RethinkBirth.com's exclusive

Birth Plan KitHow to have the best birth possible...even if it doesn't go as planned!

by Krystal Trammell, CLD (CBI);

Childbirth educator, doula, mother, writer, advocate

Congratulations, Mama! I’m so excited for you as you embark on this journey.

Pregnancy is a time of growth and learning, and there are many decisions to be made.

One quick and simple way to become more informed about your options is to create a

birth plan. This eKit is an excellent tool to help you explore your options thoroughly

without feeling like you’ve got to swallow some medical texts before proceeding.

In this kit, you'll find a concise breakdown of the options available, how they might

affect you, and why you may want to learn more. I've even sought out the best

evidence-based, easy-to-understand links for further reading on certain topics, so you

won't have to spend (quite so many) hours on Google doing it yourself.

When I had my own babies, I found various, seemingly endless lists of things to avoid,

but little clear information about WHY.

I knew what I generally wanted, but I didn't realize how un-informed I actually was...

The birth plans I ended up creating were long, wordy, full of irrelevant information, and

they didn't encourage any in-depth conversations with my care provider, either.

The process of writing them didn't really make me think deeply about my choices,

nor did they help me to feel any more empowered or prepared for giving birth.

That's exactly why I created this kit for YOU, Love!

It's just one of many creations inspired by my passion

for helping mothers & babies –

...as you can see on my website, RethinkBirth.com.

The process of creating a birth plan is kind of like perusing a travel guide to

the strange land of labor. :)

It's a great idea to discuss your birthing options with someone who's a professional in

the childbirth field, in addition to your care provider. Obviously, you'll be discussing

your birth plan with your care provider too - but it's helpful to get an “outside opinion”

on your plans from someone who's very familiar with the hospitals, birthing centers,

midwives and OBs in your area.

Prenatal appointments are often very short, and the truth is, sometimes things just

don't get talked about until you're suddenly left facing them:

• What if you go more than a few days past your due date?

• What if your water breaks before active labor starts?

• Will you be expected to be on continuous fetal monitoring?

• Will you have access to a tub, shower, birthing ball or squat bar during labor and

delivery?

These are the kind of questions that your care provider almost certainly has a standard

answer to – and you'll want to know his or her policy (or more specifically, how flexible

it is) ahead of time.

Doulas are also an invaluable help to moms both prenatally AND during labor - and

they can be of great help to you while creating your birth plan!

Writing a birth plan that’s helpful for you and practical for your care providers

So, this may come as a shock...but the truth is, a lot of birth plans don't actually get

looked at – by anyone - once you're in labor. This is why it's very important to make

sure that your care provider and his or her place of practice are both on the same page

with you about your birth preferences!

Keeping your birth plan simple and direct is one way to ensure that it gets noticed.

You can also ask your care provider to sign a copy of your birth plan. If he or she is

being asked to put their signature on it, they're much more likely to discuss all of the

finer points with you before they do so.

Especially if you're birthing in a large hospital, if you have a birth plan that's got your

doctor or midwife's signature on it, the nurses will be much more likely to make sure

that plan is being followed!

“So, how do I create a birth plan that gets read and respected, yet still covers all the

things I care about?”

Prioritize! What you include in your plan, and what you can safely leave out, depend a

lot on where and with whom you're planning to birth.

• If you're birthing in a birth center, for example, you won't need to include

anything about wanting to have access to a shower or being able to eat and

drink during labor – because that's standard policy at birth centers.

• If, however, you know you'll be at a hospital where most moms are simply

offered ice chips and IV fluids, you might want to have a conversation with your

care provider about eating and drinking during labor – and you'd probably

include a line about it in your birth plan!

• Try to keep it short and simple. Use a single sheet of paper (one side) for your

birth plan. Bullet points are easy to read, and 12-14 point text is best.

Your birth plan can be broken down into four categories:

1. Labor (dilation of the cervix from 0-10 centimeters)

2. Delivery (pushing the baby out!)

3. Postpartum (delivery of the placenta, healing)

4. Newborn Care (breastfeeding, routine procedures, etc.)

ALL the OPTIONS!

