Building Your Birth Preferences
I like to follow the KISS model for helping my clients develop their birth plans (Keep It Super Simple)
You don’t have to include the following, since they are the standard of care here:
Freedom of movement in labor
Use of tools like birth balls, peanut balls, and squat bars
Freedom to drink/eat until you have an epidural (then clears only)
Choice of pushing and delivery position, even with an epidural (though you may want to specify if there’s a specific position you’d like to use!)
Skin-to-skin contact immediately after birth (if baby transitions well)
Newborn checks done skin-to-skin
Baby stays in the room with you after delivery
Standard medical interventions:
Continuous fetal monitoring (alternative: intermittent monitoring with doppler, information linked below)
Maternal vital checks (blood pressure, pulse, temperature, oxygen saturation)
A saline lock: capped IV access, not connected to anything.
Cervical checks on admission and and before pushing, no more often than every 4 hours unless medically indicated (alternative: decline unless results will change plan of care)
Staff Preferences
Would you be okay with students or residents being involved in your care? Resident doctors are graduates of medical school who are in training under the supervision of board-certified doctors (attending physicians) or certified nurse midwives. Medical students and nursing students are often “observers during birth. When residents are managing your care.
Are you comfortable with male providers and staff being present during your labor and birth? If there are some scenarios where it would feel comfortable, but some not, list them.
Building the Main Plan
Please read The Evidence on: Fetal Monitoring and decide what kind of monitoring you’d prefer
Pain Management Options
Watch, read or listen to the Evidence on: Epidurals during Labor for Pain Management
Which of the following most resonates with you?
Epidural only in extreme circumstances
Strongly prefer unmedicated, but may consider epidural after long/exhausting labor
Hope to birth unmedicated, but I am not attached to this plan
Plan to labor without epidural at first, but eventually plan to get one unless birth progresses too fast
Plan to get epidural on the sooner side after trying a few comfort measures
Epidural is very important to me; want it placed as soon as possible
Reflective question: If you are planning to go without an epidural, under what circumstances might you change your mind (example, prolonged labor, Pitocin induction)? If you are planning one, what circumstances might change your mind (for example, you arrive at the hospital at 8-9cm)?
To learn about the pain management options listed below, head to this link.
Other pain management strategies and comfort measures you may want to include as part of your toolkit:
Injectable Opioids
Nitrous Oxide
Acupuncture or Acupressure
Quiet Room
Soft Voices
Dim Lighting
Conscious or Guided Breathing
Hypnosis or Meditation
Massage, Counter Pressure, and Hip Squeezes
Music
Frequent Movement
Sterile Water Injections
TENS Unit
Shower or Tub
Words of Affirmation
Pushing and Birth
Consider what positions you may want to push in. Read this article from Evidence Based Birth® about the Evidence on: Birth Positions.
Some common options are: side lying, all fours, squatting, standing, on your back, and using a birth stool.
Other preferences you might include:
You or your partner catching the baby
Using warm compresses on the perineum
Touch baby’s head as they crown,
Use of a mirror
After Birth
How long would you like to delay cord clamping? Common choices include waiting until it stops pulsing, waiting for it to completely turn white, waiting 60-90 seconds, or until the placenta is born. If you’d like more information about delayed cord clamping, you can watch or listen to this video.
Next, please read this article on the use of Pitocin during the third stage of labor. This is standard practice across hospitals and providers. If you would like to use expectant management, please note it in your birth preferences.
Would you like to keep or see your placenta after birth?
Baby Preferences
How do you plan on feeding baby? If baby has blood sugar issues, would you like to use donor milk, bring expressed colostrum, use sugar water, or formula?
The Evidence on: Vitamin K for Newborns
The Evidence on: Erythromycin Eye Ointment for Newborns
The Evidence and Ethics on: Circumcision
Consider whether you’d like to have the Hepatitis B vaccine on the day of birth (usually administered 1-2 hours after birth with Vitamin K), if you’d like to delay until a later pediatrician appointment, or decline
Back Up Plans
Next view the Induction page and Cesarean Birth Preferences
