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Birth Plan Template and Checklist

Birth Plan Template and Checklist


“If you don't know your options, you don't have any.” - Diana Korte

This is perhaps one of the most well known quotes in the birthing world and it's also the best reason I know to develop a birth plan, although I prefer to call them “birth preferences.” The thing is, birth can't be planned. Even when some details are known, like your estimated due date, birthing center, hospital bag, birth team or birth partner, and other factors, there is too much about it that is unknown for anyone to fully plan! However, take the time to look into your options about topics that might come up so you will know what your preferences are. Think of it as putting together a tool box. All of the tools will fit in the box, but there are probably some that you want to be at the top for easier access. If you needed to, you can always get to the tools at the bottom.

Birth Plan Template


To help make it easier for you to communicate your birth preferences with your health care providers, Motif Medical has developed a wonderful free birth plan template! Please feel free to download this PDF to help organize your thoughts and make sure you print out a copy to take with you whenever baby decides to make their appearance — it's an easy way to let your nurse know what you want. Be ready to say this is my birth plan!


Motif Printable Birth Plan Template



Birth Plan Checklist


So what should you think about when you’re figuring out how to write a birth plan? The following is a list of things to consider when you're coming up with your birth plan checklist. This list is not comprehensive, but I did try to include what I think are the most important and most common options that people ask about.

Who do you want in the delivery room with you? At the top of your birth preferences, you'll want to list anyone you plan to have with you at the delivery—your partner, doula, friend, birth photographer, etc.

What comfort measures do you plan to bring with you? Let your care providers know if you want to use alternative lighting to create a more homey atmosphere—a strand of Christmas lights or flameless candles can make a cozy birth environment. If you want to incorporate music, audio hypnotherapy, or essential oils, make sure you include that in your preferences.

Do you want to eat and drink as desired during labor or would you prefer to get fluids through an IV? Some people find that labor makes them extremely nauseous, so eating and drinking is the last thing they want to do, but it's a good idea to know the risks and benefits of taking in your own nutrition while in labor. My favorite resource for information on this topic is a blog post published by Evidence Based Birth titled, Evidence On: Eating and Drinking in Labor.



Do you want to wear a hospital gown while you're in labor or would you prefer to wear your own clothes? Everyone has their own comfort level on this—some people choose to buy a labor gown to wear during the delivery, some people wear the hospital gown, and some want to wear their own clothes. Whichever you prefer, know that birth can be messy and the clothes you wear might not wash clean.

Do you want to wear a hospital gown while you're in labor or would you prefer to wear your own clothes? Everyone has their own comfort level on this—some people choose to buy a labor gown to wear during the delivery1, some people wear the hospital gown, and some want to wear their own clothes. Whichever you prefer, know that birth can be messy and the clothes you wear might not wash clean.

To whom do you want questions directed? When you first get to the hospital or birth center or when your midwife arrives at your house, your care provider will have several questions they need someone to answer. If you'd prefer to have your partner answer questions for you, make sure to put that in your preferences.

Movement: do you want to be able to move around your room and/or walk the halls while you're in labor? It's a good idea to talk about this option before labor starts, as some facilities don't have the equipment to allow this while they're monitoring the baby's heartbeat. Talk to your provider about what you want to do during labor so that you are all on the same page. Some hospitals and birth centers will also have options such as birth balls or peanut balls, a labor tub, showers, or a squat bar. Find out what will be available at your facility and what you would need to provide.

What are your preferences for medications for pain relief during delivery and for labor pains? If you are birthing in the hospital, you will have several options for pain medication—epidural and IV pain medications are common and some hospitals will also have the option of nitrous oxide, which is administered through a mask. It's also helpful to mention in your birth plan if you'd prefer to be unmedicated.

Induction/augmentation: You may want or need your labor to be induced, so you'll want to familiarize yourself with the methods that could be discussed along the way. Pitocin, cytotec, and a foley bulb are frequently used to get labor started in someone who isn't already having contractions. Pitocin and breaking your water (artificial rupture of membranes/AROM) can be used to increase the frequency or strength of your contractions. A vacuum or forceps are tools that can be placed on your baby's head during the pushing stage of labor to help assist your baby being born. All of these methods carry their own list of pros and cons. You'll want to familiarize yourself with each one and indicate your preference of using or not using them on your birth plan.

What positions would you like to utilize during both labor and delivery? Let your provider know if you have any strong preferences about where and how you delivery your baby, including if you want perineal support during the birth or not or if you would rather have an episiotomy or let your tissues tear on their own, if needed.



What positions would you like to utilize during both labor and delivery? Let your provider know if you have any strong preferences about where and how you delivery your baby, including if you want perineal support during the birth or not or if you would rather have an episiotomy or let your tissues tear on their own, if needed.

Do you or your partner want to catch the baby? Talk to your provider to see if this is an option. Also let them know if you want to delay the clamping and cutting of the umbilical cord, and find out their usual wait time. It may be that their typical timing is acceptable for you or it might be something you want to remind them of at the delivery.

Know what you want to do (or not) with your placenta. If you plan to have your placenta encapsulated or if you want to take it home for any reason, write this down on your birth plan so your team will know to set it aside for you.

Cesarean Section: Whether your plan is for vaginal birth or cesarean section, everyone should read about having a baby by c-section. There are several options you'll want to research for this type of birth. Write down what type of anesthesia you'd prefer and who you want to be with you in the operating room. Ask your provider if having a clear drape is an option at their facility, as that may be another thing you want to consider.

Newborn care: One of the first decisions you'll want to make about the care of your new baby is what happens in the first hour after the birth. The American Association of Pediatrics, the CDC and the World Health Organization all recommend that baby be placed skin-to-skin immediately after delivery (or as soon as they are medically stable and the mother is awake), regardless of delivery method or feeding plans, and for the mother/baby dyad to stay skin-to-skin for at least 1 hour. Other important decisions to make about the care of your new baby include the Vitamin K injection, erythromycin eye ointment, and the Hepatitis B vaccination. These medications can be administered any time after the delivery or delayed for the first hour1. You'll want to indicate if you plan to breastfeed or bottle feed, if you want your baby to stay in your room with you (generally called “rooming in”) or be taken to the nursery while you are sleeping. Something else to consider is being ready to talk to a lactation consultant.Whew! That's a lot to think about! While there's so much planning for postpartum, a birth plan is great for starting your motherhood journey in a great way! Happy birthing!

Reference

  1. Safety in Maternity Care, Centers for Disease Control and Prevention.

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All content published on the Motif Medical site is credited for information purposes only. This information should not substitute as medical advice, diagnosis, or treatment. Always consult your doctor or qualified health professional with any questions regarding the health of you or your baby.

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