Updated: May 26, 2021
TLDR: In this article, we will review how to make a birth plan and how to advocate for your birth plan. To learn more about what a birth plan is and why you may want to make one, see our FAQ here.
Hello, my name is Roma (she/her) and I am the author of this post! I currently reside on the traditional territory of the Haudenosaunee, Anishinabewaki, Neutral, Mississaugas of the First Credit Nation, and Mississauga Peoples. This unceded land of Treaty 3 3/4 and Treaty 8 is currently known as Burlington, Ontario. I would like to acknowledge my positionality as someone who has never been pregnant or given birth. As such, I do not claim to understand the complex relationship that any individual may have with their pregnancy. The goal of this post is to help folks make informed decisions regarding their pregnancy and advocate for their birthing needs. This post is not intended to privilege any type of decision over another but to provide a comprehensive view of the options available. I would also like to take this opportunity to acknowledge the lack of agency, support, and culturally-appropriate care that Black people and Indigenous people experience during pregnancy. This has led to a greater rate of maternal and infant mortality in these communities. I hope this post can provide some strategies for all folks to advocate for their needs during pregnancy, and that making a birth plan can be an uplifting and affirming experience to help people feel more in control during their pregnancy and labour/ delivery.
There’s no right or wrong way to make a birth plan. The goal of this post is to help you make a plan that is the best for you and whomever you've chosen to involve in your birthing process. In general, your birth plan should include requests for the care you receive:
In this post, we will go over the types of requests that can be made for each of these stages of your pregnancy. We will also go over strategies for how to advocate for your birth plan. See our FAQ here about what a birth plan is and why you may decide to make one.
You can make your birth plan on your own or with a pregnancy support person (e.g. partner, friend, family member, co-parent, etc.), but it may also help to make your birth plan in consultation with your care provider. This can be a midwife, doula, obstetrician, OB/GYN, family practitioner, pediatrician, maternal-fetal medicine specialist, and/or neonatologist. Your care provider should take the time to help you create a birth plan which meets all your needs.
Creating a birth plan with your care provider can help foster understanding and expectations of the birthing process between you, your care provider, your support person(s), and anyone else you want to include in your birth plan. It gives you an opportunity to ask questions about the process so that you can make informed decisions for yourself and your baby.
Importantly, a birth plan is not a binding contract, but a scenario for how things will ideally go if all goes according to, well, the plan. Of course, you can change any parts of the plan whenever you wish. Aspects of the birth plan may also have to change during labour/ delivery to ensure the health of you and your baby. Therefore, in addition to practicality and feasibility, a birth plan must also be flexible.
Begin your birth plan with the names and numbers of all the key members who will be involved in your birth. This includes yourself, your support person(s), your care provider(s), and anyone else you expect to be at your side. It is also a good idea to include the names of anyone you do not want present at your delivery.
Making Your Birth Plan
Note: The lists below are not inclusive of all the options that may be available to you. Based on the location you choose to give birth, your medical history, and the health of your baby, more or fewer options may be available to you.
Requests Before Birth
For requests before birth, you may consider the following:
What care providers you would like to support you pre-, peri-, and postnatally (e.g. doula, midwife, primary care provider, obstetrician, etc.).
Who you want to have as your primary pregnancy/ labour/ delivery support person (e.g. partner, family member, friend, etc.).
Who you would like to be present and when (e.g. during labour, during the delivery, after delivery).
Where you want to give birth (e.g. at home, at the hospital, at a midwifery unit).
What type of atmosphere you want for the birth (e.g. lights, music, items to bring with you).
Whether you want photos/videos of the birth and who should take them.
What type of equipment you would like to have available (e.g. birthing stool, birthing chair, birthing tub, exercise ball, in-room shower).
What type of birthing positions you would like your support person and/or care provider to support you in.
What you would like to wear.
Whether you would like to eat and drink (as recommended by your care provider).
Who you would like to assist you in making any last minute decisions during/after delivery, if needed.
Who you would like to make decisions for you and your baby, if you are unable to do so for any reason.
Requests for Labour & Delivery
Requests for labour/delivery will likely require the greatest input from your care provider, and the options available to you will differ based on your medical history and the health of your baby. However, you may consider the following:
Whether you prefer a vaginal birth or Caesarean section (i.e. C-section)
Alternatives to pain medication you would like to use.
If you are comfortable using oxytocin to induce or augment contractions, if needed.
Other strategies to induce or augment labour you would be comfortable with, if needed (discuss available options, both medicinal and non-medicinal, with your care provider).
If you would like to use a catheter.
Whether you would like an IV for hydration.
How you would like your baby’s heart rate to be monitored (internally or externally; continuously or only if the baby is in distress).
Whether you are comfortable with instruments such as forceps or a vacuum being used to assist with the delivery, if needed.
You and your provider’s views of episiotomy (a cut made between the vagina and anus to help deliver the baby) and if/when it may be needed.
