Maximize your childbirth outcome with these suggestions for an effective birth plan.

A simple birth plan is important for several reasons. First, it serves as a clear communication tool between expectant parents and healthcare providers, outlining preferences for labor and delivery. This helps ensure that the parents' needs and desires are taken into account during the birthing process.

Second, having a birth plan can reduce anxiety for parents. It encourages them to consider various options, from pain management to post-delivery care, fostering an informed decision-making process. A birth plan aims to enhance health results by focusing on you during labor and delivery.

To work effectively, your care providers need to read it your birth plan, so keep it short and sweet. Use the following tips to tailor your preferences when creating your birth plan:

  • Keep it brief. List only what’s most important to you. You can refuse any intervention when it is offered - just ask for the Against Medical Advice Waiver.

  • Make it easy to read. Avoid small fonts. Use bullet points and leave some white space.

  • Present it with food/gifts. Nurses work long hours and appreciate snacks. Consider building a small basket or gift bag of reasonably healthy snacks, such as cookies, fruit, crackers, cheese, nuts, etc. Chocolate is always a nice addition. Bring an additional basket for the postpartum nurses, too.

  • Make it relevant. The nurses don’t need to know that you plan to labor at home for as long as possible, or that you’ll delay newborn procedures until you’ve left the hospital - simply note whether you accept or decline medications and procedures.

  • Solicit help. Most doctors and nurses are in the health profession because they want to help; however, because they are in the medical profession, many haven’t witnessed an unmedicated birth. They may truly believe that routine interventions such as an epidural, episiotomy, I.V., catheter, etc. are all helpful to a birthing person. Asking for their help in avoiding such interventions may provide a different perspective.

  • Keep it positive and simple. Try to avoid the words and phrases that include no or don’t.


Finally, a straightforward birth plan can facilitate smoother interactions among the care team. Laying out key preferences clearly helps avoid misunderstandings and allows for better alignment with the medical staff's protocols. While flexibility is essential, a simple birth plan can be a valuable tool for supporting a positive childbirth experience.

 

Please have a draft copy of a birth plan ready to review with your primary doula during your Birthday Planning session around 34-35 weeks gestation. Please include your partner.

After your meeting with your doula, revise your birth plan using Google Docs, and send it as an attachment to her so she can suggest edits if needed, and you will be able to accept/decline any changes she may suggest to you.

If your medical care provider or birthing facility provided you with a "checklist" type of birth plan, please use it to help you write your formal birth plan/preference sheet, which should resemble a sample from below. These are tried and true example plans but feel free to copy statements from several below to compile your own work.

 

Episiotomies, Tears, and Pushing

To limit tearing during the second stage of labor:

  1. Support your skin! Avoid processed foods, focus on nutrition, and eat a well-rounded diet.

  2. Plan on a waterbirth or water immersion for a long period of time right before delivery. We encourage you to explore what underwater birth can offer you and to seek out medical facilities and care providers that offer inflatable tubs or birth pools for labor and delivery. For further reading on waterbirth, check out NPR's Shots article from March 2014.

  3. Apply warm compresses when crowning; there is sufficient evidence to support the use of warm compresses to prevent perineal tears. Read the Cochrane review of eight randomized trials (involving 11,651 women) conducted in hospital settings in six countries. How to mix water and when to apply cloths: https://www.youtube.com/watch?v=_Up-GKAj_fI

  4. Get off your back! Squat, kneel, stand, or lay on your side while pushing.

  5. Breathe the baby down and focus on completely relaxing your pelvic floor. Bear down gently when you feel the urge to push with contractions. Use mind-body relaxation techniques such as guided meditation (hypnosis).

  6. If an epidural is used, you likely will not feel the urge to push with contractions and must be directed on how to push and how long to do it. This is called purple-pushing and increases your risk of tearing and/or the need for an episiotomy.

  7. Read about natural tearing when pushing versus a midline or mediolateral episiotomy. The degrees of lacerations are explained and photos are posted.

 

INT, Saline, or Heparin (Hep) Lock

An INT port is a saline or heparin lock that provides vein access (a portal) that is used for low-risk mothers in labor in the hospital. It allows immediate access to a vein in the event of a complication and can be placed during the initial blood draw upon arrival at the facility. This allows you to be free from the IV lines and pole, affording you increased mobility during labor.

