design-birth-plan

Design Birth Plan

Create a concise, realistic birth preferences document that supports informed consent and shared decision-making.

Why This Is Best Practice

Adopted by: ACOG, WHO, RCM (Royal College of Midwives) — all recommend documenting patient preferences before labor. Impact: Women with a birth plan report significantly higher satisfaction with their birth experience regardless of whether all preferences were followed (Kuo et al., 2010). Birth plans increase informed consent and reduce labor anxiety (Lothian, 2006). Why best: Labor is fast-moving; verbal communication breaks down under stress. A written plan ensures preferences are communicated to every provider, including those not present at prior visits.

Steps

1. Keep it to 1–2 pages maximum — providers read short documents; long plans create tension.
2. Discuss with OB/midwife before 36 weeks — confirm what's feasible at your delivery location.
3. Structure: Environment → Labor → Pain Management → Delivery → Immediate Newborn Care → Cesarean (if applicable)
4. Environment preferences:
   • Lighting (dim preferred?), music, who can be present, photography/videography wishes
   • Mobility during labor (walking, tub/shower, birthing ball)
5. Labor preferences:
   • Continuous support person (doula, partner, family)
   • Fetal monitoring: continuous vs. intermittent (discuss hospital policy)
   • IV access vs. hep-lock only
   • Labor augmentation: discuss consent threshold for Pitocin
6. Pain management:
   • Preferences (epidural / nitrous oxide / unmedicated / open to options)
   • See design-labor-pain-management-plan for full options
7. Delivery preferences:
   • Pushing position (semi-recumbent, squatting, side-lying)
   • Delayed cord clamping (60+ seconds — ACOG recommended, increases neonatal iron stores by 30%)
   • Skin-to-skin immediately after birth
   • Placenta preferences (examine, encapsulation, etc.)
8. Newborn care:
   • Vitamin K injection (legally required in most US states)
   • Eye ointment (erythromycin)
   • Hepatitis B vaccine (recommended at birth)
   • Breastfeeding initiation within first hour
9. Cesarean section section (if needed):
   • Clear drape preference, skin-to-skin in OR, music, partner present throughout

Rules

• Frame preferences as "preferences, not demands" — medical emergencies override all plans.
• Include a statement: "I understand birth does not always go as planned and trust my care team to make the safest decisions."
• No birth plan replaces consent discussions in the moment — it initiates, not replaces, conversation.

Examples

Concise opening line: "I am aiming for a low-intervention birth. I trust my care team's clinical judgment if plans need to change." Cesarean section section: "If cesarean becomes necessary: I would like the clear drape lowered so I can see my baby born, and skin-to-skin in the OR if possible."

Common Mistakes

• Writing a rigid 5-page plan — creates adversarial dynamic; short and flexible builds trust.
• Omitting the cesarean section section — 32% of US births are cesarean; having preferences documented reduces surprise and distress.
• Not reviewing with the OB at 36 weeks — some preferences (e.g., water birth) may not be available at your facility.

Health Disclaimer: Birth plans are communication tools, not medical contracts. Clinical decisions during labor are made by your care team based on the safety of you and your baby. Discuss all preferences with your OB or midwife well before your due date.