It is time to write up the birth plan! The birth plan is very important and takes ample thought and research, so don’t save it for the last minute. I learnt a lot during my antenatal classes and I also had to do some research on my own before finalizing my birth plan. Everyone has their own preferences and sometimes others may eagerly tell you “you MUST do _____” or “definitely do _____”, but remember, it is YOUR body, pregnancy, and delivery. You know yourself the best and you should make sure that you do your own research before letting others shift your perspective on what your birth should look like and how you feel about certain interventions. As always, speak to your doctor regarding any questions you may have, as well as your birth preferences. This is one of the reasons why it is so important to find a doctor that is on the same page as you, or, when he does not agree with you, is respectful of your decisions (as long as it is safe for you and the baby). My doctor has been incredibly supportive of all my decisions and it has made me feel encouraged and confident throughout the entire process.

It is also important to remember that the birth plan is there to let your healthcare team know your preferences and is not an iron clad contract. A lot of things can happen during birth and it may not pan out exactly the way you want it to. The birth plan will reflect how you feel towards certain interventions and what to do in case something changes. This is a helpful article about drafting your birth plan, here is another one.

Many hospitals will provide a birth plan template for you to fill out. My birth plan from Matilda was quite simple. It basically asked me what my main goals were, ways to achieve those goals, and biggest fears for the birth. My main goal is to have a healthy baby and my fear is to have a traumatic birth/birth that will negatively affect the baby. I would like to have a delivery that is as natural as possible with limited medical interventions, but I am open to them if they are needed.

Some of the things you should try to list out in your birth plan include:

• Vaginal or c-section birth
• Pain management: this can include epidural, gas, TENS machine, injection, breathing/meditating. Speak to your doctor about the options available in the hospital and also do your own research
• Atmosphere of delivery room: dimmed lights, music
• Who do you want with you in the delivery room
• Birth positions: upright, laying on your back, etc.
• Procedures for after the baby is born: delayed cord clamping, instant skin to skin
• Other procedures: newborn metabolic screening, hearing test, cord blood storage, circumcision (if you are having a boy)

Here is a quick explanation of some of my preferences below:

• No epidural unless absolutely necessary: epidurals are a very effective and popular method of pain relief. This article provides an excellent overview of the procedure and also some pros and cons, here is another one. While they are a great method of pain relief, epidurals can increase the risk of having a forceps or vacuum assisted delivery and you may have limited mobility and sensation in your lower body. My doctor had also said that epidurals prolonged labor and affected the coordination of contractions. Epidurals can be very useful if the pain is unbearable or if you are too exhausted (the epidural can provide you with some relief so that you can sleep/rest). Some may opt for an epidural right away but I would like to try delivering without the epidural, unless I am no longer able to push effectively or if the doctor feels it is needed. Contrary to popular belief, it is never too late to get an epidural (unless the baby’s head is crowning or the anesthesiologist is busy). My main pain management will be breathing techniques.
  • Do what works for you, if you are extremely nervous about the pain and the epidural will give you more confidence, go for it! But always make sure you know about the pros and cons before making that decision.
• No routine episiotomy: Tears are something that everyone is scared of. Episiotomies (incision in the perineum) used to be done routinely as it was thought to prevent natural tears and healed better than natural tears. However, current research reveals that women who do not have episiotomies may actually labor and recover better. In both my UK and American antenatal classes, it was said that they should NOT be done routinely and should only be done if deemed medically necessary. However, while talking to my friend who is a pediatrician, it seems that episiotomies are still done routinely in Hong Kong. According to this article, the incision could be more extensive than a natural tear and the episiotomy can be at risk of infection, cause pain during sex, and even result in fecal incontinence. Be sure to speak to your doctor to get his insight into episiotomies. I spoke to my doctor and he also said that it should never be done routinely and is seen as a surgical procedure that is only done if the baby needs to be delivered quickly or if it seems that the birth is likely to result in a severe natural tear.
• Delayed cord clamping: delayed cord clamping is when you delay the clamping of the umbilical cord after the baby is born. Traditionally the cord is clamped instantly, but there is now there is evidence that delayed cord clamping can be beneficial for babies by increasing their blood volume, red blood cells count, and iron levels. The article I linked to above also talks about some risks associated with this procedure, but none of them are statistically proven and the benefits are deemed to outweigh the supposed risks.
• Skin to skin: Babies are often whisked away after birth to be cleaned and weighed, but there is increasing evidence on the benefits of instant skin to skin contact between the newborn and mother. This article from UNICEF provides a great overview. In my birth plan, I have mentioned that I would like skin to skin right after my baby is born, whether I have a vaginal birth or c-section.

There is a lot to think about when creating your birth plan and I hope that this post is helpful for new mamas! Remember, the birth plan is there to outline all your preferences and will play an important role in creating a smooth delivery. Make sure you are informed regarding all the different types of procedures and interventions, so that you can vocalize your preferences and can stay calm, collected, and confident during your delivery!