Writing a birth plan

As the first and second trimesters pass, every mum-to-be starts to imagine their ideal labour. Where it will happen, who will be there and what type of birth to choose are some important considerations. While the course of childbirth can’t always be predicted, writing a birth plan is the best way to prepare for the birth you would like.

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A birth plan is a written record of what you want to happen during labour and after birth. You can write it yourself or receive help from your midwife. Either way, it’s a good idea to discuss your birth plan with your midwife face-to-face, so that you can ask questions and they can get to know you better.

It’s also important to remember that a birth plan isn’t set in stone; you can change your birth preferences at any time.

Before you begin

Every birth plan is unique and depends on your personal circumstances. So before making a start consider your medical history, personal circumstances and what is available at your chosen maternity service. These will help you to write a safe and practical birth plan.

Now onto the key points to include in your birth plan:

Where you would like to give birth

You will have a choice of where to give birth. To aid your decision, ask your midwife of GP local about local services and availability. They can also discuss any health issues with you that may affect your decision.

At home
NHS or private hospital
Midwifery unit or birth centre

If you are expecting a straightforward pregnancy and both you and the baby are healthy, you can opt for a home birth. The main benefit of home birth is being in familiar and comfortable surroundings. Your birth partner and midwife can be by your side throughout to provide support and some pain relief options.

Here are some other birth plan considerations for a home birth:

How long would it take if I needed to be transferred to hospital?

Which hospital would I be transferred to?

Would a midwife be with me all the time?

Can I obtain a birthing pool?

The majority of women in the UK give birth in the maternity units of NHS or private hospitals, where they will be looked after by midwives and sometimes a doctor, if additional help is needed. You will have more care choices by going private, but options are still available on NHS units.

You will have direct access to obstetricians, anaesthetists and newborn (neonatal) care, should you or your baby need it. However, it’s important to consider that you could be looked after by a few midwives and be transferred to a postnatal ward after birth.

Here are some birth plan considerations for a hospital birth:

Are tours of the maternity facilities available before the birth?

When can I discuss my birth plan?

Are TENS machines available?

What kind of equipment is available?

Are birth pools available?

Are partners or close friends allowed in the delivery room?

What is the policy on induction, pain relief and routine monitoring?

How soon can I go home after birth?

These units provide a more ‘homely’ setting that the maternity wards of an NHS hospital. They offer a middle ground between the comfort of a home birth and the extra support from a hospital. Compared with NHS hospital births, you are more likely to be looked after by the same midwife and less likely to require delivery intervention such as forceps or ventous.

Facilities and care can vary between midwifery centres, so here are some birth plan considerations to make:

Where are my local midwifery units or birth centres?

What pregnancy, neonatal and anaesthetic care is available?

What kind of equipment is available?

Are birth pools available?

What is the policy on induction, pain relief and routine monitoring?

Are epidurals available?

Are partners or close friends allowed in the delivery room?

How soon can I go home after birth?

Your birth partner(s)

Having one or two birth partners present during labour is another key point to specify when writing a birth plan. This could be the father, a close relative, friend or a private healthcare professional such as a doula. While the decision is up to you in most cases, it’s worth checking the policy on birth partners being present if you plan to give birth in a hospital or midwifery unit.

In the event that you need a little extra help using forceps, ventous delivery or caesarean section, you can also request your birth partner to leave the room.

Birthing equipment

When thinking about how you would like to give birth, you may find that items such as wall bars, mats or beanbags will help to change position and improve comfort. These types of equipment are more common at midwifery unit and at home births, but your midwife will be able to tell you what’s normally available and whether you could provide your own equipment.

Here are some birth equipment ideas to include in your birth plan:

  • Beanbag or mats

  • Birth ball

  • Birth pool

  • Wall bars

  • Absorbent pads

  • Non-medical cord tie

  • Music, podcast or hypnobirthing tracks

Pain relief

Your choice of pain relief is usually down to personal preference, but it’s best to speak with your midwife or GP about options and what is best for you.

You can use a number of pain relief methods at different stages of labour; some women use a combination of methods. Pain relief examples to include in your birth plan include:

  • Breathing and relaxation

  • Massage techniques

  • Being partially submerged in water (water birth)

  • Gas and air

  • TENs machine (transcutaneous electrical nerve stimulation)

  • Epidural

Birth positions and movement during labour

It can help your midwife and birth partner to know which birth positions you would be comfortable with, so this is another point worth including in your birth plan.Carefully changing positions and moving around can improve your experience in labour, by speeding up the process and reducing the risk of needing an epidural or caesarean.1

You can research some of the best birth positions here.

Special plans

An increasingly popular request at birth is private stem cell banking. This is where a small sample of stem cells are taken from the umbilical cord blood after birth, then frozen in a stem cell bank specifically for your child. Cord blood stem cells can be collected safely alongside delayed cord clamping, and are proven to treat over 85 diseases and conditions.

Delayed cord clamping is recommended by the World Health Organisation (WHO) to prevent iron-deficiency anaemia and provide your baby with the blood cells and nutrients they need for healthy development. To achieve this, the umbilical cord should be clamped no earlier than one minute after birth and once the cord has stopped pulsating.

An increasing number of mothers are also choosing placental encapsulation after their baby has been delivered. This is the practice of ingesting the placenta after it has been steamed, dehydrated, ground, and placed into pills, believed to impart numerous health benefits. You can still opt for cord blood stem cell banking alongside placenta encapsulation.

Additional preferences

While this page covers the most immediate considerations for writing a birth plan, there are some you may have missed that are equally important.

Have you thought about baby monitoring during labour? Your midwife can regularly check that your baby is happy and healthy using a Pinard stethoscope, doppler, Electronic Fetal Monitoring (EFM) or telemetry2.

What about skin-to-skin contact? You could have your baby lifted straight onto you before the cord is cut, or ask the midwife to wipe your baby and wrap him/her in a blanket first.

When it comes to personal safety, it’s worth considering the possibility of an episiotomy if birth becomes difficult, and a Syntometrine® injection to prevent heavy bleeding after delivering the baby. It is advised to discuss these options with your midwife or GP, to determine whether they should be a necessary part of your birth plan.

[1]www.philips.co.uk

[2]www.nhsinform.scot