how to write a birth plan for a home birth

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!)

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