Some things listed here may not appeal to you - and that’s perfectly okay.

Some ideas will work better in early labor, or active labor, and others will be helpful the

whole time:

Breathing techniques - Slow, deep belly breathing is likely to be your #1 coping

technique during labor. Low, deep moaning (instead of tight, high-pitched sounds) is

also great as things pick up. Quick, panting breaths can help you get through the peak

of each contraction during transition, when labor is the most intense, from 8-10cm

dilation.

Music helps set the mood. You can do meditative sounds, seek out special birthing

music, or just listen to whatever makes you happy! A bluetooth speaker lets you use

your smartphone to bring your playlist anywhere - even in the shower.

Birth affirmations are wonderful, rhythmic reminders that you can use, often in early

labor, to focus your mind so that your body can take over and do the work of labor.

Here’s a list of them to read over. You can read over these daily during pregnancy, or

perhaps one will just come to you once labor begins. Words are powerful - use them

to your advantage.

A focal point - This can be just about anything; an art piece, an item of baby’s

clothing, a beautiful crystal, burning candle flame, or even the clock on the wall - but

the idea is to have something that you can focus on that’s outside of your body, that

you keep your eyes on while you’re breathing through the peak of each contraction.

Heat can be an extremely comforting sensation during labor, often on the lower back

or across the hips. You can invest in a reuseable rice-filled heating pad with a belt, an

electric heating pad, or even use disposable heating packs for injuries or menstrual

cramps.

Massage of the neck, upper and lower back, shoulders, hips and feet can help you to

remember to relax in between contractions, so that you can better integrate the next

one. You can buy special arnica-infused massage oil (great for muscle pain, and

rubbing directly on the belly!), or you can use a wooden or battery-operated massage

tool.

Shower or bath - Water is an excellent comfort tool for labor. It works best once

you’re quite sure it’s labor, and you need to change something. Water can really bring

down your feelings of intensity, and helps you to dilate more easily.

Guided visualization - As the contractions get stronger, you can ask your partner (or

doula!) talk you through finding your “happy place” during each contraction. As the

waves come on stronger, you can imagine walking on the beach, relaxing by the lake,

or anything else, so long as your partner does a good job of describing it to you in rich

imagery. This is something best practiced well in advance, but can be very helpful,

especially if you’re feeling like you want to “escape” from your labor.

There are also various alternative tools and techniques that are worth investigating:

• Birth ball - sitting on this helps to open the hips, and to take pressure off the

perineal area when sitting

• Water - a warm shower or bath can be incredibly soothing during active labor

• Aromatherapy with essential oils - check usage guidelines carefully and

make sure you can remove the scent if it becomes overwhelming! (for example,

on a cotton ball instead of directly applied to the skin)

• Acupressure/acupuncture - some acupuncturists do on-call work and will

attend births!

• Bach flower remedies - these ultra-gentle, emotional “medicines” are an

excellent help during the tumultuous time of birth, especially Rescue Remedy.

Learn more about Bach flowers here: http://rethinkbirth.com/bach-flower

• TENS Unit - these handy devices use the Gate Control theory of pain to drown

out the slower, muscle-fiber sensations of labor contractions by applying a low

and subtle electric current to your skin, via gel-pads placed on your back. They

are used throughout Europe to great success, with virtually no ill effects. You

can buy one for about $60. To learn more about TENS use in labor, try this link:

http://www.bellybelly.com.au/birth/tens-machines-for-labour-pain/

• Hire a DOULA! They are worth their weight in gold, and there’s a doula out

there for every woman or couple, at every price point. Here’s why you need

one: http://rethinkbirth.com/do-you-need-a-doula/

Here are even more points to consider, broken down into the four main birth plan

categories:

1. Labor Considerations:

Hydration – In many cases, you can request to drink water frequently instead of

getting IV fluids. If you’re delivering at a hospital, your care provider might want you

to receive a “saline lock”, which is a capped-off IV line, just in case they need to get

quick access to your veins. This can be inconvenient, but it’s much better than being

hooked up to a cumbersome IV pump for your entire labor.

