3 Things To Include In Your Birth Plan

Birth is unpredictable. A birth plan can help lay out some preferences for the birthing parent ahead of time so it’s an easy understanding for the different providers that may come and go throughout the labor, delivery, and postpartum recovery.

Usually, a birth plan can have specifications such as:

  • Atmosphere requests: labor positions and props (birthing ball, stool, etc), wearing your own clothing, music, focal points, massage, aromatherapy, and shower or tub use.
  • Medical requests: epidural use, pain medication and alternative pain relief, IVs or herapin/saline block, fetal monitoring, and episiotomy requests.
  • Baby care: delayed cord clamping, skin to skin requests, vaccination and vitamin consent or denial, bathing, and breastfeeding requests.

Many care providers and hospitals have their own standard procedures, so it’s always a good idea to talk to them beforehand to know what to expect, and what you can say yes and no to.

So what happens when your birth doesn’t go as planned? Instead of thinking of your birth plan as a list of preferences, perhaps think of it as a contingency plan. It’s easy to set a plan going into birth knowing what you want. But what happens when that is not possible?

I wanted to deliver my daughter in the comfort of the birthing center. But when I stalled out and had to go to the hospital for an epidural, I had no idea what to expect, how to say no to things I didn’t want, or request things I did want.

3 Things I Wish I’d Had In My Birth Plan

Who Is Allowed In The Room

It was easy at the birthing center. They all knew me, and both our families lived states away. However, when I heard that my father-in-law came into my labor & delivery room at the hospital (my husband caught him and ushered him out before I saw him), I was not happy. The hospital did not know my plan or preferences of who I wanted in the room! While I thought we had made it clear that we’d call them when we were ready, listing who was allowed in my labor & delivery as well as postpartum recovery rooms for the hospital on an actual piece of paper with copies in my birth bag would have been extremely helpful.

Position And Breathing For An Epidural Delivery

At the birthing center, my plan was to listen to my body and however it happens, happens. I did not think about what would happen if I needed an epidural! While there are some exceptions like walking epidurals (again, talk to your care provider and/or hospital for details), usually an epidural birth happens with the birthing parent laying on their back. This is a less than optimal position for getting baby out of the pelvis. Fortunately, there are a couple things to do that can help if you do have an epidural to aid in pushing, and this can easily be laid out in your birth plan and reviewed with your care provider beforehand.

  1. Internal rotation of the hips. I’ve talked about this on my social media before. When internally rotating at the hips (think kicking the ankles wider than the knees), that turn of the leg bone helps the sit bones at the bottom of the pelvis spread apart. Externally rotating (think knees wide) is a common position to think is helpful but it actually brings the sit bones closer together, making that outlet that much smaller for baby to get out. Try it now and see how it feels!
  2. Allow your bottom to hang free. You know how in your annual internal exam at the gynecologist, they ask you to scoot your bottom all the way to the edge of the bed? Well, they’re getting at something there! If you’re flat on your back, your sacrum has no room to move so your tailbone is right in the way. Scoot your bottom to the end of the bed, or add a pillow or blanket under the top of the back of your hips. Try it now with a rolled blanket or firm pillow! On your back, place your prop at the bottom of your hips to see how that feels. Then, move it a littler higher, toward the top of the hips, allowing your bottom hang off your blanket or pillow and notice how that feels in your tailbone area!
  3. Keep a neutral spine and exhale with your pushes. Many care providers will coach curling the spine and breath holding during pushing, however this method is based on outdated research. To optimally push with the breath, the spine should be kept more neutral and baring down with an exhale. Breath retention deprives you and your baby of needed oxygen and works against your body’s natural synchronization of your diaphragm (the muscle at the bottom of the ribs primarily used for breathing) and pelvic floor muscles. A great way to feel this in your own body is to try the two methods the next couple of times you have a bowel movement. Try once curling your spine and holding your breath as you expel. Then the next time, try keeping a more neutral spine and exhaling.

And I still can’t stress enough to talk to your care provider ahead of time! They are more comfortable with certain methods, and it’s best to be sure you’re both on the same page so as not to throw any crazy curve balls when it’s go time!

A Plan For A Cesarean

If you don’t think about it, you won’t have one, right? While that’s not necessarily true, about 1/3 of women in the US are giving birth by c-section. While I didn’t go that route myself, I definitely wish I’d been more prepared had my birth had to go that direction. So how do you plan for a c-section?

  1. Talk to your care provider, and ask about a gentle cesarean. The standard cesarean is hidden behind a drape and the baby is whisked to a warmer after birth for pediatric care. Gentle cesareans offer a closer to vaginal birth experience in which you can have a clear drape to actually see your child being born, have that immediate skin-to-skin contact, and delayed cord clamping. Of course, circumstances could always arise that all those things aren’t possible. But these options with a c-section won’t ever be possible if you don’t talk to your care provider several weeks before your due date.
  2. Prep your birth support for how they can best support you. The best birth stories are those in which the birthing parent feels the most supported by those around them. Maybe you would feel most confident holding hands with your partner. Or maybe gentle verbal coaching and encouragement from your doula is what would help you through a c-section birth. Maybe you could use a point of focus like an affirmation card or a cherished item. Talking the prospect and plan of a c-section through with the support person or people that will actually be there with you can prove a big help in the mental preparation of birth.
  3. Practice your mindfulness tools while pregnant. Birth is a huge life transition already. If you were planning a vaginal delivery and plans changed to a c-section, it can create a collision of massive emotions that without a strong mindfulness practice, could wreak havoc on your mental health. Mindfulness teaches kindness and compassion. It can help you process and soften around your emotions. Mindfulness honors the emotional complexity of this miraculous event, and allows space for grief and joy and everything in between to coexist.

I was planning an unmedicated vaginal birth. Not thinking of the other birthing possibilities ended up biting me in the ass. While I still had a vaginal birth, the birth plan I made would have served me much better had I actually discussed and written a plan for hospital birth options. Learn from my experience! Include who can have access to your room, pushing position for an epidural, and a plan for a cesarean birth. I hope you find this information useful! Please let me know if you have any questions.

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