Birth Preferences: What They Are and How to Use Them

Source: *Why Did No One Tell Me This* — Natalia Hailes and Ash Spivak

What a Birth Preferences Document Is (and Is Not)

A birth preferences document is not a contract. It is not a promise from your care team. It is not a list of demands or a guarantee of any particular outcome. It is a communication tool, and a good one, because it forces you to think through your values and priorities before you are naked and in labor and being asked to make decisions quickly.

Think of it as a way to have a conversation with the room before the room gets busy. The staff who walks in on a shift change does not know your history, your fears, or what matters to you. A one-page document, written clearly and with context, gives them that. It is not about controlling the birth. It is about making sure the decisions that arise during birth happen with you, not around you.

The most important thing to hold: preferences are not the same as a plan. Hold them with an open hand. The job of labor is to move through whatever actually happens, which may look nothing like what you imagined.

Questions to Ask Your Birth Location in Advance

These questions from Hailes and Spivak help you understand what is and is not possible before you arrive. Some of the answers will shape your preferences. Some will reveal whether this location is actually the right fit for you.

**Logistics and support:**

• Can my partner stay overnight after the birth?
• How many support people are allowed in the labor room?
• Can my support people stay with me if I get an epidural or need to go to the OR?

**Movement and comfort:**

• Do you have birth balls and peanut balls, or do I need to bring my own?
• Do the labor rooms have baths or showers I can use during labor?
• Am I limited in pushing positions at any point?

**Policy:**

• What is your policy on eating and drinking during labor?
• If the baby and I are healthy, is there a limit on how long I can push?
• As long as everyone is healthy, can my baby stay with me at all times postpartum?

**Postpartum:**

• Do you offer breastfeeding/chest-feeding classes immediately postpartum?
• Do you have lactation consultants on staff, and how often are they there?
• What level NICU do you have if my baby needs additional care?

**Specific to unmedicated birth intentions:**

• Can I have a hep-lock instead of an IV so I can move freely?
• Can I have intermittent monitoring instead of continuous monitoring?
• What is your threshold for recommending induction, and at what gestational age?

Questions to Ask Your Care Provider Before Labor

These apply whether you're working with an OB or a midwife. The answers reveal the provider's approach and philosophy as much as their policies.

• Will you personally be at my labor? At what point do you typically arrive?
• What is your cesarean rate, and what do you think accounts for it?
• How do you feel about a doula being part of my birth team?
• If my water breaks before contractions start, what is your protocol? How long before I need to come in?
• How far past my due date can I go before induction is recommended?
• Do you support VBACs? (Even if this is your first birth, the answer tells you how conservative the practice is.)
• Do you support delayed cord clamping?
• Do you support gentle cesareans or family-centered cesareans if surgery becomes necessary?
• What does your postpartum care look like, immediately and in the weeks that follow?

How to Structure Your Preferences Document

There is no single format. One page is better than two. Shorter is read; longer is skimmed.

Consider organizing it this way:

**Who we are:** A sentence or two. Your names, your relationship, any relevant medical background (previous cesarean, specific concerns, etc.).

**What matters to us:**

A short list of the things that are highest priority. Not everything you want, just the things you feel most strongly about. For example: freedom to move during labor, intermittent monitoring, delayed cord clamping, skin-to-skin immediately after birth.

**If interventions come up:**

A note that you understand interventions may be necessary and you want to be walked through B.R.A.N.D. before any decision is made. You are not refusing care. You are asking to be included in the conversation.

**If surgery becomes necessary:**

If you have strong feelings about gentle cesarean practices (music, lowering the drape, skin-to-skin in the OR), list them here as requests, not requirements. Most hospitals can accommodate these with advance notice.

**Postpartum:**

Feeding intentions (breast, chest, formula, or combination). Rooming-in preference. Anything related to visitors or separation from the baby.

The Birth Partner's Role in Holding the Preferences

Once you arrive at the birth location, the preferences document has a very specific job: it gets handed to the nurse at intake, the attending provider, and anyone new who joins the team. The birth partner is the one who does this.

From there, your job is not to enforce the document. It is to make sure the people in the room know it exists and have read it, and to raise a flag if something seems to be happening without consent or awareness.

If a recommendation is made that conflicts with what your partner wanted, your job is not to argue. It is to slow the conversation down enough for your partner to actually participate in it. Ask for five minutes if needed. Use B.R.A.N.D. Help your partner go inward before answering.

Hailes and Spivak are clear: the goal is for decisions to happen with the laboring person, not to them. That sentence is the whole job description.

Choosing Between an OB and a Midwife

This choice shapes what kind of birth experience is likely to be available to you. It is worth understanding the difference before writing any preferences.

Obstetric training focuses on managing complications. Midwifery training treats birth as a normal physiological process and provides individualized care informed by a person's emotional and social history as much as their medical history. Midwives can work in hospitals, birth centers, and home settings. They can consult with OBs when needed. They are not an alternative to medical care. They are a different model of it.

For low-risk pregnancies, working with a midwife is associated with lower rates of episiotomy, vacuum or forceps delivery, and cesarean birth, as well as higher satisfaction with the birth experience. Still, even with a midwife you chose specifically because you trusted them, use the provider questions above to make sure you are genuinely aligned.

Holding Preferences Lightly

This is the hardest part to prepare for because it cannot be practiced. You can read everything and still find that labor unfolds in a way that makes your preferences document feel irrelevant.

The birth is not a project to execute. Hailes and Spivak put it plainly: "We can influence, we can't control." What you can control is how you move through whatever actually happens. A person who labored for 30 hours and ended up with a cesarean after hoping for an unmedicated birth is not someone who failed. They went inward again and again, made decisions from a real place, and kept showing up. That is what the preparation is actually for.

The preferences document is a starting point. What you build by going through the process of writing it, the questions you ask your provider, the conversations you have with your birth partner, those things stay with you no matter what happens in the room.