What is a birth plan?

A birth plan is a way of communicating with the nurses, nurse midwives and doctors who care for you in labour. It tells them about the kind of labour you would like to have, what you want to happen and what you definitely want to avoid. It's not written in tablets of stone because the best birth plans acknowledge that things may not go according to plan. You need to write the plan in such a way that your doctor doesn't feel she has her hands tied. She may need to recommend a course of action which is not what you had originally hoped for, but which is in the best interests of your baby.

Before you start writing, get as much information as you can:

• Go to antenatal classes. You can take classes at the hospital where you plan to deliver or the nearest hospital, and there are also private classes available in major urban centres such as Penang and Kuala Lumpur.

• Talk to women who have given birth at the hospital you are going to. Find out how easy or difficult it was for them to get the kind of care they wanted.

• Talk to your husband or the person who will be your birth companion. What sort of labour and birth would they like you to have? How do they see their role?

Then jot your 'birth wishes' down on a piece of paper -- just as they come to mind. You can sort them out later.

What to include in your plan

First of all, discuss it with your doctor. Not all doctors are supportive of the idea, so it is best to check where yours stands on the issue before proceeding.

Here is a list of headings that you might want to use in your birth plan. You certainly don't have to use them all. Perhaps only a few are really important to you. Perhaps there are others which you can think of which aren't included here.

Birth companion/husband

Write down who you want to be with you in labour. Do you want this person to stay with you all the time, or are there certain procedures or stages in labour when you'd prefer him or her to leave the room?

Positions for labour and birth

Mention which positions you would like to use during labour. Also say how active you would like to be: would you like to remain upright and mobile for as long as possible, for example, or would you prefer to be in bed.

Pain relief

Say what kinds of pain relief you want to use, if any, and in what order (for example, you might prefer to try pethidine before an epidural).

Monitoring your baby's heart rate

Electronic monitoring requires that a belt be strapped around your waist, so you will not be able to move or walk around. If you prefer to be mobile, let your doctor know during one of your antenatal appointments - perhaps you can specify in the plan that you would prefer not to be continuously monitored unless it is absolutely necessary.

Delivery position

Say whether you want to give birth lying on the bed, or kneeling, standing or squatting. However, it is best to check with your doctor first as some doctors are used to delivering babies with their mothers in a certain position, and they prefer to stick to that!

Feeding the baby

Be clear about whether you want to breastfeed or bottlefeed. If you want to breastfeed exclusively, state in big, bold letters "No bottles" or "No formula". Sometimes, the paediatrician will insist on formula due to a baby's condition. You may wish to state that you would like to be informed about it. Also make a note of when you would like to start breastfeeding - right away, after you're settled back in your room, etc.

Cutting the cord

Will your husband do this, or the doctor? Again, discuss this with your doctor before putting it down in your birth plan.

What happens next

Say if you would like to hold your baby first before the nurse midwife or attending physician takes her away to be checked.

Unexpected situations

Some women write down what they want to happen if their baby has to go the special care baby unit (SCBU). They might want to be allowed to care for him as much as possible themselves, and to be transferred with him to another hospital if a transfer is necessary. They might ask for their husband to be allowed to stay with them at the hospital (most private hospitals allow this if and when facilities are available).

Special needs

You may have very special needs that you want to mention in your birth plan. If you have a disability, write about the kind of help you will need in labour. Say whether there is any special equipment that would assist you.

If you have particular religious needs, make sure that you include these. It might be important for you to have certain rituals carried out when your baby is born. Or you might require a special diet during your hospital stay. Write all of these things down. Hospitals and health professionals are committed nowadays to being culturally sensitive and treating people as individuals.