Creating your Birth Preferences
I use the term “preferences” instead of “plan” because birth is unpredictable and there may be things outside your control that necessitate a change in plan. It is important to remain open and flexible as things unfold, remembering that the ultimate goal is a healthy mom and baby.
Below are some possible ideas for you to include in your birth preferences. I’ve distinguished between my personally “recommended” statements and other “optional” statements, but know that it is all optional at the end of the day! You don’t even need to do a birth preference doc at all.
There are very thorough birth plan templates/tools out there, but I believe it’s best to keep short and sweet - a handful of bullets at most. The staff are more likely to be receptive and follow it. You can see that mine was extremely simple.
Some hospitals have their own birth preferences templates that you prefer you use so their staff are familiar with format (e.g. UCSF has this excellent template, here is CPMC’s)
You can also create a separate doc for your inner crew (partner/doula) with more details like positions, counterpressure moves, music, visualizations, if you want photos/videos taken, etc.
Review this doc with your partner and/or doula, as they will likely help advocate for you at the hospital
Bring two copies of the printed doc to the hospital and share with nurses upon admission into L&D room
Include the name of your pediatrician
During Labor
Recommended statements:
I would like to be informed and asked prior to all procedures
While you would hope most staff would do this anyway, unfortunately it is not always the case; you will feel like a more active participant in the birth experience if you are told what is going on
I would like for the room to be quiet and the lights dim
This can really improve the atmosphere of a hospital room and allow you the focus you need to manage through contractions
I would like to be able to move around freely during labor
This means wireless fetal monitoring that allows for mobility (vs. being tethered to the hospital bed). This is a no-brainer IMHO. Whether it is “intermittent” or “continuous” monitoring likely depends on if you have any high-risk factors, but if you have a choice, intermittent may be a better bet if you want to avoid overreactions that could lead to unnecessary interventions.
Optional statements:
I would like to minimize cervical checks; I do not wish to know the results of a cervical check
Cervical checks are when the doctors insert their fingers into the cervix to assess dilation
They will definitely do a check when you’re admitted to the hospital, and again if you are starting to feel the urge to push to assess if you are fully dilated, but often they will do additional checks in between to see how things are progressing
Some women find these checks uncomfortable or disruptive to labor, so wish to minimize; others find it demoralizing to learn that dilation isn’t progressing as fast as they thought, so they prefer not to know
I would like to avoid X procedure, unless absolutely medically necessary
This could be: saline lock, amniotomy/artificial rupture of membranes, pitocin to augment labor, episiotomy, use of forceps/vacuum, C-Section
You can read about the benefits and downsides here
For pain relief, I would like to use / I would like to avoid X
This could be: epidural, nitrous oxide, opioids
You can read about the benefits and downsides here
Remember - you can always change your mind!
During Delivery
Recommended statements:
During pushing, I would like warm compresses and counter pressure to reduce perineal tearing
This is an easy, no-downsides way to protect your perineum, and most nurses are very familiar with it
Optional statements:
During pushing, I would like to use a mirror
This can be very motivating, as you can start to see the baby head appearing. If you’ve had an epidural, it can be especially useful to have this visual feedback as you push, since you won’t be feeling physical feedback
But this isn’t for everyone, some people feel more of an “ick” factor here!
I would like to follow my own urges rather than being directed when to push
Most OB/midwives will coach on how to time your pushes with contractions, but some people prefer to just listen to their own body’s intuition which can also work great
In Case of C-Section:
Recommended statements:
I would like my partner / mother/ doula to remain with me the entire time
Most hospitals allow just one person to accompany you into the operating room
I would like to breastfeed as soon as possible
One of the downsides of a C-section is it may be trickier to breastfeed immediately depending on the circumstances of the C-section (e.g. anesthesia type) but let them know it’s a priority to do ASAP; usually it will be in the recovery room but sometimes it could even be right away in the operating room
Optional statements:
I would like the screen lowered so I can watch the baby come out
Some people want to witness the birth - you can even ask the doctors to describe what is happening - while others feel a bit queasy seeing surgery and prefer to wait until it’s over
I would like my baby to be swabbed with my vaginal fluid to support their microbiome
This is a new practice - called “vaginal seeding” - isn’t yet approved by the ACOG so your hospital may not be supportive
After Birth
Recommended statements:
Allow the cord to stop pulsating before clamping it
Delayed cord clamping is now best practice in most hospitals, but it’s still worth including here to be sure. Waiting a few minutes to cut the cord allows for more blood to be transferred to the baby, which gives baby an extra boost of iron.
