When you’re planning a home birth, it’s easy to feel like you don’t need a birth plan. I think for a lot of moms, the point of a birth plan, really is to tell your caregivers about the ways you hope your birth will differ from the “normal” birth in that setting. In a hospital, where some nurses or obstetricians might assume you’ll want an epidural or an episiotomy, you need to make sure they know if you don’t. I hate to describe it this way, but I think a lot of families, especially those planning an intervention-free birth, write birth plans as a battle plan for what interventions they’re planning to fight against.
With a home birth, there’s no battle. The “procedures” you’re hoping for in your birth aren’t unusual for a home birth midwife–they’re normal for her. Her usual protocol is pretty much the protocol you want for your birth, so why would you need a birth plan?
My midwife, however, encouraged me to write a birth plan. I never did finish a written one for my first birth, but I did discuss details with her of things I was hoping for my birth. With a home birth, the plan isn’t so much about protocols and procedures as it is about atmosphere. It’s about creating the whole experience of birth. And although I think that wanting a certain type of experience shouldn’t be the main reason for choosing a home birth, there’s no doubt that it’s a nice side benefit. Assuming that everything in your birth goes well and that there are no complications, why shouldn’t you plan what kind of atmosphere you want for your baby’s entrance into the world? I spend weeks (sometimes months!) planning my daughter’s birthday party every year, choosing colors and themes and games and guests; why shouldn’t I put some thought into the theme and colors for my baby’s first birthday?
Protocols and Procedures
I said already, and I’ll reiterate: the main purpose of a home birth plan is not to establish the protocols and procedures you want your midwife to follow. And really, I think the best birth plans should never have to do this. The best way to set yourself up for the kind of birth you want, especially if you want to minimize interventions, is to choose a caregiver whose normal protocol is similar to the birth you want. If you don’t want an epidural, then don’t choose a caregiver who routinely uses epidurals. Sure, you can fight them and get the birth you want, but why set yourself up for a battle? Labor is enough work by itself–you deserve a caregiver who truly supports the kind of birth you want. That doesn’t have to mean a home birth; there are plenty of midwifery practices in the Atlanta area who are truly supportive of and comfortable with intervention-free birth. If you feel like you’ll need to fight an obstetrician to get the birth you want, then don’t use one unless your pregnancy is high risk and you really need the interventions. (In which case, your hopes for the experience of birth should take second place to interventions that might be necessary. But be sure to get a second opinion about whether you really fall into a high risk category, and make your own decisions about what birth location is truly the most risky for you and your baby.)
Nevertheless, there are some procedures that you should discuss with your midwife. All home birth midwives are not the same, and the procedures that your midwife is used to doing during labor might differ from stories you’ve heard. For example, most home birth midwives avoid internal exams (and some never do any), but you might want a few. Do you want an internal exam when you feel like you’re ready to push? Will you want any to check progress, or are you comfortable with your midwife assessing that in other ways?
How much guidance do you want your midwife to offer you during the birth? Some women prefer a hands-off approach, in which the midwife is a silent attendant who’s there just in case; others want the midwife to help direct pushing or suggest different positions. You may not have any idea what you’ll want until you’re in labor, but it’s definitely worth discussing with your midwife how you think you’ll feel. I also think it’s perfectly fair to tell her you expect her to read your mind and interpret your body language to figure out what you want in the moment! (Which might be an unfair expectation on my part, but my midwife did such a great job at that the first time around that now I figure that’s just what a midwife does!)
Would you want your midwife to do anything to speed up labor if you felt it was progressing too slowly? Home birth midwives will not use any drugs for this, of course, but some will strip or even break your membranes if you want them to. This can cause labor to get a lot more intense a lot more quickly, and it can increase the risk of infection as well, so do your research about this ahead of time so you can make an informed decision during labor. Some home birth midwives prefer not to do anything to augment labor, so you should know whether your midwife even considers this an option.
When do you want to cut the cord? After it stops pulsing, after the placenta is born, or not at all (if you’re planning a lotus birth)?
What do you want to do with the placenta?–dispose of it, plant it, encapsulate it, or eat it?
How do you want your midwife to support your perineum during crowning? Being in water can help prevent tearing, and many midwives like to use a warm cloth with water and herbs to support your perineum.
Will you want your midwife to perform perineal stitches if you tear, or do you want to heal naturally? If you do want stitches, talk to her about her experience with this and find out what severity of tearing she’s qualified to repair. What level of severity would cause you to want to go to the hospital for stitches?
Under what (non-emergency, of course!) circumstances would you want to transfer to the hospital? This is definitely a decision to reconsider during labor if necessary, but I think it’s important to discuss with your midwife ahead of time as well. If you start begging for pain relief in the middle of labor, do you want her to transfer you or encourage you to work through it? (Of course this depends on where you are in labor as well; if you’re pushing and everything is going well, it’s probably too late to transfer!) But you should find out how much your midwife is willing to encourage you in the middle of labor if you’re feeling discouraged and wanting to transfer, especially if you have a long early labor. Some midwives will believe you immediately when you say you want to transfer for pain relief, while others will work harder to encourage you to stay home and keep trying. Talk to your midwife about this so you won’t be disappointed in retrospect that she either didn’t respect your wishes in the midst of pain or that she didn’t encourage you to follow through with the natural birth you were planning for.
