The Top 15 Birth Plan Questions Every New Mom Should Consider

At this point in your pregnancy, you may want to prep for your precious baby’s arrival, but disclaimer: Every birth is different, and chances are, yours probably won't go exactly how you want or imagine. However, even if your twinkle lights don't make it to the ceiling or your chosen doctor doesn't arrive in time, preparation can significantly help to create a calmer, more positive birth experience.

Everyone has different wishes, but it's smart to do your research and be fully informed about the decisions you'll be expected to make, not only for you, but for your new baby as well. Of course, no birth can be perfectly planned, and you should remain mentally flexible with a plan B and even a plan C for anything that may come up. 

If you’re giving birth in a hospital, always check with your doctor to see what is allowed in the hospital. Go over your birth plan with your husband or birth doula in case advocacy is needed. If birthing at home, you can go over your birth plan with your midwife. 

So, what should be included in your birth plan? Let’s get into the top 15 questions you should consider when putting together this essential piece of paper:

Birth at Home or the Hospital?

The big question, and a very good place to start! This is obviously up to you, as is every decision for your birth, but there are significant pros and cons to consider in comparing home birth to hospital birth. Hospital pros include having all the medical staff and equipment available on site (in case of medical emergency/necessity), especially if there are any specific health issues present and you’d rather act on the side of caution. You have the epidural available if you need/want it, and you have nurses taking care of you and cleaning up after your birth.

In my experience as a doula, however, hospital staff is often a gamble. I’ve known really sweet and gentle nurses, and some that aren’t so sweet, patient, or gentle. The same goes for Ob-Gyns – if your birth goes past your doctor’s shift, another and possibly strange doctor might deliver your baby. Other disadvantages include restricted movement, as you’re often hooked up with cords and IVs to monitors and machines. You could also be pressured into medical decisions you aren’t comfortable with and may not be actually necessary, even if you have a birth plan. 

When birthing at home, you’re in your familiar space and you can add any details to your area to make it comfier and more relaxing (diffuser, twinkle lights, birthing tub), and you have your midwife and possibly doula assisting you according to your birth plan. Some cons include the potential need for a hospital transport in the case of a prolonged labor or medical emergency, due to the lack of medical equipment and personnel. Your insurance also may not cover associated costs with a home birth, so it's important to check beforehand. If you have other children or pets, a home birth can feel more chaotic than an isolated hospital birth and you may need to plan ahead to account for child or pet care. Lastly, birth is obviously a messy ordeal, so keep that in mind if preparing for a home birth to set up plastic sheets, towels, and have someone in charge of the clean-up.

What To Eat Beforehand?

Even if you’ll be at home, but especially if you plan to birth at a birthing center or the hospital, keep your nutrients in you! The hospital staff will most likely tell you not to eat anything except liquids until after the baby is born (in case a C-section surgery is necessary), and this might be the case at the birthing center as well. Besides, you may not even feel hungry once the active labor pains start, but it’s important to eat protein and vital nutrients beforehand so your body has quality fuel for the major exertion ahead. 

So, what to eat? Don’t settle for fast food on the way to the hospital or anything heavy or greasy (you’ll be nauseous enough), and obviously nothing inflammatory or on your personal list of food sensitivities. Eggs might sound or smell gross, but if you can stomach any of the following, some clean protein options are baked wild-caught salmon, free-range scrambled eggs, steak, healthy jerky, and organic turkey or chicken. Berries and melon are gentle fruits high in water content as well as antioxidants and vitamin C, all of which will help with easing muscle cramps, boosting energy and serotonin levels, and reducing cortisol and oxidative stress. And dates are said to help labor progression. These anti-inflammatory foods will help promote blood flow and relax your uterus. 

Who Do You Want in the Room with You?

Who do you want there with you? Your husband, a birth doula, your mother? Not every man can be a competent and compassionate birth support, and not every mother is a peaceful and supportive presence in such a delicate time as labor and birth. I only say this because, as a doula, I’ve had more than one woman say they wouldn’t want their mom in the room with them, and I’ve had others say their husband wouldn’t do well with seeing his wife in distress and/or the sight of blood.

However, I also know of several husbands who were an amazing supporter for their wife during birth and basically doubled as the birth doula. Similarly, the majority of women I’ve spoken to have had their mothers present for at least their first birth and were glad to have their nurturing support.

It's important to talk with those you want in the room with you beforehand to gauge how their presence and actions will make you feel.

It's also important to have a conversation with your husband and family members prior to birth on managing expectations once the baby arrives. Do you want everyone and their mother showing up at the hospital while you're in labor or while you're trying to rest up afterwards, or would you rather cherish the moment just you and your husband until you arrive home days later?

Who Is Your Advocate?

