How to Write a Birth Wish (or Birth Plan)

A birth wish helps you determine what is most important to you for the birth of your baby. Unlike the commonly used term, "Birth Plan," it isn't meant for you and your partner to decide how exactly the birth of your child will happen  as this is a process that is different for everyone and varies based on your bodies needs. Rather, it is a space for you to think about, explore and understand your options before the birth of your child. It also encourages communication between you and the staff who will be there helping you guide your baby out. 

Below is an layout of how you might want to shape your birth wishes. It has been adapted from DONA International's Doula training guide.

Part I: Introduction

Personal Information (two to three sentence): What would you like the staff to know about you? For example, you might describe strongly held beliefs or preferences, relevant previous experiences with hospitals or health care, fears, concerns, or other information that would help the staff get to know you and treat you as a special individual.

Message to Staff. Would you like to express your appreciation for any support, expertise, and assistance the staff can provide to help you have a safe and satisfying birth?

Names of those on mother’s support team who will attend the birth

Part II: Labor Options
You can consider the following options for labor. To keep the plan brief, try to condense your wishes to general statements and use bullet points.

Activity in labor. Do you want the freedom to walk, change positions, take a bath or shower, or move about in labor to promote comfort or progress? Or will you be content to remain in bed?

Food and drink. Do you prefer to eat and drink at will, at least in early labor, or are you comfortable having intravenous fluids and sucking ice chips?

Fetal heart-rate monitoring. How do you feel about continuous fetal monitoring (internal or external), intermittent monitoring, or, instead, having your nurse or midwife listen with a hand-held ultrasound stethoscope? If you must have continuous monitoring, would you prefer wireless telemetry to having your monitor belts connected by wires to the monitor?

Pain Medications. Do you prefer to use them? Do you want them as soon as you go into labor, or will you try and delay them until mid-to-late labor? Do you want to avoid pain medications entirely, if possible? How important is this to you?

Part III: Birth Options

You can consider the following for birth.

Positions for second (birthing) stage. Do you want the freedom to move and use a variety of positions?

Pushing techniques. Would you prefer spontaneous, non-directed bearing down with your reflexive urge to push, or the prolonged breath holding and straining of directed pushing?

Perineal care. Would you like warm compresses on your perineum and other measures to prevent an episiotomy? How strongly do you feel about this? Would you rather risk a tear than having an episiotomy?

Part IV: After-Birth options

You can consider the following options for postpartum care.

Immediate care of the baby. Do you want the baby placed skin to skin with her immediately after birth? Do you have preferences regarding newborn routines (eye care, vitamin k, newborn exam, etc)?

Contact with baby. Do you want to have the baby with you continuously or have her/him spend time in the nursery?

Partner presence. Would you like your partner, family member, etc to stay in the hospital with you? Can you use a cot or a foldout chair and sleep in the room overnight?

Feeding. Will the baby be breastfed or formula-fed? If you will breastfeed, how do you feel about the baby being given any water, sugar water or formula? Do you want to feed the baby on cure? If the baby is to be formula-fed, do the two of you want to do all the feeding yourselves or do you want to have the nurses do some of it?

Circumcision. If the baby is a boy, will he be circumcised or not?

Part V: The Unexpected

You should think through some of the possibility of difficulties such as:

Difficult labor. Is the birth plan flexible enough to apply even if complications or difficulties arise during labor? (Use phrases like, ‘ as long as labor proceeds normally’ or ‘unless medically indicated’). If difficulties do arise, do you still want to be consulted before procedures are performed, or would you prefer to leave all decisions to the staff? And if labor is very long, who else can help, such as a relative or doula, so that the partner can eat, sleep or just take a break?

Transfer. If you have planned an out of hospital birth but develop complications and have to be transferred to a hospital, who do you want to remain with you? Do you want to keep whatever options from your birth plan that are still possible? Do you want to be kept informed of the caregivers concerns, recommendations, and reasons for them, so that you can make informed decisions?

Cesarean birth. If you must have a c-section, whom do you want present? Would you prefer to be awake and alert or sedated during and after surgery? Would you like to see and touch the baby as soon as possible after the baby’s birth? After the birth, if the baby needs a higher level of care available in the nursery, would you like your support team to go with the baby or stay with you? What about postoperative sedation? Would you prefer to receive sleep or sedative medications afterward or to accept some trembling and nausea in order to remain awake and to hold and nurse the baby?

Premature or sick infant. Would you and/or your partner like to be involved as much as possible in the care and feeding of the baby, even if the baby is in a special care nursery? Do you want explanations of the baby’s problems, the procedures to be done and the decisions to be made? Do you want to accompany the baby to a different hospital if the baby has to be transferred? If the baby cannot nurse, do you want to express your colostrum (the ‘pre-milk) and your milk to feed the baby by bottle or tube or to store until the baby can take it?

Stillbirth or death of the baby. Such a tragedy, as rare as it is, leaves parents stunned with grief that is almost impossible for them to make important decisions. Discuss the possibility together, and think about how you want the situation to be handled. Consider some of the following:

An opportunity to hold and say goodbye to the baby in private
A chance to dress the baby
Mementos (pictures, lock of hair, footprint, etc)
Help from a counselor or clergy
An opportunity to discuss the birth and the baby’s problems with the doctors, midwives, doula, etc
An autopsy to determine the cause of death
A memorial service or funeral
Ongoing support from a group or counselor

Part VI: Personal Choices

Are there other choices that will help make this the best birth experience for you? Consider the following: