Planning for natural birth? A birth plan is an effective tool when wielded wisely - how can it be used to support natural labor and delivery preferences? Follow along as we review birth planning basics, special considerations for natural birth, and how to put your natural birth plan into action.
Birth planning is more than a document - it means supporting your pregnancy health, communicating your preferences for care, and navigating a complex system of health care in the United States. Planning for a natural birth comes with some unique considerations that we cover here and in our downloadable birth planning template.
Birth Planning 101
Natural Birth Planning
- Defining natural childbirth
- What does natural birth mean to me?
- Why plan for natural birth?
- How can I support my natural birth goals?
Labor & Delivery at the Hospital
- Expectations & Emotions
- Common Interventions & Alternatives
- Labor Induction - Augmentation - Fetal Monitoring - Pain Relief
Birth Plans in Action
Takeaways on Natural Birth Planning
Birth Planning 101
A birth plan can be an incredibly helpful tool for communicating with your care team and shaping your experience during labor and birth. A quality birth plan can be especially useful while navigating a hospital birth, during which the staff supporting you may not be familiar with your health history or personal preferences and goals. In the United States, over 95% of pregnant people give birth in hospitals, and birth plans have become increasingly popular ways of referencing and discussing your options for an informed and empowered labor and birth experience.
Whether you are planning for a natural childbirth or otherwise, an effective birth plan can support your goals, as long as it includes some key elements and is easy to read and use! Check out our complete overview of birth planning and download our template to get started writing your plan - and read on for more information about natural birth planning.
Natural Birth Planning
In the process of learning about your options and planning with your support team, you may find that the language of “natural” birth and health varies between people and even providers. No matter where you are in your family’s reproductive journey, there are some questions worth asking as you consider what kind of experience you want to have, from conception and pregnancy to labor, childbirth, and early parenting.
Defining natural childbirth
Without making judgments, it is safe to say that “natural birth” does not mean the same thing to everyone. Traditionally, “natural” in this context has meant “childbirth without medication”. For many, that means excluding all medications, from drugs to induce labor to pharmaceutical pain management. For others, “natural birth” might mean having a vaginal delivery with minimal interventions, or the use of some medicines but not others.
The standard definition is rooted in the idea that human reproduction is a natural or even cultural event, and not a medical one. This concept is a valuable reminder that humans (and our mammalian predecessors) have successfully birthed many generations without modernized medicine. At the same time, sometimes even very low-risk pregnant people have health complications that indicate the need for medical care, which itself can vary in intensity and types of treatment.
Understanding that the details may look a little different between individuals, the most common elements of a natural birth include:
- Minimizing the use of medications
- Minimizing the use of interventions
- Prioritizing spontaneous (i.e. they happen on their own) biological or physiological processes
What does natural birth mean to me?
What does “natural” mean in your own experience? How might your definition shape labor and delivery? Get clear on what you consider to be “natural”, why it feels valuable and important to you, and what your experience would, ideally, include in order to meet that goal. What does “natural” mean to you in the following instances?
- When or how labor starts
- How labor is supported, measured or monitored
- The kind of care you receive in labor
- How you navigate intense sensations and pain
- How your baby is born
Why plan for natural birth?
Deciding to plan for a natural birth is a wonderful goal - but how does one plan for it? Doesn’t pregnancy just happen, without medical assistance in most instances? Why would childbirth be any different?
In reality, having choices in labor and birth is a relatively new phenomenon. For thousands of years, “natural birth” was the norm, with most people birthing at home under the care of family members, community healers, or traditional midwives. Most of these people did well, which is impressive considering that not even doctors understood the value and safety of washing their hands until the mid-1800s. Since then, a wide array of options have been made available by modern medicine, each with their own unique history of invention, use and application in health.
Today in the United States, many interventions have become standardized - meaning they are offered to all people as a matter of protocol. For things like basic hygiene, this is a great improvement! In some situations, modern surgery or tools can be life-saving. In other instances, however, one option does not fit - or benefit - all. In this way, the high level of medical intervention in the United States can present obstacles to people who would prefer a low-intervention experience, which is why it is helpful to plan for something “natural”.
How can I support my natural birth goals?
Different provider backgrounds can influence your care and experience. An obstetrician's job includes serving high-risk clients with complex complications and performing surgery, and so their training and experience includes a lot of focus on these critical skills. A midwife specializes in low-risk care for people with relatively uncomplicated pregnancies, so they see a lot more natural labor and birth and may have specific skills for supporting unmedicated labor.
- Finding a provider who is supportive of your goals and even enthusiastic about natural birth is the first step to supporting your goal for a natural childbirth.
Once you’ve chosen a provider, you may have options about where you receive care and have your baby. The more we understand about systemic challenges and even hospital design, the more we understand that the setting of birth can determine health outcomes. What kind of setting helps you to feel the most safe, secure and supported? Where do you feel most confident, and what kind of options does your provider offer to support a natural birth goal?
- Choosing a birth location where you feel safe and supported is an important step towards a natural birth - a calm, comfortable environment aids the biology of birth, and can make it easier to communicate your needs and desires if you do require medical assistance.