Freedom of movement – You’ll have more freedom of movement if you don’t have an

IV and don’t need to have continuous fetal monitoring. With an IV stand and

continuous fetal monitoring, you’ll be able to get up and move, but not as easily.

Getting an epidural will restrict you to the bed (possibly on your back) for both

laboring and the pushing stage.

Fetal monitoring - Midwives usually use a doppler or fetoscope for this, and will listen

to the baby’s heartbeat for a few minutes, and then leave you alone. Hospitals use

monitors that strap around a mother’s belly with pink and blue stretchy bands, one to

monitor contractions, and the other to record baby’s heart rate. These are not

foolproof, and often need to be adjusted throughout labor and birth many times.

You may prefer to ask about intermittent monitoring, where you’ll stay on the

monitors for a period of time, and then be able to take them off and move freely.

Usually OBs like to ask for 20 minutes on, then 40 minutes off for each hour.

Some hospitals will have telemetry or wireless monitoring, where you’ll have the

same bands on your belly, but instead of being connected to a computer desk, they’re

connected to a wireless unit that you can put over your shoulder like a purse.

Telemetry monitoring is great to ask about if you want to get in the shower or bath,

but your care provider wants you to stay on the monitors. The belly bands are water

resistant, and the nurses can cover your IV or saline lock with plastic so it won’t get

wet.

Environment & Atmosphere – Whether you’re birthing in your own home, or in a

large hospital room, your environment does affect your comfort level throughout labor,

delivery, and recovery. You can always request to have the lights dimmed, the

blinds shut (or opened!), and your own music playing. You can bring

headphones or a bluetooth speaker, your body pillow, and a sleepmask and

earplugs for naps. You can wear your own clothing throughout the process. You can

ask your care providers to use quiet voices, or to not have any extra people in the

room with you unless necessary. You can even bring in electric candles for ambiance

- or anything else that may help you to focus, or to be more comfortable.

Vaginal exams – While vaginal exams are often seen as a required part of birthing,

you may be surprised to hear that they are not always helpful or necessary, either

during pregnancy or labor. Talk to your care provider about his or her philosophy on

vaginal exams. If your waters break, you will not likely have many exams due to the

increased risk of infection.

Pain medication – This can be a touchy subject, but it doesn’t have to be. You may

already know you don’t want pain relief, or you may already know you DO. Many

women are on the fence about this, and go in thinking they’ll want narcotics, but then

end up having a natural birth - or vice versa. Even if your labor is induced with

pitocin, there’s no guarantee how your labor will feel for you. Each experience of

labor is subjective and unique to each of us, and is not something that can be

objectively measured.

Sometimes it’s helpful to have “room to complain”, and as labor intensifies, you may

say you want drugs...but actually you’re still deciding, or you just wanted to verbally

vent! In this case, it can be good to make up a “code word”, something you wouldn’t

normally say, that lets your partner and doula know that you are serious, and really do

want to change your mind now. It can be something nonsensical like “pineapple!” - or

you can come up with something appropriate.

So, in a medical setting, nurses are trained to interact with laboring women by offering

to “manage their pain”, and so unless you specifically ask them not to, they’ll be

coming in frequently, asking you about your level of pain, about where you are on the

pain scale from 1-10, and whether you’re ready for any pain relief. Now, if you want to

have an unmedicated birth, and you’re repeatedly being asked about pain - it’s going

to be a lot harder to stick to your plan! In this case, you may want to specify that the

nurses please NOT ask you any questions about pain, and that you’ll ask for pain relief

if you decide you want it.

Epidurals & IV narcotics - Epidurals are by far the most common form of pain

medication during labor in America. Epidural medicine does not cross the placenta or

act directly on the baby, while IV narcotics do. Also, epidural anesthesia lasts

throughout labor (providing it’s not a very long labor), while IV narcotics only last

about 1-2 hours, and cannot be given when a mother is close to delivering her baby.

IV narcotics usually create a feeling of being drunk or “loopy”, and many women dislike

that feeling.