If birthing at home, your midwife will probably know all your birth requests or ask about certain ones if you haven’t been able or thought to discuss it sooner. But what about in the case of a hospital birth or transfer, if the labor goes too long or a medical emergency arises, not to mention consistent personal support? Would you have a birth doula with you, or would your husband or your mother be a better advocate? 

You don’t want to go into a birth unprepared, especially in a hospital. This is not to display hospitals in a negative light; quite the opposite, because countless women have had to depend on the resources and expertise available at hospitals with the experienced staff. But many women have also had negative experiences in their hospital births because of strict protocols, an uncompassionate nurse or doctor, or a lack of consideration and/or respect for the patient’s wishes. Not all hospitals are equal, and some have a better reputation and more impressive staff than others. So, it’s best to meet and discuss with your doctor/hospital care providers about how you would like certain details of the birth, who your advocate will be, and see if they are agreeable to your wishes.

Natural Birth or Epidural?

Let me get this out of the way first: there is no “unnatural” birth. However, for clarity's sake, a “natural birth” typically means no drugs or epidural (anesthesia). Some women choose a “natural birth” because they don’t want the drugs or because they want to experience what their body can do unassisted. Some women try to go as long as they can naturally, then have the epidural as an option if they feel too exhausted to go on or like the pain is overwhelming. 

One reason why some women wait for their epidural is so they can naturally stimulate the baby down to the birth canal; sometimes, taking the epidural early on slows the labor progression and then the mother cannot push as effectively. Pitocin can be given to speed up the labor or induce labor, but because it stimulates intense birth contractions, it’s customarily administered with an epidural. Keep in mind, there are side effects of Pitocin to consider as well.

Vaginal Delivery or C-Section?

Medically speaking, a vaginal delivery is the most natural way to birth and is thought to be healthiest, for both mother and baby. It lowers risks of needing a blood transfusion, getting a postpartum infection, or having uterine scarring. However, if some women have medical complications or health problems, a c-section might be considered necessary or strongly suggested. 

Tip: If your husband will be in the room with you during delivery, it may be a good idea for him to stay near your head, holding your hand and looking in your eyes to encourage and comfort you, instead of being toward your lower end where your Ob/midwife will be coaching the baby out. This is because it could be somewhat shocking for your husband to see your vagina dilated and looking bloody. Once the baby’s head is crowning and coming out, then your husband may want to peek down and see the head emerging or touch the little head, but at this point he’s focusing on the baby’s progress more than anything else. You know your husband best, though. Have a conversation with him now about what to expect and ask him where he would like to be and how involved he would like to be during the birth.

Movement Ability?

As a birth doula, I’ve personally seen how movement helps labor progress, so I would say you want to have the freedom to move around as much as possible. This mostly applies to hospital births, since hospital regulations usually require monitors and corded machines to be used. 

It can be frustrating and can even make your labor more painful and difficult if you’re just stuck on the bed with a ton of cords getting in your way. A young mother whom I coached remotely told me about her birth experience: Because of some health complications, it lasted 36 hours! After being stuck for hours at 7cm and finally having to get an epidural, she said her labor significantly progressed the last few hours before birth when her night nurse came in every 30 minutes to help her change positions. This movement was a key factor in her labor progression and demonstrates how the body needs gravity on its side to push the baby down the birth canal.

Another woman told me about her first birth experience at her birthing center. She had requested for full movement freedom because she didn’t want to be hooked up to any cords or monitors. She had practiced hypnobirthing religiously during her pregnancy, and when she went in after laboring at home for a period, they found she actually was 9cm dilated by then without realizing it! For the rest of her labor, she moved and practiced stretching and hypnobirthing techniques, and her delivery went well. Her active labor and delivery lasted about 16 hours in total. Again, every woman’s body is different, as is every birth experience, but certain factors like movement (and hypnobirthing) can really make a difference! 

Delivery Position?

Ideally, you’ll want to move as much as possible during labor and be able to do labor positions to push baby down, but for the birth do you want to be sitting up or on your hands and knees? Lying down on your back is the least natural and least effective way to birth a baby (unless the baby is actually crowning and coming out) because you need gravity on your side to push the baby down the birth canal. In my doula experience, squatting to open the pelvis, hands and knees, or sitting up and leaning back have been most comfortable for the mother and most effective for delivery.

Episiotomy or No?

An episiotomy is a cut (incision) made in the tissue between the vagina and the anus (the perineum) during childbirth and is meant to prevent tearing. One problem with episiotomies is they’re done more often than is necessary. In fact, it used to be a routine part of childbirth. An incision might only be necessary if the baby’s shoulder is stuck behind the pelvic bone, if the baby’s heart pattern becomes irregular and a quick delivery is needed, or if forceps are needed during a vaginal delivery. Or even if the baby’s head is larger than the vaginal opening can naturally allow. You can communicate with your care provider if you’d prefer that they don’t perform an episiotomy unless absolutely necessary. If it is needed, your care provider will stitch it closed after birth.

