The Daily Doula

21 Jan 2016

Birth Plans: A New Way to Think About Them.


Almost every couple I work with today asks me whether they should write a birth plan. Birth plans began trending a few decades ago as a way for parents to express their desires to caregivers working with them through labor and birth. Birth plans can be a great idea, as long as you use them as a guide. You should not expect to meticulously plan every aspect of your birth, but instead be flexible and prepared 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.  Think back to your wedding day, or any other event 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 wrapping individual chocolates for the favors. The night before the wedding, 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, 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.   Even with the best laid plans, this event had its surprises.  – Imagine now 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inflexible and difficult when changes, no matter how small, to their plan are necessary (b) birth plans often contain outdated information that no longer applies; or (c) birth plans occasionally include language that seems defensive and sets a stage for defensiveness among the medical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 an understanding your birth philosophy and your hopes for an outcome.  Lets 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 and this may be true in some cases.  Let’s be fair, 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 that obstetricians, midwives and other hospital staff deserve respect for their knowledge and their academic achievements in this area. We do not get anywhere together if we look at them as the enemy.

If you are writing a birth plan in an attempt to control the elements of your birth you will likely only gain a false sense of control from doing so.  On the other hand if wanting to be a decision maker; a part of a 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 birth place.  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 birth place.   For example, I read a birth plan the other day where the woman was declining having an enima.  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 birth place 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 chose 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 birth place, 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, but nature of what it is, can not be completely controlled.

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