All About Birth Plans, Created By a Labor and Delivery Nurse 6


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All About Birth Plans

Photo Credit: Stephanie Hitchins, see more at stephaniehitchins.com

Written birth plans can be controversial in the Obstetrics world! This simple post will help you evaluate if a birth plan will be a support to you in the labor and delivery process. And, if so, as a Labor and Delivery nurse, I will show you how to go about creating and presenting your birth plan. All humans are created equal… but not all birth plans are!

What exactly is a birth plan?

A birth plan entails the mother’s wishes in labor, delivery, recovery, and the postpartum period

What is a good birth plan

 Birth Plans

“So should I, or should I not, create a birth plan?”

This decision is up to you and your support team! If you decide on yes, please continue forward! If not… that is okay too! You may discover some of my older posts such as True Labor vs False laborCheck List of What to Bring to The Hospital, orCervical Dilation & Effacement with a Fruity Theme

How to create your birth plan and present it to your healthcare team.

Step 1: Research!

Well-written birth plans are done with the help of trusted sources. Take prenatal classes from your hospital as well as a tour to better understand the options they provide. Also, don’t forget to ask your provider their preferences as a birth plan most likely will not change their habits!

Example questions you may want to ask your hospital if applicable:

– How many people can I have in the delivery room/ O.R.?

– Are baths/showers available to use during labor/delivery?

– What types of pain medication are offered (analgesics, epidurals, spinal epidurals, laughing gas)? (See my post about the most common medications used in Labor and Delivery here.)

– What types of fetal heart rate monitoring options do you offer?/ Am I offered wireless monitoring that gives me the ability to walk around?

– Are squatting bars, yoga balls, peanuts, and birthing stools available to use or do I need to bring my own?

– What is the hospital’s policy on taking the placenta home?

– Does the hospital encourage the infant to “room in” during the night?

– Are pictures or videos allowed in the labor room?

 

Step 2: Create Your Birth Plan!

The 10 Birth Plan Rules

The Right Verbiage

When writing your birth plan I recommend using the phrases “We would like to”, “We anticipate”, “We hope to”, “We have prepared for”, and “In case of an emergency”. This type of verbiage will help your provider and team know that you understand labor is unpredictable and you are open for changes if necessary.

Getting To Work!

There are many birth plan templates out there. As a labor and delivery nurse,  I am not a fan of the templates that have the patient check the boxes and are over a page long. These can be difficult to read and do not show that the patient has done much research (just in my own opinion!) I recommend you write your own personal birth plan and keep it simple. I have created an outline for you below to give some direction! Some of these questions may not be applicable to your circumstance and if so, just skip them!

* Many of the questions below are taken straight from one of my favorite resources Americanpregnancy.org

Name of Patient/ Title of birth plan:

Brief/Pertinent History:

  • Due date
  • Doctor/midwife
  • Group B. Strep (GBS) status
  • Rh incompatibility (blood type)
  • Risks with this pregnancy. Examples include Trial of labor after a cesarean delivery (TOLAC), In vitro fertilization (IVF), multigestation (twins or more), gestational hypertension, gestational diabetes and/or any other problems with past pregnancies or deliveries
  • Any severe allergies

(If you do not know your GBS status or blood type, it is OK, just skip it!)

Labor:

  • Who do you want to be present?
  • Do you have a doula?
  • Are you okay with any students or residents involved in your care?
  • Do you want mobility, or do you wish to stay in bed?
  • What activities or positions do you plan to use? (walking, standing, squatting, hands and knees)
  • What will you do for pain relief? (massage, focal points, music, hot and cold packs, positions, labor imagery, relaxation, breathing exercises, tub or Jacuzzi, medication)
  • How do you feel about fetal monitoring? Are you okay with intermittent, continuous or internal monitoring?
  • How do you plan to stay hydrated? (sips of drinks, ice chips, IV)
  • Do you want a routine IV or a heparin/saline lock?
  • Do you want to take pain medications, or not?
  • Do you have a preference for certain pain medications?
  • Are you against having your membranes artificially ruptured?
  • Do you wish to wear your own clothing?
  • For home and birth center births, what are your plans for hospital transport in case of emergency?

