“In order to have the best possible birth outcomes,” says doula and registered nurse Ebony Harvey, “you have to be comfortable communicating what you want and what you don’t want.”
And a birth plan is a great way to do that.
In “Overdue,” our maternal health series made in partnership with Un-ruly and Gerber, Ebony gives an overview of what goes into creating a birth plan.
To see birth plan examples and learn about birth preferences you may not have considered, keep on scrolling! (You can also navigate to the section you want by using the table of contents.)
Table of contents
What Is a Birth Plan?
A birth plan is simply a plan for your birth. It defines what you want to happen during labor, delivery, and postpartum—and it covers your ideal to worst-case scenarios.
It’s also:
… an opportunity to define what a good birth experience means to you.
…. a way to vet the people who will be on your birth team.
… a document of your desires that you created before you go into labor.
… a directive to your birth team when you’re unable to vocalize your wants, or feel pressured to deviate from them.
But it’s important to know that a birth plan is not a set script for your labor day. It also doesn’t guarantee you’ll get everything you want in a birth experience.
No two births are exactly the same, and there are many unknown variables that can alter your plan.
However, having a labor and delivery care plan is very important in general—and especially for us: We are at higher risk for health issues that can complicate giving birth.
That affects the experiences we have during labor and delivery compared to our white counterparts. A 2011 study published in the American Journal of Obstetrics and Gynecology found that white women were more likely to choose inductions when they were full-term (or 39 weeks pregnant).
As for Black women? We were more likely to be induced preterm due to “specific medical indications.” And WebMD reported that those indications can be “subjective” and “rooted in structural and systemic racism in health care [and] implicit bias from clinicians.” (The difference between choosing induction and being induced aren’t lost on us.)
We are also more likely to have C-sections that aren’t medically necessary. So creating a labor and delivery care plan is a way to have your choices heard. It lets you make decisions about your birth, instead of feeling like things just happened to you on your labor day.
How Do You Create a Birth Plan?
Now you know what birth preferences are and why having a labor and delivery care plan is so important. But how do you create one?
The best way to start is by thinking about what you do and don’t want, says Ebony. This includes what you’d like to happen in several worst-case scenarios. A plan that doesn’t account for these potential situations leaves you vulnerable.
“Your plan is like your [plan] A, B, C, D, E, F, and even G,” Ebony explains. “You want to cover all of the things.”
To help you figure out your worst-case scenario wishes, you can use an “if/then” sentence structure to develop your back-up plan. Play the scenarios out until you’ve exhausted all options and made a plan for every potential event. Take these birth plan examples for instance:
“If I’m not progressing in my labor and I need to be induced, then I will ask my doctor to use unmedicated solutions like membrane sweeping before moving on to pitocin. I do not want my water broken manually.”
“If I need to be transferred to a hospital during my home birth and I need a cesarean, then I want to have a gentle C-section.” (You can learn more about what that is in the section on birth preferences you may not have considered.)
If you’ve been pregnant before, think about what you did and didn’t like about that experience. What would you like to replicate? What would you do differently?
Once you’ve identified that dos and don’ts list, write it all down. Then you can create a separate streamlined version of this wish list to share with your birth team. (Basic resume rules apply here: Keep your list of birth preferences to 1-2 pages max.)
Your birth plan can be a simple bullet-point list in a Word doc or churched up with the help of a birth plan template you found online. The most important thing is that it clearly conveys your wishes.
Ideally you’ll have a preliminary birth plan made before you find your care provider. It can help you find people who are aligned and have experiences with your desires. That said, it’s never too late to create a birth plan. The only no-no is not sharing it with your support team. A birth plan that isn’t referenced or discussed regularly (at every appointment and during labor and delivery) isn’t of much value to you.
But remember: Both you and your birth plan need to be flexible. You may find that you and your baby’s health may change throughout your pregnancy, making you go from your plan A to your plan C.
You may feel some disappointment if that happens, and that’s real. But we hope you also make space for the fact that you’ll still have a say in your care and that the most important thing is your health and your baby’s.
What Birth Preferences Should You Include in Your Birth Plan?
Use the Five Ws when thinking about your birth preferences: the who, what, when, why, and where of it all. (You can also include “how.”)
Ask for birth plan examples from your friends or search online. A few basic questions to get you started on building your birth plan:
Where will you give birth?
There are typically three answers to that question: at home, in a birthing center, or at the hospital.
There are benefits and risks to birthing at any one of these locations. We encourage you to do your own research and make the decision that makes the most sense for you.
How will you give birth?
When it comes to birth methods, there’s no “right” way to give birth. All birth is natural, and the most important thing is that you and your baby are united safely.
That said, knowing how you’d like to deliver your child is a critical part of your birth plan. Do you want to have a planned C-section? Did you have a C-section with your first child, but want to try for a vaginal delivery (also known as a VBAC)? Do you want to have a water birth?
Whatever you decide, remember you’re choosing a preference while still planning for other possibilities should your preference not work out on your labor day.
Who will be with you when you give birth?
Who do you want to be with you when you give birth? Make those preferences known. You want to choose people who can support and advocate for you.
