Communication Tools: Birth Preferences for your Birth Plan

 Your needs in birth are as individual as you are.

Your experience of labour and birth should be exactly that – YOURS. Every birth is unique and each woman will approach childbirth in her own way. It is important that you have the information you need to decide what is right for you and your baby, and that your experience of labour and birth reflects these wants and wishes.

Being informed will help prepare you for birth and help you make decisions on what is important to you in labour. It can also help you make important decisions should changes arise in your labour. Your care providers should present you with information but many women also like to read up on options at home first. It is important that information is from a reliable source and based on evidence.

Informed Decision Making

You will have lots of decisions to make throughout your pregnancy, labour, birth, and caring for your new baby. Being involved in the decision process ensures that your care is specific to you and your baby. You know your needs best! You will be required to make choices – to either accept, or decline, or do nothing – for all tests, treatments, and procedures in your pregnancy, and during labour and birth.

In order to make the best choice for you and your baby, you need to have all the information from reliable sources.

Including:

• the benefits – positive ways in which accepting or declining a test/treatment/procedure will affect you and/or your baby, as shown by high quality research
• the risks – the ways in which accepting or declining a test/treatment/procedure will harm you and/or your baby, as shown by high quality research
• implications – any associated risks of a test/treatment/procedure to you and/or your baby
• any future consequences of the action

For more information, see “No Thank You” – A Guide to Informed Decision Making 

Tools to Use in Decision Making

A supportive care provider is an essential part of a positive and healthy birth experience. Your care providers are there to work for you – to support you and ensure that you have the best birth for you and your baby. It is important to have regular discussions with your care team on any worries, your options, or questions you may have. Any concern or question you have is worth raising, and you care team will be happy to discuss it with you! Birth is not the right time to go over your options, its best to have these conversations early. A birth plan, or birth preferences can be a great way to initiate discussion on your care options and the preferences you have for you and your baby. Your preferences are not ‘demands’ or set in stone, but are simply a way to discuss with your care team what is important to you, what you would like to avoid, your preferences should complications arise, the use of tools or options available to you and more. Many hospitals have a sample ‘birth plan’ tick-box of preferences – or you can write out your own.

Your Preferences for Your Baby’s Birth

The following are birth preference points you might consider. A birth preference plan is a way to communicate your needs and what is important to you during the birth of your baby. It is also a way to notify your care team of points that you would like more information on, would like to talk about, and are unsure about.

Your birth plan is a great way for your care team to understand what is important to you in labour, birth, and how you would like to care for your baby. Birth preferences are not a list of demands – Nor are they set in stone – but are a way to be involved in your care. Remember: You may change your choice at any time!

Questions you might like to think about:

A Bit About You

• Do you have any concerns, fears, or personal or religious beliefs that you feel your care team should know about?
• How were your previous experiences of labour and birth? Is there anything you feel your care team should know?
• Is there anything you feel strongly about (either as a desired preference or something you wish to avoid)?
• Do you have any allergies?
• Do you have any diet requirements or needs?
• How do you feel about students observing your birth?
• Do you prefer to limit the amount of people who enter your birth room?
• Is privacy important to you?
• Is there a health care provider you wish to either, avoid, or would like attend you (where possible)?

Labour companions

Who do I want with me in labour?

• Partner
• Family Member
• Friend
• Doula
• Would you like more than one support person?

Monitoring the baby’s heartbeat

What are your thoughts on:

• electronic foetal monitoring
• admissions trace
• intermittent monitoring

When would continuous electronic monitoring be recommended?

Pain Relief

What methods do I want to consider:

• relaxation and breathing techniques
• different positions
• massage and acupressure
• water
• TENS
• gas & air (Entonox)
• injection (pethidine)
• epidural

Other issues to consider:

Do you have a ‘code word’ for pain relief?
Would you like to be the one to ask for pain relief?
Would you prefer to not be asked in labour if you would like pain relief?
Would you like pain relief early in labour? Or wait to see if you want it later?
Is pain relief readily available if you need it in your unit?

Labour and Birth

Atmosphere:

• Would you like music playing in labour?
• Would you like the lights dimmed?
• Would you like privacy?
• Would you like to roam?
• Would you like to photograph or video the birth?

During labour:

• Would you like to stay active?
• Would you like to eat and drink as normal?
• Would you like to try birth aides? (such as: cushions, bean bags, birthing balls, floor mats, bath, straight back chairs, shower, squat bar, birth stool)
• How do you feel about routine interferences such as: breaking your waters, CTG, sweep, vaginal examinations?
• Why might a syntocinon drip be suggested? How will this affect your labour?
• Do you want to be upright and mobile in labour?

“I had a lot of questions about labour and birth and having a birthplan gave me the opportunity to express what was important to me while getting more information on the issues I had questions about. I found it a great tool for getting discussion going and being involved. Most of the points on my birthplan were normal practice in the MLU anyhow, but it was great to have that chat and have a clear understanding for all involved”

During birth:

• Is there a position you might like to try for birthing your baby? (such as: all fours, kneeling, standing, squatting, on birth stool, on your side, on your back)
• Or would you prefer to choose whatever feels most comfortable on the day?
• Is there a position you would like to avoid?
• Would you like to breath the baby down?
• Would you like to push when you feel the urge or help (coached pushing)?
• Would you like a mirror to see your baby being born?
• How do you feel about tearing vs episiotomy?
• Would you or your partner like to ‘catch’ the baby?

