juno midwives

A birth plan is a great tool for you to explore your options for labour and birth and to figure out the things that are important to you. Within mainstream maternity care, birth plans are often undertaken between 34 and 36 weeks and often seem to be a ‘tick box’ exercise. You can create a birth plan at any gestation and you can include as little or as much information as you like.

Sometimes people prefer to use the phrase ‘birth preferences’ because it’s thought that ‘birth plan’ sounds too rigid, when we all know that there are no guarantees in birth. However, I think that ‘birth plan’ is totally appropriate, you plan for other things in your life and you don’t always know the outcome of them, so why is birth any different? Let’s give women and birthing people a little more credit and respect that they understand a birth plan is not set stone. Plans change. We get it.

So, semantics aside, what are some good things to consider for your birth plan? This is a long one, so hang in there with me folks!

Place of birth

Do you want to birth at home? On a midwife-led unit or labour ward? Are you still undecided? That’s okay. Think about what’s driving your decisions – are you making a decision based on fear? Or making the decision that feels intuitively right to you? There’s no right or wrong answer here… what makes one person feel safe won’t make someone else feel safe.

Birth partners / supporters

Have you thought about who you might want present at your birth? Do YOU want this person there, or have they assumed they will be? Have your birth partners educated themselves about birth and how to support someone in labour? Or have your birth partners had traumatic experiences of birth? Will they be bringing that energy into your birth space? This is SO important. It can be extremely unhelpful to have someone in your birth space who doesn’t trust the process or is fearful – even if that person is your mum, you sister, your best friend, your partner…you do not need that level of baggage in the birth room. Choose wisely my friends.

Students

If you birth in hospitals often there are midwifery and medical students on the wards. They are there to learn and they often need to witness births. You might be completely happy to have an extra person in the room but you are absolutely allowed to decline having students present if it does not feel right for you. Do not feel bad about this. They will see births.

The birth environment

Wherever you choose to birth, it’s important to think about how to optimise the environment to promote oxytocin and keep the space calm. If you’re birthing in hospital you might choose to bring an eye mask to block out light, or headphones so you can listen to hypnobirthing tracks or a birth playlist to get yourself in the zone. You might bring a pillow from home, your comfy dressing gown, electric tea lights or aromatherapy to really make the space cosy. You might make a sign for the door, requesting people use low voices and knock before entering. You can bring whatever you need to make yourself feel comfortable.

Coping with labour

Have you thought about coping strategies for labour? Perhaps you’re interested in hypnobirthing and have done a course? Or know that warm water is particularly soothing to you – maybe using water for labour and birth will work for you. Maybe gas & air is in your plan. Perhaps you’ve always known you want to have an epidural. Perhaps you want to try opioid medication in early labour? Or maybe, you definitely do not want that. Have you considered aromatherapy, a TENS machine or a birthing ball to support yourself during labour? Have you heard of the comb?!

Positioning in labour

Have you considered how your movement and positions may aid your labour? If you labour spontaneously with no pain relief you’ll likely move intuitively, but if you opt for an epidural it’s useful to consider what positions to get in to support your baby’s journey through your pelvis – basically you want to stay off your back. Consider side-lying with pillows between your knees, use a peanut ball, use a birth ball, kneel, stand, sit, dance! Keep that pelvis open and allow your sacrum to move!

Monitoring in labour

Midwives follow the NICE guidelines when offering monitoring in labour. This includes monitoring a woman or birthing persons vital signs and the fetal heart rate at regular intervals. It is again, your choice if you want to be monitored as frequently as the guidelines recommend. There are two types of fetal monitoring – intermittent auscultation, where the midwife listens in every 15 minutes or so and continuous fetal monitoring, where your baby’s heartbeat is continuously monitored throughout labour. In relation to continuous monitoring, there is also the option to have this done abdominally via your tummy or to have a small clip placed on the baby’s head via your vagina. Both these options may be presented to you and you always have a choice. You may be recommended to have one form of monitoring over the other, but it is worth remembering that continuous monitoring has not been shown to improve outcomes but has been shown to increase interventions. 

