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The Importance of Writing a Birth Plan

By Dr Ellie Rayner

Every parent is different in their approach to labour and birth, but many do find creating a birth plan a useful step in the process of preparing to meet their baby. A ‘Birth Plan’, or more commonly referred to as your ‘Birth Preferences’ is a list of what you would like to happen during your labour, birth and in the first few hours after your baby has been born. It is personal and unique to you and may vary over time.

Many women do not have a birth plan and just want to ‘go with the flow’. Some women have a preference for only one or two things, for example they may wish to avoid an epidural or want the baby cleaned before skin-to-skin contact, whereas others like to create a detailed list of what they would like to occur. There are no right or wrong approaches to take when creating one, and it is important to know you can change your preferences at any time. Your birth plan should aim to be as adaptable as possible to all birthplace settings and to different scenarios.

When should I create a Birth Plan?

It is never too early to start considering your options for labour and birth and deciding what is and isn’t important to you. There is a page in your maternity notes on birth options that your midwife should discuss with you around your thirty-sixth week of pregnancy. This not only gives you the opportunity to ask questions about services and protocols specific to your local area, but also for your midwife to get to know you and understand your feelings and priorities towards labour. In most NHS maternity units, this is part of your routine antenatal appointments therefore the time you get to discuss each part with your midwife may be limited. For some parents, this time will be enough to create a plan they are happy with, whereas others may spend a lot of time researching different aspects and writing a detailed birth preference brief later. Whichever you choose to do, it is important you keep a copy in your notes so that anyone caring for you during pregnancy and labour is aware of your choices.

The earlier you start to look at your different options for aspects like where to have your baby or what pain relief you would like to consider, the longer you have to research all your options carefully and make an informed decision right for you. Antenatal classes are usually started from 20-24 weeks onwards and often cover some of the different aspects you might like to consider so around this time is usually a good time to start. Each birth plan will be unique to your personal circumstances and the circumstances of your current pregnancy. For example, if you have certain medical conditions or you, or your baby have required additional monitoring your midwife or obstetrician may have already discussed certain recommendations relating to labour and birth. If you have had a baby before, events of your last pregnancy may also influence how you approach labour this time, so it is important to include this in your discussion with your midwife. For example, if you had a quick labour before, you may want to discuss a having a homebirth or if you had a previous caesarean birth you may wish to aim for a vaginal birth this time.

What should I include?

There are many things you can include in your birth preferences, but most parents include things such as:

  • Who will be your birth partner
  • Where do you want to give birth
  • If you want to use special equipment like a birth pool
  • What types of pain relief you would like to use
  • How you would like to deliver the placenta
  • Whether you would like skin to skin with your baby after birth
  • How you would like to feed your baby.

Birth Plan vs Birth Preference

The term ‘Birth Plan’ is commonly used, but many parents find it more helpful to approach this as a ‘Birth Preferences’ list instead. Unfortunately, things don’t always go to plan during pregnancy, labour and birth and therefore it is especially important to remain flexible and be prepared to change your previous idea and do things differently to how you ideally hoped if you have to. Sometimes there may be requests that cannot be facilitated as these options are not available, for example the birth pool may be in use or there may be unexpected complications that arise and by having a ‘Plan B’ option for what you would like to happen in some of these situations you are less likely to feel disappointed and unprepared at the time. By taking the time to consider the alternative options and scenarios beforehand, for example, an unplanned caesarean, you may feel more reassured and informed if the situation occurs. All birth preferences should be read by the Midwives that care for you at the onset and throughout your labour and they may discuss different aspects with you and your birth partner to clarify something you have requested. If, on the day, there is a reason that things have changed, and your midwife or obstetrician recommends altering part of your birth plan then they will discuss this with you in full and give you their rationale for this recommendation. They should also offer you time to discuss with your partner and answer any questions you have.

Birth plan templates are available online from many sources such as the NHS choices website or you can create your own. It can be especially useful to do this with your birth partner and discuss each aspect together to ensure you both feel comfortable with the decisions you have made. If you have any questions about anything you should or shouldn’t include, talk to your midwife or obstetrician ideally before labour and if researching any parts online, make sure to use a recognised resource such as the Royal College of Obstetricians patient information section or NHS websites for accurate, up-to-date information that you can trust.

About the Author

Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective.

She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth. 

The Maternity Collective provide complete online antenatal and birth preparation courses led by a team of NHS healthcare professionals, including a Community Midwife, Obstetrician, Internationally Board-Certified Lactation Consultant (IBCLC) and Newborn Sleep and Behaviour Expert. Their 7-hour online course of 37 videos has been undertaken by more than 4200 parents to date and has fanatic reviews.