With an epidural, you will be restricted to the hospital bed. You may retain some

movement of your legs, but it’s not likely that you’ll have enough strength or control to

get up into different pushing positions when the time comes. You’ll have a catheter

inserted into your bladder as well, which will be removed once it’s time to push. You

will still feel your contractions, but it will be a pressure feeling only, and your control

and awareness of the pelvic floor and other muscles in your lower body will be greatly

diminished. A first-time mom with an epidural can expect to push for about an hour

longer than without one.

Epidurals do interfere with the natural hormone spikes of labor, and can affect the

newborn indirectly in this way. This article by the renowned Dr. Sarah Buckley expertly

explains some of the risks of epidural analgesia: http://sarahbuckley.com/epidurals-

risks-and-concerns-for-mother-and-baby

However, epidurals can be a helpful choice - for example, if a mother is exhausted

and unable to rest enough to regain the energy to push when the time comes, an

epidural can provide enough relief for a nap of perhaps 2 hours. In some mothers,

there is extreme tension, fear, and pain due to past trauma or unresolved issues. This

means that they are in fight-or-flight mode, so an epidural could possibly produce

enough of a calming effect on the mother that she is then able to labor and dilate -

because when a woman is in a state of terror, she simply cannot do the work of

laboring, even if she’s being induced. If an epidural can prevent a woman from

having a Cesarean delivery, then any risks are likely worth it, on balance.

2. Delivery Considerations:

Pushing – Some women prefer to be coached or guided on when and how to push,

while others find any type of coaching or direction annoying! Generally speaking, you’ll

be more likely to be able to listen to your body about pushing if you are not medicated,

and have freedom of movement to position your body in whatever way feels best.

Being on hands and knees, side-lying, or supported squatting are all great

positions for pushing. Being flat on your back with your legs up in stirrups is the least

effective, least comfortable way to push - and here’s why:

http://www.givingbirthnaturally.com/birth-positions.html

Freedom of movement is doubly important during the pushing stage!

Interestingly, this article discusses the body’s spontaneous pushing ability or “fetal

ejection” reflex, more commonly present in unmedicated deliveries:

http://talkbirth.me/2012/02/24/spontaneous-birth-reflex/

Waterbirth – Do you want to labor in the water? Deliver in the water? While some

hospitals offer waterbirth, this is a much more common option at birth centers or

homebirths. Read this article to learn all about why it’s safe and beneficial to birth in

the water: http://www.bellybelly.com.au/birth/waterbirth-birth-in-water/

Episiotomy - usually this is not done unless birth is imminent, but there’s a potential

health concern that indicates baby needs to be born ASAP, rather than after another

three or ten contractions. The vagina and perineum are very stretchy, resilient tissues,

and evidence shows that it’s easier to heal from a natural tear than an episiotomy:

http://www.mamabirth.com/2012/11/obstetric-lie-81-episiotomy-is-better.html

Some say that using compresses of warm, wet washcloths, and/or olive oil, can help to

minimize tearing by bringing additional blood flow to the tissues during crowning

(when baby’s head is about to emerge): http://www.giving-birth-naturally.net/avoid-

an-episiotomy.html

Talk to your care provider about his or her views on episiotomy. They are becoming

less and less common, but it’s worth asking about, just to avoid any “surprises”.

3. Postpartum Considerations:

Cord clamping & cutting – Immediately? Actually, more and more care providers

are recognizing the research and benefits of allowing the “golden minute” instead of

clamping the umbilical cord immediately. Waiting 60-90 seconds allows the newborn to

retain up to 33% more of its blood volume, which is circulating through the placenta,

baby, and umbilical cord at the time of birth. https://youtu.be/PYifnp-qiWw

Cutting the cord immediately used to be common practice, but it’s equivalent to saying

“Breathe, NOW!” to the newborn. Also, read this article on the many benefits of

delayed corn clamping and newborn blood volume:

http://www.bellybelly.com.au/birth/cord-clamping-delaying-cord-

clamping#.U4e8bvldWSo

Placenta delivery – If your labor has not been medically induced or augmented with

pitocin, it’s still extremely common practice in American hospitals to start an IV drip or

give a one-time injection of pitocin to help deliver the placenta and to prevent

excessive postpartum bleeding. However, oxytocin is also released naturally due to

baby’s first breastfeeding session (nipple stimulation!). This oxytocin helps the uterus

to clamp down and stop bleeding, thereby preventing postpartum hemorrhage.

http://midwifethinking.com/2012/05/05/an-actively-managed-placental-birth-might-

be-the-best-option-for-most-women/

Whether or not you get this prophylactic (preventative) dose of pitocin, it’s a great idea

to get started with breastfeeding soon after birth, within the first 30 minutes, and

before the first hour of life. This early bonding time may be awkward, and baby may

or may not get a good latch, but just trying, just having baby against your bare skin is

healing and healthy for both of you.

