Five Things to Consider When You Make Your Birth Plan

Getting ready to make the best decisions for you and your baby 

Pregnancy can be an unpredictable time, whether you’re expecting your first baby or your fourth. Creating a birth plan can put your mind at ease by helping you express your needs clearly to family members and health care providers. The first, and biggest, decision you’ll make will impact every other aspect of your plan: whether you’d prefer to have a vaginal birth or an elective cesarean section (C-section). While medically necessary cesareans can be lifesaving, there are trade-offs for moms who choose to have a cesarean when it isn’t needed to protect their health or the health of their baby. 

Jessica Angelson works as a certified nurse midwife at a birthing center in San Francisco, where she creates a birth plan with each of her clients. “This process brings to light crucial conversations that will make people feel more satisfied and empowered,” says Angelson. “We raise questions like, ‘How do you feel about labor pain? What would be your best outcome for birth?’” It’s also educational, she says. “If you don’t know what an epidural is, you don’t know how you feel about it!” 

One important part of the education process is to learn about the risks and benefits of different types of birth. While an elective C-section may take some of the guesswork out of your plans, this option also limits the flexibility and health benefits of your birth experience and recovery process. 

Here are a few things to consider, and discuss with your provider, when writing your own birth plan.

1. C-section vs. vaginal birth

More than 30 percent of American births are now cesarean — a whopping statistic that has risen fast in recent years. There are some situations in which a C-section is safer for the mom and baby, and most women recover without complications from this procedure. Yet it’s also important to remember that a C-section is a major surgery that increases recovery time and the risk of life-threatening complications. Babies born vaginally gain some crucial advantages along the way, such as a dose of good bacteria that they receive via vaginal birth, which provides a critical boost to the immune system.

You may also have scheduled a cesarean only to find that your baby wants to arrive a few days early. A plan for both possibilities will ensure your needs and desires are met, even if circumstances change.

View the C-section vs. vaginal birth infographic

2. Atmosphere

How do you imagine your surroundings during labor? With a C-section, you’ll be in an operating room. That limits who can be present (usually only your partner) and means your surroundings will be out of your control. If you’re aiming for a vaginal birth, you can choose stress-reducing tools to help you feel relaxed and empowered, and you’ll have greater flexibility to select what setting to give birth in. And many women spend the beginning phases of labor at home, without rushing straight to the hospital.

Angelson asks clients to consider which friends or family members will be most supportive before deciding who’s welcome in the room. Let them know in advance whether you’re okay with videos or photography. Many women also opt to bring their favorite music, lighting or personal items from home. Angelson also encourages asking who will be present at the birth if the provider you’ve seen during your pregnancy can’t be present. “I suggest asking, ‘If it’s not you, what are the other options? Will I know that person beforehand?’” You may also want to request that everyone present introduce themselves, since medical residents are sometimes called in to attend.

3. Labor preferences

If you’re having a vaginal birth, over the course of your labor, you may want to try different strategies to boost your stamina and make yourself feel more comfortable. A warm bath or shower reduces the production of stress hormones and increases endorphins without prolonging labor. Are there labor positions you’d like to try? Tools like birthing balls and bolsters can also be useful, and you can ask if they’re available or whether you can bring your own. Angelson says she also asks clients in advance whether they’d like to be told how far their dilation has proceeded so they can follow how quickly labor is progressing. Whatever you choose, a confident, positive outlook can smooth the path to a vaginal birth. If you are having a surgical intervention with a C-section, labor may not be an issue.

4. Pain management 

While a C-section always involves an epidural to block all feeling from the waist down, you’ll likely have a few options for pain medication if you choose vaginal birth. Some women opt for no pain medication at all, while others prefer an epidural. The timing of when to opt for pain medication is also an important thing to discuss — as is deciding whether to designate someone who is with you during labor, like your spouse, to aid the decision-making process. Talk through the potential scenarios with your provider, even if you don’t think you want to make a decision in advance. Melissa, a New York City mom who had a vaginal birth in a hospital, says, “I eventually did have an epidural, which was great for me. But before that, our doula used pillows and bolsters to help change my position. I was surprised at how much moving my body around helped ease the pain.”

5. Hospital stay 

The length of your hospital stay varies depending on the type of birth you have. If you’ve had a C-section, your stay may last four or five days, and you may be instructed not to climb stairs, exercise or lift anything heavier than your baby. If you’ve had a vaginal birth, you may go home with your newborn as soon as 24 hours after your baby arrives. Many first-time moms are surprised at how quickly they can recover after a vaginal birth. “I was shocked at how much better I felt pretty quickly after giving birth,” says Melissa. “I was ready to walk around and get home to my own bed the next day.” There are also differences in recovery time for getting back to your regular activities. With a C-section, that recovery time can be six weeks or more. 

Start the conversation 

Talk to your doctor about what’s right for you, and if you already have opinions about specific interventions, be sure to have an open dialogue with your Ob/Gyn. As a general guideline, Angelson encourages clients to “keep your conversation focused on your values and priorities about the big things in labor, to make sure you feel safe and cared for.”

Does all this planning pay off? Absolutely, says Angelson. While no one can predict exactly how your birth will go, a little planning for this big event goes a long way. Set aside time to create a safe, healthy birth plan tailored to your needs.