When you’re preparing to give birth after a loss, it’s important to understand your options and reflect on what type of labor and birth experience you’re hoping for. During pregnancy, talk with your prenatal care provider so you can begin outlining your wishes.

Pregnant woman reading on couch - Creating a Pregnancy After Loss Birth Plan: What You Need to Know

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Just like all loss parents are unique, all birth plans for babies born after loss are unique, too. There’s no prescribed format for a birth plan that works perfectly for all loss families. Still, there are some key elements that you should probably consider before it’s time for your baby’s birth[1]“Subsequent Birth Planning,” Still Birthday, September 15, 2011, https://stillbirthday.com/2011/09/subsequent-birth-planning/. When you’re creating a pregnancy after loss birth plan, here’s what you need to know.

What Is a Birth Plan?

A birth plan is a brief, written document that shares your wishes for your labor, your baby’s birth, and the immediate postpartum period[2]“Creating Your Birth Plan,” American Pregnancy Association, https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/birth-plan/. A plan is often a rigid outline, but birth is fluid and unpredictable. Therefore, it can be helpful for parents to use the term birth preferences, rather than birth plan. This phrase, birth preferences, more accurately reflects the nature of birth, allowing you to note elements you’d like to implement or exclude if things go as expected. You can also add some secondary preferences in the case of unexpected situations or complications[3]“Birth Plans,” reviewed by Elana Pearl Ben-Joseph, MD, June 2018, https://kidshealth.org/en/parents/birth-plans.html.

Why Is a Birth Plan Important?

It’s important to have a birth plan so your care team knows your preferences[4]“Make a Birth Plan,” March of Dimes, 2020, https://www.marchofdimes.org/materials/birth-plan.pdf. Birth plans are relevant for all settings, including hospitals, birth centers, and homes, and all types of births — whether you go unmedicated or have an epidural and whether your baby is born vaginally or surgically[5]“What to include in your birth plan,” LaQuita Martinez, MD, Medline Plus, June 2, 2020, https://medlineplus.gov/ency/patientinstructions/000567.htm. Especially when you’re giving birth after a loss, you’ll want to communicate your history and any special requests, including ones that will help reduce triggers or honor the baby you lost. In addition, writing down your birth preferences will most likely give you confidence in your informed choices, helping you feel empowered to say “yes” or “no” to certain things during the birth process[6]“Writing a Birth Plan,” Journal of Midwifery & Women’s Health, https://onlinelibrary.wiley.com/doi/pdf/10.1111/jmwh.12192.

What Should Be Included in a Pregnancy After Loss Birth Plan?

History

As a loss parent, you can’t assume that every member of your care team knows your medical history. Start your birth plan with a brief overview of your loss or losses. As you write, think about how your previous pregnancy or birth experiences have shaped your current preferences. For example, if your baby was born still, you might request that the new baby’s first cry be celebrated by everyone in the room. Or, maybe your first loss was a miscarriage, and the sight of vaginal bleeding has the potential to bring up emotional trauma. Even with a healthy baby in your arms, you could ask for reassuring words from the nurses, reminding you that postpartum bleeding is normal.

Environment

One of the things you should decide is who you want to be present for your birth — in addition to your provider and medical support staff. For example, are you hiring a doula and/or a birth photographer or videographer?

Also, consider your senses and your preferences for sights, sounds, and smells. Do you want music playing or do you prefer silence? Do you want the lights dimmed? Are you planning to use aromatherapy? Do you hope to have a tangible comfort object, like a pillow or blanket, with you?

Labor

When it comes to labor and contractions, you’ll want to note your preferences for pain management. If you’re opting for an unmedicated labor, you might consider breathing exercises, meditation, or hydrotherapy. You can also mention your wishes for pain medication or an epidural, and at what point during labor you want to introduce these interventions, remembering the fluidity of birth and that you might change your mind during labor.

Some birthing parents prefer minimal talking during labor and check-ins from the care team only when medically necessary. Others like frequent reassurance from the labor and delivery staff.

Pushing and Birth

In this section, note your preferences for positioning during the pushing phase. You might also have special wishes, such as asking if your partner can catch the baby and requesting that the baby be placed on your chest. Most immediate newborn checks can be done while the baby is skin-to-skin with the birthing parent as long as the baby is healthy and doesn’t need medical attention away from you.

If you’re having a scheduled C-section, you can tailor your preferences for a surgical birth. This might include inquiring about a clear drape, asking for frequent updates from the surgeon, getting immediate confirmation that the baby is healthy upon delivery, and requesting to see and hold your newborn as soon as possible.

Immediate Postpartum and Newborn Care

Some of the common birth plan elements for the immediate postpartum time include delayed cord clamping and cutting, who will cut the cord, and wishes for newborn procedures. For a surgical birth, you might request that your partner stay with and/or hold the baby while the doctor finishes the surgery and note your desire to hold the baby as soon as it’s safe.

Other common considerations during the postpartum period are whether the baby will exclusively room in with you or go to the nursery periodically, whether you will breastfeed or formula feed, and how much support and direction you might like from the care team when it comes to education.

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