Placenta encapsulation? Many mammal species consume their own placentas

directly after delivery, and there is mounting interest in this practice for humans as

well, lately! Trained placenta encapsulation specialists create capsules that are no

more troublesome for a mother to consume than her prenatal vitamins. The placenta

produces hormones for 9+ months, so then, at birth, the resultant hormone drop has

many effects on the mother, some of which can be decidedly unpleasant:

https://youtu.be/VLkmspBdkM0

While there is still a dearth of evidence and research about the benefits of placenta

encapsulation, many women report increased energy levels, increased milk supply,

minimal bleeding issues, faster healing, and a decrease in symptoms of baby blues or

PPD.

Depending on where you’re delivering, and what state you’re in, you may have to talk

to your care provider about obtaining your placenta for encapsulation. Read here

about the benefits of this practice: http://placentabenefits.info/articles.asp

4. Newborn Care:

Skin to skin contact – It’s becoming more common to have your newborn baby

placed directly on your bare chest immediately after delivery, which is great for both of

you! You’re then both covered up with blankets, and mom’s body temperature

maintains baby’s temperature better than any warming device. There are many

benefits of immediate, prolonged contact with your baby. After the “golden

minute”, consider the “golden hour”. In the absence of any emergency issues,

bonding is the top priority in the first hour after birth. http://www.choicesinchildbirth.org/files/2009_SEARS_Golden-Hour.pdf

Feeding baby – You may want to specify that your baby not be given any pacifiers or

bottles, especially if he or she must be sent to the nursery for any length of time.

Breastfeeding might be natural, but that doesn’t mean it’s instantly easy for mothers

or babies! While pacifiers and bottles have their place, it’s best to minimize their use

or avoid them completely if possible in the first few days.

There is a learning curve – but you'll likely master it. Skin to skin time and

cuddling is important, as is learning about what’s normal and what’s not. Take a

breastfeeding class. See a lactation consultant. Get in touch with your local La Leche

League for support. If things aren’t going well, keep trying. Get a second opinion, and

finally - don’t feel guilty or miserable if you need to use formula, either temporarily or

permanently. Feeding your newborn baby is an act fraught with emotion for most new

moms, no matter how they’re doing it.

Newborn procedures – Many of the standard procedures such as assessing weight

or administering medications, can be delayed or declined immediately after birth, to

facilitate bonding after an uncomplicated delivery. Even if the newborn nurse is

standing there waiting, you are not being unreasonable to ask her to give you some

more time together!

First bath – So, in hospitals, the first bath is sometimes done in the delivery room,

near the mother. Other times, the baby is taken to the nursery, away from his or her

parents. While a newborn is usually dried off after birth, they are not “dirty” and

neither soap nor water is beneficial for them, especially when they are being removed

from mom’s warm, comfortable arms to get “clean”. The first bath can be delayed for

a few hours, or simply declined in favor of doing it at home, in several days. Here’s

one perspective on bathing and bonding: http://www.bestforbabes.org/booby-traps-

series-why-the-newborn-bath-should-wait/

Vaccinations – This is a huge topic, much broader than I can cover here. There are

risks & benefits involved with vaccinating, and there are risks and benefits of not

vaccinating as well. The Hep B vaccine is often administered directly after birth, but

it’s also common for parents to ask their pediatrician to do it at the first well baby visit

several days later. Vaccines can always be delayed if either parent is feeling uneasy or

wanting to do more research into this weighty, complex topic. Each family must decide

what is best for their child, in their educated opinion. Here is one great website with

