In early pregnancy, labor and birth may seem far off. But now's the time to create a birth plan that details your wishes for when your baby arrives.

What's a Birth Plan?

The term birth plan can be misleading because it's not an exact plan or a binding agreement. It’s a guideline and list of preferences about what you'd like to have happen during labor and delivery.

A birth plan can't map out exactly how your baby's birth will happen — labor involves many variables, so you can't predict exactly what will happen. A birth plan can, though, help you think about what's most important to you during your baby's birth. It can also improve your communication with the people who'll be helping during your delivery.

You don’t need a birth plan. You can have a positive birth experience without one. Some people just like to have everything in writing — as a reminder for themselves, their partner, and for their health care team.

How Do I Make a Birth Plan?

Before you make decisions about each of your birthing options, you'll want to talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.

You may find that your obstetrician, midwife, or the facility where they admit patients already has birth-plan forms that you can fill out. If so, use the form as a guideline for asking questions about how pregnant women in their care are routinely treated. If their responses are not what you're hoping for, you might want to look for a health care provider or facility that better matches your goals.

Do your best to be flexible — if you know one part of your birth plan won't be met, weigh that against your other wishes. If your options are limited because of medical needs, insurance, cost, or geography, focus on one or two areas that are most important to you. If your wishes don't always align with that of your doctor or midwife, ask why they usually do things a certain way and listen to the answers before you make up your mind. There may be important reasons why they choose some birth options over others.

Finally, find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high-risk because of your age, health, or problems during pregnancy (current or previous), your health care provider may advise against some of your birthing wishes. You'll want to discuss, and consider, this information when thinking about your options.

What Options Might I Put in My Birth Plan?

Atmosphere during labor and delivery. Many hospitals and birthing centers let women make some choices about the atmosphere in which they give birth. Do you want music and low lighting? How about the freedom to walk around during labor? If possible, would you like to eat or drink during labor? Find out if you can request things that may make you more comfortable.

Procedures during labor. Your birth plan can include preferences about fetal monitoring, extra birthing equipment you'd like in the room, and how often you have internal exams during labor. Sometimes labor may need to be induced or sped up for medical reasons. You can share your thoughts about the different options available to induce labor.

Pain management. This is important to most pregnant women and something you have a lot of control over. Be sure to discuss it with your health care provider. Ask about pain medicines and the different ways you can get them. Also ask about other forms of pain relief, including massage, relaxation, breathing, birth balls, and bathing. Know your options and make your wishes known to your health care provider. Also, some women change their minds about pain relief during labor, and that's perfectly OK.

Position during delivery. You can try a variety of positions during labor, including the familiar semi-recline with the feet in stirrups. Other choices include lying on your side, squatting, standing — or whatever else feels right at the time.

Episiotomies. When necessary, doctors do episiotomies (when the perineum — the area of skin between the vagina and the anus — is partially cut to ease the delivery). You may have one if you risk tearing or in the case of a medical emergency. But if there is an option, you can discuss your preference with your provider.

Assisted birth. If the baby becomes stuck in the birth canal, an assisted birth (i.e., using forceps or vacuum extraction) may be necessary.

Cesarean section (C-section). If you need to have a C-section, you'll have to consider a few things. Do you want your partner to be present, if possible? What about viewing the birth — do you want to see the baby coming out?

After the birth. Decisions to make about the time right after birth include:

• Would your partner like to cut the umbilical cord?
• Does your partner want to hold the baby when the baby emerges?
• Do you want immediate contact with the baby, or would you like the baby to be cleaned off first? Do you want to see the baby before your little one gets eye drops?
• How would you like to handle the delivery of the placenta? Would you like to keep the placenta?
• Will you be donating the cord blood to a blood bank or storing it in a private bank?
• Do you want to feed the baby right away?

Other things to think about include feeding preferences (breast milk? formula? both?) and whether you're OK with your newborn getting a pacifier. Depending on where you give birth, you might have different options for where the baby will sleep at night (newborn nursery? in your room at all times, or only when you're awake?). You also can discuss religious or cultural practices, such as circumcision if the baby is a boy.

What Else Should I Know?

When you've made your birth plan, schedule a time to go over it with your doctor or midwife. Find out where you agree or disagree and talk about it. During your pregnancy, review the birth plan with your partner periodically.

Try to keep the plan as simple as possible and put your wishes in order of importance. Focusing on your priorities will help ensure that the most important of your wishes are met.

Make copies of the plan: one for you, one for your chart, one for your doctor or midwife, and one for your birthing coach or partner. And bring extra copies in your labor bag, in case your doctor is not on call when your baby is born.

You can't control everything that happens during your baby's birth. But you do play a role in the decisions made about your body and your baby, and a birth plan can help you do that.