There are many benefits to having a saline lock - just in case it is needed for medications to treat pain, nausea, heartburn, hemorrhage, etc. but there are also risks to consider with every intervention.
 

 

Routine Newborn Procedures

When drafting your birth plan or preference sheet, please consider the following routine newborn procedures. The PKU test is required but for the others listed, you will need to write on your plan/sheet whether you'll accept or decline the medicine, vaccine, or procedure.

  • PKU or "heel stick" test - Phenylketonuria (PKU) is a genetic disorder, which your newborn will be tested for in the first few days of life. This test involves sticking the foot of the child for blood. It is only accurate when your baby has been receiving a diet containing phenylalanine, in both human milk and artificial formulas, for a period of 24 hours.

  • Hepatitis B Vaccine - Vaccine-derived immunity for Hepatitis B (HBV) is short-lived and needs to be given again later in life to provide protection. Talk to your pediatrician about the potential risks of this vaccine. Some parents choose to have their pediatrician give the shot at their baby's first visit rather than at the hospital.

  • Vitamin K injection virtually eliminates the chance of life-threatening Vitamin K deficiency bleeding. The only known adverse effects of the shot are pain, bleeding, and bruising at the site of the injection. Out of many millions of injections, there has only been one report of an allergic reaction in recent history.

  • Erythromycin eye ointment - Newborns receive erythromycin eye ointment after birth to prevent pink eye in the first month of life, also called ophthalmia neonatorum (ON), also known as neonatal conjunctivitis, is an infection that causes inflammation of the conjunctiva during the first four weeks of life. The most common cause of ON is chlamydia, a sexually transmitted infection. A less common but more serious cause of ON and the reason for mandatory erythromycin eye ointment is gonorrhea, another sexually transmitted infection, that now accounts for less than 1% of reported ON cases in the U.S. A newborn can get ON from chlamydia or gonorrhea if the mother is infected at the time of the birth. If the baby's mother does not have chlamydia or gonorrhea, then the newborn cannot catch ON. If a baby is born by c-section and the bag of water didn't break before surgery, then it is extremely unlikely that the baby would catch ON.

  • ​Circumcision​ - In the US, it is illegal to circumcise babies that are assigned female at birth. You may elect to circumcise your male infant before you leave the hospital. (this is typically done the day following their birth.) Circumcised male newborns may experience fewer urinary tract infections (UTIs). A review found that under 1 year of age, 1.38% of intact males had a UTI versus 0.14% of circumcised males. About 111 circumcisions would be needed to prevent a single (treatable) UTI in infancy. Overall, UTIs occur more often in females. About 8% of girls and 2% of intact boys have had a UTI before age 7. The rate of early complications after newborn circumcision is around 2%. The most common complications are bleeding, swelling, and cosmetic concerns following the procedure that may lead to reoperation. Circumcision is a painful procedure that requires pain treatment.

  • Baby’s first bath - Recent research has shown that delaying the first bath after birth can have a significant impact on the newborn transition and early bodyfeeding. Because of this research, we encourage parents and care providers to look at delaying the first bath until you leave the birth facilty.

 

Skin to Skin With Your Newborn

Early skin-to-skin care (also called kangaroo care) is a natural process that involves placing a naked newborn on the mother’s bare chest and covering the infant with blankets to keep it dry and warm. Ideally, skin-to-skin care starts immediately after birth or shortly after birth, with the baby remaining on the mother’s chest until at least the end of the first breastfeeding session (Moore et al., 2012). Note: Laying a baby on top of the birthing person’s gown or on top of a towel does not count as skin-to-skin.

Skin-to-skin care can start at different times. In research studies, there are 3 main types of early skin-to-skin care for healthy term infants:

  1. Birth or immediate skin-to-skin care starts during the first minute after birth

  2. Very early skin-to-skin care begins 30-40 minutes post-birth

  3. Early skin-to-skin is any skin-to-skin time that takes place during the first 24 hours.

Skin-to-skin care after a Cesarean has many benefits for the birth giver and babies. However, the parents recovering from a Cesarean can’t do skin-to-skin if they are routinely separated from their babies. In order to do skin-to-skin, mothers and newborns must stay together—a process known as couplet care. Why don’t more people receive couplet care? Is it possible for hospitals to make the switch from routine separation to routine couplet care after a Cesarean? Keep reading to find out.