If you decide to give birth at home or a midwifery unit, it may be a good idea to strategize a plan if transport to a hospital is needed. Your care provider should assist you with this.
Requests After Birth (Newborn Care)
Finally, you can include requests for newborn care in your birth plan. Again, these options will likely require some input from your care provider. Here are some ideas to get you started:
Whether you would like someone (e.g. partner, friend, family member) to cut the umbilical cord and when you would like the umbilical cord to be cut.
If you had a vaginal birth, how you would like to birth the placenta (if you had a C-section, the placenta would be removed during surgery).
Whether you would like to see or keep the placenta (discuss with your care provider if this is an option for you and the required procedures)
How soon after the delivery you would like to hold your baby (right after delivery, after being cleaned and swaddled, after weighing the baby, etc.).
What types of medical exams/ procedures you would like to be administered for your baby, when you would like them to be administered, and if you (or your pregnancy support person) would like to be present.
If you gave birth at home, it may also be a good idea to strategize a plan if you or your baby is not well after delivery and/or if transport to a hospital is needed.
If you gave birth at a hospital or midwifery unit, how soon you would like to go home.
Advocating For Your Birth Plan
By making a birth plan you are already advocating for your needs during your pregnancy! Thinking through your options and making informed decisions is a great way to advocate for your health and the health of your baby.
The most important way to advocate for your birth plan is to make sure that you understand your birth plan. Understanding your birth plan will ensure that you are comfortable with all the requests that it contains and that you can explain it to someone else (like another care provider) if needed.
One of the best ways to understand your birth plan comprehensively is to make your birth plan in collaboration with your care provider. They are the ideal person to ask questions about birth plan requests and likely have the most medical expertise to help you make informed decisions. This process can also help establish a bond between you and your care provider so you are able to trust them to carry out your birth plan.
Your care provider may have their own birth plan checklist available from their clinic, or you may have to bring in a template that you find online. Regardless, the options contained in any premade birth plan may not include all the options available to you. Do not feel apprehensive to deviate from a template and make personalized requests – your provider should let you know if these are realistic for your pregnancy and/or if they are able to provide your request at your chosen location for the delivery.
While making your birth plan, be sure to ask your care provider any and all questions that come to mind. It can help to do your own research beforehand (as you are already doing by reading this piece) and come up with a list of questions/ requests to bring to your provider. While it is important to communicate your needs and personal preferences, it is also important to listen to your care provider as they may have valuable insights which you may not have considered.
If at any point, your provider suggests a treatment option or intervention that you disagree with, speak up! Explain why you are uncomfortable with that option. Also, give your care provider an opportunity to explain why they suggested the option – they may have an important medical reason for doing so. Working together, try to make the best decision possible which both you and your care provider are comfortable with.
Okay, now that you understand your birth plan, the next best way to advocate for your birth plan is to entrust your birth plan with someone who will be with you throughout your pregnancy and delivery. This can be a partner, a family member, a close friend, or anyone else who you trust. Understanding your birth plan will ensure that you are able to explain your birth plan to this person! They will then advocate for you via your birth plan, if the need arises. For example, you may forget parts of your birth plan while delivering, you may be unable to articulate your needs while delivering, or you may be too exhausted after delivery to execute parts of your birth plan. The entrusted individual should make sure your birth plan is being carried out as outlined by having conversations with your care team. Having someone you trust and who knows your birth plan well can help ease a lot of stress of whether the decisions you made in your plan are being followed. It also ensures that someone other than your care provider understands your birth plan and is advocating on your behalf.
Finally, you can advocate for your birth plan by accounting for unexpected situations. Making a robust birth plan can be very fulfilling and can ease the stress around pregnancy; however, unexpected situations can arise, especially during labour and delivery. Therefore, it is important to leave room in your birth plan for unexpected situations. This can help you rationalize the limitations of your birth plan, and can help limit feelings of disappointment if your birth plan isn’t perfectly executed.
One way to account for unexpected situations is to make “Plan B’s”; for example, how will you be transported to the hospital if you are delivering at home? Under what conditions will you undergo a C-section, if any? What are your options if there is a preterm delivery? Again, making these decisions is easiest with your care provider – they likely have established protocols/scenarios which they can take you through.
Another way to account for unexpected situations is to have a trusted individual who can either assist you in making any last minute decisions or make decisions on your behalf if you are unable to do so. Note that the latter may have legal requirements under surrogate decision-making laws, so discuss this with your care provider. The person you choose to support you in this manner should be someone who knows you well and who you believe will take your values into consideration to make a choice which you would have yourself made.
In summary, you can advocate for your pregnancy- and birth-related needs by making a birth plan and you can advocate for your birth plan by understanding your birth plan well, entrusting your birth plan to someone you can count on, and by accounting for unexpected situations that can arise during and after delivery
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