Assuming all is well, following the birth of your baby:

• Would you like your baby handed to you immediately? Delivered up onto your stomach?
• Would you like to find out the sex of the baby yourself?
• Would you like the baby cleaned or dressed first?
• Would you like immediate skin to skin?
• Would you like delayed cord clamping?
• Would you like to cut the cord? Or your partner?
• Would you like to breastfeed immediately?
• If bottlefeeding, do you have a preference of formula to give your baby?
• If bottlefeeding, would you prefer the midwife, you, or your partner to give the first feed?
• Do you have a preference for the birth of the placenta? Would you like an injection to birth the placenta? Or would you prefer to birth the placenta in your own time?
• Would you like an injection of vitamin K for your baby?
• Would you prefer oral vitamin K – or none at all?
• Would you like to be the one to dress your baby for the first time? Or your partner?
• Would you and your partner like to spend some time alone with your baby following the birth?
• Would you like to shower soon after the birth?
• Would you like to give your baby’s first bath? Or your partner?
• Would you like instruction on bathing and caring for your baby?
• Would you like access to a lactation consultant?
• Would you like to have the option of early release home?
• Does the hospital provide home visits?

If your baby needs help:

• When are babies admitted to NICU?
• If your baby is admitted, would you like to stay with your baby?
• Would you like to consider skin to skin or kangaroo care?
• Would you like photographs of your baby to keep with you?
• How would you like your baby to be fed?
• If exclusively breastfeeding can you stay with your baby?
• If exclusively breastfeeding will you be provided with a pump?
• If exclusively breastfeeding will you be given privacy to feed or pump?
• Would you like to be involved in your baby’s care plan?

Induction of Labour (labour is started artificially)

• Why might I be induced?
• How is it done? (gel, breaking waters, oxytocin drip)
• Do you have a preference in how labour is started?
• What is the policy for post-dates (going overdue) in my unit?
• What is the care plan if I ask for more time?
• What is the care plan if I wish to avoid induction or decline?
• May I request an induction?
• If you request an induction, would you like to decide on the date/gestation?

Assisted Delivery – forceps or ventouse

• Why might an assisted delivery be advised?
• Would it require an episiotomy (a cut to your perineum) ?
• If assisted delivery is recommended, would you like to reconsider your options for pain relief?
• If episiotomy is recommended would you like local pain relief?
• What is the care plan if I ask for more time? (assuming baby OK)
• What is the care plan if I decline?
• Assuming you and baby are OK, would you like more time to push? Change positions? Ask for a break to resume in an agreed time period?
• If you require an assisted delivery, would you like to have the baby brought down to the perineum to allow you to push the baby out yourself?

Caesarean Section

• May I request a Caesarean section?
• If planned, do I have a say on when (date)?
• If planned, can I chose the consultant who performs the Caesarean?
• When might I need a Caesarean section?
• Would you like to be awake (using epidural or spinal anaesthetic)?
• Would you prefer to be asleep (general anaesthetic)?
• Would you like the lights dimmed in surgery?
• Would you like the people in the room to introduce themselves prior to beginning surgery?
• Who would you like with you?
• Would you like to photograph or video the birth?
• Would you like music on in the surgery?
• Would you like delayed cord clamping?
• Would you like to have the screen up or down? (see your baby being born)
• Would you like to find out the sex of the baby yourself?
• Would you like immediate skin to skin?
• Would you like to keep your baby with you in recovery?
• Would you like your partner to do skin to skin with your baby while you are in recovery?
• Would you like to breastfeed as soon as possible?
• If bottlefeeding, do you have a preference of the kind of formula your baby is given?
• If bottlefeeding, would you like a midwife or you or your partner give the first feed?
• What pain relief would you like available after surgery?
• Do you have a preference for how long you would like to stay in hospital?

“It was a huge surprise to hear I’d need a Caesarean after previous normal births (transverse baby). I wanted to maintain some control over my birth, despite needing surgery. I made a birthplan with some of the points that were important to me and had a chat about it with the consultant. I was delighted when he agreed that he would support me in delayed cord clamping, skin to skin, and having my baby in recovery with me (assuming all went well).”

Breech Baby

• Would you like your baby be turned before labour? (ECV)
• Would you like a vaginal breech birth?
• Would you like a Caesarean section?
• Would you like suggestions of alternatives? positioning? acupuncture? moxa?
• How do you feel about catheterisation? Some units recommend siting a catheter in breech vaginal births in case a Caesarean is required. Would you like catheterisation? Or prefer not to have catheterisation unless required for a caesarean?
• Would you like an epidural or not? Some units have preferences that breech and twin births should be under an epidural in case a Caesarean is needed – remember, it’s your decision on the day!

Twin Births

• Would you like a vaginal birth?
• Would you like a Caesarean section?
• How do you feel about catheterisation? Some units recommend citing a catheter in twin births in case a Caesarean is required. Would you like catheterisation? Or prefer not to have catheterisation unless required for a caesarean?
• Would you like an epidural or not? Some units have preferences that breech and twin births should be under an epidural in case a Caesarean is needed – remember, its your decision on the day!

Related Reading for Informed Decision Making:

Induction of Labour – Is it Right for You?

Epidural – Is it Right for You?

“No Thank You” – A Guide to Informed Decision Making

For information on the placenta and third stage of labour – The Mysterious Placenta and the Third Stage of Labour

Choice in Pregnancy and Birth in Ireland:

10 tips for Preparing for a Positive and Healthy Birth