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Now it’s time to get to the nitty gritty – how do I write a birth plan that is realistic, will be well received and leaves me looking forward to my birth experience? As with everything to do with your birth it all boils down to your care provider. Whether you have chosen a care provider who cares about and supports your birthing goals will help you to decide how you will word your plan. If you have chosen a care provider who believes in your ability to make great decisions for your birth then you plan will likely only need to be very brief and cover “in case of” scenarios. If you have chosen a care provider who actively does not support your birthing goals then you need a new care provider before you need a birth plan! The information I am providing is on the assumption that you are birthing through an Australian public hospital and are receiving “standard care”. So I am assuming that you will be seeing different midwives and OBs over the course of your pregnancy and that you won’t necessarily know the care providers that you will have in labour and birth and also that you will be “encouraged” to follow hospital policy in regards to testing and procedures.

 
As a doula I would greatly encourage women to think about their pregnancy plan as a first step. Write down all the tests and procedures you will likely be offered and then do a little reading on each one and decide whether you would like to consent or decline. Low risk women in the Australian public system will generally (but not always, so check with your provider!) be offered: An early pregnancy dating scan as well as various blood tests to check for vitamin and mineral levels, STDs and general wellbeing; the Nuchal Translucency scan at 11 -13 weeks; The Morphology scan at 20 weeks; the glucose tolerance test (GTT) at 28 weeks, If you are rhesus negative you will be offered Anti-D at 28 and 32 weeks, GBS swab at 36 weeks, you may be offered a late pregnancy growth scan and you may also be offered a stretch and sweep induction starting from 38 weeks. There is various evidence both for and against each of these and it is well worth doing some research into each of these and forming your own opinion on whether it is necessary for you.

 
When preparing a Birth Plan I like to include a short introductory paragraph which introduces you and broadly states your birthing goals. For example: “I had a previous traumatic caesarean and am planning a peaceful, hypnobirth VBAC this time” or “I have been diagnosed with full placenta praevia and am planning a family centred caesarean to welcome our baby into the world”. It’s also a good idea to acknowledge your care providers with a simple “Thank you for helping us to achieve our birthing goals

Most birthing plans are divided into sections according to the stages of labour. This can be useful as it means your carer can simply flick her eyes to the appropriate section straight away.

Early first stage:
If you are planning to labour at home as long as possible (which most care providers would recommend) then do not include early first stage information in your birth plan. Discuss this with your doula and birthing partner. Think about how you will keep up your hydration and nutrition, as well as ensuring that you get plenty of rest. Include what will happen with your other children or who needs to be called to come to you. Perhaps include some information regarding when you would like to head to hospital and what pain coping techniques you would like to use while at home.

Active first stage:
What would you or wouldn’t you like for pain coping / pain relief; include if you plan to use the bath / shower.
What would you like to consent to in terms of foetal monitoring?
Do you wish to have “routine” vaginal exams or would you prefer to only have them if you ask or none at all? – Note: Don’t use the phrase “minimal VE’s only”. Minimal is a very subjective term and what you consider minimal could be very different to your care provider. Most hospitals would say that they only do minimal VE’s as a matter of routine anyway.
Will you consent to or decline augmentation if labour is lengthy? It is worth doing some reading and deciding what YOU consider to be a “lengthy” labour – like the word minimal, lengthy is very subjective. Would you only consider augmentation after 12, 24, 36 hours of active labour? Would you prefer to simply put no augmentation?

Second stage:
Do you want to be coached in your pushing or would you prefer to push instinctively?
Who will catch the baby?
Do you consent to an episiotomy or would you prefer to tear naturally or have the perineum supported to help lower the risk of tearing?
Would you like a mirror so you can view your progress or would you like to be reminded to touch the baby’s head as it comes down?
Do you wish to have a physiological third stage and / or delayed cord clamping?
Baby to be placed immediately onto mum’s chest for breastfeeding?

After birth:
Who will cut the cord and when? Or are you planning a lotus birth?
Do you wish for your baby to receive the Hep B vaccine or the Vitamin K injection?
At what point would you like weighing and measuring to be done?
Do you wish to be discharged straight from birth suite?

We all know that sometimes birth doesn’t go according to plan and it is well worth having a think about and discussing with your doula and birthing partner what you would like to do if things deviate from normal. Think up or ask your doula to provide you with some different scenarios and then talk through what you would like in those instances. I also highly recommend writing up a caesarean birth plan and will cover caesarean birth plans and family centred caesareans in a future post.

NOTE: Do not use the words “unless medically necessary” anywhere in your plan. This implies that you believe that your care provider performs unnecessary interventions which could be considered very insulting.

I would also consider including a paragraph at the end stating that you are aware that sometimes special circumstances or complications can arise and that if this happens you would like to be provided with all the Benefits, Risks and Alternatives of the proposed course of action (Refer to the BRAN or BRAIN decision making tool) as well as privacy to discuss this with your birthing partner and doula before making a decision.

So the take home message from this three part Birth Plan series is:
Birth plans should be well researched and suited to your specific, individual circumstances. It should reflect YOUR goals for your birth and be based on your own cultural beliefs, values, experience and health. A birth plan should be prepared in close conjunction with your care provider as well as your support team. And it is always worth having a plan B – because you just can’t predict the weather!

This is just one of many ways you may wish to consider writing your plan so please feel free to comment below with your thoughts on what you consider essential to include in a birth plan or your own favourite links and templates.

Here are some links to further information on birth planning and template plans you may be interested in:
http://www.whole-woman.com/index.php/a-birth/117-sample-birth-plan
http://www.bellybelly.com.au/birth/birth-plan-can-you-plan-birth

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