Additional Birth Preferences
Once you have those basics decided, you’ll have a really strong birth plan that you can build on with additional preferences or shift based on insight from your provider.
These are birth plan examples of other things you can add to your list:
- cultural traditions
- food, hydration, and mobility needs
- test and vaccination preferences
- golden hour observation: This is uninterrupted skin-on-skin for the first hour of the baby’s birth
- pain management methods: For example, let’s say you want an epidural but don’t want to be completely numb from the waist down. You can ask for what’s known as a “walking epidural.” Or if you want an unmedicated birth, you can ask that repetitive questions like “Do you want an epidural?” be limited and note that you’ll ask for one if and when it is desired. (You can learn more about comfort measures here)
- hospital transfer plans: This is important if you want to have a home birth or a birth at a birthing center. If you need to be transferred to a hospital for any reason, where do you want to go?
Birth Preferences You May Not Have Considered
As you can tell there are so many options of what you can put into your birth plan. What we shared above are some of the more well-known birth preferences. But here are some examples of other desires you may want to add to your birth plan.
Music Therapy
Music can be a great tool to help you throughout your labor. It can reduce anxiety and even strengthen your contractions!
For more information, check out our article that breaks down what you should know about creating a labor playlist that supports your birth.
Aromatherapy
Diffusing essential oils in your birthing space can provide a relaxing atmosphere while giving birth. So relaxing, it may even help your labor: A 2019 study published in the journal Women and Birth found that it “reduced labor pain during the 8–10 cm dilatation transition phase of the first stage labor.”
The study also said that “in addition to the pain-relieving effects, aromatherapy reduced the [labor] duration of the active phase and the third stage, with a trend toward significance in the second stage.”
If you do add aromatherapy to your birth plan, make sure you’re using essential oils that aren’t harmful during pregnancy or for newborns.
Gentle C-sections
Cesarean sections (aka C-sections) are surgical deliveries. After getting an epidural or spinal for pain management, a provider will make an incision in your abdomen and uterus to reach your baby. Usually there is a curtain between you and the surgical site, so you don’t see your baby being born.
Now there’s another option to those standard practices: gentle C-sections. While still a surgical procedure, gentle C-sections bring some of the experiences of nonsurgical deliveries to cesareans. You get to see your baby’s arrival thanks to a clear drape or a drape with a clear window cut out. (Your bump blocks your view into the incisions being made.)
The baby also isn’t immediately pulled out by the provider. Instead, their head is freed while the rest of the body remains in utero and attached to the placenta. (This delay replicates what would happen in a vaginal delivery.)
Then the provider helps ease out the baby’s shoulders and the rest of the body from the incision, supporting the baby as they come out. You get to hold the baby and have immediate skin-to-skin contact. (Note: If you have a traditional C-section and you and your baby are safe, you should advocate for immediate skin-to-skin contact, too.)
Just note that a gentle C-section isn’t always a viable option. You may not be able to have one if you need to be under general anesthesia, if the surgery is complicated, or if the baby needs immediate medical attention.
However if you’re a good candidate and would like to have one, it’s an example of something you can add to your birth plan.
Delayed Cord Clamping
Delayed cord clamping is exactly what it sounds like: Your provider delaying the clamping of your baby’s umbilical cord. This is done so your baby can continue receiving iron-rich blood through the cord.
Suggestions on how long to delay cord clamping varies, but the American College of Obstetricians and Gynecologists (ACOG) suggests at least 30 seconds to a minute. Other birth workers suggest delaying until the cord stops pumping.
While there is a slight increased chance that your baby will have jaundice if cord clamping is delayed, there are still quite a few benefits to the practice, according to ACOG. This includes:
- increased red blood cell volume;
- lower risk of necrotizing enterocolitis (a potentially fatal bowel disease in infants that Black babies are at a higher risk for);
- lower risk of brain bleeds, or intraventricular hemorrhaging; and
- a boost in iron during their first months of life.
That said, do your own research before deciding if this is something you’d like to explore.
Newborn Care Instructions
How do you want your birth team to administer care to your baby now that they’re here? Do you want to get your baby circumcised? How do you feel about your baby getting vitamin K injections?
Talk to your provider and doula about what typical newborn care is provided in the setting you’re giving birth, and make decisions around what you do and don’t want in your birth preferences.
“A newborn care education course before or during pregnancy are amazing to help with this,” says registered nurse and doula Ebony Harvey.
Breastfeeding Support
If you plan to breastfeed your baby after giving birth, it needs to be in your birth plan. Especially as a Black woman: Hospitals are nine times more likely to give Black mothers formula to feed their babies than white moms, according to a report on UPI.com.
What breastfeeding support do you want? Who do you want it from? Do you want help with expressing colostrum (the first milk your body makes) and feeding it to your baby? Medela’s resource on including breastfeeding in your birth plan is a great first step to figuring out what you do and don’t want.
Birth Plan Examples
Sometimes seeing birth plan examples can help get the gears going.
We have three for you to consider as you create your own birth preferences.