Optional statements:
I would like to do immediate skin-to-skin
This is only in the “optional” section because it is now such an established best practice that all hospitals should be doing it anyway, so it may just clutter up your birth plan. But if you want to be extra sure, feel free to include.
My partner would like to cut the cord
This can be a special role for them to play, but it may also be an overwhelming and emotional time so it’s possible they will ultimately duck out. Also, if baby needs more urgent medical attention, the staff may need to cut it sooner themselves.
Allow the placenta to deliver spontaneously without pulling on the cord
Experienced doctors will do this gently and it can help reduce the risk of needing to remove the placenta manually; however, it can be uncomfortable and in most cases it will be delivered fine on its own (especially if pitocin is administered).
Please inform me before administering Pitocin and uterine/fundal massage
These can both be very helpful for stopping hemorrhaging and helping the uterus contract so I recommend having it done, but sometimes doctors do them automatically without informing you, which isn’t a great experience.
Newborn Care
Recommended statements:
Please do not bathe baby
It is now best practice to delay baby’s first bath - some hospitals now delay a few hours or days, but I recommend giving first bath at home, up to a week after birth. Here’s why:
Babies are born with a layer of white substance called vernix on their skin; it helps moisturize their skin and provides a protective barrier against infection. Bathing baby too early eliminates this useful protection.
Babies are also initially very bad at temperature regulation - leaving the bath makes them very cold, the stress of which can affect their blood sugar levels and make them then too tired to adequately breastfeed
Of course, nurses will still wipe away the blood and other birth gunk; and in the first week you should definitely spot clean any areas with spit up and obviously clean diaper area, etc. We’re talking about postponing a real full bath with soap.
Optional statements:
Please don’t administer Erythromycin ointment
This is an antibacterial eye ointment that protects baby from infection if Mom has chlamydia or gonorrhea. It is very important in those cases, so the establishment practice is just to give it to all babies. But most moms I know in happy, monogamous relationships are pretty darn sure they don’t have either disease.
While the ointment is perfectly safe for baby, it does blur their vision for a few hours, which can impact eye contact, bonding, and breastfeeding. So consider declining its administration if you’re confident you don’t have an STD.
I’d like to wait for the HepB vaccine until the first pediatrician appointment
HepB can be passed from an infected mother to her baby during birth and is a very serious disease, so as a precaution US hospitals now offer the vaccine as soon as possible for all mothers
But if mom doesn’t have HepB, there isn’t an important difference between giving it at birth vs. later in the first week
In fact, in most EU countries and in most provinces of Canada, it is only recommended at birth for babies of infected mothers
The reason some people opt to wait is it’s one less shot for baby to receive (and less of a tax on their little immune systems) during their first days on the outside
But you may also just want to get it over with while you’re there at the hospital
We would like to circumcise
Very personal choice, and one which you and your partner should align on in advance. Takes less than 20 minutes and usually performed the next day. The doctors will teach you about post-op care for the site (mainly keeping it clean and possibly vaseline + gauze).
Please do/do not take baby to the nursery
Most hospitals today advocate “rooming in” - keeping your baby in your recovery room throughout your stay, rather than having them spend time being cared for by nurses in the nursery. This is said to encourage bonding and promote breastfeeding.
However, there isn’t compelling randomized data to back this claim (paper) - in fact, if you’ve had a very exhausting and difficult birth, it may be safer for the baby for you to get a few hours break.
Some parents have a fear about baby mix-ups in the nursery, but most modern hospitals (like CPMC) have electronic ID ankle tags
You don’t need to decide this in advance, you can always change your mind! You might end up feeling like you don’t want to spend a minute away from your new baby, but it’s also completely understandable if you want to entrust the professionals for a bit while you recover from the serious and overwhelming ordeal that is birth!
