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Birthing Plans
A team approach to giving birth
In an ideal world, childbirth would go without a hitch. Each of us would have a perfect labor and delivery. Life and, unfortunately, obstetrics often do not follow the desired course. Instead, unforeseen events often force a change of plan. An approach to birth and delivery called a birthing plan will help a couple and their doctor work as a team toward the safe delivery of a healthy baby and the well-being of the mother.
Topics Often Included in
the Birthing Plan
- management of early labor
- pain control and comfort measures
- desired people present
- the extent of monitoring preferred
- other medical procedures (IVs, catheters, enemas)
- episiotomy (cutting the tissue just behind the vagina to make the delivery easier)
- cord clamping and cutting
- positioning of the baby after delivery
- timing of breast feeding and length of stay in hospital.
In forming a birthing plan, the parents-to-be and doctor discuss all aspects of the pregnancy during prenatal visits. The options and situations that might arise are part of the planning. Topics often included in the birthing plan are shown in Table 1. These are all important subjects to discuss with your doctor. You may get ideas that you had not considered.
Doctors appreciate a couple taking an active part in labor and delivery. They may become wary, however, when a woman and her partner present a birthing plan written as if it contained laws, never to be broken. Often, just changing the wording is all that is needed to make a plan acceptable to all. The statement, "We would like to avoid a caesarean section," will be better received than "No caesarean section at all costs!" Remember, those in the maternity unit are not working against you. They are there to give you care and help you have a successful delivery.
When the plan is settled, the team will try to meet as many of your requests as possible. However, everyone involved must be flexible and realistic. Situations may arise that require a change in the plan. When things are explained to you and your questions are answered, you will be less disappointed if the plan does not work out exactly as you had hoped. Emergencies and unexpected events do occur.
It would be ideal if you and your doctor could discuss every situation in advance but this is unlikely to happen. As a team, we should not be too rigid in our expectations of labor and delivery, but be optimistic and open-minded.
Important in a birthing plan are those items unique to you. If you tell staff members that bright lights cause you headaches, they will know to keep lighting low. When you receive a needle, state if you prefer to have each step explained or to look away until the nurse is done. If you have a name you use to refer to your baby, tell the staff so they can use it too.
Some people choose to be called a name other than their given name. When caregivers need to get your attention, it is helpful to know the name you respond to most readily. Any hints you can give are helpful to those trying to give you the best possible birth experience. The following chart shows how birthing plans and real life events can be at odds with one another.
To conclude, despite all good intentions for a "natural childbirth" according to a birthing plan, it may not be possible. Unexpected complications could arise. If these have been discussed in advance, there should be no disappointment or resentment. To have a healthy mother and a healthy baby is the goal. To reach it, the team must have good communication, careful decision making, and be free to make appropriate and timely interventions when needed.
Birthing Plan |
Other Possibilities |
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Early (Latent) Labor or Pre- Labor |
We would like to spend our latent phase of labor at home where we can cope well, feel relaxed and possibly sleep. At home we could drink fluids and snack throughout this phase of labor. | A long latent phase of labor may make it difficult for you to cope at home. You may become frustrated, exhausted, emotional or uncomfortable. If there are signs that the baby is distressed, or you have vaginal bleeding or prolonged rupture of membranes with fever and no active labor, you may need to go to hospital for induction of active labor. |
Active Labor |
By staying mobile during labor, we expect the need for pain relief will be less and labor will progress more efficiently. In this way, we hope to avoid the use of artificial aids to labor. The comfort measures we plan to use are relaxation, breathing techniques, showers, TENS and massage. We would prefer that the baby be monitored by listening to the heartbeat at intervals and not using the monitor continuously. | Even when couples use all the techniques they learned to aid labor, progress may be too slow and contractions may not be effective enough. This may mean an intervention such as rupturing the membranes or helping labor with an IV Syntocinon™ drip. Each labor is unique. Further pain control such as narcotics, nitrous oxide and epidural may be desirable or necessary. If the baby shows signs of distress such as an abnormal heartbeat or meconium (bowel movement) in the fluid, or measures to help you are being taken, continuous external or internal (fetal scalp) monitoring may be needed to ensure the baby's well-being. |
Second Stage of Labour |
We aim to achieve a spontaneous vaginal delivery without use of forceps or vacuum. We used the hands and knees position when our first child was delivered and this seemed to work well. We would like to choose that birthing position again. We prefer tearing of the perineum (the tissue just behind the opening of the vagina) in a controlled manner to an episiotomy. After delivery, please let the father cut the cord and place the baby on the mother's tummy immediately. We hope that breastfeeding can be started as soon as possible. | An exhausted mother who is having difficulty pushing or a baby that is not well positioned, not descending through the pelvis or is not tolerating labor may need help. Limitations such as the delivery facilities available may interfere with some of the positions chosen for the second stage of labor. Inadequate stretching of the perineum may interfere with the delivery doctor's ability to control tearing. This or signs of distress in the baby may make the use of episiotomy more appropriate. Babies that are slow to begin breathing well, have low APGAR scores (a rating given to baby's breathing, heart rate, muscle tone, skin color and response to stimulation) or have had meconium in the amniotic fluid often need immediate suctioning. These babies may need extra oxygen while being observed to ensure they adjust well. Some may even require transfer to the intensive care unit for further treatment. This obviously interferes with the early start of breast feeding. |
Third Stage of Labor |
We would like the placenta to deliver spontaneously (without pulling). We prefer to avoid using anything to start contractions in third stage. | A placenta that doesn't deliver properly may need to be removed by hand. This may mean the mother needs sedation or a general anesthetic so the doctor can explore the uterus and remove the remainder of the placenta. Bleeding that cannot be controlled by uterine massage alone is usually treated by IV fluids and injections of a medication such as Syntocinon™ to make the uterus contract. |
Postpartum |
We plan to be discharged home as soon as the mother and the baby are considered healthy following delivery. Ideally, this would be within a few hours of birth. | A baby who is unable to feed or a mother who is unable to move or cope well may require a longer stay in hospital. If either one needs extra treatment, it is best to keep them as close together as the hospital setting allows |
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