Top Ten Tips for Creating a Birth Plan

By: Elizabeth Stein birth plan

1. Remember, your baby is going to come when the baby wants to come.
Your baby is in charge. Your baby does not read the due date on the prenatal chart or your sonogram report. Your due date is used to manage the pregnancy to schedule prenatal appointments, schedule tests, sonograms and an induction if necessary.

2. Know exactly who will deliver you.
Does your midwife or physician belong to a group? If that person is not on call the day you go into labor, who will actually deliver you? Clarify this so you are not disappointed.

3. Rest up. Labour is like running a marathon.
Save your energy spurt for when you are in labor. When you get that energy spurt that predates labor, save it inside of you. Don’t waste your energy cleaning the kitchen or bathroom.

4. Stay home as long as possible unless told by your midwife or physician to go the hospital.
It is more comfortable to labour at home in familiar surroundings than the hospital. If you have no risk factors you may labour at home. Early labour can last many hours so don’t become exhausted. Eat, drink, walk, rock and take a shower.

5. Know when you should go to the hospital.
You should go to the hospital immediately if your water breaks or you are group B strep positive or have a medical or obstetrical reason and were told to go straight to the hospital. Talk to your midwife or physician to find out exactly when they want you to call them or go directly to the hospital.

6. Eat and drink continuously at home.
Know the hospital rules and follow them regarding eating and drinking in labour. Most hospitals don’t allow eating solid foods in labour, but many will allow clear liquids. Other hospitals may only allow IV’s and ice chips. Plan on respecting these rules. This emphasizes the importance of eating and drinking at home prior to admission. Even if you vomit during labour (common in labour) some of the food will have been absorbed into your body.

7. How will you labour?
Walking, on a birthing bed, sitting in a chair, rocking on a big ball, in the shower? A combination of all of them?

8. Be open-minded about measures that promote a vaginal delivery.
AROM (artificial rupture of membranes), pitocin and epidural. Some women say “I want natural”. I define natural as vaginal and
cesarean as surgical. Do everything you can to have that vaginal delivery.

9. Know when to bail out and have a cesarean delivery.
There are no gold stars for torture. Cesarean delivery is not a failure, just another route of delivery. You just don’t want to have a cesarean that isn’t indicated (decided on too early). Discuss with your midwife or physician how and when they decide to
perform a cesarean in labour. In other words, how do they manage labour? Realize that some conditions are delivered by cesareans: breech, multiples (usually), placenta previa. Understand how prolonged dilatation and descent (taking a long time for your cervix to open and your baby to descend) is managed.

10. If you are planning to deliver in a birth center or at home, know the protocols for transfer.
What are the reasons for transfer to the hospital, who decides-midwife or patient? Who has the final say if there is a disagreement about the need to transfer? How will you get to the hospital? What hospital will you be transferred to? Does the midwife have privileges there? Will a physician take over your care? Did you meet him/her during your pregnancy or is the physician a stranger? Will your midwife stay with you?

Your baby’s first cry is the sound of success. Your new title is MOM. Enjoy your baby and let your birth story become history.

Elizabeth Stein, CNM, MSN, MPH practices obstetrics and gynecology at Ask Your Midwife in New York City. To learn more about Elizabeth Stein and Ask Your Midwife, please visit





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