“Well, that didn’t go as expected.” <– Me, 348,487 times since becoming a mom. The first time I went into labor, I planned to touch up my makeup just after delivery for beautiful mama/newborn photos. In reality, I forgot I was sporting a Breathe Right strip while my husband snapped pics. So glamorous.
That said, I’d never consider (or recommend) going into labor without a birth plan.
Why a Birth Plan?
- Creating a plan gives you a chance to research and decide how you feel about different options ahead of time. Do you want the freedom to eat and sip on labor aid while you birth your baby? What about pain management and skin-to-skin care after baby is born? (We’ll dive into all these options in more detail below.)
- Even if you know what you want, you may not feel like talking much during labor. Having a plan – and sharing it with your loved ones – keeps you from having to play twenty-questions while in labor.
- Discussing your plan with your OBGYN or midwife before the big day is a good way to make sure you’re on the same page. For example, maybe you want a water birth but it’s against hospital policy, or maybe it’s totally fine and your birth team just needs to know in advance so they can prepare. Either way, it’s important to have that conversation before the big day.
With that in mind, here are 10 questions to consider when creating a birth plan:
1. How do I feel about labor induction?
Inducing labor can be done for elective or medical reasons. More and more hospitals are restricting elective inductions before 39 weeks due to health outcomes, but it’s still an option in most areas. (1)
Although there are definitely times when induction is necessary for medical reasons, more and more care providers are highlighting the benefits of allowing labor to start spontaneously when possible.
Here’s an overview of the benefits of both spontaneous labor (allowing labor to start on its own) and medical induction:
Benefits of waiting for labor to start naturally
According to this study:
In the last weeks of pregnancy, maternal antibodies are passed to the baby—antibodies that will help fight infections in the first days and weeks of life. The baby gains weight and strength, stores iron, and develops more coordinated sucking and swallowing abilities. His lungs mature, and he stores brown fat that will help him maintain body temperature in the first days and weeks following birth. The maturing baby and the aging placenta trigger a prostaglandin increase that softens the cervix in readiness for effacement and dilatation. A rise in estrogen and a decrease in progesterone increase the uterine sensitivity to oxytocin. The baby moves down into the pelvis. Contractions in the last weeks may start the effacement and dilation of the cervix. A burst of energy helps pregnant women make final preparations, and insomnia prepares them for the start of round-the-clock parenting.
The watchful waiting and the intense wanting of the big day to arrive are all part of nature’s plan. When the baby, uterus, placenta, and hormones are ready, labor will start. Additionally, all that preparation sets the stage for an easier labor and a fully mature baby who is physiologically stable and able to breastfeed well right from the start.”
Are there any benefits to inducing labor?
Sometimes, yes. When certain medical conditions such as preeclampsia or heart disease are present, a doctor may determine that it is safer for baby to be born than to remain inside the mama’s womb.
Induction is something that is also often discussed if a woman goes past her due date. However, it’s important to note that:
- Even when the exact day of conception has been identified by researchers – the length of a normal pregnancy can vary by up to five weeks. (2)
- The 40 week due date we all assume is “average” may actually be a little too short. This study and this study suggest that due dates should be calculated to include 40 weeks plus 3-5 days.
- The World Health Organization does not recommend induction in uncomplicated pregnancies under 41 weeks (3)
Is it possible to encourage labor naturally?
According to one study, eating dates during the last few weeks of pregnancy can reduce the likelihood of needing and induction and shorten labor. Here are some more tips for inducing labor naturally.
Are Pitocin and oxytocin the same?
Chemically speaking, oxytocin and its synthetic version, Pitocin, are identical. However, although Pitocin can stimulate contractions like oxytocin and is often used to try to artificially start labor, there are five important differences that affect labor and the postpartum period. Here’s how to increase oxytocin naturally for a better birth and postpartum experience. (These suggestions can be helpful even if Pitocin is needed during or after labor.)
2. Do I want to eat and drink during labor?
No one expects athletes to run a marathon without water, but some hospitals require low-risk laboring moms to do without during the marathon of marathons. When this policy was created in the 1940s, anesthesia procedures were somewhat crude and doctors wanted to reduce the risk of aspiration.