If you do have to transfer, you might want to have an emergency birth plan as well. Keep in mind that if you only plan to transfer in an emergency, then you do not want to be walking into the hospital and telling the staff what to do. However, you might want to have a written birth plan to give them regarding care for your newborn after it’s born, especially if the closest hospital to you has a lot of routine practices that can hinder breastfeeding. One important point to discuss with your midwife is what her role will be if you have to transfer. Some midwives are hesitant to accompany you to the hospital because of the legal status of midwifery in Georgia. Ask her if she’ll come and identify herself as your doula if she’s not comfortable telling hospital staff that she’s your midwife.
Do you plan to have any newborn procedures done like eye drops or vitamin K? Some midwives can offer these. If your midwife doesn’t and you want something, you’ll need to plan a postpartum visit to your pediatrician pretty soon after the baby is born.
Comfort and Atmosphere
Are you planning a water birth? If so, what temperature do you want the water, and how long do you want to stay in? Do you want your baby to be born in the water?
Do you want other natural methods of pain relief during labor like massage, acupuncture, aromatherapy or chiropractic adjustments? (Yes, there are chiropractors in Atlanta who will come to your house and adjust you during labor.) Can your midwife do any of these for you, or will you have someone who can do them come to your labor?
Do you want your midwife to offer pain relief methods like counter pressure during labor?
Are you using any specific methods like self-hypnosis, Birthing from Within, or Bradley birth? Is your midwife familiar with the method? How can she support your practice of this method during labor?
Which room do you plan to birth in? Of course this can change, but it’s a good thing to at least think about beforehand. Personally I’ve always thought it would be wonderful to birth outside, but I keep having winter babies.
What kind of lighting do you want during labor? Many women want dim lights or candles; I used scented vanilla candles with my daughter.
Do you want music playing? It’s nice to create a playlist if you like that sort of thing. You might want different types of music during different stages of labor. I had music chosen for the moment when my daughter was being born, but we ended up not playing it. My midwife asked if I wanted it, and I gave her a funny look, which she thought meant I didn’t want it. I actually was just in the nonverbal animal stage of labor and I wasn’t able to process her question. Next time, I think I’ll ask her to just start the music without asking.
Is there anything particular you want to happen during the immediate postpartum period? Skin-to-skin contact with your baby and breastfeeding are standard for home birth midwives, but you might want something special. Would you like for all the attendants to leave the room for a while (after the placenta is born, of course) so your family can spend a few minutes alone together enjoying the magic of birth? Would you like to take a bath with your baby? Do you have any cultural or family traditions for newborns that you’d like to do? Tell your midwife about it so she’ll remind you.
What outfit do you want to dress the baby in first? Or do you want to keep him naked and skin-to-skin for a few days (assuming he’s warm enough)? What diapers do you want to use (or not, if you’re brave and planning to EC!)?
Attendants and Roles
Who do you want to attend your birth, besides your midwife and her apprentice(s) if she has any? Besides your partner or spouse, do you plan to invite any other relatives or friends? Would you like a doula? (You probably don’t need a doula for a home birth, because a home birth midwife will provide you continuous support throughout labor, but you might want a doula if she’s an expert in something you’re using like self-hypnosis and your midwife isn’t experienced with it.
When during labor do you want your midwife to arrive? Most midwives have a usual procedure here; for example, she might usually come around the time that you’re transitioning into active labor. If you feel like you’ll want or need support during early labor, talk to her about your preferences (which may depend on whether any of her other clients are in labor at the same time!). When my daughter was born, my midwife’s apprentice came when I was still in early labor. She knew I still had a long time to go, but she asked if I wanted her to leave and come back or just stay. I asked her to stay, and she did–for about 30 hours. She called the midwife when I was transitioning.
Who, if anyone, do you want to take pictures? If you want a lot of pictures, you might want to have an attendant who’s there for that specific purpose. The midwives will be busy, and your partner might be too caught up in the wonder of the moment to think about it till the excitement is over.
If you have older children, do you want them to be present at the birth? Will someone come to take care of them (or take them away)? Again, it’s good to have a designated person whose only responsibility is taking care of older children, although it’s certainly possible to just let them hang out and watch.
Do you want to see or touch the baby as it crowns? If so, ask your midwife to remind you and to have a mirror ready.
Who do you want to catch the baby? I caught my daughter myself, and I highly recommend that if it appeals to you! If you or your partner want to be the one to catch the baby, tell your midwife so she can remind you to get into position when it’s time.
Who do you want to announce the baby’s sex? I did this when my daughter was born. Not sure I’m going to do that next time, since I thought at first she was a boy! Hey, I’d just been through 36 hours of labor. And I had water in my eyes. I saw something dangling (it was the cord). I wasn’t really looking that closely.
Who do you want to cut the cord, if you’re cutting it? (My husband did this for our daughter.)
How long do you want your midwife to stay after the birth? Is there anything specific you want her to do before she leaves? Most midwives have a protocol for this (for example, they’ll clean up the towels and the floor but not the water birth tub). Talk to her about what she normally does and let her know if you’d like anything different.
Anything else? Experienced home birthers, am I forgetting anything? What’s in your home birth plan?