What is a birth plan and why do you need one? Brittany Sharpe McCollum of Blossoming Bellies Wholistic Birth Services, shares her expertise and advice on creating an effective birth plan.
Birth plans are tricky. Everyone has an opinion on whether or not they are useful, what they should include, how in-depth they should be, and how they should be presented. Just a simple online search can result in multiple websites with printable birth plans that require just a simple check mark to cover every common intervention of which one can think. Yet most doctors and many midwives tell their clients to leave their plans at the door because birth is unpredicatable. So where does that leave a pregnant woman, looking to have her voice heard throughout her labor and seeking to be actively involved in the decisions being made regarding her body and her baby? In order to sort through this, let’s start with the basics.
The typical notion of a birth plan is pretty straightforward; it is an outline, written or just in one’s head, of the specifics as to how the birth is envisioned. It is, in essence, the laboring person’s wishes and intentions for their experience. Some people prefer to have a list written out of what they do and do not want and how strongly they feel about certain options while others prefer to go into the experience without specific expectations or strong feelings one way or another. How can a birth plan fit both of these scenarios? And even more so, how can it be a positive tool for communication with clinical staff without leaving providers feeling like they are being dictated to and without leaving mothers feeling anxious over having every detail go as planned?
This is the conundrum one often finds oneself in when being knowledgeable and assertive and having expectations doesn’t match up with the policies and routine and practices of the birthing place. In an ideal setting, providers and clients would be on the same page and have developed a relationship that involves deep trust, mutual respect, and comfort with one another. However, most people in the U.S. are giving birth with OB and midwifery practices averaging anywhere from six to twelve providers while hundreds of hospitals have adopted the “laborist” model of care, where certain providers only attend clients in labor, never having met them at prenatal office visits. This leaves laboring people having to assert their priorities and develop a relationship with a whole new set of staff upon entering their place of birth. Hence the need for a birth plan.
There are two types of plans I encourage my clients to put together in preparation for their births. The first is a short and sweet, very basic, list of general requests to their nurses, doctors, and/or midwives. The second is an in-depth more detailed outline of the specific things that they want to ideally have or not have happen during the experience. The first simple list of birth wishes is usually geared more towards those birthing in a hospital, as a written tool they can use to open up the doors of communication with their providers. The second, in-depth, list of wishes is helpful to share with those with whom one may have a more intimate relationship and/or for providers whose own labor expectations and philosophies are similar to the laboring person (commonly among smaller practices or in a birth center or homebirth setting). Having these expectations written out helps those whom will be providing almost constant emotional, physical, and/or clinical care to anticipate the laboring person’s needs and assist in advocating for what is desired.
The simple birth plan is a one-page document, with client’s name(s), support people’s names, and estimated due date at the top, and a short bulleted list of very basic general reminders and possibly one or two specific things that are really important for the provider to remember (such as medication allergies). In my trainings years ago, I learned of two simple statements that can help someone in labor get the support they need, regardless of how they choose to birth and this is what I have been passing on to my clients for the past ten years. First, “I want informed consent at all times.” Second, “I want a nurse whom is supportive of a natural/low-intervention birth.” That’s it. Clear and concise and right to the point. This short list of birth expectations can be given to a nurse in triage and then also to the labor and delivery nurse and the obstetrician or midwife.
The first statement, “I want informed consent at all times.” is a great way to cover all one’s basics, particularly in a hospital setting where many things are done a certain way because it is easiest for providers whom are working with more than one client at a time and working with people whose expectations are night and day different. The most beneficial part of it is that it reminds providers that this person (and/or their partner or support person) is interested in asking questions, having conversations, and weighing out options before committing to recommendations. It is a way to encourage communication between provider and client without closing oneself off to changes in circumstance or priorities.
The second statement, “I want a nurse whom is supportive of natural/low-intervention birth,” is crucial for anyone wanting to be actively involved – whether physically, emotionally, or mentally – in the labor process. A nurse whom is comfortable with a natural birth is generally more willing to offer suggestions – position changes, many of which can be done even with pain medication, counterpressure, etc., bring in extra pillows or blankets, and offer juice or water. She is often a bit more open to checking in more frequently and going above and beyond the conventional expectations.