 

Placenta Encapsulation

It's purported that ingesting placenta via encapsulation or chocolate truffle, fruit smoothie, or alcohol-extracted tincture, may naturally promote milk production, prevent postpartum depression, and speed healing. There's no current evidence that ingesting the placenta will provide any health benefit. If you are unsure if this long-time practice is right for you, keep your placenta on ice at the hospital and deep freeze it as soon as possible. You can encapsulate your placenta up to one year after its birth.

The CDC advises against ingesting placenta in any form. Placentophagy can be harmful to you and your baby. Here's a link to more info on their site. Right now, we don’t know if placentophagy has any effect on postpartum depression and if any effect it may have, maybe due to the placebo effect. More info is posted here in the National Library of Medicine.

Afterbirth Anywhere provides a clinical approach to placenta encapsulation services that protect the integrity of the placenta throughout the process. With trained specialists and a dedicated workspace designed solely for placenta encapsulation, their services are efficient and can process a placenta in less than 20 hours. Their specially designed workspace allows for better sanitation than an at-home kitchen, it also protects the placenta and the entire family from unintended exposure to contaminants in a busy home.

Afterbirth Anywhere uses temperature-controlled equipment to ensure the placenta is not degraded by exposure to high temperatures or variations in temperatures. Their encapsulation process ensures that each capsule has a consistent amount of finely ground placenta to allow for proper dosing. It's important to note each pill should contain pure placenta with no herbal additives that may cause unexpected side effects rendering the pills unusable. Afterbirth Anywhere is the go-to provider for area birth professionals, as well as, several national professional groups.

If you're undecided, you can preserve your placenta in your freezer for up to one year postpartum and see if you later need it. 

In this video, you will learn:

  • Frequently marketed claims about placenta encapsulation

  • How many experimental trials have ever been done with placenta encapsulation

  • Results from the newest randomized, placebo-controlled trial on placenta encapsulation


We recommend the services of Anywhere Afterbirth. Learn about their process and How To Keep Your Family Safe: Placenta Processing And Sanitation. If you plan to hire a placenta specialist NOT associated with Natural Afterbirth, you must choose where your placenta will be processed. Read a comparison of the benefits and drawbacks to each option.

"As far as caring for the placenta, the short answer is that I ask them to put it into two freezer bags (double-bagged) or some hospitals will put it in a food-grade plastic container. It needs to be put on ice within 4 hours of the birth, preferably 2 hours. I ask them to bring a cooler with them to store it in." - Melanie Belk Nasmyth of Natural Afterbirth.

See attached file for complete instructions for placenta safety.

 

Cord Clamping

Some OBs state their practice is to clamp the cord approximately 60 seconds post-birth. Others wait to clamp the cord until after it has stopped pulsating, ensuring baby receives all the cord blood available. And there are several care providers who tell their patients they will clamp and cut the cord immediately to prevent newborn jaundice. Whatever you decide is best for your baby, I hope the below evidence prepares you for an informed discussion with your care providers.

Although there is no strong scientific support for immediate cord clamping (ICC), entrenched medical habits can be glacially slow in changing. Here are some often-heard objections to delayed cord clamping (DCC), and how an advocate for delayed clamping might respond to them.

It is the position of the American College of Nurse-Midwives that delayed cord clamping should be the standard of care in all birth settings for term and preterm newborns. In situations requiring resuscitation, umbilical cord milking may be of benefit when delayed cord clamping is not feasible, particularly for the preterm newborn.

Milking the cord must take place before the cord has been clamped. This is beneficial for babies who are struggling to breathe in the minutes following birth by allowing the placenta to deliver oxygenated blood via the cord. Watch the below video by Penny Simkin about delayed cord clamping so you can see the amount of blood that is transferred before cutting the cord.
 

 

Information on Cord Blood Banking

The American College of Obstetricians and Gynecologists (ACOG) offers sound advice on cord blood: 

  • Patients should know the chances are remote that stem cells from their baby's banked blood will be used to treat their child or another family member.

  • Patients should be aware it is unknown how long cord blood can be successfully stored.

  • Physicians who recruit patients for for-profit banks should disclose any financial interest or potential conflicts of interest.

  • Children who develop genetic diseases or inborn metabolism disorders cannot be treated with their own cord blood -- no one can be treated with their cord blood as it would carry the same genetic mutation.

Read more here.