Everything You Need to Know About Birth Plans: What to Include and What to Expect

When you're pregnant for the first time, there are a lot of things on your mind. From decorating the nursery to creating your baby registry, there's so much to do in what feels like so little time. Trust me, as a mom of three kids, the third trimester may feel like it takes three years, but the rest of the pregnancy is over before you know it. No matter where or how you've decided to give birth, preparing for the big day is likely another thing in the back of your mind, even if it's something you've been avoiding.

For a first-time mom, birth plans can be a tricky business, and many women don't know where to start. Some even ask the question: Do I really need a birth plan? Even though things may not always go the way you plan in birth, thinking about your preferences, preparing for different possibilities, and making sure your spouse, doula, and anyone else supporting you are on board is essential in preparing for a positive experience.

If you're not sure where to start, we'll discuss everything you need to know about how to create a birth plan and what you need to prepare.

What Is a Birth Plan Exactly?

Any mom who has given birth before can attest that it isn't exactly like what you see on TV or in movies. While there are many different options you can choose from during your labor, birth is mostly an active event — one that you, as the mom, are participating in (even if you get an epidural!) A birth plan is essentially a way for you to think through what you want to happen in birth, what decisions you plan on making, and how those around you can support you.

The options you need to think through for your birth plan will depend on whether you're giving birth in the hospital, in a birth center, or at home. The vast majority of women in the U.S. (about 98.4%) give birth in the hospital, but no matter where you give birth, it's a good idea to have a plan!

Simply put, your birth plan will include information about your health, your preferences for yourself in labor, and your preferences for your baby after they're born. It also might include information about what you want to happen in case of an emergency.

Do I Really Need One?

Many people talk about how unpredictable birth can be and wonder what the point of having a plan is. I like to think about it like this — we can't say for sure what's going to happen before any event in our lives — whether it's the start of a new year or you're taking a family road trip. But we still make plans based on what we expect to happen. We can't say for sure what will happen during labor, but that makes it even more important to have a plan in place.

Creating Your Birth Plan

The good news is, creating a birth plan doesn't have to be complicated — and you don't have to start from scratch! There are many templates online, such as this one from the American College of Obstetricians & Gynecologists (ACOG). But you don't have to start by copying the options from a template.

If you're feeling more creative, start with a different approach. Instead of looking at a template with birth choices, find a blank page in a notebook or journal. Take a few moments to think about labor and the birth of your baby. What do you want it to feel like? How do you picture the environment? Who do you want to be in the room with you?

Writing down some words to describe the environment and the type of support you want can help you think through your birth options before filling out a template. You can create your birth plan on your own or involve your spouse, birth partner, doula, or even a close friend.

What to Include

Once you've thought through what you want birth to look like for you, it's time to create a solid plan. Especially if you give birth in the hospital, one of the purposes of your birth plan is to communicate your preferences to the hospital staff and any other member of your birth team.

While I highly recommend you journal your birth preferences in any medium that helps you prepare mentally and emotionally for birth, handing your labor and delivery nurse a beautiful painting of what you want labor to look like isn't going to help much. So, let's get into the nuts and bolts of what to include in your written-out plan.

Necessary Information About Your Health

Especially if you're giving birth in the hospital, the hospital staff will have your medical records and any vital information about your health in your chart. However, it can be helpful to have any relevant information at the top of your birth plan so any new staff member can easily view it along with your preferences.

For example, if you've had a previous c-section but are trying for a vaginal birth after cesarean, or VBAC, that may be something to put at the top of your plan.

Members of Your Birth Team

Next up is who you want in the room. Hospitals will have policies about visiting and generally won't let anyone waltz in. But it's still important to have a spot where you can put in writing who is allowed to be there.

If you've listed your husband, mom, and doula as the only members of your birth team, but your mother-in-law shows up unannounced, this can help other members of your birth team take the necessary steps to protect the birth environment.