The more in-depth birth plan is where one can really flesh out their hopes and desires for their experience. This is where specific interventions may be discussed (for example, “I do not want labor augmented unless there is a medical indication” or “I would prefer having my water broken over the use of Pitocin”). This is also the place for details about the laboring environment – the desire for low lighting, candles (flameless or with a flame, depending on place of birth), reminders to use the bathtub, etc. This in-depth plan keeps all support people on the same page, allows for partners, if applicable, to help advocate when the laboring person may not be in a position to do so, and reminds doulas about the specifics of that client’s expectations. One of the greatest benefits of this plan is that it encourages expectant couples or the expectant person and support people to communicate together about what their priorities and expectations are of the experience and how to best integrate them with those of the clinical providers. This plan should be shared prenatally with support people, including doulas and any clinical providers with whom one has a more intimate relationship, and then kept in the birth bag to reference while in labor. It reminds the laboring person and support people of the things they can be discussing with the provider when the physician or midwife is spending that extra time in the room (which is more likely to happen when they’ve reminded the provider that they will be asking questions and seeking more information).
People often ask about the necessity of having an “in the case of cesarean” and a “postpartum” section in the birth plan. In my experience, these are best to have in the second, in-depth plan, while really having support people on board to help with advocating in these times. Most providers are not checking back in with the birth plan once the baby has been born. They will often ask what the parent’s decisions are regarding common procedures (such as the Vitamin K shot, antibiotic eye ointment, hep B vaccine, etc.) but do not look for the birth plan in an effort to consult it. An unscheduled cesarean does also not often lend itself to providers having the time or the thought process to consult a written plan. However, support people can check the more in-depth list both if a cesarean becomes necessary and/or after the baby is born and let providers know what expectations are.
A scheduled cesarean is another situation where a concise birth plan can be handed to a provider and then followed up by questions and expectations as set out by the birthing person. One often has a lot more say than they realize in how things unfold during a cesarean birth. Check out this great twelve minute video looking at some of the options coming about for cesareans.
To sum it all up, the birth plan that one hands to their provider should generally be short and sweet to ensure that it is well received and serves the purpose of opening up the doors of communication. The more in-depth plan is a great tool to remind the laboring person as well as any support people of what the original priorities were and to help encourage advocating and discussion in the moment. Thinking of the birth wishes as less of a plan and more of a list of priorities can help free expectant couples of the anxiety of planning for an intense and powerful experience and can open one up to being in the moment and letting go of the thinking part of the brain (that neocortex that often interferes with the more primal parts at work during labor). I always like to remind my clients that labor and birth offer an incredible opportunity for self-exploration, growth, and practice at letting go – one of the first lessons in the entire parenting journey.
“Call the Midwife.” The Atlantic, 12 Jun 2015,
“Hospitals look to laborites to fill gaps left by on-call obstetricians.” Kaiser Health News, 29 July 2015
“The Laborist: A Flexible Concept.” ACOG, 2017,
“The natural caesarean: a woman-centred technique.” YouTube, uploaded by reelflowtv, 18 Jan 2011,
“Profile of Ob-Gyn Practice.” ACOG, 2003
Brittany Sharpe McCollum, CCE(BWI), CD(DONA) is the owner of Blossoming Bellies Wholistic Birth Services, providing childbirth education, doula services, workshops for expectant parents, breastfeeding classes and support, infant and toddler nutrition classes, doula training and mentorship opportunities, and pelvic bodywork workshops for birth professionals from doulas to childbirth educators to midwives, nurses, and OBs in the greater Philadelphia area. Her classes can be found in South Philadelphia, Fairmount, Fishtown, West Philly, Mt. Airy, and Collingswood, NJ. Brittany began Blossoming Bellies in 2006, after the birth of her first son left her feeling that there was a great need for women and their partners to be empowered and confident in their births while finding the resources and education in the community to support that. She encourages women and their partners to explore their birthing options, to be aware of their rights, and to be empowered to make informed, evidence-based decisions throughout the childbearing year. Brittany lives in South Philadelphia with her husband, two sons, and daughter. Check out her services at http://www.blossomingbelliesbirth.com/ and follow Blossoming Bellies on Facebook and Instagram.