Mode of birth

Some women and birthing people know before they labour that they are having a caesarean section – birth plans are still totally relevant here. You can consider if you want to do skin-to-skin with your baby in theatre, asking for delayed cord clamping, having the lights lowered in theatre, having music of your choice playing and having the drape lowered at the time of birth so you can your baby immediately. You may wish to think about what your wishes are in relation to instrumental assisted birth – if you’re offered a forceps or a ventouse.

Your perineum

Lots of women and birthing people will sustain some form of tear to their perineum during birth. You may be recommended to have a tear sutured, think about if this is something you are happy to have. There is some evidence to show that warm compresses applied to the perineum when pushing can reduce the incidence of severe tearing – put this on your birth plan if it’s something you want! On the other hand, a ‘hands-on’ technique by care providers may increase your chance of tearing – so be specific about if you want ‘hands on’ or ‘hands off’ the perineum at your birth. Episiotomy (a cut to the vagina to make it wider) may be recommended at the point of birth, but you ultimately have to give your consent for one to happen.

The placenta

The placenta can be birthed physiologically – this means you push it out yourself with no medication. Alternatively you can have an ‘actively managed’ placental birth, whereby you’ll be given an injection into your thigh, after hopefully some delayed cord clamping the midwife will likely clamp and cut the cord and then they will pull on your placenta to remove it. There are even options for injections, although in practise I do not see a choice being offered. Syntometrine is often the first drug offered – it is a combination of synthetic oxytocin and ergometrine. Syntocinon is the other – this is synthetic oxytocin alone. When compared, NICE state that syntometrine may be more effective than syntocinon alone in preventing post-partum haemorrhage (blood loss greater than 500ml) but it also carries potential side effects including nausea and vomiting and hypertension (raised blood pressure). Do you want risk vomiting when you could be enjoying skin-to-skin with your newborn, if you don’t really need to? For some people, an actively managed placental birth may be the safest option. The choice, as always is yours. What happens during your labour and birth may influence this choice.

Immediately post birth

This can be a glorious time of getting to know your newborn, have you heard about the Golden Hour? Do you want to pick your own baby up first when they’re born? Do you want your birth partner to announce the sex if you don’t already know? Do you want to be the first person to speak to your baby? Do you want uninterrupted skin-to-skin for as long as possible, because you’ve read about the benefits and know this is the best thing for you and your baby? Do you want to delay the newborn checks or any perineum checks for yourself until you’ve had the chance to gently meet your baby?

So many options!

This list is by no means exhaustive. There are so many options and things to choose during birth. There may be things that are very specific to you or you may have particular needs. Writing everything down in a birth plan communicates your needs, wishes and desires with your healthcare provider. It’s not frivolous or silly to write birth plan. It’s not silly to make a plan for one of the most transformative events of your life. Sure, things might not go to plan…but that doesn’t mean the plan wasn’t worth doing. The plans helps you to get to the nitty gritty of what matters most to you during your birth.

I would recommend having a couple of plans. Your dream, ‘everything goes how I want it’ plan and your alternative birth plan, eg. Your caesarean section plan. The internet is full of birth plan templates, we particularly like this visual one from The Positive Birth Movement. But you can make one in whatever format you want. And of course, it goes without saying…you don’t have to make a birth plan, but I would ask you what do you have to lose by thinking about your birth options – and perhaps more importantly, what do you have to gain? 

We offer one-off birth planning discussions, either face to face if you’re based within an hour of Folkestone, Kent, or online if you’re anywhere else in the country, or indeed the world! We can help you figure out what’s important to you, discuss the evidence for recommendations, help you formulate your plan and help you navigate the maternity system. Get in touch if you’d like to book a birth planning session!