Creating a Natural Birth Plan That You’ll Actually Use (Practical Advice From a Midwife)

As a midwife, I love catching squishy babies in unmedicated tub births.  There is nothing better than the moment when a baby gently enters the world in a warm tub and doesn’t quite realize that they’ve been born yet.  However, I also believe in supporting families and meeting people where they are. That’s why creating a birth plan is such a crucial part of your pregnancy.  

Putting together a birth plan as a first-time mother can be overwhelming when you don’t even know what choices you have to start.  By reviewing your options, it empowers you to choose what works best for your family.

How does a birth plan help you?

A birth plan should begin by helping you understand what your options are for birth and opening the door to a dialogue with your healthcare provider.  Typically, you focus on the more natural side of birth and then venture into birth preferences if it switches gears into a delivery that requires more interventions than expected.  Unexpected situations often crop up during labor!

What are the steps for writing a birth plan?

1.  Learn everything you possibly can about your options.  Talk to your healthcare provider and what they usually see and make sure they don’t cut episiotomies unless it saves your baby’s life.  Speak with your partner about what they have envisioned.  Ask family or friends what resonated with them.  Tap in deep to your desires and choose which items are important to you.
2. Sit down with your doctor or midwife and cover everything in the document.  As a nurse and midwife, I can assure you that we want you to birth as closely to your ideals as possible.  However, if you don’t tell us until the big day, it’s hard to sit down and talk about what we need to do to make it happen.  This can also be a gamechanger to see if your OB provider is supportive of your plans for birth or not.
3. Write out a clear and concise birth plan.  It’s best to keep it easy to read and short with bullet points. Make several copies and ask that one be scanned into your record and pack a few in your hospital bag.  If you’re birthing at home, you are ahead of the game.

What should I include in my birth plan?

If any of these conversations with your healthcare provider result in red flags, it’s okay to move on to someone you feel will better support your wishes.  Your clinician can be the most critical difference between an empowered or traumatic birth.  Many pregnant people opt for a midwife to offer a more holistic touch to their pregnancy.

Since kindergarten, we’ve been using the five w’s to identify the background of any newsworthy circumstance. While life is marked with spectacular milestones, this is one of the monumental ones!  

Who should be present? 

While some want to be surrounded by all of their loved ones, many prefer the intimate environment of just their partner and perhaps one other essential support person.  In a perfect world, your chosen support partner would know just what to do.  If you want to birth in a hospital, nurses are lovely and will be there throughout your hospital stay but doulas are a different animal.  A partner has to juggle your existing relationship and a nurse needs to document your medical progress.  However, a doula is there to support you throughout your labor and birth.

The American College of Obstetricians and Gynecologists (ACOG) states that women who use a birth doula are more likely to have a positive birth experience (source).  You are more likely to have successful unmedicated childbirth with a doula teaching you and your partner ways to manage the contractions and find natural pain relief methods.  While being DONA certified is not a requirement, it does ensure a certain level of training.  

What type of pain management do you include in your birth plan?

While many women opt to avoid all medication, there is a range of analgesia (pain medication) throughout labor and birth.   The opioid can be infused either intravenously or intramuscularly.  Often, these opioids are enough to take the edge off.  Some birth settings also offer nitrous oxide as an option to inhale during the challenging parts of your labor.  Have you heard of laughing gas?  Nitrous oxide is a different mix of the same gases.  You apply a mask to your face as long before the peak of a contraction and keep it on your face as you desire and when you remove it.  You may feel drowsy, lightheaded, or it will leave your body within 30 seconds.

Epidural anesthesia gives decreased sensation and pain relief in the lower section of your body because it infuses a numbing medication like bupivacaine or lidocaine.  In some cases, you may also receive a narcotic at the same time.  You cannot get out of bed after an epidural is placed.  If you wind up with an epidural, make sure to engage in frequent position changes to help your baby navigate the passageway during birth.

Where do you plan on birthing?

Birthing options include delivering at a hospital, birth center, or home.  It’s vital to realize that your OB provider has specific credentialing and licensing for where they are able to practice.  Make sure to converse with them early on to identify where you can opt to birth and if you’re comfortable with it.

Identify your (why) for your birth plan

So you want to have an unmedicated birth or “go natural”?   Your “why” is what you cling to during times that you feel like you can no longer do it.  You have faith, values, and reasons why this journey matters to you.  Find a mantra and cling to it.  Some examples that I’ve heard over the years include:

• I am brave, and I am strong.
• I can do hard things.
• This brings me closer to my baby.
• I take this one contraction at a time.
• Breathe in, breathe out.
• I am a bad***.

When do you want to give birth?

Typically the when is up to the little person, however this begs the other question: are you open to labor induction or augmentation?  Allowing birth to commence on its own is known in the medical arena as expectant management.  During expectant management, the baby will pick their own birthday.  Other parents prefer an elective induction in which you choose to receive a number of medications to encourage the birth of your baby.  Sometimes your doctor or midwife will discuss inducing you for medical reasons, but that’s an entirely different animal!

How do you want to give birth?

Consider your ideal position in which you would like to birth.  Make sure your provider is open to nontraditional birthing positions.  I am a huge fan of the hands and knees or left side lying position for giving birth.  In some studies, it minimizes tears (source).  However, it’s not about me- it’s about you!  Make sure your birth attendant knows and supports that.  Your baby should be placed immediately in skin to skin (also known as Kangaroo care) following birth unless they are compromised. (source)  If you prefer to nurse, breastfeeding within the first hour is critical for success (source).  

What else should you include on your birth plan?

• What do you want to do with your placenta? Some moms prefer that the place of birth dispose of it, others want to take it home to bury under a tree or freeze it, and some opt to ingest it.
• How long after birth do you want to bathe your baby? By delaying the bath at least twelve hours, it increases the likelihood of breastfeeding triumph (source).
• Rh negative moms also need to receive RhoGam, an immunoglobulin to ensure their next pregnancy runs smoothly, if their baby has a positive blood type.
• Consider how you feel about giving baby meds like:
  • eye ointment to prevent sexually transmitted gonococcal infections from affecting your baby’s vision, 
  • the hepatitis b vaccine in the first few days of life, 
  • vitamin K to prevent newborn hemorrhage with clotting disorders.

What shouldn’t go on my birth plan?

Don’t waste your precious birth plan space on things like enemas or episiotomies, as those are no longer practiced.  Also, don’t say “avoid unless medically necessary” because that gives us a whole lot of leeway.  Simply state “if my baby is in fetal distress” or other precise wording.  

Beyond the Birth Plan

When in doubt, if you are overwhelmed by what your birth attendants are saying to you, practice with your advocate or partner ahead of time.  You should be focused on your birthing!  Remind them to ask:

• Are there any other options?
• Is that absolutely required? 
• What else can we do?

The birth plan is ultimately a conversation starter between you and your healthcare providers.  We support you in this beautiful journey to parenthood. However, we also are supportive of changing your mind at any point during labor!  Being flexible, should the situation require it, can be empowering.  
For a valuable resource, consider the birth plan created by the American College of Nurse Midwives.

This article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.