Pregnancy is filled with many surprises and unknowns, with labor and delivery being one of the biggest. Every delivery is different, and many women feel comforted knowing that they have carefully prepared a plan of action to cope with this climactic event. Preparing a birth plan not only gives your doctor and nurses specific instructions as to how you and your delivery are to be handled, but gives you the opportunity to educate yourself on all the aspects of labor, delivery and postpartum. The most important element of a birth plan is flexibility — labor and delivery is the most unpredictable part of a pregnancy. The smallest complication can make even the most carefully composed birth plan obsolete.

When composing a birth plan, remember to keep it short and sweet. Busy doctors, midwives and nurses will most likely not have the time to read through the novel you've penned and called a birth plan. One page is preferable, although two pages is still within acceptable length. Remember that there are many variables during labor and delivery and keep these in mind when composing it — you must be able to take the expert advice of your doctor or midwife during labor, even if it's "not in the birth plan." Really, the ultimate goal here is a healthy baby and a safe delivery — not fulfilling the meticulously scripted delivery you've dreamed about the last nine months!

A birth plan should cover three main areas: labor and delivery, postpartum and complications. To keep it simple, prioritize the things that are most important to you, such as medications, instructions on cutting the cord, etc. The following are decisions you should make for each aspect of the delivery.

Labor & Delivery:

• Who is allowed in the delivery room during labor?
• Would you prefer to remain confined in bed, or do you want to be able to move freely?
• Do you have any laboring positions you'd like to utilize?
• Fetal monitoring: Would you prefer external or internal fetal monitoring?
• How will you cope with labor pain? Specify if you'd like to use medication, or stay drug-free. If you want medication, specify if you'd prefer an epidural, or IV medications. For a natural birth, specify if you'll be using massage, breathing techniques, meditation, a birthing ball, or Jacuzzi/shower.
• Do you want a routine IV put in?
• During delivery do you want an episiotomy?
• What position would you like to deliver in? Many women eschew the traditional semi-reclining, feet-in-stirrups position and opt for sitting, lying on the side or squatting for delivery.

Postpartum

• Immediately after delivery, who will cut the baby's umbilical cord?
• Do you want the baby put on your stomach or chest immediately after delivery? Should he be cleaned first? Wrapped in a blanket, or put on your bare skin?
• Do you have any plans for the placenta/cord blood?
• Do you want the baby to sleep with you in your room?
• Do you want the baby to be given a pacifier or bottle, or to exclusively breastfeed?

Complications

• Do you want a routine IV in place in case there are complications?
• Do you want to be induced if labor stalls out?
• In a difficult delivery, do you want the doctor to use forceps or a vacuum to assist in getting the baby out?

It is important to remain positive and flexible in your birth plan. Using phrases such as "we hope," and "we would like" communicate to your doctor that while you have a preference, you are willing to make changes should complications arise. Your birth plan will differ, depending on where you plan to give birth. A hospital birth plan will read very differently from a home or birthing center birth plan. Just be sure to include instructions on how to be transported to a hospital if you are giving birth at home or a birthing center and complications arise.