As labor and delivery approaches, many expecting moms are creating a birth plan to prepare for childbirth. Learn what one UAB expert recommends, including in a birth plan during the third trimester of pregnancyOnce the calendar page turns and the pregnancy app announces that Week 28 has arrived, many expectant mothers may feel like celebrating. Reaching the third trimester often brings a mix of emotions — excitement about meeting their baby, relief that the end of pregnancy is in sight and potentially some anxiety as labor draws closer.
As delivery approaches, many women begin checking off items on their to-do list. One task that can help them feel more prepared is creating a birth plan, but what exactly should a birth plan include?
Laura Money, nurse manager for the University of Alabama at Birmingham’s Women & Infants Services, explains what a birth plan is and key considerations for expecting parents.
Q: What is a birth plan?
A: A birth plan is a way to communicate preferences during labor, delivery and the time immediately after birth. It is important to remember that this is not a guarantee of what will happen — labor and birth can be unpredictable — but it helps the mom, their support person and the healthcare team understand what matters most. It also encourages shared decision-making during what can be a scary, uncertain time.
I recommend to start talking early in the pregnancy with the healthcare team. At UAB, we start documenting a birth plan as early as the first visit. It can change as the mom and babies’ journey changes, but it is good to start early.
Q: What are some things that a mom-to-be could consider including in their birth plan?
A: There are several things that pregnant moms can consider including in their birth plan, and several can be included in both a planned vaginal delivery or cesarian section.
For a planned vaginal birth, some things to consider are:
- Pain management: Whether the goal is an unmedicated labor, an epidural or keeping options open. Patients may also indicate how frequently they would like to discuss pain management options during labor.
- Labor positions and movement: Preferred laboring positions and whether they would like the freedom to move around during labor.
- Fetal monitoring: Preferences regarding fetal monitoring if continuous monitoring is not medically indicated.
- Labor induction or augmentation: What interventions the patient is OK with that may be used to start or progress labor.
- Support persons: Who is permitted in the labor room.
- Labor environment: Preferences for lighting, music and noise levels.
- Eating and drinking during labor: Whether the patient would like to eat or drink during labor, if medically appropriate.
- Communication updates: Individuals who should receive updates during labor.
- Comfort measures: Tools and resources such as warm compresses, birthing balls, birthing bars or peanut balls.
- Delayed cord clamping: Whether delayed umbilical cord clamping is desired.
- Skin-to-skin contact: Preferences for immediate skin-to-skin contact after delivery.
- Infant feeding: Plans for breastfeeding, formula feeding or a combination of both.
For a planned cesarian section, items in a birth plan could include:
- Support person: Who may accompany them in the operating room.
- Drape management: At UAB, operative drapes can be lowered so parents can see their baby immediately after birth, if desired.
- Operating room atmosphere: Preferences for a quiet environment or a more celebratory setting.
- Skin-to-skin contact: Whether skin-to-skin contact is desired in the operating room or recovery area. In some situations, patients may wish for their support person to provide skin-to-skin contact until they are able to do so themselves.
- Recovery preferences: Visitor preferences, including who may visit and how many visitors are allowed, as well as pain management goals during recovery.
- Infant feeding: Plans for breastfeeding, formula feeding or a combination of both.
Q: What are some things to include in the birth plan for the baby?
A: After a successful and safe delivery, there are newborn procedures that are recommended, and parents need to decide what is wanted for their child. These options included:
- Cord blood banking or donation: Families interested in banking or donating cord blood should make arrangements before delivery.
- NICU preferences: If the baby requires care in the neonatal intensive care unit, parents may want to identify whether the support person will accompany the baby or remain with the mother. Families may also designate another individual if needed.
- Visitors and handling: Preferences regarding who may see or hold the baby shortly after birth.
Evidence-Based Care for You and Your Baby
At UAB, we follow evidence-based practices that support bonding, newborn transition, and early infant health. These practices include:
- Immediate skin-to-skin contact after birth, when clinically appropriate
- Initial drying and assessment of your baby while on your chest
- Delayed cord clamping
- Delaying your baby's first bath
The following newborn care services are routinely offered after delivery and will be discussed with you as part of your baby’s care:
- Erythromycin ophthalmic ointment (eye ointment)
- Hepatitis B vaccine
- State newborn metabolic screening preferences
- Hearing screening
- Vitamin K injection
- Critical congenital heart disease screening
Candice Dye, M.D., associate professor and pediatrician in the Department of Pediatrics at UAB and Children’s of Alabama, says newborns are born with low levels of vitamin K, a necessary vitamin that helps the body clot blood thus preventing bleeding. Because of this, it has been universally recommended that all babies receive a vitamin K injection shortly after birth.
“Without the vitamin K shot at birth, babies are 81 times more likely to develop a vitamin K deficiency bleeding, and of those, one in five can die,” Dye said.
Additional comfort and labor support options
Money provides other laboring options that are offered for patients at UAB that may not be available at all hospitals.
- Wireless monitors
- Birthing balls
- Peanut balls
- Birthing bars
- Music therapy
Expert Labor Support Every Step of the Way
Money adds that in addition to these comfort measures, all UAB Labor & Delivery nurses receive specialized training in evidence-based techniques that promote optimal fetal positioning during labor. Each patient’s nurse will provide individualized guidance on movement and position changes based on the patient’s comfort, labor progress, and baby's position. This personalized coaching can help improve comfort, support labor progression, and facilitate the baby's optimal positioning for birth. Learn more about UAB’s Women & Infants Center and obstetrics and gynecology services.