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A birth plan is a great way to set your intentions and how you plan to achieve the experience that you envision. They are also a great way to communicate your desires with your care providers. It can be overwhelming to think about what to include in your plan. You may be wondering how much detail to go into and how to get started. Enjoy the process of putting your plan together! Prenatal classes, reading, and talking with your midwives or obstetrician will help you get familiar with your options.

Here are our 5 top tips to writing your birth plan.

1. Discuss your community’s standards and routine practices with your care provider.

The most common items I see on birthing plans are: delayed cord clamping, uninterrupted skin to skin, early breastfeeding and delayed baby bath. At THM as well at SJH, we practice evidence-based care and there is great evidence to support all of these. These are practices that we do as our standard of care and not things you need to specifically request. Having this discussion also helps you figure out what procedures you may be worried about that are not at all routine (such as episiotomies which are now rarely done).

When you plan to decline any of the components of routine care, it’s important to note them on your birth plan

2. Include rituals, ceremonies or cultural practices you plan to observe.

This can be anything meaningful for you. Perhaps you want your partner to announce the sex of the baby or assisting with the catch, or you plan to sing a traditional song or offer a prayer. Let us know if you need us to help you make any special arrangement or if you just need quiet or privacy when the time is right.

If your ceremony includes candles, fire, or smoke of any kind we will have to collaborate ahead of time to make appropriate plans. If electric/flameless candles can be substituted, please do so.

Please note that the hospital policies don’t allow capturing videos of care providers without their consent and no videotaping of the birth itself. Please discuss videotaping at a home birth with your midwives.

3. Think about comfort measures and pain relief.

A birth plan should include things that will help you stay calm, grounded and centered. Your perception of pain will be less when your stress hormones are lower. Think of ways that you soothe yourself during challenging times and how to incorporate a version of that into your birthing experience.

Here are some examples of things you could include:

• I would like the room to be dimly lit and quiet voices so I can stay “in the zone”.
• I will bring posters of my birthing affirmations and post them in the room.
• I plan to be upright and mobile throughout the delivery. I am open to positions being suggested to me to help the labour progress well, but ultimately, I want to labour in positions of my choosing.
• I prefer to wear my own clothes.
• I would like to eat and drink as I feel is right.
• I would like to use the tub, counter pressure and massage for pain relief.
• I plan to listen to music
• I will use a TENS machine

Make sure to include your preferences around medications for pain relief.

• I prefer not to be asked if I want an epidural. I will ask for one if/when I need one.
• I am/ am not open to opioid injection or IV in early labour if I am not coping.
• I want to get an epidural as soon as it is safe to do so.
• I want to try and avoid an epidural.

4. Consider never saying never.

If there are certain procedures that you would never consent to, even if death were likely or certain for you or your baby, these should definitely be in your birth plan and discussed ahead of time with your care team.

During your labour and birth, depending on how you or your baby is coping, you may opt to do something you were hoping to avoid. Remember we do NOT do any procedures on you or the baby without your consent after a discussion of the risks and benefits.

Here are some examples of things that can be tricky to include in a birth plan:

• No vacuum or forceps. (Here’s why: If your baby’s heart rate is abnormal during the pushing phase and should be delivered ASAP for best health outcomes, an instrumental delivery may be the best way to make that happen.)
• No cesarian section. (Here’s why: There are many reasons why a c/section may be offered or recommended to improve the chance of a good outcome. You will always be involved in the discussion of whether a c/section is the best option and always the one to make the decision.)
• No formula. (Here’s why: Formula is NOT given to your baby unless 1) you ask for it or 2) there is a medical reason why your baby may need additional supplementation – like low blood sugars. Again, nothing can be done to your baby without your consent, but sometimes there are reasons why we would recommend formula for your child).
• No continuous monitoring during labour. (Here’s why: The standard of care is intermittent auscultation (listening to the baby for a minute with the Doppler at 5-30 minute intervals, depending on the stage of labour. We would only recommend continuous monitoring if there is a medical reason that makes your labour higher risk.)
• No male care providers. (Here’s why: While all of the midwives at THM identify as female or nonbinary, if a complication develops during the pregnancy or labour, we may need to consult with the OB on call. Several of the OBs and residents at SJH are male and may be the only care providers available who can providing an advanced level of care at the time of your birth.)

5. Outline wishes for your baby’s care.

• how you plan to feed your baby
• what medications you want/not want your baby to have
• what tests do you want/not want your baby to have

6. Bonus tip: Think about Plan B for when things don’t go as planned.

List any special requests for when things take an unexpected turn. This is the section where you think about how you will make lemonade if you are served up lemons.

