First off why call it birth preferences as opposed to a birth plan?

Personally, I feel as though when we call it a birth plan, it implies that we have any kind of control over what happens during the birth process. As much as we wish it to be, that simply is not the case. I’m sure others can agree that we would love to be able to know exactly when labor will start, how long it will last for, that everything will go picture perfect, and at the end we will have a beautiful baby to show for it! Reality is that we have no idea when labor will start, or how long it will last for and there is no guarantee that everything will go picture perfect. Hence the term birth preferences or even birth map.

When it comes to defining your birth preferences I would always suggest to create different versions. A long in-depth version for the birthing person, partner, and doula or other support people to have and read prior to labor. A quick bullet-point version of only the highlights for the midwife, OB, and hospital staff to quickly read when arriving at the birthing location. And a preference list of in case of emergencies for the birthing person, partner and support people. This last one is an apocalypse guide if you will, in case things go down hill, what are you ok with doing and when are you ok with it being done.

All birth preference lists have a specific purpose. To start the long in-depth version for yourself, your partner and other support people is where you would picture your absolute dream of a birth experience and put it on paper. Things like having the lights dimmed, essential oils diffusing, twinkle lights up, specifications for golden hour including delayed cord clamping until cord is white and no longer pulsing with immediate skin to skin. An example would look like the following:

For pain management I want-

• To be able to get in and out of a tub with water or use the shower
• Nitrous Oxide gas during the pushing phase to take the edge off only if requested using the code word “Clowncar”
• Freedom to walk around the room and move utilizing a birthing ball and to have intermittent monitoring or a wireless monitor to help get the most movement possible

Discuss the atmosphere, who you want in the birthing room with you, how you want to manage pain, how you would like to push, different fetal monitoring methods, anything and everything you can think of. Your doula can either provide a template to use or help you ensure you didn’t miss anything. This version is ok to have long detailed sentences. It ensures that everyone who is there to support you knows what you want out of the birthing experience and how to help you accomplish it.

Now because that birth preference list has sooooooo much information on it. The hospital staff will not have the time to read a multi-page document. That’s why you create a streamlined version just for them. There’s no need to include things like the kind of atmosphere you want because your partner and doula can communicate to the staff that you would like the lights dim and music playing. Things like essentials oils being diffused may not be allowed in your hospital or birthing centre so always check before doing so. The things that should be on this version of your birth preferences are the medical preferences and in short bullet point format. An example would look like the following:

For pain management I would like-

• Hydrotherapy
• Nitrous Oxide
• Freedom to walk and move
• Intermittent monitoring

Keep it short, sweet, and to the point, try to keep it all on 1 page. OBs generally don’t show up until the pushing phase so providing the birth plan to the nurses upon arrival is important. They are the ones interacting with you for the majority of your labor and they are busy people. Your nurse may be looking after a few other birthing parents at the same time as you, so having a quick highlight reel of what you want is better. Then your doula and partner can fill in the gaps as needed as they helped you create your in- depth birth preferences. If you have a midwife, you are likely discussing topics like this during your prenatal appointments and they are already in the know so providing a plan like this may not be needed at all.

Lastly the Apocalypse – All Hell Breaks Loose version of your birth preferences. This version should be as long and in-depth as the one for yourself, partner, and doula for your perfect ideal birth. However, on this version I want you to include anything and everything that could go wrong and what interventions you are willing to take and when. This could look like the following:

Episiotomy: only in the event of true shoulder dystocia and as small an incision as possible to avoid a 4th degree tear and a longer recovery period

Cesarean Section: only in the event of placenta previa, umbilical cord prolapse, placental abruption, active genital herpes infection, uterine rupture, or true fetal distress; a gentle cesarean is preferred with skin to skin contact as soon as possible, delayed cord clamping (at least 2 minutes) and partner cuts the cord

Think about things like if you’re planning a physiological birth, at what point would you be ok with getting an epidural, when would you be ok with getting a shot of synthetic oxytocin after delivering the baby and before or after the placenta is delivered, when would you be ok with an instrument assisted delivery. The point of this is so that you are doing research ahead of time to ensure you have already thought about and created plans in case of emergencies. During labor it is unfortunately very easy for medical providers to attempt to coerce you to do things that you didn’t want to out of fear and not providing you with all the information. (That is not to say that all medical professionals are like that.) By educating yourself and your partner ahead of time and making sure your doula is also aware of this plan it is easier to make better educated decisions in times of crisis. Your doula can remind you of what you had discussed and decided during the identifying process of your birth preferences and help you ask the right questions to your provider in the moment to help you make the best decisions possible for yours and baby’s health.

Your doula does NOT speak on your behalf as you have the right to change your mind at any point during labor! You may have felt strongly about one thing before labor began and in the moment completely changed your mind, and that is perfectly OK! As your doula they should be there to help you make sure you know all of the risks, benefits, and side effects to every option that you have. They are there to help you with informed consent and ensure you feel in control to have the best experience possible, even when things make a bad turn.

Having birth preferences is a great tool to ensure you are satisfied with your birth experience and it helps to ensure that you’re support team can help make that happen. While there is no way to guarantee emergencies won’t happen or that everything will go perfectly, having a map of what you’re ok with ahead of time makes it easier to make quick decisions and ensure everyone is on the same page and that way you aren’t feeling out of control for what is going on with your body and delivery experience.

Need help with a birth plan! Reach out and see how I can help you ensure you have the best experience you can and feel in control of the choices you have to make.