Wherever you choose to have your baby, your care team and loved ones will best be able to support your natural birth goals if you communicate clearly. This may mean having a structured planning session - or two - with your support team, be it partner, doula or friend - and taking your questions to your primary health care provider.
- Reviewing your plan with your team and asking questions will help you to identify any potential challenges, secure alternative options, and provide your team with specific details about the ways they can support your goals.
Once your support team is on board, the actual planning process may take some time - learning and discussing your options may require some patience or returning to your plan more than once - and that’s okay! In the meantime, continue to care for yourself and your pregnancy with your natural birth goal in mind, choosing the foods, activities, and companions that uplift your confidence, comfort and health.
- Deep nourishment, gentle movement, plenty of rest, and minimizing stress are all supportive of your strength, energy, and the hormonal dynamics that shape natural birthing health.
Finally, consider getting additional support! International research has shown that support from a doula is one of the most effective ways to minimize unnecessary interventions and increase parental satisfaction. Doulas can even improve birth outcomes and long term success in areas like breastfeeding and postpartum mood.
- Extend your support team with a doula! Click here to learn more about doulas, the process of hiring one, and how Starling’s curriculum and expert team of birth pros can compliment on-site labor support from a doula.
Labor & Delivery at the Hospital
If you are having your baby in the United States, there is a high chance you are having your baby in a hospital setting. The steps above include getting out-of-hospital support so that you can more confidently navigate some of the broader systemic challenges of modern healthcare. Whether or not your support includes a birth doula, or working with a Starling group, below are some helpful specifics about navigating hospital spaces with the intention of having a natural birth experience.
Expectations & Emotions
When it comes to satisfaction and even mental health, expectations can shape our experience for better or worse. Experiences that closely align with our expectations tend to be easier to process and accept. For example, you may walk into a busy clinic expecting a long wait, some paperwork, and perhaps a short visit for a screening. With these expectations, some extra forms to fill out wouldn’t be particularly surprising or troublesome. On the other hand, if you walked in expecting a quiet, efficient waiting time and a 45-minute appointment with your favorite staff person, you might be reasonably disappointed when that did not occur.
Hospitals exist to provide care, but they are also subject to the pressures that come with running a business, managing a large number of employees, and providing complex care to a huge diversity of patients with different needs, concerns and risks. Labor itself can be a long process, and the sensation, sequence, timing or challenges that come up can be hard to predict. Being aware of systemic limitations and biological uncertainties ahead of time can inform a realistic expectation, so that you and your team can focus on the things you can do to support your specific goals.
Get clear on your expectations and what is most important in your own desire for a natural birth with questions like these:
- What are my expectations for the style and amount of care I will receive?
- How would I like communication about my care to feel? Am I expecting lots of privacy and time to get additional opinions?
- Will any of these plans require additional planning or advocacy at the time of labor? How do I expect to proceed if I have a concern or question?
- What do I expect of the space I labor in? Is there anything I should plan to do to create my ideal environment there?
- How might I feel if labor doesn’t go as I imagine? What are my preferred backup options or alternative plans if I need to adjust my expectations?
- How would I like to feel in collaborating with my support team and staff? How can I create those feelings regardless of unexpected changes or systemic limitations?
Common Interventions & Alternatives
Many common interventions in obstetrics have become standard protocols, but in many cases they are optional. For someone desiring a natural birth, it is important to understand that every intervention comes with its own set of potential benefits and risks. The more interventions performed, the higher the chance that additional interventions will be needed. Sometimes these are very helpful or at least harmless, other times, introducing new drugs or procedures can cause additional problems that require medical care. A little learning ahead of time about the most common protocols can help you to discern what makes the most sense and feels best for you, your body, and your baby.
- What is it? Using medications or procedures to initiate the cervical changes and uterine contractions of labor before they occur on their own.
- How might it affect a natural birth plan? Most medical induction techniques require other interventions (such as additional fetal monitoring), and induction itself may not fall into your definition of natural. Depending on the methods used, the body’s natural labor pattern may “take over” after the initial effect of the induction, but the process often leads to additional interventions to maintain labor progress or treat the side-effects of the induction process.
- What are the alternatives? When induction is presented as an option, a patient has the right to decline, postpone, or wait and see before deciding. Some people have success using minimal induction methods and then declining or having no need for other interventions. There are also some natural and non-medical methods of encouraging the body’s natural readiness for labor. Overall, avoiding or minimizing elective (i.e. not medically indicated) induction procedures is more supportive of a natural birth plan.
- What is it? Using medications or procedures to increase the frequency and strength of uterine contractions. Augmentation is often paired with induction, and may also be used if a labor pattern slows or stalls, which can also be a normal part of physiology.
- How might it affect a natural birth plan? Augmentation methods often include medications and procedures that are not generally considered natural, and may lead to other interventions. Some methods, such as nipple stimulation, might utilize the body’s natural response system. Ask your provider about the ways they might augment labor and how those methods align with your natural birth goal. It is also worth noting that labor is not a linear process with one universal speed or duration - consider the reasoning for augmenting labor and if it represents an actual medical need or an approach to influencing labor’s timing.