Some situations to consider:

Your planned home birth requires a transfer into hospital, you have an epidural when you planned to be unmedicated, you have an unplanned c/section or your baby goes to the NICU.

So that’s it!

Once you have assembled your list, review it with your care provider. Your midwife or OB will make a copy for your chart so that everyone you encounter during your birthing experience can quickly get oriented to your wishes. If you decide you want something different than what you included on your birth plan on the day of your birth – that’s okay too! Every birth is different and sometimes you don’t know what you want or need until you’re in the moment. We are excited to work with you to achieve your most empowered birthing experiences!

The Hamilton Midwives is a teaching practice where students of the Midwifery Education Program at McMaster University may be involved in your care. Gaining practical experience through clinical placements is the main way in which midwifery students learn and how our profession is able to grow. As midwifery students, we are grateful for every client who trusts us to participate in their prenatal and postpartum care and allows us to assist with their labor and birth.

The Midwifery Education Program is a four-year undergraduate degree. In our first year and a half, we take classes that explore the basics of midwifery including pharmacology, anatomy and physiology, principles of midwifery care, and a history of the profession. These classes provide a foundation for later courses that focus on practical experience through different clinical placements. Though this course work is extremely important, the anticipation of finally attending and participating in a birth is unrelenting!

Our first clinical placement takes place in our second year of the program at a midwifery practice, where we learn clinical skills under close supervision by a Registered Midwife. Next, in our third year, we complete interprofessional placements with nurses, obstetricians, lactation consultants, and other healthcare providers involved in the care of pregnant and postpartum people and their newborns. These placements allow us to better understand the various professions we will collaborate with as registered midwives. Our senior year placement gives us the rewarding experience of following our clients from the very beginning of their pregnancy to the very end of their postpartum period. In this year-long placement, we take on greater responsibility and perform many aspects of clinical care independently. Every time we provide care, a Registered Midwife is close by either in person or at the end of the phone – whichever is most appropriate to the clinical situation. The Midwives at THM take their responsibilities as preceptors very seriously, both in terms of keeping clients safe and ensuring an excellent level of care, and in terms of providing quality learning and mentorship for students.

Students come into the Midwifery Education Program from all walks of life. It is a direct entry program, meaning the only requirement for admission is a high school diploma, but many people have previously studied or worked in other fields. Through conversations with our fellow students, we’ve come to realize that most people are drawn to the midwifery profession for a similar reason - we want to help clients make decisions about their pregnancy, birth, and parenthood that feel best for themselves and their families.

I, Claudia, entered the midwifery education program after working as a research analyst at a mental health hospital. I have always been interested in the human body and its capabilities and loved working in healthcare but desired a more hands-on career – and midwifery sure is hands on! I remember attending my first birth during my initial midwifery placement and being amazed when, all of the sudden, there was a whole new person in the room to care for. Being the first hands to touch a new person is continually remarkable, and I doubt it will ever get old. In a few short years, I have gone from attending my very first birth to independently guiding clients in making decisions about their care. Looking back to this initial experience, I am proud of the amount I have learned and how much I have grown as a healthcare practitioner.

For me, the most rewarding part of being a midwifery student is seeing how I have impacted a person’s pregnancy, birth, postpartum or parenting experience for the better. This semester, I have cared for a few clients who struggled with breastfeeding in the postpartum period. Being able to meet a client in their home and provide breastfeeding support in the setting where they most often feed their baby can really help clients get the hang of nursing. I put the skills I learned while completing my interprofessional placement with a lactation consultant to good use, assisting these clients with positioning and latching their babies. I felt joy seeing the relief on these parents’ faces as they finally achieved a pain-free, deep latch, and continue to delight in their confidence with feeding their babies moving forward. This is just one example of how I saw my efforts as a midwifery student positively impact a client’s pregnancy and parenting journey. Such experiences have helped solidify that midwifery is the right career for me. It is incredible to watch clients who I have developed a relationship with throughout their pregnancy come into their own as parents, and I am forever grateful that I get to assist people on this path again and again.

As senior students, we are looking forward to becoming registered midwives soon! We are excited to focus on providing care for and building meaningful relationships with our clients, without the added stress of completing papers, exams, and schoolwork. As students who have worked in Hamilton for a good portion of our placements, we hope to expand the roots we have established and continue to grow our relationship with the community that we have become a part of in the new role of registered midwife.

Note:

Claudia Di Clemente and Touka Shamkhi will continue working with The Hamilton Midwives after graduation. They will start working as Registered Midwives in the summer of 2022 with due dates starting in the fall.