Birth Plan Example #1
Meet Tasha, a 28 year-old second-time mom. She had her first baby when she was 25 and it was traumatic. She looks young for her age, and she felt like everyone on staff treated her and her husband as if they were teen parents.
Tasha labored for hours, but they were told it wasn’t progressing and that their baby would go into distress if they didn’t do a C-section. They move forward with the procedure, and her daughter is happy and healthy, thank God,.
But now that she’s pregnant with baby #2, she’d like to try for a vaginal delivery and have more advocates in her corner. Here are some of the things she’d like in her birth plan:
- I will labor at home until my contractions signify that I’m in active labor.
- I would like to give birth in a birthing center. I want the lights to be dimmed while I labor and my labor playlist played on my external speakers at a low volume.
- My doula Sherrie Daniels (phone number) and my husband (phone number) will be my support people. If my husband isn’t able to make it to the delivery, my mother-in-law will step in for him. My birth team will comprise a midwife and their support team.
- I do not want any cervical checks.
- If I need to be transferred to a hospital for a C-section, then I would like my husband and/or my MIL, doula, and midwife to be present in the operating room, too.
- If I’m unable to have immediate skin-to-skin, then I want my husband to experience that with the baby.
- I want my baby to receive all the neonatal care and his Hep B vaccine.
- Unless the baby is in distress or getting his circumcision, I want him to be in the room with me at all times.
- I want breastfeeding support from lactation educators within 24 hours of delivering the baby.
- I will have a home visit with a pelvic floor specialist for an assessment within the first three weeks of giving birth.
Birth Plan Example #2
Meet Cara, a 36-year-old first-time parent. They will be co-parenting with their life-long friend Shawn and his husband Dan. Their best friend Denise is a doula; Cara has heard and seen enough stories about the Black maternal crisis to know that they want to have a home birth.
These are some of their birth preferences:
- I want to give birth in my living room in a kiddie pool with Shawn, Denise, Dan, my midwife, my step-mom, and my sister.
- I would like to labor in the shower.
- I will drink smoothies and juices as I labor. My sister will be in charge of making them and getting them to me.
- My step-mom will offer emotional support through leading us in song and praying for my health and the health of our family and community’s newest member.
- I will use comfort positions like walking around the room and rolling on a birthing ball.
- If I need to be transferred to a hospital, I would like to go to [insert name of hospital]. My birth team then will be Denise and my midwife. I need hospital staff to know my pronouns are they/them. Denise will correct anyone who misgenders me.
- If I need to be induced, I do not want my membranes to be swept or my water broken. I will use prostaglandins gel to start contractions. If that doesn’t work, then I’ll move on to pitocin.
- If I need to have a C-section, I would like a gentle C-section with a clear drape and delayed exit for the baby. I would like Denise and Shawn to support the baby in their crawl to my chest for immediate skin-to-skin contact. I want the baby to be assessed after observing the golden hour.
- I would like delayed cord clamping until the blood stops pulsing to the baby. Then I will cut the baby’s umbilical cord.
Birth Plan Example #3:
Meet Nana, a 32-year-old first-time mom with her boyfriend Jay. She has scheduled a C-section; due to the way fibroid removal has scarred her uterus, she wouldn’t be a candidate for experiencing labor. Not that she wants to experience it—her pain tolerance is very low. Here are some of her birth preferences.
- My boyfriend will be with me in the operating room and will cut the umbilical cord.
- My veins are small and the left vein has always been difficult to work with in past procedures. I want an IV in my right arm, and a nurse who is really good at inserting an IV.
- I don’t want any residents or interns in the room.
- I would like an epidural or spinal as close to my procedure as possible so the pain medication doesn’t wear off.
- I want skin-to-skin contact and breastfeeding support from the hospital team.
- I would like the lights to be dimmed after the procedure when I’m not being checked on by nurses.
- I want my postpartum doula and lactation consultant to visit me in the hospital and support me in my transition home.
- I do not want any pain medication after delivery that will make me groggy or nauseous or unable to interact with the baby.
- I want the baby to be examined in my room.
- I would like to breastfeed exclusively. If the baby has latch issues, I’d like help expressing my milk into a cup to feed the baby by syringe.
The Case for Postpartum Birth Plans
Now that you’ve created an outline for what you want for your birth experience, and read through some birth plan examples, you can see just how helpful they can be.
With that in mind, it’s also a good idea to create a plan for your postpartum experience as well.
“Similar to birth preferences, a postpartum plan should include discussions of support teams, preferences (for example, do you want to breastfeed on demand overnight or have someone help with nighttime feedings) and planned check-ins with your care provider,” according to The New York Times’ guide “Protecting Your Birth: A Guide for Black Mothers.”
Just bring that same level of introspection to the process, and you’ll set yourself up for an easier transition into the fourth trimester.
So let’s reflect on what you’ve learned. You’ve learned why a birth plan is so important, how to create one, and examples of what you can put into your plan. And you understand that your birth preferences aren’t set in stone. They can be affected by emergencies, your eventual provider’s hospital policies, or you simply changing your mind once you have new information.
But by building flexibility and thinking through all the possibilities, you’re increasing your likelihood of feeling like your wishes are being listened to and followed on your labor day.
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