The role of a birth plan

When you're facing a week full of tight deadlines, a to-do list makes it easier to prioritise and plan. Similarly, when you’re about to give birth, a birth plan lets your partner and birth team know how you want your labour to go. 

However, it is important not to depend too heavily on your birth plan, but to let your obstetrician guide you on what’s best for you and your baby.

“Creating a written plan helps you and your partner think through your ‘birthday wishes’ – what’s really important to you, what you hope for, how you envision the process unfolding and what you would like to avoid,” says Erica Neser, breastfeeding consultant at Mediclinic Stellenbosch.

On a practical level, having a birth plan can help you through the challenging parts of labour, keeping you focused and ready to keep going even when you feel like giving up. Make sure to share your birth plan with your support team, including your midwife, doctor, nurses, doula, and partner. This way, they know your preferences and it helps avoid any misunderstandings.

However, it’s important to remember that some things on your plan might change during labour if they’re not best for you or your baby’s health at that moment. “You need to feel okay about that,” says Erica. She adds that some items on your birth plan might already be standard practice at hospitals, but for others, you might need to discuss and agree on them with your doctor or hospital.

Above all, the point of a birth plan is to inform yourself about birthing options, comfort measures and pain treatment and to discuss these with your obstetrician beforehand. It should help you feel prepared and ready for the big day.

Erica says it’s best to keep your birth plan brief – no longer than one page. Using bullet points, a large font size, and highlighting key points will ensure it’s easy to understand. “No one has time to read through long paragraphs when labour is moving quickly. Also preface all points with the statement, ‘I would prefer to…unless medically necessary.’”

So, what should you include? Dr Colin Makgato, an obstetrician and gynaecologist at Mediclinic Vereeniging, says it's a good idea to clearly state your wishes about how you want to give birth. “You should also give thought to your goals and options for managing pain.”

Suggestions for your birth plan

I would prefer to:

• wear my own clothes throughout labour and birth
• stand/sit/lie on my side during fetal monitoring   
• avoid having epidural/episiotomy/vacuum assistance
• not have unnecessary people in the room
• not take pain medications (note that nurses will continue to offer you pain relief throughout your labour)
• give birth in a position of my choice/that feels most comfortable
• push when the urge is present (or be coached when, how long, and how to push)
• delay cord clamping for minutes/until the cord stops pulsing/cord turns white
• have my birth partner cut the cord (or not)
• leave the vernix on my baby's skin
• delay weighing and measuring of my baby until after the first breastfeed
• delay my baby's first bath until the second day.

It’s important to discuss your preferences with your obstetrician beforehand to understand what's possible and practical. Remember that this picture might change depending on what’s best for the health of you and your baby.