Top stories this week

• 1.  Baby's Development in the First Trimester
• 2.  Second Trimester Infant Development
• 3.  Fast family recipes for a healthy year ahead
• 4.  Third Trimester Infant Development
• 5.  Should you do Pilates while Pregnant?

Writing a Birth Plan

Writing out your labor and delivery goals helps give you more control during your birth. Here’s how to get started.

by: Nancy Ripton

or all you type-A moms-to-be, creating a birth plan is a great way to organize your thoughts and help put you in charge of your delivery. "It can also make you aware of options you didn't know existed," says Mary Murry, director of Nurse Midwives at the Mayo Clinic. Your birth plan can be as simple or as detailed as you like. The goal is to open lines of communication with your doctor, doula or midwife and make sure you don't overlook anything that may be important to you during labor.

To help you out, Just the Facts, Baby has created an online birth plan you can fill out and edit throughout your pregnancy. All you need to do is signup and we'll save your birth plan so you can refer to it (or update it) whenever you like.

Before you get started, here are some key things to consider when creating a birth plan:

Avoiding induction & augmentation

Studies show having your labor induced increases your chance of having a C-section by at least 10 percent. Talk to your healthcare provider about her views on induction and augmentation (contraction stimulation). "Unless the baby or mother is in distress, there is no reason to have an induction until after 42 weeks of pregnancy," says Murry. If you do need an induction, it's important to have told your healthcare provider which method you prefer.

Most women opt for natural methods, such as breaking the water or nipple stimulation first. "Once you start using chemicals, your body's not in charge anymore," says Murry. Your contractions may come closer together, giving you less chance to regroup in between. "It's best to exhaust all natural options first."

Establishing your pre- and post-delivery environment

Would you like music played during labor? Do you want to change into your own comfy pajamas as soon as you deliver? Would dim lights help you relax? These seemingly small details can go a long way toward boosting your comfort level. A birth plan is also a great way to let your healthcare provider know whether you would like a mirror to see the actual birth, if you would like to touch the baby's head or if you want your husband to cut the cord.

Choosing pain relief options

Exploring your pain-relief options through a birth plan helps ensure you don't overlook any choices that may be available to you. For example, you may decide that you want an epidural, but not until you are five centimeters dilated. Another major consideration is mobility. If being able to move around throughout your labor is important to you, you can ask for a walking epidural. There are also other pain options available (such as Stadol, Nubain and Demerol), that you can ask your physician or midwife about.

If you opt for an unmedicated birth, it's crucial to have a support network to help you naturally deal with the pain. "You need to realize you don't know what to expect," says Murry. Even if you're convinced you want a natural labor, it's a good idea to have a back-up "pain plan" just in case.

Deciding on fetal monitoring

Continuous fetal monitoring isn't possible with certain births, such as home and water births. Even if you decide against monitoring, know that the safety of your baby always comes first and that you may need to change your plans at the last minute.

Avoiding an episiotomy

It can be easier to say "I'd rather not have an incision down there" when you have a written document detailing your episiotomy wishes in front of you. A birth plan also encourages conversation on how to minimize the chances of an episiotomy. For example, anything that warms up the muscles and prepares them to stretch can help. This may be mineral oil, warming packs, slower pushing or use of perneal massage. You should also think about positioning. "Side or lateral birthing positions are less likely to cause tears," says Murry.

Preparing for the possibility of a cesarean

No birth plan is complete without a back-up birth plan. About 30 percent of American births are via C-section, so even if you plan to go au natural, this procedure needs to be addressed. Decide whether you still want your coach present during the C-section. Do you want to view the birth via a mirror? Do you want to breast feed as soon as possible? Go through every scenario with your care provider. If your doctor is resistant to a birth plan, tell her how important going over these details is to you. If she's still not receptive, you may want to consider changing providers.

Nothing is carved in stone

The main thing to remember is that, regardless of how detailed your birth plan, no birth can be planned down to the exact detail. "You need to be as flexible as possible and open to different things," says Murry. "Use your plan to open discussions, but don't get too attached to doing everything exactly as you laid out, just in case."

Meet our expert:

Mary Murry is a member of the American College of Nurse-Midwives and the Certified Nurse-Midwives Service Directors Group, and has been a nurse-midwife practitioner for over 20 years. She is the director of the Advanced Practice OB/GYN Service and instructor of Obstetrics and Gynecology at the Mayo Clinic, Rochester, Minn. Murry is also the co-author of the Mayo Clinic Guide to a Healthy Pregnancy.