- What are the alternatives? There are many ways to support labor progress, including movement, position changes, eating, resting, and some specific maneuvers practiced by nurses, midwives, doctors and even doulas. Learning more about what to expect in labor, and working with your support team closely, can help everyone to align with a natural labor experience and decide appropriate uses, if any, of medical augmentation.
- What is it? Regular or continuous tracking to check on your baby’s heart rate during labor; monitoring devices may also be placed to measure the timing of contractions. Fetal monitoring may be done with a handheld device (like a fetoscope or Doppler) by a provider, or the monitor can be strapped to the laboring person’s abdomen, where it picks up data that can be viewed remotely by computer. While intermittent fetal heart rate monitoring is important to track baby’s response to labor, the evidence on continuous monitoring shows that it does not improve outcomes and may lead to unnecessary interventions.
- How might it affect a natural birth plan? While being monitored, a laboring person may be strapped to various devices and machines, and have limited mobility and discomfort. Monitoring may include regular interruptions to adjust the monitor when you or your baby move. Since the data collected serves as a liability protection for the hospital, some people experience care that prioritizes the data over their comfort or preferences. Intermittent monitoring may allow more freedom to move and comfort, which is more supportive of a natural birth plan.
- What are the alternatives? Certain medications come with risks that necessitate continuous fetal monitoring. Otherwise, intermittent monitoring is usually available, which involves a manual check on the baby's heart rate at frequent intervals, or about 20-40 minutes of remote monitoring with a longer break in between checks. You can also request a mobile or wireless monitor that allows for more freedom of movement and position changes.
- What is it? Pharmaceutical products, including opioids and epidural anesthesia, are often used to alter the way pain is perceived in the brain, or temporarily numb sensation in an area of the body. Every pain medication has its own effects, dosage and risks for the pregnant person and baby.
- How might it affect a natural birth plan? Pain is a very subjective experience. Both the intensity of labor sensations as well as responsiveness to drugs will vary from person to person. Most pain management medicine affects some aspect of natural birth, whether it is the body’s own hormonal responses, a laboring person’s capacity and ability to move freely, or the psychological experience of labor.
- What are the alternatives? Pain management may or may not feel necessary, and there are many ways to navigate the intense sensations of labor contractions. Massage, hugs, focused breathing, hot showers, and even guided meditations can all influence the perception and sensations of labor. Even informative conversations can help, as fear and stress tend to increase tension in the body and result in more pain. Whichever support measures help you to feel safe and mentally relaxed are probably good activities to try.
Birth Plans in Action
As you develop the specifics of your birth plan using our overview and template, there are some things to keep in mind about how you will actually use this plan. Especially if your natural birth planning goals include alternatives to the standard of care at your birthing facility, it will be important to utilize your birth plan as a resource for effective communication, and not as a document that replaces collaborative discussions about your care. You are always the decider - here are some tips about using your plan to make decisions effectively.
- Be mindful of tone, formatting and language - are you making demands in all capitalized letters, or highlighting every other sentence? A plan that is easy to read, easy on the eyes, and easy to discuss is more accessible to your staff and less likely to signal an unrealistic expectation that they feel they cannot provide.
- Work with staff proactively. Have multiple copies of your birth plan on hand, note important details upon admission, and make use of any on-site tools like a whiteboard or staff members’ initial introductions. Research shows that regularly checking in with staff and having “team huddles” as needed helps all parties to feel informed, clear on their roles, and supported in protecting the family’s vision and priorities..
- Conversations about care can be difficult when emotions are high. Take a moment with your private team if needed, and directly express concerns about safety or comfort sooner rather than later.
- Use your B.R.A.I.N.! That’s a reminder to consider Benefits, Risks, Alternatives, your Intuition (or other Information), and whether you can say, “No,” or “Not right Now.” A doula, educator or Starling coach can help you to practice techniques like this for informed decision-making.
Takeaways on Natural Birth Planning
You’ve already taken the first step in birth planning by reading this overview - congratulations! We hope this framework for thinking about your options, your expectations, and how to use your birth plan has lent you some more confidence in pursuing your natural birth goals. Click here for more on birth planning specifics and to download our template, keeping today’s main points in mind.
- Natural birth is usually a possibility for a typical pregnancy and is best supported when the pregnant person and their care providers are in alignment on their goals.
- Understanding local standards and facility-specific protocols is important to navigating care during labor and birth, especially for people having their baby in a hospital setting.
- Systemic challenges to natural birth can be mitigated by working closely with your medical team and additional support people, including partners and doulas.
- Supporting a healthy pregnancy with sufficient nutrition and rest is foundational to supporting the spontaneous physiology of natural labor and birth.
- Expectations are a major determinant of satisfaction, so getting clear on what is or is not realistic for a given provider or setting is one way to protect emotional health and well-being.
- Understanding medical interventions and how or why they may be offered is important for effectively and safely choosing alternatives or discerning the appropriate care for your natural birth preference.
- A quality birth plan takes some time to create, so learn, ask questions, and help your team to stay updated on your preferences and needs as you go.
- A birth plan is not a contract but a dynamic resource that boosts communication and puts clients in the decision-making role.