivery of the placenta?
- How will you feed your baby? If you are going to breastfeed, it helps to put him to the breast as soon as possible.
- Do you want your baby to be given Vitamin K (either by injection or by mouth) to prevent a rare but serious blood clotting disorder.
- Do you want to be left alone with your baby and your partner for a few minutes immediately after the birth?
It is common to have your husband with you when you give birth, but this is your choice. Some women prefer to have their mother or friend as their birth partner instead.
Though obviously you are able to choose your preferred methods of giving birth you do have to be flexible as there's no way of knowing if your labour will be straightforward.