Breastfeed or Use Formula?

Breast milk is healthiest for the baby, according to countless health experts. This is just biological fact. If you're in a hospital, it's standard for a lactation consultant to visit you post-birth at least once to assist and answer any questions you may have. It's recommended to have a breastfeeding pillow on hand at the hospital or at home to help you ease into those first feedings.

However, not all women are able to nurse for one reason or another, or choose not to. Some women don’t produce enough milk, or if the mother or baby has medical complications it may not be possible to breastfeed. Keep in mind that lots of women need to supplement or exclusively use formula and you shouldn't feel ashamed if you fall into this category. Some hospitals provide formula when this occurs, but if you feel strongly about a certain brand, you can bring that along with you as well.

Skin-to-Skin Contact?

Skin-to-skin contact has always been one of the first steps of introducing a newborn baby to the world, so it can sense the familiarity of its mother. This was the tradition of birth for centuries, because it helps bond the baby and the mother to each other even more, gives the baby security in the familiar presence of its mother, stimulates breast milk production, and encourages the baby to nurse for its first vital nutrients. 

Despite that, some hospitals are charging extra for this now due to the additional staff they deem necessary for the task. Every parent should have the freedom to hold their own baby whenever they choose, especially right after birth when the bonding factor is most crucial, as well as for stimulating breastfeeding. If you plan to birth in a hospital, check with your care provider ahead of time to make sure you won’t be charged extra or inhibited from holding your baby right away and having skin-to-skin contact (follow up with an email for confirmation so you have it in writing). 

Vitamin K Shot?

The vitamin K shot is administered to newborns to address low levels of vitamin K at birth, which prevents their blood from clotting effectively. Some mothers opt out of the vitamin K shot, usually because they question it’s necessity when people have survived without it for all the generations before the shot was introduced in 1961. Many women feel it’s unnecessarily invasive and refuse it, while other women aren’t worried about it or prefer to pick their battles. This decision is completely up to you; as with the other points, I simply advise you to research it to reach an informed position. 

Immunizations?

Whatever your position is on immunizations/vaccinations, be aware that this is an important point to have on your birth plan. Regardless of your doctor’s position on the matter, I would recommend you do your own research, if you haven’t already, in order to have an informed opinion. 

After birth, routine vaccinations for newborns include the first dose of the Hepatitis B vaccine and the RSV immunization. Doctors recommend these shots as preventatives against liver disease and cancer, but it is ultimately your choice whether or not you wish to have your newborn vaccinated. 

Baby in Room?

Do you want to keep your baby in your room after birth or give permission to take the baby out? If you’re in a hospital or birthing center and if there is a medical necessity/emergency, your care providers might need to take the baby out, but even in such a case, it would be a good idea to have a family member accompany the baby. Otherwise, it’s not really necessary to have your baby taken out of the room. It would be best that, if possible, your baby stays at least near you for the first several hours after birth for security and familiarity. Hospitals even encourage rooming-in for bonding. And if the baby is not on your chest skin-to-skin for the next several hours, then have your husband or a present family member hold the baby.

Who Goes with Baby?

It’s usually unnecessary to take the baby out of the room, since all the washing, feeding, and measuring equipment is in each birth room. In case of medical necessity or an emergency, however, who accompanies your baby? You probably don’t want strangers taking your baby out of your sight, especially if the staff has been pressing you to give the baby shots you don’t want.

I just think of the Don Knotts movie The Ghost and Mr. Chicken, in which Luther (Knotts) tells his school crush he is really the Prince of Wales, “but there was a mix-up at the hospital.” Imagine! But jokes aside, you probably want to protect your vulnerable baby. If you are not able to go, I would advise for you to arrange for either your mother or husband (or whoever is supporting you in the room during the birth) to accompany the baby. 

Circumcision?

This is obviously only necessary to include in your birth plan if you're having a baby boy. This is a question that is up to you and your husband to agree on together. This is more of a cultural and religious topic than strictly medical, but it will be a decision to make, nonetheless. Circumcision is not medically necessary, but it is often recommended for lowering the risk of bacterial infections.

Many women have started to reject the expectation of circumcision because of the pain it causes the baby and the fact that the actual risk of bacterial infections as a result is extremely low today in developed countries.

Especially in the supposed land of the free, every woman should have the autonomy to choose how she wishes to birth her baby and protect her baby once born. Personal medical health is one of the most fundamental rights, and it’s a problem when hospitals seek to override and disrespect a woman’s wishes and personal dignity, especially in the midst of one of her most significant life experiences. Granted, modern medicine is a saving gift to have, especially in the case of medical emergencies, but outside urgent need, there should not be any controlling fear factor presented to you (that often has money as a root factor). Birth is not a medical condition or a disease in need of treatment – it’s a perfectly natural and human experience that deserves reverence and respect. 

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