research and articles to consider: http://www.nvic.org/

Erythromycin eye ointment – This routine procedure can safely be declined in many

cases. Here’s why: http://evidencebasedbirth.com/is-erythromycin-eye-ointment-

always-necessary-for-newborns/

The Vitamin K Shot – This is another routine procedure that the newborn receives in

his or her first few hours of life. Vitamin K is the clotting factor in our blood, and all

human newborns are born “deficient” in Vitamin K at first. The baby’s levels steadily

rise until day 8 of life, when they are equal to normal levels. If there were a bleeding

issue in the baby at birth, or a surgery was needed before day 8 of life, the Vitamin K

shot would be crucially necessary. See this article for more information: http://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/

Circumcision – Circumcision is a cosmetic surgical procedure carried out on a male

child long before he is able to give consent. It is often conducted without any

anesthesia because of the incorrect yet pervasive belief that infants do not feel pain.

Care of an intact penis is less difficult than care of a circumcised penis, especially in

the early weeks, where there will be an open wound exposed to urine and feces. This

article clearly explains the function and benefit of an intact foreskin throughout a

male’s life: http://www.greenmedinfo.com/blog/foreskin-why-it-such-secret-north-

america

Please learn more about circumcision here: http://www.thewholenetwork.org/

Newborn blood screening (“the heel stick”) - In most states these screening tests

are legally mandated, and are done to screen for various life-threatening metabolic

disorders. You can request that all screenings be done in your presence, or that the

other parent be present during the tests. The heel stick can often be done while baby

is in mama's arms - or even while baby is latched on and nursing. This way the

procedure is less traumatic for baby.

“Rooming in” versus the nursery – Most hospitals now routinely have babies stay

nearby their mothers – as well as a space available for the other parent to stay in the

room overnight as well. This facilitates strong bonding and contributes to the well-

being of both mama and baby.

Planning for success, planning for acceptance, planning for peace...

Hopefully you feel much more prepared and well-informed about your choices for labor,

delivery, and the care of your newborn baby. I encourage you to continue to research

anything you’re still unsure about, and if you’d like to speak to me further about

anything mentioned here, please email me. I’d love to hear from you.

Writing your birth plan - in summary:

As you read through this kit, you’ve been taking note of what’s really important to you,

and now is the time to gather those important points together under the four main

headings we mentioned earlier:

1. Labor

2. Delivery

3. Postpartum

4. Newborn Care

Small details:

Finally, it's a good idea to have your and your partner's full names and the name of

your doula at the top of the plan.

It also helps to have a sort of disclaimer in the form of a sentence or two that indicates

that you understand that birth is unpredictable and that game-time decisions must

sometimes be made that will deviate from your plans. A sample birth plan is included

on the next page for you to print out or use as a template to write your own.

WOW! You did it! I bet you feel so much more prepared and informed now!

One of the first parts of becoming a parent is your willingness to delve into the tough

topics, learn and grow, in order to be

I hope this eKit has been helpful and illuminating, and I hope it’s inspired you to a

greater level of courage and confidence in your innate ability to give birth!

~ Krystal Trammell, CLD (CBI)

www.RethinkBirth.com

+ Birth Preferences +

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I understand that birth cannot be planned in the typical sense; however, these are some of my most important preferences in any case, and I would like your acknowledgment and support in honoring them as much as possible.

If changes need to be made as labor & delivery progress, I would like to be given a few moments alone to confer with my partner and/or doula before being asked to make a decision immediately. Please help us to make informed choices by discussing all procedures and options with us ahead of time.

Labor:

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Delivery:

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Our Baby:

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In the event of labor induction or Cesarean birth:

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We appreciate you taking the time to review our wishes, and we thank you for your support in respecting them.

Signed_______________________________________________________

Date: _____/_____/_____ Practice: ______________________________

P.S. Got more questions?? I’d love to hear from you! Please send me an email at Krystal@RethinkBirth.com

RethinkBirth.com offers digital resources for doulas, birth professionals, and mothers:

• Childbirth education curricula & resources

• The Conscious Pregnancy Workbook

• The Mother Blessings eKit

• Cesarean & Labor Induction resources

• Henna art