Creating a Realistic Birth Plan

What a Birth Plan Actually Is

A birth plan is a communication tool. It tells your medical team your preferences for a normal, uncomplicated birth.

It is not:

• A binding contract
• A guarantee of how birth will go
• A test of your strength or commitment
• Something to feel guilty about if you deviate from it

It is:

• A way to communicate preferences
• A starting point for discussions with your provider
• Helpful for your partner/support person to advocate for you
• A guide for medical staff who might not know you

Keep It Short

No one is reading your 5-page birth plan. Nurses are busy. Make it one page, bullet points.

My entire birth plan:

That's it. One page. Clear preferences, flexibility built in.

What Actually Matters

Focus your birth plan on things that either:

1. Have medical implications
2. Significantly impact your comfort or experience
3. Might not happen automatically

Things Worth Including

• Pain management preferences: Epidural yes/no, willing to try unmedicated, etc.
• Who stays with you: Partner, doula, family member
• Immediate postpartum: Skin-to-skin, delayed cord clamping, who cuts cord
• Feeding plan: Breastfeeding, formula, combo - helps nurses support you appropriately
• Medical history relevant to birth: Previous surgeries, anxiety disorders, trauma history
• Religious/cultural preferences: If they impact medical care

Things Not Worth Including

• Requesting no episiotomy (doctors don't do routine episiotomies anymore anyway)
• Demanding no C-section (no one wants unnecessary surgery - trust me)
• Specific music/lighting/aromatherapy (nice if it happens, not critical)
• Refusing all interventions (puts medical staff in impossible position)
• Micromanaging every detail (see: things you can't control)

Pain Management

This is the biggest decision in most birth plans. Be honest with yourself.

Planning Unmedicated Birth

If this is your goal, great. But include a line like "if I request pain medication, please provide it without judgment."

Changing your mind doesn't mean you failed. Labor is unpredictable.

Planning Epidural

Specify timing if you have preference: "as soon as available" vs "I'll request when ready"

Know that sometimes epidurals don't work perfectly. Have a backup plan.

Keeping Options Open

Totally valid. "I'd like to start without medication and reassess" is a complete plan.

Interventions

This is where birth plans get contentious. Here's the reality:

Medical interventions aren't elective. They're offered when there's a medical reason.

Instead of blanket refusals, try this framework:

Common Interventions

• Continuous monitoring: Sometimes required, sometimes optional. Ask about intermittent monitoring if low-risk.
• IV fluids: Often required with epidural, sometimes optional otherwise.
• Pitocin for augmentation: Used if labor stalls. Discuss when it's truly necessary.
• Breaking water: Can speed labor but isn't always necessary. Ask about timing.
• Vacuum/forceps: Used when baby needs help, usually discussed in the moment.
• C-section: Emergency vs. non-emergency have different timelines for decision-making.

Immediately After Birth

These preferences often get lost in the chaos. Worth specifying:

• Skin-to-skin: "Immediate skin-to-skin if baby is healthy"
• Delayed cord clamping: "Wait 1-3 minutes if possible"
• Cord blood banking: If you're doing it, make sure hospital knows
• Who cuts cord: Partner? You? Doctor? Doesn't matter?
• Placenta: Want to see it? Take it home? (Some people do. Most don't.)

C-Section Preferences

Even if you're planning vaginal birth, include C-section preferences. About 1 in 3 births are C-sections.

• Support person: Who comes with you to OR?
• Gentle cesarean options: Clear drape to see baby? Skin-to-skin in OR? Arms free?
• Music: Some ORs allow this
• Immediate feeding: Can you try breastfeeding in recovery?

Newborn Care

Specify preferences for baby's first hours:

• Vitamin K shot: Standard and recommended. If declining, know the risks.
• Eye ointment: Required by law in most states, prevents infections.
• Hepatitis B vaccine: Usually given before discharge. Optional but recommended.
• Bathing: Can be delayed - some parents prefer this.
• Circumcision: If having a boy and choosing circumcision, specify timing.
• Rooming in: Baby in room with you vs. nursery time.

Feeding

Let the staff know your plan so they can support you appropriately.

• Breastfeeding: "Planning to exclusively breastfeed, would like lactation support"
• Formula: "Planning to formula feed"
• Combo: "Planning to combo feed"
• Supplementation: "Okay with formula supplementation if medically necessary" or "Prefer to discuss before supplementing"
• Pumping: If you want to pump, hospital can provide pump

What I Wish I'd Known

Labor Moves Fast Sometimes

I had this whole plan about laboring at home as long as possible, using a birthing ball, trying different positions. I went from 4cm to 10cm in 45 minutes. None of that happened. It was fine.

You Might Not Care About Things You Thought You'd Care About

I thought I'd want music, dim lights, a calm environment. In active labor, I didn't care about any of it. I cared about getting through the next contraction.

The Medical Team Wants You to Have a Good Experience

They're not the enemy. They're not trying to force interventions. Approach birth planning as a collaboration, not a battle.

Discussing with Your Provider

Bring your birth plan to a prenatal appointment. Go through it together.

Good questions to ask:

• "What's standard practice at this hospital?"
• "Which of these preferences align with hospital policy?"
• "Which might be challenging?"
• "What do you recommend based on my medical history?"

If your provider dismisses all your preferences or makes you feel stupid for having a plan, that's a red flag. You need a provider who respects your input.

The Most Important Line

End your birth plan with something like this:

"Primary goal: Healthy baby, healthy mom. These are preferences for an uncomplicated birth. In an emergency, I trust my medical team to make the best decisions for me and my baby's safety."

This tells your team: You have preferences, but you understand birth is unpredictable. You're working together.

After Birth: Processing

However your birth goes, you'll have feelings about it.

If it went according to plan: Great. Doesn't make you better than someone whose didn't.

If it didn't go according to plan: That's okay. You didn't fail. Birth is unpredictable and you did what you had to do.

If you had a traumatic birth: Talk to someone. Birth trauma is real and deserves support.