Delivery:

  • Who do you want to be present?
  • Do you prefer a certain position to give birth?
  • Would you like a mirror to watch?
  • Would you be willing to have an episiotomy? Or, are there certain measures you want to use to avoid one? (mineral oil or massage)
  • How do you feel about forceps or vacuums? (do you prefer one or the other in case of an emergency)
  • If you need a cesarean, do you have any special requests such as skin to skin as soon as possible?
  • Who would you like to cut the cord and when? (Right after delivery or until pulsation stops?)
  • Do you want to do skin to skin (kangaroo care) and for how long?
  • Are you okay for erythromycin and vitamin K to be given to your baby?
  • Any special requests with your placenta?

Postpartum:

  • What are your preferences for your baby’s care? (baby’s first bath and where you would like baby to sleep)
  • Do you want your baby boy circumcised?
  • Are you okay for your baby to have pacifier or glucose water?
  • Do you want your baby to have the hepatitis B vaccine in the hospital?

It is always nice to leave words of appreciation for your support team here at the end of your birth plan!

Step 3: Share Your Birth Plan!

Make at least three copies of your birth plan. One to discuss with your provider at an appointment towards the end of your pregnancy, one to give to your labor and delivery nurse, and one to have for your support people in the room with you.

 

For those of you who have utilized birth plans before, what was your experience? Would you do it again? If you appreciated this post please let me know in the comments below!


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6 thoughts on “All About Birth Plans, Created By a Labor and Delivery Nurse

  • Suzie T.

    I have been wanting to know a nurse’s take on birth plans! It is so great to hear you are open to them as I have heard some nurses are hesitant towards birth plans… is that the older generation of nurses do you think?

  • Kimberly J.

    Thank you! I feel like this will help me to organize my thoughts for my birth plan! I am 30 weeks pregnant now and am starting to get anxious/nervous! Thank you for all of your tips and thoughts!

  • Christine

    Thanks so much for this post! There are so many things my husband and I haven’t considered, so this puts things into perspective! We’ll need to do our research for sure. Thanks for all of the tips and for putting this together; I feel so encouraged to create a birth plan. 🙂

  • Jen

    I’m a labor and delivery nurse and I have to say I cringe every time a mom comes in with a birth plan. It’s not that I don’t want to see their desires met and give them the best experience possible, but it seems like lately the patients with birth plans, something goes wrong. I had a patient last week who had the most detailed birth plan I’ve ever seen. Two full pages, single spaced, outlined everything that patient wanted from laboring without meds, cutting the cord, never being separated from her baby … it was very well thought out and she had done a lot of research. I wanted more than anything to give her the birth experience she desired. She ended up needing a c-section as she never dialated despite a two day induction. Twelve hours after her section, when I came on shift, her uterus ruptured and she was taken back to the OR where they did a hysterectomy to save her life. She ended up in the ICU. Nothing went according to her plan and I felt awful. I cried with her and with her family and it affected me deeply. That story is an extreme, but I tell it because everyone who writes a birth plan should be prepared that things might not happen the way you want just because you write it down. We still have to make sure baby looks good on the strip and intervene if need be for you and your baby’s safety. The bottom line, know your wishes, but try to remain open minded. I’ve never met a L&D nurse who didn’t want to give a family the most beautiful experience possible.

    • Breanne Clinger Post author

      I think us labor and delivery nurses can be superstitious with our work. How many times have you knocked on wood at work- or am I alone in this!? And is it just my unit that treats the “Q” word…(quite) as a cuss word? And how often do you cringe when you are driving to work and see the full moon lighting the sky? To address your story- I am so sorry you had that awful experience. Yes that story is extreme- and a ruptured uterus is VERY RARE. I do not want any readers to feel scared or associate a birth plan with a bad outcome- because it is not. But yes absolutely, I agree that every woman who writes a birth plan should be prepared with a plan B and have the realization that labor is many times unpredictable. I also agree that L&D nurses want to give families “the most beautiful experience possible”. But, everyone’s “beautiful” is different, and that is where I believe a birth plan is helpful.