On birth plans: I always tell students in my classes to think of their birth plans at three different levels.

Level 1) Planning with partner / support people. In late pregnancy, Mom and her partner discuss in detail what their hopes and expectations are so that the partner can help advocate for her during labor no matter what may come up.

I recommend that they go to either http://www.childbirth.org/interactive/ibirthplan.html or www.birthplan.com . Both these websites have very detailed checklists of what they do and don't want. The couple can go through this checklist, and it encourages them to think about and discuss the whole broad range of things that might come up, and figure out ahead of time how they'd want to handle things.  This is the level of birth plan they would want to share with their doula. However, this produces a far more detailed birth plan than other professionals want or need, e.g. most caregivers _assume_ you don't want an episiotomy 'unless medically necessary.'

Level 2) The "birth plan" for the doctor. I tell students to think about what the 5 biggest issues are for them, and discuss those with their doctor ahead of time to clarify their options and desires. During classes, when I cover these interventions, I specifically suggest that they discuss these with their doctors in advance, since some of these choices need to be written up into doctor's orders: induction or augmentation, IV's, continuous/intermittent monitoring, pain meds, c-section.

Level 3) The birth plan for the nurses. It is _only one page long_ (and not a tiny font, single spaced kind of page.... think resume formatting :-) )  It includes

a) a brief paragraph introducing "who's in the room" - can give a little background on the couple, concerns that may have come up during the pregnancy, other support people, etc.

b) a brief paragraph that describes the "big picture" of what they're hoping for and what the nurses' role is within this. (e.g. "we would like as quiet and peaceful a process as possible, with minimal interruptions" or "we're nervous about remembering what to do, and would feel more comfortable having our nurse with us frequently to give ideas and suggestions" or "we are planning on an epidural, but want to wait until 5 cm dilation... we'd like support for this decision and help getting us there" or "we are planning to avoid pain medication. Please do not offer it, or imply that I might need it.")

c) another paragraph which addresses any special issues that 'if the nurses knew this about me, they would understand me better, and better support my decisions or actions". The examples I give in class are things like needle phobias, blood phobias, cultural issues (e.g. regarding men in the room), religious issues (e.g. Jehovah's witnesses and the bloodless program), personal history (e.g. history of drug abuse as the motivator for avoiding pain medication, history of sexual abuse, miscarriage, or abortion. (I use this moment in class to address the issue that if these things are in your past, they may affect your labor, and your ability to 'open up' and progress in labor. I encourage people to think about and talk about these issues in advance so they are less likely to affect the labor.)) I emphasize here that their confidentiality will be respected, and that this will help the caregivers provide better care.