Birth Plans; A new way to think about them

Birth Plans; A new way to think about them

Almost every person or couple I work with today asks me whether they should write a birth plan. Birth plans began trending a few decades ago when birth was becoming more medicalized. They emerged as a way for parents to express their desires to prenatal care providers and were used mostly by people hoping for a more natural birth experience. Birth plans are still used today and can be a great idea. I’d like to suggest looking at a birth plan as more of a guide to what you want than an expectation of what will be. We can’t meticulously plan every aspect of birth. It’s important to express your desires, but remain flexible for any unexpected circumstances that might arise.

There are few things a person can fully control in life, and birth is certainly not one of them. If you’re married, think back to your wedding day. If not, think of a big event or party you’ve planned. Even with all of the elements you had control of, all the details squared away meticulously in your head, I’ll bet something went off course.
My younger sister planned every detail of her wedding, going so far as to spend hours making and individual chocolates and wrapping them in white organza bags as favors. The night before the wedding, once everything was perfect, each detail planned and executed with precision, we all took off to enjoy the rehearsal. When we returned, we found a very excited dog at the door to greet us. Sure, he was happy to see us, but more importantly, he was eager to get outside due to a sick stomach. He had eaten every one of those lovely chocolates she’d spent hours wrapping and consumed most of the organza as well. Even with the best-laid plans, this event had its surprises. – Imagine how something as unpredictable as birth?

It’s important to understand where the birth plan comes from and what its intention was at the start. The concept of a birth plan was envisioned to help expectant parents prepare for the physical and emotional aspects of the birth process. The birth plan was designed as a way to clarify preferences.

As well-intended as this concept was at its start, birth plans are often criticized today. They are criticized for a number of reasons, including (a) concerns that parents will be inflexible and difficult when changes, no matter how small, to their plan are necessary (b) birth plans often contain outdated information that no longer applies; or (c) birth plans occasionally include language that seems defensive and sets a stage for defensiveness among the medical team.

Birth plans get a bad rap because of the way they seem to have morphed over time. I’ve seen some of these concerning plans myself. Instead of stating preferences, they draw a hard line regarding what will and will not happen during the birth. Consider presenting yourself in a way that will create a more open dialog with your care providers.

Most birth professionals I speak to love the concept of birth plans in terms of understanding your birth philosophy and your hopes for an outcome. Let’s face it, you are choosing to do the most intimate thing a person can do in the company of people who may not really know you. This is a great way to get some basic things across quickly.

I often hear from couples that they fear the doctors, and nurses may try to influence their decisions based on their own biases. There is some truth in that fear, but we need to be reasonable and try to understand why. Doctors and nurses are human beings with their own experiences which shape their opinions just like the rest of us. With this said, I believe obstetricians, midwives, and other hospital staff deserve respect for their knowledge and their academic achievements in this area. At the same time birthing, people and their partners deserve respect for the hard work they do preparing and educating themselves for birth. A birthing person’s desires and intuition must be respected as well. This is where informed consent and shared decision-making come in. It is important for providers to look past any bias they have and present people a full picture. Once that is complete providers and birthing people can make a shared decision based on evidence, intuition, and personal desires.

If you are writing a birth plan in an attempt to control the elements of your birth you may gain a false sense of control from doing so. On the other hand, if wanting to be a decision-maker; a part of the team in your birth experience is the driving force behind it, you will likely benefit from doing so.

Before writing a birth plan take the time to find out what the standard procedures and practices are in your chosen birthplace. Get to know your care providers by asking questions at your appointments. Questions and discussion are good! Meaningful conversation between you and your provider is an important way to gain confidence in your care. These conversations can help you understand the procedures you are electing or asking to avoid.

Keep in mind that many internet-based birth plans do not explain birth options or help you understand the possible effect of accepting or denying certain interventions. Most of these birth plans are frequently long and can include a whole host of things that do not apply at your birthplace. For example, I read a birth plan the other day where the woman was declining to have an enema. Now, it’s possible that there are places in the US that still do this, but that is not commonplace today. Do your due diligence and find out more about your chosen birthplace so you know what you should include in your birth plan and what can be left out. And remember that you will not have a great chance of achieving the birth that you want if you’re birthing at a place that will not support your desires. Be sure to choose a birthing location that’s a good fit for your personal desires and philosophy.

In the end, it may be best to think of your birth plan as less of a “plan” and more about presenting your philosophy of birth. If, after learning about your chosen birthplace, you still have specific concerns about certain policies or procedures, be sure to note this somewhere and discuss it with your providers prior to going in for your birth. Remember, birth can be unpredictable. You can prepare for it, educate yourself, and envision the best possible outcome based on your desires, but birth, by the nature of what it is, can not be completely controlled.