Today anesthesia procedures are much more precise, and a recent review of available studies found no difference in outcomes between women who were allowed to drink during labor and those who weren’t. Actually, there was one small difference – the women who were allowed to eat and drink birthed their babies a little faster than those who weren’t. (4)
According to the American Society of Anesthesiologists:
Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus. ” (5)
There are times when eating and drinking may need to be avoided, such as when eclampsia or pre-eclampsia are present, or if opioids – which delay stomach emptying – are used to manage labor pain. However, for low risk mamas, all these organizations recommend eating and drinking during labor if desired:
- The World Health Organization (WHO)
- The American College of Nurse-Midwives (ACNM)
- NICE Clinical Guidance for the United Kingdom
- The Society of Obstetricians and Gynecologists of Canada (SOGC) (6)
If you decide that you want to eat and drink during labor, here are some snack/refreshment ideas:
Nuts and seeds
Popsicles (We love coconut pineapple popsicles and strawberry yogurt popsicles)
Veggies and hummus
Red raspberry leaf tea
3. What is the policy on moving freely while in labor?
According to this study, walking, squatting, and even dancing during labor may result in:
- shorter labors
- more efficient contractions
- greater comfort
- less need for pain medicine in labor
That’s because movement often helps open up the pelvis while encouraging baby to move into the birth canal. “Moving or walking can be the perfect tool for pain management — it’s the way your body helps you get through labour,” says midwife Lorna McRae. (7)
That said, not every mama wants to move a lot through labor. For most of my three labors I preferred to lay on my side with a pillow supporting my pelvis, but toward the end I always instinctively got up and started moving around. Every mama is different, and there is no “right” way to labor. However, you’ll want to know whether you’ll have the option to move freely if you want to.
4. What about pain management?
There are a variety of techniques and procedures that can help ease tension throughout labor. Here are a few you may want to discuss with your doctor or midwife:
- Birth ball – Can help open up the pelvis and help mama find a comfortable position while laboring
- Breathing techniques such as the Bradley Method
- Cool or warm washcloths – Some mamas get very hot while laboring, and a cool washcloth on the forehead can be relaxing. On the other hand, warm washcloths can be placed on the back to ease discomfort during contractions.
- Doula care
- Massage (including techniques like counter pressure and hip squeezes)
- TENS unit
- Warm water to labor in
5. How do I plan to give birth?
- Vaginal birth
- Gentle caesarean
- Water birth
6. Do I want continuous fetal monitoring or intermittent?
Continuous electrical fetal monitoring (EFM) is standard practice in many hospitals, but research says that “based on the evidence, intermittent auscultation [monitoring] is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM).” (8)
With continuous monitoring, the risk of newborn seizure drops from 0.3% (very rare) to an even more rare 0.15%. However, according to Rebecca Dekker, RN, PhD, the risk of cesarean section, vacuum/forceps delivery and an increase in perceived pain all go up. She covers the research on both approaches here. Scroll to the very bottom of the post for a helpful list of pros and cons.
Other considerations: Moms used to have to choose between freedom of movement and continuous electrical fetal monitoring (CFM), which required moms to be hooked up to a machine and stay in bed. Things have changed recently with the introduction of wireless fetal monitors, however not all moms are comfortable with continuous monitoring due to the increase in EMF exposure.
Other options, such as a fetoscope (stethoscope designed to listen to a baby’s heartbeat) can also be used for hands-on listening (monitoring at regular intervals).
7. Who will be in the room with me?
Do you want certain family members, a doula, and/or a birth photographer? What about the baby’s siblings?
A couple of notes: I wasn’t sure how my children would react when they saw me in labor, so I asked a trusted friend to care for them and take them out of the room if they seemed uncomfortable. My oldest loved being present for both of her siblings births, but my middle child was not all that interested in the birth of my youngest.
Also, if you’re birthing at a hospital or birthing center, make sure photography and/or videography is allowed during labor.
8. What about delayed cord clamping?
Delayed cord clamping is becoming the standard of care in many hospitals, and for good reason.
“It’s incredible to see what a difference an extra three minutes and one-half cup of blood can have on the overall health of a child, especially four years later,” Dr. Ola Andersson told CNN. She was the lead author of a study that found delayed cord clamping resulted in neurodevelopmental benefits for preschoolers.
Delayed cord clamping or cord milking is sometimes possible when baby is born via cesarean section. Read more on the benefits of delayed cord clamping here.
Note: Although delayed cord clamping is usually not considered compatible with cord blood banking, some sources say it is compatible if the cord is allowed to pulse for 1-3 minutes. (9)
Another option to store a child’s stem cells for later therapeutic use is to bank a baby tooth when it comes out. Unlike cord blood which has a limited number of therapeutic uses, the stem cells found in tooth pulp have a wide variety of potential uses. I’ll be writing more about that soon.
9. Do I want to be skin-to-skin with my baby right after birth?
Babies benefit immensely from skin-to-skin care in the moments after birth. When it’s not possible, or even when it is, mamas should know that it’s also beneficial in the days, weeks, and even months after baby arrives. Here’s your guide to getting started.
10. Do I want to keep my placenta?
Some women opt to encapsulate their placentas for postpartum support. For many, placenta encapsulation benefits mood and energy levels by delivering oxytocin, thyroid stimulating hormone, interferon, prolactin and several other components.
