Expert Advice: What To Consider In A Birth Plan

As a professional labor and delivery nurse, one of the biggest problems that I face in caring for patients is the dreaded birth plan. There, I said it. We hate them. Although I appreciate you putting so much time and effort into your labor and delivery experience, I need you to understand that these are preferences. We may not be able to accommodate all of your requests and that is okay! So let me break it down for you.

I love that you have done your research and you know what you want. I also plan on you and your baby staying safe during this birth experience. This is where we might collide. Your birth plan says no IV site, no fetal heart monitoring, and freedom of movement throughout labor. I can’t always accommodate those requests due to your medical history, prenatal history, test results, or previous tracings. It is a safety issue. I promise I care about your experience.

What should this birth plan include? It can be as simple as I don’t want anyone in the room and I want the lights off to 10 pages of preferences, but let’s discuss the basics for now. How do you want the atmosphere of the room? Lights on or off. Soft music, television, or absolute quiet. Who is going to be in the room when you labor and when you deliver? Do you want to use essential oils? Do you have a doula? What position do you want to labor in? What position do you want to push in? Do you want to use the birth tools like the peanut ball, labor ball, or squat bar? What do you want for pain management? It is time to express whether you really want this to be natural, IV pain medication, or are you considering an epidural.

While we are talking about this, decide if you want to be fully supported with no exceptions or if there is a reasonable time to decide what you do, in fact, want that epidural and you want it now. Do you want a mirror to see your baby? How do you feel about an episiotomy? What about a forceps or vacuum delivery, are you open to that? Who is cutting the cord? Do you want delayed cord clamping? After the baby is delivered, do you want to go immediately skin to skin for bonding or would you prefer to just have the baby wrapped up in blankets? Do you want some time to bond with the baby before visitors are allowed in? It is also important to include your feeding preferences, breast or bottle.

No one ever wants to talk about the other side to this birth plan, but it is necessary to plan for everything. Outside of a true emergency, what are your OR preferences? Who is your surgeon? Do you want a spinal or general anesthesia? Do you want to attempt skin to skin with your baby in the operating room? Who, if anyone, can see your baby while you are in recovery?

The last things to really plan for is newborn care. Some people like to delay the bath, while others want their baby bathed right away. Generally, babies receive three medications after birth: erythromycin ointment in their eyes, a vitamin K injection, and a hepatitis B vaccination. It is important to include this on your birth plan, especially if you want to decline any of the medications. Who is your pediatrician? It is also important to include your feeding preferences, breast or bottle. If you would like to take your placenta home with you, have it encapsulated, or anything other than it staying at the hospital, this needs to be told upfront.

RELATED: 10 Things To Consider When Writing Your Birth Plan

As you can see, there is a lot to think about. It can be overwhelming. It is good to think ahead of time what you want so you can be clear about your preferences. It is also good to understand that although we value and respect your birth plan, things to happen that warrant different actions. In this case, safety trumps the birth plan.

Jamie Prock, RN-BSN, is an OB Nurse currently practicing within the Indian Health Service.

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