Birth plans – love them or hate them, pretty much every woman and care provider has an opinion on them. Some feel that they simply set a birthing woman up for disappointment while others feel that they are a vital tool in achieving an empowered birthing experience. So let’s have a look at birth plans – what they are and what they aren’t and how they can help a birthing woman, her care providers and her support team.
In part one of this article, I’d like to look at some common misconceptions about birth plans.
“Writing down a birth plan sets a woman up to be disappointed if things don’t go according to plan.”
Regardless of whether you write down a birth plan or not we all have ideas about how we want our births to go. These ideas may be as simple as “I’d like a vaginal birth” or “I really want Doctor Jo Bloggs to deliver my baby” or “I’d like baby’s dad to cut the cord” or your ideas may be more complex, running up a list of tests, procedures and interventions that you do or do not wish to have. Not writing these down doesn’t make these desires go away – all it means is that it’s highly possible that your care providers during labour won’t know about them! I had 2 births that didn’t go according to plan. The first, with no birth plan, was very traumatic for me. The second, where I had spent hours working on my birth plan and discussing it with my doula and midwife I found to be far less traumatic. The fact is that a birth plan has very little to do with whether a woman will be disappointed by her birth experience.
“We should call them “birth wishes” or “birth preferences”.
Okay – firstly I understand why people may prefer to use these terms. They sound “nicer” and a lot less confrontational. Like you are going in and asking if this is okay instead of telling your care provider that “This is what I plan”. And that is exactly why I don’t like these terms. They suggest that you’re not terribly committed to the ideas you’ve written down. You know – I wish for world peace and I wish I’d win lotto, doesn’t make it even remotely likely to happen! As for preferences – what happens when what you’d prefer is different to what your care provider prefers? A care provider has no legal obligation to respect a preference. They do have a legal obligation to respect what you do and don’t consent to.
“But you can’t *plan* birth!”
No you can’t. But I also can’t plan the weather – doesn’t mean I won’t schedule in a trip to the beach next weekend and then just change my plan if it rains. You really just never know what is going to happen in a birth and I see this as an excellent reason to make sure you have a great birth plan. Because the process of writing out your birth plan should include talking to your doula, your birth partner and your care provider/s about different scenarios. For example: If you put in your plan that you really don’t want an epidural this should open up conversation about what you DO want to use for pain coping and/or relief, under what circumstances you might feel that an epidural is the best option for you and what you would like to have happen in that circumstance. These can then be written, briefly, into your plan. Writing a plan and discussing it with your doula and care provider ensures that you are able to think about different decisions, assess different options and do some research prior to being in labour. It saves you from having to engage your neo-cortex at that vital moment!
“My only plan is to have a healthy baby – I don’t care how it happens!”
Firstly let me put it out there that having a birth plan and / or wanting a positive and empowering experience does not mean that you don’t consider the health of your baby to be most important. As a student doula I always make the assumption that a mother’s number 1 goal for her birth is to have a healthy and safe baby. Wanting a positive experience does not make you selfish. Now that we’ve got that cleared up, going through the process of birth planning can also help to ensure that you do, in fact, have a healthy baby and a healthy birth. Every single test, procedure or intervention that will be offered to you by your care provider holds varying degrees of risk to both you and your baby. By going through the process of researching and writing a birth plan you can make decisions about which risks are acceptable to you and which are not and can ensure that you are aware of alternative options. For example you probably don’t want to find out after you’ve had pethidine that it can cause breathing problems for bub if given close to birth or find out after you’ve had a c/s for foetal distress that the induction you had actually holds a high risk of causing foetal distress. It also enables you to ensure that your care provider is aware of your goals for a healthy birth and understands which risks and options are more acceptable for your family.
“Will anyone even read my birth plan?”
If your primary care provider is not interested in your goals, wishes and preferences for your birth then I would consider it a good idea to find a new care provider! A birth plan should open up plenty of conversation with your care provider, who should be sharing with you plenty of evidence based information regarding your options as well as your hospital’s policies. Remind your care provider that you chose them to be your care provider and obviously you wish for them to give their opinion of your birth plan. Remind them how important it is to you that you have their support for a beautiful, positive and safe birth. Bring them into it! Once in labour it is not unusual for many women to attach a sign to their birthing room door advising that they have a birth plan and, unless there is an emergency, staff are to familiarise themselves with it before entering. If it becomes clear to you that a person who is caring for you has not read your plan or is not interested about your birthing plan then it would certainly be considered reasonable to ask for a new care giver – even if you are in labour at the time!!
These are just some of the misconceptions I hear a lot. If you have any you’d like to add please comment – I’d love to hear your own thoughts about birth plans! In the second part of this article I will look at some specific benefits of researching and writing a birth plan as well as how to do this effectively.