Creating a Birthing Plan

A birthing plan simply outlines and clarifies your preferences for labor and delivery. The process of thinking through your options and discussing them with your doctor beforehand is much more important than actually showing up at the hospital with an itemized list. Your coach or partner can help make sure your wishes, where possible, are carried out on the delivery day.

Keep in mind that a birthing plan describes an "ideal" scenario. In fact, it's probably best to think about birth preferences, rather than a concrete plan. You should be willing to be flexible -- you may change your mind about certain things when you are actually in labor, or your health care provider may feel that steps are medically appropriate even though they are not what you would have preferred.

So what's to prefer? Births are a little like weddings - you've probably been to weddings that you think are lovely and tasteful and elegant, and you've been to others that you thought were vulgar and tacky. But the bride and groom chose to spend their day with that cake, those flowers, and that DJ - and it was right for them. Similarly, some women want to have a birth without any pain medicine and minimal medical intervention, and want to hold and bond with their baby immediately after birth, amniotic fluid and all. Other mothers would happily have an epidural placed before the first contraction, and would like their baby washed, with lots of soap, diapered, and dressed before touching him or her for the first time. Within the realm of what's safe, there are lots of different "right" ways to have a birth. You and your partner should think about what works best for you.

The following are some of the key issues -- think about your preferences, then talk to your practitioner or the hospital to learn about general policies. Discuss the risks and benefits of the various options. You may have to fill out specific forms or releases concerning many of these items ahead of time.

• How do you feel about using medication for pain relief in labor? Do you want to try to go without pain medicine, or would you prefer to have anesthesia as early as possible?
• Would you like to be able to labor in a tub or shower, if one is available at your chosen birthing center or hospital?
• Is there anything you want to bring to the hospital? Check the hospital's guidelines about videocameras, music, pillows, lights, etc. Some hospitals have rules regarding video taping the birth.
• Who do you want to be present during labor? During delivery? Is there anyone you specifically want kept out of the room?
• What is the role of your coach?
• Is there a particular delivery position or procedure you would like to follow? How do you feel about the use of stirrups to brace your legs? If you do not want to use stirrups, who will be with you to help hold your legs when you push?
• Would you like to have a mirror in the room when you are pushing, so you can watch your baby emerge?
• Do you have strong feelings about assisted delivery methods (forceps, vacuum extraction) or cesarean delivery?
• If you have a cesarean, would you like your partner or coach to be present during the surgery?
• Who do you want to cut the umbilical cord?
• Do you want to hold your baby immediately after birth, or do you want her washed and swaddled before you meet her for the first time?
• Do you have specific desires about a bonding period with the baby after birth?
• Do you have strong feelings about receiving a routine IV to replenish your fluids?
• Are you planning to breastfeed? If so, how do you feel about having your baby stay in your room after delivery? Would you like to avoid pacifiers or supplements, unless ordered by your baby's pediatrician?
• Do you want anyone from the hospital to help you with breastfeeding, or to explain bottlefeeding or other babycare issues?
• Do you want a male baby to be circumcised?

Some other issues routinely come up in books and web sites about birthing plans, but are rarely used at hospitals today. Check with your health care provider to make sure, but generally, you won't be offered an enema, nor will your pubic area be shaved, unless you specifically request it.

There are other issues besides those listed here. As you continue to read about labor and delivery and talk to others who have gone through it before (especially if you can talk to women who have delivered at the same hospital), you will gain a better understanding of where you stand on the issues.

Don't feel like you need to have a strong position on all of these topics. While women and their partners are, in general, more active in the decision-making process than they were in the past, many women still rely heavily on their practitioner and other attending staff to guide them through the process.

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