Writing an Interactive Birth Plan

Let'sdefine an interactive birth plan. It is most simply, a guide to your choices for your birth experience, from environmental conditions to new baby care.

It's also critical to note that it is a statement of preferences, not a dictation of terms. You have to remain open and flexible to change should circumstances dictate it, especially in a first time pregnancy. As you near the end of your pregnancy, birth plan choices should be discussed between the mother, care provider and birth companions.

As a visual guide, you can review my actual birth plan. Download my birth plan here.

Let's first talk about the necessary sections of an interactive birth plan:

BIRTH TEAM

This refers to the people you prefer to have with you during the birth, including your preferences for interns or students to be present.

PREPARATIONS

This section includes what routine procedures you do, or do not, want performed. It can include such things as your feelings on enemas, routine pubic shaving, and clothing for labor. If you prefer to wear a comfortable shirt vs. a medical gown, here's where you state it. You also might want to add any allergies or pertinent medical conditions so that the nursing staff is made doubly aware. You can also list your preference for no IV or a saline lock or heplock.

EARLY AND ACTIVE LABOR

This section of your interactive birth plan should include such items as:

Environmental Conditions
-Choices for lighting, quiet vs. loud environment, background music, filming or photography can be listed.

Positions/Activity Level
-Preferences for walking vs. lying in bed.

Pain Relief
-Include what methods you are using-Hypnobirthing, Lamaze, Bradley, etc.
-Detail other choices such as massage, breathing, counter-pressure, birthing ball, shower/tub, etc.

Food
-Indicate whether or not you want the choice of food or beverages like ice chips. This section of your interactive birth plan can be somewhat controversial.

Fetal Monitoring
-Choose from external, internal or intermittent fetal monitoring or telemetry where available.

Internal Exams
-Here you indicate your choices for internal exam frequency.

Method of Elimination
-Decide if you prefer to walk to the bathroom or have a catheter.

Labor Augmentation
-List your opinions on medical vs. natural methods and time limits for labor and such interventions as rupturing of membranes.

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PUSHING & DELIVERY

This section of your interactive birth plan includes any or all of the following items:

Positions
-This section includes preferred positions for pushing-squatting, side-lying, all fours, standing, rocking chair, shower, kneeling, etc and any desired support equipment like squatting bar, tub, kneelers, pillow, wedge, etc.

Pain Relief
-Again specify your choices and whether you want medication to be offered unless you request it.

Episiotomy
-Indicate what methods of preserving the perineum you prefer: massage, hot compresses, etc.
-Decide on tearing vs. episiotomy, pressure episiotomy and/or local anesthesia.

Expulsion Techniques
-Include preferences for time limits, positions, and self-directed vs. guided pushing, as well as choice of forceps over vacuum extraction if needed. 

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BABY'S ARRIVAL

Decide who will cut the cord and whether to delay routine procedures. Also if nursing, you may indicate that you want to put the baby immediately to the breast.

AFTER BIRTH/POSTPARTUM
In this section of your interactive birth plan, specify your preferences for spontaneous vs. assisted placental delivery, perineal care, fundal massage and routine administration of pitocin or other drugs.

RECOVERY/POST-RECOVERY
Choose to room-in with baby or nursery care. Also decide whether to take calls or visitors and your desired length of stay. If the baby is a boy, you may discuss circumcision here.

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BABY CARE

Immediate Care
-Indicate if you'd like bathing, weighing, etc first or to delay it and bond.

Feeding
-If nursing, you may want the baby right to the breast and prohibit supplementation like pacifiers or sugar water.

Airway
-Specify preferences for suctioning.

Newborn Procedures
-Indicate choices for location of early baby care and the  procedures-bathing, wiping down, etc.

Eye Care
-Routine procedures can be delayed to allow form more bonding time and non-irritating choices can be given.

Warmth
-Indicate preference for incubator or holding the baby

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Contingency Plans

In this section of your interactive birth plan, be sure to also include sections for cesarean delivery, including options for epidural vs. spinal, staying with the baby, and incision type. 

Following this, you should include a section for baby complications, including prematurity. If the baby requires a transfer to a NICU, state your wishes for holding and visiting the baby. 

At the conclusion of your interactive birth plan, it is imperative that you have your provider sign and date it. Without this signature, it will carry less weight and possibly is more likely to be ignored by medically-minded nursing staff. Also, be sure to carry multiple copies in case there are shift changes, etc. 

Remember to advocate for yourself. Your interactive birth plan is the perfect way to do so. It's also crucial to discuss your preferences with your birth companions to ensure that if you can't speak for yourself, your voice is still heard.