Drawing up a birth plan: what should you include?

A birth plan is an overview of your wishes for the birth. You write down what is important to you, who will support you and how you would like to be informed when there are choices to be made. You do not need to predict how your labour will go. The plan helps your birth team to get to know you, particularly at a time when you may not have much opportunity to explain everything.

Start with a few points that are truly about you. Discuss these with your partner or another support person, and then with your midwife or gynaecologist. You are free to change your wishes during labour. Even without a birth plan, you can still let people know what you need.

Start with what you need to feel heard

A birth plan doesn’t have to be a list of medical procedures. In the session on the birth team, midwife Geke emphasises communication: how do you want to be spoken to, what helps you make choices, and are there things you’re dreading?

Ask yourself, for example:

• Do I want a brief explanation first, followed by more details if I ask for them?
• Does it help if someone calmly repeats what’s going to happen?
• Do I want my partner to listen in and ask questions, or do I want to lead the conversation as much as possible myself?
• What do healthcare professionals need to know about a previous experience, fear or personal boundary?
• What helps me during a contraction: silence, encouragement, touch or, conversely, space?

You don’t have to write down a personal experience in detail if you don’t want to. You can also note that you’d like to discuss this separately with your healthcare professional beforehand.

What topics can you include?

Choose what’s important to you. These topics may help you get started:

• Your birth team. Who do you want to be there, and what role will that person play? A partner could also be a friend, your mum or anyone else with whom you feel safe.
• The place of birth. Where do you hope to give birth? Discuss what is possible in your situation and what is important to you if you do have to go to a different place.
• Rest and support. Think about music, lighting, movement, positions and who will help you with food or drink.
• Managing pain. What would you like to try, and what would you like to know more about? You don’t need to decide on medication just yet. You may also want to read the overview of pain relief during labour.
• Examinations and choices. What kind of explanation would help you before an examination or treatment takes place? For example, what would you like to discuss in advance regarding an internal examination?
• The first moments with your baby. What are your wishes regarding contact with the baby, cutting the umbilical cord and photographs? Discuss what is possible if you or your baby need care.

You don’t need to go into detail on every topic. A brief description of what matters most to you is more helpful than a standard form that reveals nothing about you.

A brief example birth plan

Use this as a starting point and adapt it to your situation:

• My main wish is to understand what is happening. Please explain briefly what you are proposing and ask what I need to be able to have a say.
• My support person is … They may help me ask questions and remember information. Please continue to address me directly as well.
• During contractions, … helps me. I actually find … unpleasant. Please ask before you touch me.
• For pain relief, I’d like to try … If my needs change, I’d like to discuss the available options again.
• If we need to go to hospital or require other treatment, I’d like to know why and which of my wishes can still be accommodated.

Add your names and any practical information the healthcare provider may need. Write at the top whatever stands out immediately and is most important to you. A longer explanation can follow, but make sure the key points are easy to read at a glance.

What can your partner do during labour?

Discuss the plan together before the contractions start. That way, your support person will know what kind of help you’d like and what you’d like to ask the healthcare provider. It doesn’t have to involve a complicated division of tasks. Simply staying close by, breathing calmly alongside you, offering you a drink and repeating an explanation can make a big difference.

Also agree that your partner doesn’t need to guess what you’re feeling or want. A phrase such as ‘Would you like further explanation, or do you have enough information?’ can help you express what you need yourself. If you’d rather leave a decision to the healthcare provider, discuss that too. Having a say also means deciding how much you want to be involved in decisions at that moment.

What if you speak very little Dutch?

State in your plan which language you understand well and discuss in advance how explanations will be given during labour. Ask what language support is available and how a professional interpreter can be arranged if necessary. Do not automatically assume that everyone on duty speaks the same language.

A translated plan can help, but it is no substitute for a conversation. Go through the key words and wishes with your healthcare provider. Your partner can support you; professional language support may be needed for complex or sensitive explanations. Make sure the agreement on communication is also recorded in your medical records.

When should you discuss it and how should you share it?

Ask during an antenatal check-up when there will be time to discuss your birth preferences. You don’t need to wait until you have a perfect document: questions and doubts are actually a good way to start the conversation. Your healthcare provider can explain what’s available locally and which preferences are suitable for your health and that of your baby.

Ask how the plan will be included in your medical records. Keep an up-to-date version yourself and make sure your support person can find it. Take a copy with you if you’re giving birth somewhere else. Update the document if your wishes or medical situation change.

What if your birth goes differently?

A birth plan is no guarantee that everything will go according to your first choice. So also consider what you want to keep in place if the place of birth, pain relief or treatment changes. Perhaps a calm explanation remains the most important thing for you, or you want to know how your support person can remain involved.

A different course of events does not mean your preparation has failed. The question remains: what is happening, what options are available and what do you need right now? After the birth, discuss what happened if you are left with questions or an uneasy feeling.

Working together to turn wishes into a practical plan

In the free course lesson on the birth team, Geke shows how you can work together to consider support, choices and your birth plan. This way, you can turn a list of wishes into something you can discuss together.

Get started together: watch the free lesson on the birth plan (video in Dutch).