4 tips for creating a family-centered birth plan

Increasingly, patients want to include their families in their birth experience. This can come in many shapes, from having older children attend the delivery to including their partner or support person in pain management support. 

The backbone of a successful family-centered birth is to create a comprehensive birth plan with your provider.

It should cover your expectations, preferences, and goals from labor through delivery, as well as contingencies for emergencies situations, such as an unplanned cesarean section (C-section) or maternal health complications.

As a certified nurse midwife (CNM) at UT Southwestern’s William P. Clements University Hospital, I encourage all my patients – even those who are having planned C-sections – to create birth plans around the 36th week of pregnancy, when we can begin to envision how the delivery might play out.

Let's discuss the top four planning points we recommend for patients who want to have a family birth experience.

1. Who will be your support person, and how will they be involved?

Whether your support person is your partner, your best friend, or a doula, make sure they know what you want and might need from them on delivery day.

During labor, for example, you might want them to walk the halls with you, play music or a movie, or help with pain management through massage. During delivery, you might want them actively involved in the delivery or more focused on coaching you. Make sure they're clear on what you want and they’re up to the tasks you have assigned them.

Related reading: Should I have visitors in the hospital while my baby is being born?

2. How much do you want your other children to engage?

Some families will bring in their children to visit with the mother during early labor and have them leave when active labor begins.

Others want the kids in the room the whole time, unless an emergency arises or a child becomes uneasy. Another option is to have them visit right after the baby's first assessments are done, during their new sibling's first hour of life.  

When planning your family-centered birth, consider your children's ages and tolerance levels. You can't expect a 2-year-old to sit patiently for eight hours or more while you deliver. And even the toughest teen might become anxious at the sight of their mother bleeding or in pain.

I've worked with families who have had kids in the room during delivery, and the children encouraged the mother through the pain. I've also seen families where one of the kids got a stomachache in the middle of labor and her grandmother had to take her to the waiting room.

If you want your children present for part or all of the birth, plan for an adult who is not your support person to be present. Their job will be to care for the kids in the delivery room and escort them out if necessary. The last thing we want during labor is you or your support person worrying about or caring for someone else.

3. What will you do in case of an emergency?

If any emergency arises, we might need to ask everyone to leave the room. Whomever you have attend your child's birth, this has to be understood as non-negotiable for your safety and that of your baby.

Three such emergencies we ask all patients to prepare for include:

• Unplanned C-section: Children will not be allowed in the operating room, so having an extra adult nearby is vital in this situation. We've had births where the patient had to go into the OR without her support person because they didn't plan for another person to attend to their older child.
• Postpartum hemorrhage: This can be visually scary for nonmedical people, especially a child. If we have to do an emergency procedure to stop the bleeding, children or bystanders should not be in the midst of the situation.
• Newborn health concerns: Not all babies enter the world kicking and crying. Approximately 10% need some resuscitation to start breathing on their own. It can be alarming if the baby is discolored or requires acute rehabilitation. In those cases, we need everyone out of the room, stat.

Related reading: Total body cooling: Saving babies' lives after emergency delivery

4. What are your pain relief goals and preferences?

Some women think it's all or nothing with pain relief. But that's not the case.

There are plenty of options to help manage pain, including:

• Aromatherapy: Applying certain amounts of scents such as lavender has been scientifically proven to relieve delivery pain.
• IV medications: These can take the edge off, and you can control up to a safe dosage with a click of a button.
• Massage: Your support person can massage your back or shoulders to relieve tension.
• Music: A sensory approach to help you focus on something besides the pain.
• Water therapy: Clements University Hospital offers showers with handheld showerheads that can help soothe labor pain in the back and abdomen.

Some women feel like they're "wimping out" by choosing an epidural. We disagree. Using any form of pain management doesn't make you less of a trouper, and it doesn't make your experience less monumental than a medication-free delivery.

What pain management techniques worked best during your delivery? Tell us on Facebook using hashtag #YourPregnancyMatters.