Top Ten Tips for Creating Your Birth Plan

by Elizabeth Stein, CNM, MSN, MPH

Many pregnant women feel unprepared for one of the hardest and yet most rewarding days of their lives, the day they give birth to a child. A birth plan will help you remain proactive -- your goal should be healthy mom, healthy baby, positive emotional experience.

As you're listing ideas, avoid unrealistic expectations and "go with the flow of your body." Be flexible and open minded. Creating a birth plan will help you be prepared for your special day.

Once you've researched and outlined the birthing options you'd prefer, discuss them with your midwife or physician during a prenatal visit. It is also a good idea to revisit each point in depth during a visit before labor.

1. Remember, your baby is going to come when the baby wants to come. Your baby is in charge. Your baby does not read the due date on the prenatal chart or your sonogram report. Your due date is used to manage the pregnancy to schedule prenatal appointments, schedule tests, sonograms and an induction if necessary.

2. Know exactly who will deliver you. Does your midwife or physician belong to a group? If that person is not on call the day you go into labor, who will actually deliver you? Clarify this so you are not disappointed.

3. Rest up. Labor is like running a marathon. Save your energy spurt for when you are in labor. When you get that energy spurt that predates labor, save it inside of you. Don’t waste your energy cleaning the kitchen or bathroom.

4. Stay home as long as possible unless told by you midwife or physician to go the hospital. It is more comfortable to labor at home in familiar surroundings than the hospital. If you have no risk factors you may labor at home. Early labor can last many hours so don’t become exhausted. Eat, drink, walk, rock and take a shower.

5. Know when you should go to the hospital. You should go to the hospital immediately if your water breaks or you are group B strep positive or have a medical or obstetrical reason and were told to go straight to the hospital. Talk to your midwife or physician to find out exactly when they want you to call them or go directly to the hospital.

6. Eat and drink continuously at home. Know the hospital rules and follow them regarding eating and drinking in labor. Most hospitals don't allow eating solid foods in labor, but many will allow clear liquids. Other hospitals may only allow IV's and ice chips. Plan on respecting these rules. This emphasizes the importance of eating and drinking at home prior to admission. Even if you vomit during labor (common in labor) some of the food will have been absorbed into your body.

7. How will you labor? Walking, on a birthing bed, sitting in a chair, rocking on a big ball, in the shower? A combination of all of them?

8. Be open-minded about measures that promote a vaginal delivery. AROM (artificial rupture of membranes), pitocin and epidural. Some women say "I want natural." I define natural as vaginal and cesarean as surgical. Do everything you can to have that vaginal delivery.

9. Know when to bail out and have a cesarean delivery. There are no gold stars for torture. Cesarean delivery is a not a failure, just another route of delivery. You just don't want to have a cesarean that isn't indicated (decided on too early). Discuss with your midwife or physician how and when they decide to perform a cesarean in labor. In other words, how do they manage labor?

Realize that some conditions are delivered by cesareans: breech, multiples (usually), placenta previa. Understand how prolonged dilatation and descent (taking a long time for your cervix to open and your baby to descend) is managed.

10. If you are planning to deliver in a birth center or at home, know the protocols for transfer. What are the reasons for transfer to the hospital, who decides -- midwife or patient? Who has the final say if there is a disagreement about the need to transfer? How will you get to the hospital? What hospital will you be transferred to? Does the midwife have privileges there? Will a physician take over your care? Did you meet him/her during your pregnancy or is the physician a stranger? Will your midwife stay with you?

Your baby's first cry is the sound of success. Your new title is MOM. Enjoy your baby and let your birth story become history.

Elizabeth Stein, CNM, MSN, MPH, is a well known midwife. Through her practice, Ask Your Midwife, PC, Elizabeth works closely with her patients to educate, encourage, and empower them to make choices that enhance their overall health, pregnancy experience and strengthens their family. She combines current medical knowledge and modern technology with the caring inherent in midwifery. Stein completed her midwifery education at Columbia University in New York City and holds Master's Degrees in Nursing and Public Health. Elizabeth Stein has been certified by the American College of Nurse Midwives since 1985 and is licensed in New York State. She has extensive experience with high-risk pregnancies as well as normal obstetrics and gynecology.

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