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Key takeaways

• A birth plan helps share your preferences with your care team.
• It is a guide, not a rigid script for labour.
• Discuss your plan with your midwife for support.
• Be prepared for plans to change for your safety and your baby's.

What is a birth plan?

A birth plan is a way to let your midwife, doctors, and healthcare team know what you hope for during your labour. It is a chance to plan things like where you would like to give birth. It also helps you decide who will be with you.

Your midwife will help you make the best and safest decisions for you and your baby.

It's good to remember that birth can be unpredictable. Think of your plan as a guide that can be flexible if things need to change for your or your baby's safety.

Key elements to include in your plan

Your birth plan can include many different preferences for your labour and birth. Your midwife can help you work out your wishes.

Who will be with you

You can choose to have someone with you for support during your birth. You can choose up to two people. Choose someone you feel comfortable with.

• This could be your baby's dad or your partner.
• It could also be a close friend or a family member.
• An antenatal teacher or doula can also be present.

You can also state if you are happy or not for student midwives, nurses, or doctors to be present.

How you are feeling

Your birth preferences can be an opportunity to explain how you are feeling about labour, the birth or the post birth period. There may be something which you are particularly apprehensive about. You may wish to mention something which you feel strongly about.

Your birth environment

You can include where you want to give birth. It is helpful to discuss this with your midwife or doctor in advance. If you would like to give birth at home, you will need to plan this with your midwife team.

It may be recommended that you have your baby in a unit with specialists available or medical equipment on hand.

You can also specify if you would like music playing, have dimmed lighting in the room, or aromatherapy scents.

You can state if your preference would be to use special facilities such as a birthing pool.

Movement and positions during labour

Moving around and changing positions can make labour easier and help to facilitate the birth of your baby. It can also lead to a shorter labour and fewer interventions. Your midwife will encourage you to be active during your labour and suggest comfortable positions.

Lying on your back can be uncomfortable. It can also make it harder for your baby to move through your pelvis.

You can try different positions:

• Walking and standing – Try to walk around during early labour. When standing keep your hips moving and your knees loose.
• Kneeling – You can rest by leaning forward between contractions, perhaps placing a cushion under your bump if your need it for extra support.
• Sitting – You can sit astride a chair and lean forward, resting on a cushion or pillow for comfort. Sitting on a birthing ball or beanbag is also an option.
• Using a birthing ball – This large inflatable gym ball allows you to rock or tilt your pelvis. Keeping your pelvis above your knees creates a good angle for childbirth.
• Supported standing or squatting – This position opens your pelvis wide, using gravity to help your baby be born; your partner can support your upper body from behind. Remember to keep your knees lower than your hips to reduce strain.
• Kneeling on all fours – This can help if you have a backache.
• Rocking your pelvis – Do this in any position you find comfortable.

Massage and soothing touch can help your body release a hormone that helps labour progress (oxytocin). Massage can also relieve stress. This helps your body release its own natural painkillers (endorphins).

If you have a type of pain relief that numbs the lower part of your body (an epidural), your movement may be more limited. Your midwife should still help you move into comfy upright positions.

Water birth

Water can help you relax during labour. Many women find it helps them move more easily. It can also help them cope better with contractions.

Your baby can be born in water with midwife support. The birthing pools are deep and spacious to move to different positions. You can also use the pool for labour only, getting out for your baby's birth if you prefer.

Labouring in water is advised if you and your baby are healthy. Your pregnancy should also be at low risk of complications.

Pain relief and interventions

You can state what kind of pain relief you would like. This includes self-help techniques and alternative therapies available in your area. You may not wish to be offered pain relief, but instead ask when you feel the time is right for you.

You can share your feelings about potential interventions. These include:

• Episiotomy – A surgical cut to the area between the vagina and anus to make the opening bigger.
• Ventouse delivery – A vacuum cup to help deliver the baby.
• Forceps delivery – A pair of special spoon-shaped instruments to help guide the baby out.

You can also state if you would like someone with you during these. This also applies if you need a birth where your baby is delivered through a cut in your tummy and womb (a caesarean section).

If you have a caesarean section

You can still have a birth plan if you are having a planned caesarean section. For example, you might want the screen lowered to see your baby's birth. You can make requests such as your chosen person with you to announce the sex of your baby, or a quiet theatre ensuring the first voice your baby hears is yours.

Care right after birth (immediate postpartum care)

You can include your choices about skin-to-skin contact. This can be done immediately with your baby, before the cord is cut. This is possible at home, in the hospital or in the theatre environment.

You can also mention your preference for waiting to cut the umbilical cord (delayed cord clamping), although this should be routine practice. This means the cord is not clamped and cut until at least 1 to 5 minutes after birth.

This allows cord blood from the placenta to keep flowing to your baby. This helps with their growth and development.

You can state how you want to feed your baby.

You can also include your preference for vitamin K for your baby. This helps prevent a rare bleeding disorder. Your baby can have an injection or oral doses.

You can also state your preferences for delivering the placenta (known as the third stage of labour).

Other preferences

You can include any special needs you have.

• This could be a sign language interpreter.
• You can also mention if you would like to follow any religious customs.
• You can also state what name you would like to be called, especially if it is different from the one on your notes.

Discussing your plan with your midwife or care team

Talk to your midwife while you are writing your birth plan. They can answer your questions about what happens in labour. They can also tell you more about birth options in your area.

Your midwife will help you work out your wishes and what you feel is safest for your individual needs.

You do not need a special form for your birth plan. You can write down a few points on a sheet of paper. Templates are available if this is helpful.

Your plan will depend on what you want and your medical history. What birth options are offered at your local maternity service will also play a part.

Your plan will go into your maternity notes or app.

Staying flexible: when plans change

A birth plan is a great way to share your hopes and choices for your ideal birth experience. What you include in it is up to you.

You can change your mind at any time, even during labour. For example, you may decide you want an epidural after all. Never be afraid to ask.

It's good to remember that birth can be unpredictable, and sometimes plans need to change. Your midwife will be there to help you make the best and safest decision at the time.

They will help to protect your birth wishes as best they can. Your baby's safety and yours are very important and may need to take priority in life saving situations.