Considerations for c-sections (planned and unplanned)
For some mamas, a c-section birth is a thoroughly considered, planned event. Even if it’s not, “a good plan shouldn’t just describe your best-case scenario; it should also include your preferences in the event that things don’t go according to plan,” writes Genevieve Howland in The Mama Natural Week-by-Week Guide To Pregnancy & Childbirth.
“I’d known long before I got pregnant that I wanted a vaginal birth, but I also knew there was always a chance of having a C-section,” she continues. “That’s why my first birth plan included my preferences in the event that I ended up in the OR. (My highest priorities? Immediate skin-to-skin contact and immediate breastfeeding, if at all possible.) Nobody wants to think about all the things that could go wrong during delivery, of course, but you also don’t want to be making important decisions in between contractions (for obvious reasons!).”
I highly recommend Genevieve’s book, and two other helpful resources on this subject are:
Creating Your Written Birth Plan
If you’ve answered the questions above and are wondering how to put it all together into a written plan, check out this post from my friend Genevieve. She’ll show you how to create a one page birth plan that practitioners won’t scoff at.
Want to learn how to have an awesome birth without leaving your couch?
If you’re looking for an evidence-based, naturally-minded resource, I highly recommend the Mama Natural Birth Course and/or The Mama Natural Week-by-Week Guide to Pregnancy and Childbirth.
You’ll learn about:
- Delayed cord clamping, which boosts baby’s iron stores by 30% and improves fine motor skills and social development later in life.
- Skin-to-skin contact, which regulates baby’s body temperature and blood pressure, reduces stress hormones, and helps initiate early breastfeeding.
- Gentle cesarean, which can “seed” baby’s microbiome, eliminate fluids from baby’s lungs, while empowering the mama.
- The importance of eating during labor, and so much more.
Click here to check out the Mama Natural Birth Course, and here to check out The Mama Natural Week-by-Week Guide to Pregnancy and Childbirth.
1. Associated Press/NBC News (2009) Hospitals to crack down on induced labors. Retrieved from NBCNews.com
2. Cooper, Charlie (2013) Length of pregnancy can vary by up to five weeks, scientists discover. Retrieved from Independent.co.uk
3. World Health Organization (2011) General principles related to the practice of induction of labour. Retrieved from PubMed
4. Ciardulli, A et. al. (2017) Less-Restrictive Food Intake During Labor in Low-Risk Singleton Pregnancies: A Systematic Review and Meta-analysis. Retrieved from PubMed
5. American Society of Anesthesiologists (2015) Most healthy women would benefit from light meal during labor. Retrieved from ASAHQ.org
6. Dekker, Rebecca (2017) Evidence on: Eating and Drinking During Labor. Retrieved from EvidenceBasedBirth.com
7. Pitman, Teresa (2009) The secret to an easier labour. Retrieved from TodaysParent.com
8. Heelan, Lisa (2013) Fetal Monitoring: Creating a Culture of Safety With Informed Choice. Retrieved from PubMed
9. Americord. Delayed Cord Clamping: A Guide to Research and Options. Retrieved from AmeriCordBlood.com
Read My Comment Policy
I respect all moms for how ever they choose to give birth. I think sometimes moms are pressured into procedures and drugs that they might not need. People want to be able to trust their doctors, but it seems like sometimes these procedures are to make the doc’s life easier.
I have chosen to have all 6 of my babies in a hospital. 5 of 6 times I did have a midwife. 4 out of 6 I did it with little monitoring, no IV and no drugs. My midwives were always supportive of my choice to do it naturally….the nurses were another story. I think they were mostly freaked out, because they just aren’t used to birth being so “un-medical”. When I stood my ground I got my own way. 🙂 The last 2 times I was given pitocin after birth to stop my bleeding and help my uterus to contract. Good article!
Thanks for your comment, Richard. Sounds like you had the best and the worst of it. On the one hand an intervention may have saved Beth’s life, and on the other a medical professional tried to go around you and pressure Dawn when she was vulnerable. Based on your comments here I doubt she would have tried that if you were around!
The C-Section wasn’t the issue. We already knew that if she got too big (she was already a high risk pregnancy). The issue was the epidural. They forced Beth early because she hadn’t moved or kicked in over an hour and her blood pressure was up.
The Doc probably did save Beth’s life, but he did it using 6 different IVs, a busted water, and a rather disturbing comment “Let’s see how fast we can do this one.”
Stop the press, you and I are actually going to TOTALLY agree! 🙂
Yes I had hospital birth with a doctor both times, yes I had an epidural both times, yes I had pitocin one time, but I am grateful to have never had additional complications other than lower heart rate due to the pitocin causing such long, hard contractions that the baby didn’t have enough time to fully recover (with Lyric). (which isn’t anything to brush off- but thankfully no lasting complications occurred as a result).
Doctors and nurses pressure most women to give birth on THEIR time table and not let the body do what it was created to do.
