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Many couples balk at the thought of submitting a birth plan to their doctor or midwife. How will they respond? Will they think you are trying to tell them how to do their job or wanting them to sign a 'contract'? People become parents the moment a baby is conceived, so it's appropriate that they begin making decisions right away.
Modern-day caregivers recognise that a woman who is pregnant for the first time has many needs: practical support; positive input and encouragement; having her confidence in being a mother reinforced; having her intuitive feelings nurtured; and acquiring parenting skills.
Caregivers who recognise that a woman needs to be involved in her own care will empower her to make decisions. They will support her in her choices at all times and make her feel important and competent, even if they disagree with the choice. This is the kind of doctor or midwife who would encourage a birth plan and view it as a forum for effective communication.
Writing a birth plan implies that you and your partner wish to share in the responsibility of the birth and hope to participate in any decisions to be made. It lets everyone know what your expectations are, however the birth turns out for you. The following points may outline the issues you would like to raise with your caregiver.
Important considerations
The choices a woman makes about who will assist her at the time of birth – both professional and non-professional – are of fundamental importance long before the birth plan is formulated. It is the most important decision you will make during your pregnancy. You should consider points such as who you want to have with you at the birth, whether you want more than one person with you, and whether your companion can stay with you throughout, even during a caesarean section.
It used to be routine practise to shave off pubic hair and give an enema to empty the bowel before labour. Ask whether these procedures are necessary. If you don't feel they are, say so in your birth plan.
It isn't always possible to make a firm decision about your position for giving birth, but it is worthwhile knowing beforehand what your options are. Find out if you can walk around during the labour and whether you will be electronically monitored. Will your doctor or midwife be happy to deliver your baby in whatever position you find comfortable? If not, you may need to reconsider your plan or choice of caregiver.
To ensure all is well, your baby's heartbeat will be monitored throughout labour. There are three methods:
The kind of pain relief you would like to use is obviously also an important decision. Some women prefer the idea of a natural birth without drugs but find that the pain becomes more than they can cope with and opt for medicated pain relief later on. It is a good idea to know what is available beforehand, as well as the risks and benefits of the various methods.
It may be necessary for labour to be induced (started off artificially) either with a prostaglandin pessary or by stimulating labour with intravenous drugs and breaking the waters during a vaginal examination. Some consultants will time the labour and advise action if things are moving along more slowly than the norm. This is called active management. You should ask your caregiver to explain her philosophy about speeding up labour, the methods used and how your labour will be monitored.
When your baby is ready to be born, a cut (episiotomy) may be made in the vaginal opening. A local anaesthetic is usually given and the cut will be stitched up afterwards. A spontaneous tear does not always need stitching and is often less painful. Episiotomies are made if the baby seems distressed and needs to be born quickly or the mother is tense and tired and the pelvic floor is unyielding. It is difficult to decide in advance whether you prefer to have an episiotomy or to tear, but if you have strong feelings, express them in your birth plan.
After your baby is born, the placenta will be delivered and there are a number of routine procedures which follow. Discuss the various techniques used to deliver the placenta with your doctor or midwife and make a note on your birth plan regarding your preference.
A caesarean may be planned (elective) or unplanned – an emergency procedure. It can save a baby's life, but you might like to state a preference for a general or epidural anaesthetic, whether or not your birth partner wants to stay with you and if you want to hold your baby immediately after he is born.
It may help to establish feeding if you put your baby to your breast straight after the birth. Ask if this is possible and if the baby can stay by your bed all the time so that you can feed on demand. If you want to bottle-feed, write this down, but remember you can change your mind once your baby is born.
If your baby is unwell at birth, admission to special care may be necessary. You'll need to think about this beforehand and find out the hospital policy regarding visiting and if there are electric breast pumps available if your baby is too weak to suckle.
All this planning may seem overwhelming, but by being prepared for all the choices, you should feel more comfortable about your pregnancy and upcoming labour. Read as much as possible and join an antenatal or parentcraft class to arm yourself with information.
10 suggestions for writing your birth plan
Click here to read more about putting together a birth plan.
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