Pregnant? It’s normal to consider how you want labor and delivery to go. While some women keep their plan short, like “epidural and get the baby out,” big planners like to go more in-depth and consider music and positions while laboring, allowing certain medications but not others, and so on.
For the record, pregnant women aren’t required to have birth plans written out with their healthcare provider. In fact, according to Dr. Philomena Salvemini, an OB-GYN at Novant Health Southeast OB/GYN in Matthews, North Carolina, most women don’t write birth plans.
If women do want to take that route, Salvemini said, “Birth plans are a great way to organize their thoughts, saying their desires and their vision of how they see, in a perfect setting, their labor and delivery going.”
She emphasized that birth plans are based on wants, not needs. “It’s very important that women acknowledge the difference between a want and a need,” she said. “There is a very basic need – the need is that the mother and the baby are healthy.” If that goal can be achieved while incorporating all of the mother’s desires for her labor and delivery, even better.
Wondering if writing a birth plan makes sense for you? Consider these 8 things.
Birth plans need to be flexible
“If someone is so rigid and inflexible in their birth plan, the health of the mom and baby can be at risk,” Salvemini said. “We need to be flexible and ready to make adjustments during labor and delivery because no one can predict how it will go.”
Pain management is important to consider
“It’s important that people have a dialogue with themselves about how they hope to manage labor pain,” Salvemini said. “It’s very individual. Some women find it incredibly liberating to labor and deliver without an epidural, and some women find it very traumatic.”
Within their birth plan, moms are welcome to include instructions like: “Please don’t offer me pain medication – I’ll request medication if I need it.” The same goes for an epidural or spinal block.
Pain management is also where that concept of flexibility comes back into play. “Sometimes you think you want something, until you’re in that moment,” Salvemini said.
Determine who you want to support you during labor and delivery
“Who your support people will be during labor is a big one,” Salvemini said. “It’s who you see with you during that really important moment.”
As of April 2022, Novant Health is allowing two support people in the labor and delivery room alongside a woman’s care team, plus a doula if the patient has chosen one.
Know your preferences for postpartum care
A few questions to have in mind whether you write your birth plan out or not are: Do you want your support person to cut the umbilical cord? Do you want your baby to receive a pacifier? Do you want help with breastfeeding?
Find an OB/GYN to assist you with your family journey.
“We try to do immediate skin-to-skin,” Salvemini said of Novant Health protocol. “The baby should go straight to the chest of the mother.”
Also, the baby stays in the room unless NICU care is needed. “We keep your babies in the room with you on purpose,” Salvemini said. “We know it’s important for the baby and the mom to bond, and if you’re going to breastfeed it is absolutely critical that you put your baby to your breast, because that nursing and suckling is what's going to get your milk in.”
This approach will also help soothe both the mother and the baby, she said.
Determine who will make up your postpartum support village
This is something you wouldn’t see in a standard birth plan, but it’s an important consideration for your overall postpartum planning. Salvemini said: “Who is your village of people supporting you? Not just in the hospital, but for at least six to eight weeks after your baby comes home?”
Maybe that means having a relative stay with you for a few weeks to help out, or to have a team of friends ready to take on helpful tasks.
“It’s important that you know yourself,” Salvemini said. “Don’t try to be a martyr.”
Birth plans should be discussed with your OB-GYN
“If you’re going to do a birth plan, try to get your thoughts organized by 32 weeks so we can edit it and go through it and make sure it’s a discussion,” Salvemini said. “And then we can get the final birth plan scanned and kept under ‘media’ in your chart.”
Don’t let a birth plan overshadow all of your preparation before labor
“I think there is an illusion of control that some people will try to perpetuate when they’re putting pen to paper regarding a birth plan,” Salvemini said. “For some women, that helps ease some of their nerves, but the reality of this is none of this is in our control. The prep work you do during your gestation in terms of maintaining your body in the most healthful manner possible is the best birth plan there is.”
Salvemini recommends eating and exercising well, meditating and just spending time envisioning your labor and delivery going well.
Need a head start? Here's a link.
If you're not sure where to start, check out this online birth plan template.
At the same time, know this: there's no pressure to use it. If a woman goes into labor without a birth plan, that’s normal.
At Novant Health, Salvemini said, “We sit with you and watch you and talk with you and we see how you’re feeling in that moment, and then adjust accordingly.”
And whether you write out your plan or simply have certain preferences in mind, she said, “Trust your body. Trust your instinct. We are always there, as your doctor and your nurse, to support you and, in a safe way, your vision.”