There are lots of things we’re told about pregnancy, but when it actually happens to you, you realise there’s so much more to learn. In Unexpected, we’ll chart some of the less spoken about things that happen in the months between finding out you’re pregnant and giving birth.
Birth is this huge life event that can go one of so many ways – naturally then, having some kind of plan in place makes a whole lot of sense.
After all, you wouldn’t turn up to your wedding without every detail ironed out, or even go on holiday without some form of itinerary, so why should the birth of your baby be any different?
A birth plan basically lets you share your wishes for what you’d like labour and after the birth to be like. While it’s not set in stone, it can be very useful for ensuring everyone’s on the same page when those contractions kick in.
Some healthcare professionals prefer to call them birth preferences. Registered midwife Marley Hall (aka @MidwifeMarley) explains this is because the word ‘plan’ can sound “quite rigid” – and if you write things on your birth plan, they’re not necessarily guaranteed to happen.
“The whole point of writing your birth preferences isn’t so that everything you write, you get,” she says. “It’s a process of becoming informed.
“So it’s basically about the process of understanding what your choices and what your options are, so that when you’re in labour, if there are any obstacles that come in the way, you can ask questions.
“You can tailor them [birth preferences] to you, and what you want and what you don’t want, and what matters to you and what doesn’t.”
It’s also really helpful for your birth partner to see your preferences so they can advocate for you when you’re in labour – a time when you might not necessarily feel up for advocating for yourself.
For example, you might put in your preferences that you really want to avoid laying flat on your back to give birth. While we often see women giving birth on their back in films and TV shows, it can be better to have gravity on your side.
Upright positions can include: sitting on a birthing stool, ball or cushion; kneeling; dropping onto your hands and knees; and squatting.
So what can you include in your birth plan?
There are lots of things you could consider in your birth plan, including:
- Where you want to give birth – do you want to do it at home, in a midwife-led birthing unit or on a labour ward?
- Who you want to accompany you when you give birth (your birth partner) and whether you want them to be in the room if you need an assisted delivery or caesarean section.
- What kind of pain relief you would like to opt for in labour. Some people stick to things like paracetamol, breathing techniques and gas and air, while others might opt for something stronger like pethadine or an epidural. Some opt to use the birth pools as a form of pain relief – in a similar way to how a hot bath might relieve period cramps. Others will choose TENS machines (not all hospitals have them so you might need to bring your own).
- What positions would you like to adopt for birth?
- Do you want to give birth in a pool or not?
- How would you like your baby to be monitored during labour? Would you like continuous monitoring or intermittent monitoring using a doppler?
- What do you want the environment to be like – do you want music on? Would you like lights dimmed? Would you like there to be minimal people in the room with you? Are you comfortable with having student midwives there?
- Do you want to opt for delayed cord clamping?
- Do you want the vitamin K injection for your baby?
- Are you happy to have vaginal exams throughout the course of labour?
- If you are advised to have an assisted birth, would you prefer to have forceps or a vacuum delivery?
- Who would you like to cut your baby’s umbilical cord – the midwife or your birth partner?
- Do you want ‘skin to skin’ after birth, and if so, do you want the baby lifted straight onto you or wiped down and wrapped up first?
- Do you plan to breastfeed afterwards or bottle feed?
- How you would feel about having an episiotomy? “Some people would rather tear,” says Hall. “The episiotomy should only really be done to make space for instrumental birth – so assisted birth with forceps. But we’re finding they’re being used a lot more than that. If you don’t want to have one, you can say you’d rather tear.”
What shouldn’t you put in your birth plan?
Obviously anything that’s irrelevant to your birth, or details about how your pregnancy was really healthy, are not really useful for your birth plan.
Just focus on what you definitely do and do not want to happen during your labour – and be reasonable about it.
“When you give birth, it’s a huge event – and it has a huge physical and mental impact,” says Hall. “So you can write down whatever you want to write down.
“Obviously if you put down you want a four-course gourmet meal after, then perhaps you want to go to a private hospital,” she laughs. “There obviously are limits.”
It’s good to bear in mind that there are instances where things might not happen as you’d expect them to. For example, if you want an epidural, you won’t necessarily get one immediately after asking for one.
In fact, you might have to wait some time for an anaesthetist to become available. The same goes for requesting birth pools, sometimes there are simply none available and you have to give birth on a bed instead.
“Some people put in the preference for a female doctor or female midwife, and whilst the majority of health professionals that work in this field are female, some are male and often it depends on who’s available on the day,” says Hall.
“Whilst the staff will always try to accommodate whatever people ask for, it’s not always possible. This is why we can’t call it a birth plan really because it’s just not rigid – there has to be some leeway.”
How long should a birth plan be?
Your birth plan can be as long or short as you’d like, just remember that your midwife will need to read through it and your birth partner will want to remember everything that’s on there – so a 50-pager of preferences is probably not advised. Bullet points might be a bit easier to digest.
Hall says one of her clients simply wrote their name, the fact it was her first baby, any medical problems she had and requested no vaginal examinations – and that was it.
But others might have a list of preferences, as well as a plan B, C and D in case they require a caesarean section, assisted birth, or need to be induced.
The midwife is a firm believer in planning for a few eventualities. “So if someone’s planning a home birth, for example, they need to be educated on normal physiological birth and how birth should go, but also what would happen if they needed to transfer to hospital,” she says.
“Or if they needed an assisted birth, or what would happen if they needed a caesarean section? I think everybody should be educated on those things.”
While people should absolutely think their birth experience will be positive and amazing, they should still be realistic: sometimes the plan changes.
“If there is an untoward event like a cord prolapse … that is an emergency so we need to get baby out quickly,” says Hall. “Those kinds of things you can’t always predict. So because of that, it’s ideal that you know what would happen in a situation where there’s an emergency caesarean section and if you did have one, what would your preferences be?”
For example, would you like to breastfeed while you’re in theatre? Would you like a gentle c-section? What about delayed cord clamping?
“People assume you have a surgical birth and the baby gets taken away – but that’s not the case,” says Hall.
“You can actually have the baby, baby gets put on your chest and the baby can stay there until you’re moved to the recovery area. So I think it’s important to look at different scenarios, but not focus too much on the scenarios that you don’t want to happen – just educate yourself about them in case they do.”
When should you write your birth plan?
You can start writing your birth plan whenever you like – the crucial thing is that you ensure you’ve gone through it with your midwife by 36 weeks, says Hall.
This gives you a chance to ask more questions about anything you’re unsure of, or to find out a bit more about the labour process.
“Every birthing unit, birth centre, hospital, has different policies so it’s always good to get any questions out in the open by 36 weeks,” says the midwife, “just to make sure that all is OK and that your birth preferences will be adhered to and listened to.”
You can download birth preference templates online and often, with NHS hospitals, you’ll be given a maternity book which has an A4 birth plan template that you can fill in. If you haven’t been given one, you can download it here.
If you do start writing your plan at 12 weeks, then save it on your laptop so you can go back to it and edit it – this is important, because if you develop pregnancy complications you’ll be able to change it easily.
Do midwives find all of these demands quite annoying? Actually no, suggests Hall. “I can only speak for myself, lots of midwives are different. I find it helpful because it means I don’t have to keep asking questions over again,” she says.
“If someone writes that they want to have vitamin K for their baby, then I haven’t got to sit there and talk to them about vitamin K and what it is.
“All I have to do is say ‘hey, is it okay if I give baby vitamin K now?’, just get that quick bit of consent before I go and give the injection … otherwise I’d have to sit there and tell them what it is, what it’s about, the risks and benefits.
“So I think it’s helpful.”