The more babies I have, the more informed I get about these things. Had I not had an AMAZING doctor that was a friend of ours, attended our church and was a believer AND managed to have the same amazing L&D nurse both times who was VERY supportive of whatever and even suggested alternate things, then I could have easily been in the c-section percentage since I have a narrow pelvis and both of my children had a lot of trouble getting under it and most doctors would have sent me for a c-section or episotimied the crap out of me. But she respected me and what I wanted.
Unfortunately, we moved and so I am looking into alternatives. ALL that said, I am going to try and have my next baby with a midwife at a birthing center here. They are really strict (socialized medicine) and may not take me because I’m considered high risk (b/c of going into labor so early with Shiloh) but am praying for the perfect midwife to believe in me.
The medically (un) necessary interventions are TOTALLY leading to a ridiculous csection rate and robbing SO many women of an amazing vaginal delivery. Obviously some are totally necessary, but I agree that the many are not.
Jen – Although I don’t know much about the medical implications of high blood pressure and its effect on your friends birth outcome, I understand your sadness over her experience. She is very blessed to have a friend like you that cares not just about the end result but also emotional impact of the process.
both of mine were born in the hospital and i loved it. my advice is to research your doctors. my ob is very old fashioned and likes to do everything naturally. she is definitely my safety net. she does not recommend inductions or epidurals. she is always available when i have any questions or concerns and not once do i remember her taking a vacation or “leisure time”.
i absolutely love hearing those little heartbeats at every visit and seeing that beautiful little profile on the sonogram. just seeing those little limbs flutter in the first months check-up, then seeing how much that wonderful baby has grown and now has actual body parts and no longer looks like an alien in the last months checkups. lol. what a joy.
my daughter was a full term baby- 40 weeks- and weighed 7lbs 9oz and my son also went to 40 weeks and weighed 9lbs 6oz. no complications with either pregnancy or labor and both were natural births 🙂
I had a hospital birth with my daughter and a home birth with my son. The home birth was done exactly they way I wanted it. In the hospital I was controlled told what to do, without any say. My daughter was given shots I never knowingly consented to. I would encourage women to seriously consider A midwife, they will let you plan and have full control over your body and the birth. I received excellent care from my midwife.
Well said, Lucy! I am hoping it will reach first time moms as well. They are the most vulnerable to the “cascade of interventions” since first labors are typically longer and doctors get in a rush. It’s so sad because many are too afraid to attempt a VBAC with later children.
Jerri, you are amazing. For me, the point where I had to dig down deeper than I ever had during labor was my “moment of truth” in motherhood. In the sleepless days and months that followed I looked back on that moment to remind myself that there is something deeper and more mysterious than will-power. I wish I could put it into words, but I think you’ll know what I mean. When I feel like I’m failing as a parent I remind myself of that moment, pray, and dig deeper.
Something to keep in mind: Not only do many Birth Center take Medicaid (Midwives that are CNMs are approved by the government for coverage. Though CPMs are not), but birth centers are required by law to be within minutes from a hospital. They are required to be close enough to a hospital so that if mom must be transferred she will be in the operating room with 30 minutes. Which is exactly how long the hospital will tell you that it will take to have a mom laboring at the hospital already in her room to get prepped and in surgery.
Most instances of birth center transfers to hospital are not truly life-threatening emergencies, transfers are often because mom is white-knuckling it through labor. There’s a vast difference between pain and suffering during labor. If a woman enters into a place of suffering (and it can’t be fixed through position changes, encouragement, etc.) and as a result of that suffering stops progressing in labor, sometimes an epidural is exactly what she needs. Midwives know to look for this and will at times be the one who suggest a transfer.
Birth Centers keep statistics in the same way that hospitals do. If you’ve got a question, you can call and ask for their statistics. I know that the Birth Center here in Denton has a transfer rate of 8% and out of that 8% not all of those moms end up or needed C-sections. Considering that the state average in Texas for C-sections is around 32% – less than 8% is excellent.
The world health organization (WHO) states clearly that when a nations c-section rate rises above 15% it is a signal that something is very wrong with healthcare.
I agree that British hospitals dont pressurise you, as the midwives are trained to deliver the baby without any medications and they are amazing in the UK.
But I was pressurised by my consultant and my mother in law who is an OBG consultant that I should have epidural because birthing experience in the 21st century should be a pleasure without pain!!!
I am glad I should my ground and did not take epidural- and the midwives were all supportive.
They even told me off for taking paracetamol:)
This is really insightful, I will be sharing this with my partner after work, thank you! 🙂
Gosh this makes me want to give birth again! I didn’t really have a written birth plan but had home births. I feel very fortunate that I successfully gave birth at home!
Twenty questions while giving birth is not something a birthing mama would want to do. Plan ahead.