Exit Strategy: What to Consider For Your High-Risk Birth Plan
Planning for the arrival of a new little human is exhilarating and nerve-wracking. If you are pregnant or supporting someone through pregnancy, you have probably heard of a “birth plan.” But what does this mean, especially for a high-risk birth? A birth plan is your roadmap to the big day. It outlines your hopes, preferences, and what matters most to you during your birth experience. It is an opportunity to think through your desires and communicate these preferences to your care team so they can support your goals. Let’s dive into some key considerations to make your birth plan personalized, flexible, and empowering—even when faced with high-risk circumstances.
Labor and delivery: Thinking through different aspects of labor and birth can help you identify preferences and prompt questions to discuss with your healthcare provider. Once you have drafted a plan, bring a copy to your next OB appointment and review it with your provider so you can make any adjustments needed to accommodate your medical needs and/or hospital policies.
When are you coming to the hospital?
If you are planning an induction, you may be given a date and time to come to the hospital and you will arrive before labor has started.
If you are planning to go into labor on your own, at what point should you head to the hospital? Working through early labor at home can be a really good option for people who want to spend less time in the hospital, want to support a natural labor process, or are planning for less pain medication. But this may not be a safe option for everyone. For example: if you have had a cesarean section in the past, are pregnant with a baby that needs close monitoring, or are just not comfortable with the idea of having contractions at home!
Induction of labor
If your healthcare provider recommends an induction, have a discussion with them about what that will entail. Asking questions about what induction methods are available, how you will be monitored, and how long you will be in the hospital can help you feel prepared.
Birth support
Who would you like to be present for your birth? A partner, mother, doula, or friend are all great options. Consider how many support people you would like to have and how many you are allowed to have at the hospital where you are delivering. Protect your peace when choosing your labor support team. Less may be more and don’t feel bad saying no- this is your birth!
Work with your support team to plan what types of labor support you would like to try. Options that can feel good are massage, hydrotherapy (shower or tub), counterpresser, breathing exercises, and supportive positions.
Think through the roles of your support team. You might want your partner to handle updates with family, a doula to guide you through contractions, or a specific friend to support postpartum care. A clear plan for each support person’s role takes away the guesswork and stress.
Atmosphere in the labor room.
Lighting: Would you like the lights dimmed to promote a peaceful ambiance? Flameless candles are a nice touch!
Music: From relaxing acoustic to pump up jams, music is an easy way to make your experience feel more personalized. You could make a birth playlist or assign a support person to DJ. Don’t forget to put a bluetooth speaker into your hospital bag!
Add personal touches: Maybe you have a playlist that feels empowering, a favorite essential oil scent, a picture of a loved one, or affirmations that remind you to breathe and focus. Share these with your doula or partner—they can bring them into the space to help you relax.
Labor interventions and preferences
Are there interventions that you know will be necessary for your birth or you know you would like to avoid? For example, you may know a pediatric team will be present for your birth and there will therefore be more people present at your delivery. Or, you may prefer to minimize the amount of vaginal exams you have throughout your labor.
Are there certain preferences you would like your care team to prioritize? For example, would you like to use a mirror while pushing? Would you like to minimize noise in your labor room? Writing these down can be a helpful way to communicate your priorities.
Pain management
What options are available to you for pain management at your hospital? Are you planning to have an epidural? Would you like to try nitrous oxide? Is it important to you to avoid pain medication if possible? Talk with your provider about what is available and recommended for you. For some high-risk conditions, you may be referred to meet with an anesthesiologist prenatally to discuss your options more in depth.
History
Is there any experience(s) you have had in the past that may impact your ability to feel safe in a hospital setting? Many people have past experiences that make the process of being in a hospital more difficult. Talking to your provider about this can help your care team build a trauma informed care plan with you.
C-section preferences
Some people need a planned c-section, while for others, it may be unexpected. If you need a c-section, who would you like to accompany you to the OR? Would you like music played during your surgery? Would you like to announce the name or sex of the baby? Even in the OR, these small things can make a big difference in your experience.
Postpartum: In the swirl of anticipation for labor, it’s easy to forget about the immediate postpartum period, yet these early moments with your newborn are precious and can benefit from thoughtful planning.
Skin-to-skin
Skin-to-skin immediately after birth has been shown to greatly support your baby’s transition into the world. Skin-to-skin is the standard of care in most hospitals, but making your preferences known is still important. Would you like the first hour of skin-to-skin to be uninterrupted if possible? If you are not able to do skin-to-skin, can your support person step in? If you need a c-section, is it possible for you or your support person to do skin-to-skin in the OR?
Cord clamping and cutting
Would you or your partner like to cut the umbilical cord? Delaying the clamping of the umbilical cord for at least a minute after birth has been shown to prevent anemia and potentially improve developmental outcomes for newborns. Most hospitals routinely practice delayed cord clamping but it is still worth requesting this if it is important to you.
Placenta and cord blood
If you are interested in cord blood collection or taking your placenta home, it is definitely important to include this in your birth plan and talk with your provider as the collection takes place immediately after delivery. Cord blood is blood left in the umbilical cord and placenta after the umbilical cord is clamped and cut. This blood contains stem cells that can be used to treat many diseases. Cord blood can be donated to public banks (free of cost) to be used for research and disease therapy or stored in private banks (with annual fees) for potential use by a family member.
Feeding
How are you planning to feed your baby? Would you like support with breastfeeding or do you have a special formula you would like to use? If supplementation is recommended for your baby, what would you like to use?
Newborn medications
Shortly after birth, it is standard for newborns to be given an injection of vitamin K in their thigh to prevent bleeding and an antibiotic ointment in their eyes to prevent eye infection. If you have questions about these medications, talk to your provider in advance.
Ongoing newborn care
Would you like to have your baby room in with you? Most hospitals can accommodate performing routine newborn care at your bedside without having to bring your baby to a nursery. Consider things like, would you like your baby to have a bath in the hospital or wait until you get home? Do you have a specific pediatrician picked out? If you are having a baby boy, are you planning on a circumcision while you are in the hospital?
Visitors
Ask about your hospital's visitor policy and consider who you would like (if anyone) to visit you in the hospital. Visits from your loved ones may be supportive and joyful but it’s also okay to tell your family and friends you will see them when you get home!
Emergency and NICU Plans
It’s tough to consider these, but knowing your preferences ahead of time can be comforting if the need arises. If your baby needs to be transferred to the NICU, would you like your partner to accompany the baby or stay with you? If you are separated from your baby, would you like to hand express or pump to support your milk supply until you are reunited?
Making a birth plan is about knowing your options and bringing a bit of yourself into the birth room. While a well thought out birth plan can help you feel prepared, It’s important to remember this plan is a guide and is not set in stone. It is impossible to predict how your labor will progress or what your delivery will be like. Leaving room for “plan B” or even “plan C” in your mind is important so that you are not set up for disappointment if your delivery does not go exactly as desired. The ultimate goal for any birth plan is a healthy happy mom and a healthy happy baby and you are an incredible birth warrior regardless of how your little one arrives! Sometimes, the most powerful thing we can do is embrace flexibility and trust the support team we have carefully chosen.