Tools You Want to Use in Labor

Nowadays, many hospitals have different tools available for laboring women. The hospital you choose may provide access to birth balls or a birthing tub so you can feel comfortable while you're laboring. Here are some options you might consider:

• Birth ball
• Peanut ball
• Squat bar
• Birthing stool
• Rebozo

Be sure to speak with the hospital or birth center you're planning to give birth at to ensure they have the labor tools you want to use. Or, plan on packing any that they don't have in your birth bag.

Options for Birth Environment

Even in the hospital, there are many aspects of the birth environment that you can control. The research shows that a woman's emotional state during labor can impact the outcome of her labor. Fear during labor may lead to undesirable outcomes such as premature delivery, fetal distress, or prolonged labor.

Creating an environment where you feel safe and supported is essential to having a positive experience and a healthy baby. Some of the options you might consider for the birth environment are:

• Dimmed lights
• Soft music playing
• Essential oils or candles
• Favorite pillow or blanket
• Quiet voices while you're laboring

The more comfortable you feel during labor, the better chance you have of experiencing a positive labor with desirable outcomes. And in case something does go off track, keeping a calm environment will help you have a clear mind to make any necessary decisions.

Pain Management and Comfort Measures

In addition to the environment you're laboring in, you'll also want to think about what type of pain management and other comfort measures you want to have available. These options will depend on where you choose to give birth. For example, in the hospital, you have the option of an epidural, but you will have to use other pain management techniques with an out-of-hospital birth. Here are some options to consider:

• Epidural
• Counterpressure
• Massage
• Breathing techniques
• Rebozo
• TENS unit
• Changing positions
• Meditation

The preferences you choose aren't set in stone — you might check massage as one of your options and then hate it once you're actually in labor. The point isn't to be inflexible, but to provide your birth team with options for supporting you.

Preferences for IV

During pregnancy, you may be tested for a bacteria known as Group B Streptococcus, or GBS, that could be transmitted to your baby during birth. If you are GBS positive, your provider may recommend that you receive antibiotics during labor to prevent the risk of infection.

Even if you are receiving antibiotics, you can note on your birth plan whether you would like the IV to stay in or you prefer a saline lock, where the needle stays in but the IV pole isn't attached unless you're receiving fluids or the antibiotic.

If you have questions about what interventions you may need during labor, be sure to talk to your healthcare provider or midwife to discuss your options.

Postpartum Preferences for You and Baby

Your birth plan should include what happens after you give birth as well. You might indicate on your birth plan that you want skin-to-skin with your baby right away and that you prefer delayed cord clamping. Your birth plan might also include your preferences surrounding:

• Baby's first bath
• Vaccines and other medical procedures
• Circumcision
• Feeding preferences (i.e., breastfeeding vs formula)
• Whether baby goes to the nursery or not

Some things in the hospital may be routine, which is why it's important to note your preferences when it comes to postpartum care for you and your baby.

In Case of an Emergency

No plan would be complete without a space for asking, “What if?” Most women don't plan on having a C-section, but in the case of an emergency, this type of birth can be life-saving. In many cases, you still have options, but you may not have the time or the ability to think through them in a true emergency.

Adding your preferences for a C-section to your birth plan, such as the preference for a gentle cesarean or the ability to have skin-to-skin as soon as possible after the birth, can help your provider know how to support you.

What If Things Change During Labor?

Many pregnant women skip the birth plan because they're told that they can't plan for what happens during birth. But if things happen differently from the way you expect, isn't that even more reason to state your preferences?

Take it from a mom who has given birth in the car — there's no way I could have planned for that. I definitely didn't expect it! But having a birth plan in place made it easier for my midwife to jump into action after our baby was born and made it easier for my husband to support me.

A birth plan isn't a guarantee — it's simply a way to document how you want things to go and how you want your birth team to support you during this incredibly vulnerable and life-changing experience. If things change during labor, your plan will likely change, too. The ability to adapt is crucial during birth, and with the right support, you can still stay calm and know that your team has your best interests in mind.

The image featured at the top of this post is ©Lopolo/Shutterstock.com