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Birth Plans: Yes, You Really Should Have One!

I’ve reached the point in this pregnancy (33 weeks!) where my midwives have started talking birth plan – and reminding me of the things I should consider as I write mine. It’s probably little surprise to know that a birth center based midwife or most hospital based midwives request birth plans from their patients. It’s in keeping with the midwifery model of care to have the patient as involved in the process as possible, and for her (and her partner) to be as informed about her choices as possible prior to the birth. Of course, birth plans aren’t the inclusive domain of midwives. Many OBs also ask their patients to write birth plans and spend just as much time discussing them as a good midwife might.

But I’ve also heard more than a few stories from women (primarily on the pregnancy/parenting message board I frequent) who were specifically instructed NOT to write a birth plan. In some cases, women were made to feel that doing so was simply a sign that they would be inflexible during labor or even oppositional to the hospital staff. Some women frame their questions about birth plans as “will I be a troublesome patient if I come in with a birth plan?” Others worry that if things don’t go according to their plans, they’ll feel more disappointment than they otherwise would have, a sentiment reinforced by some providers.

These stories raise an important fact about birth that is sometimes forgotten (or intentionally brushed aside by some providers) – a birth should not be about what’s best for the provider or the nurses or any other medical personal who may be involved. It should be about what is best for the mother and her child and her partner; it’s about their needs and wishes. Medical providers are in a service profession; they are there presumably (hopefully!) because they have a desire to help others via the specialized knowledge and skills they learn. A laboring mother should never feel or be made to feel that she’s an imposition on medical caregivers or that she should do things a certain way to please her provider.

But this doesn’t mean a laboring mother should simply storm in and issue commands about her birth willy nilly. After all, there are situations during labor and birth in which the advice of an expert is needed; I’d argue that’s true of most every birth to some degree. A birth plan isn’t intended to bypass that advice. Rather, a good birth plan is constructed by the mother, her partner, AND her provider/s as a way to explore both the mother’s wishes, fears, and expectations around birth as well as the different situations that may arise during labor. A birth plan is also not a rigid checklist to be adhered strictly to; rather it’s a guide for both the laboring mother and her providers that states preferences – a valuable tool given the large number of options a mother could make about the course of her labor and delivery.

Regardless of how or where you hope to give birth, a birth plan is both a valuable tool that you absolute should write! Here are a few things to keep in mind as you write yours:

  • Writing your birth plan is an opportunity for you to educate yourself and your partner about the different interventions that may be offered (or necessary) during labor and delivery.  Even if you feel you have few preferences, it’s best to know what all the options are and the pros and cons of each before you find yourself in the heat of labor.  It’s difficult to make decisions when you are in pain or concerned about your health or your baby’s health; understanding all the possibilities in advance – and considering your feelings on each – can make decisions during labor much easier. I found The Thinking Woman’s Guide to a Better Birth a helpful resource in sorting out the different birth interventions you may be faced with.
  • Writing a birth plan is a great way for your partner or birth support person to “get on the same page” as you are.  Partners want to be supportive – that’s easier to do if they know both what you want in advance and how best to advocate for you.  A birth plan empowers your birth partner to advocate for you in the labor room since he/she will know in advance what choice you want to make.   Creating a birth plan also gets your partner involved in the birth process – it can make him/her feel more a part of the team.  And giving birth is very much a team effort in that having the right support makes things much easier!
  • Birth plans aren’t just for mamas who hope to be as intervention free as possible.  Whether you are planning a home birth, a hospital birth with an epidural, a c-section or anything in between, you have choices to make and wishes to communicate.  Regardless of the birth you hope to have, you are still an ACTIVE participant in making that birth happen.  Writing a birth plan helps you define your role.
  • Birth plans aren’t set in stone.  We all know that even carefully laid out plans sometimes have to be adjusted or even scrapped; that doesn’t mean we shouldn’t make them.  Considering the options and outlining your wishes doesn’t mean that you’ll be inflexible if the unexpected happens.  Rather it means you’ll be better equipped to handle the unexpected and less likely to be pushed into something that may not be necessary or what you wanted.
  • Birth plans help your provider provide the right care for you.  I would be personally very wary of any practitioner who instructed me specifically NOT to create a birth plan; for me, that would be a red flag that the practitioner was more concerned about his convenience than what was right for me.  If your provider takes this attitude, take that opportunity to have a conversation about why he feels that way – which should give you a better sense of whether or not this person is going to be your advocate come crunch time.
  • There’s no magic formula for what a birth plan should look like.  Some recommend a check list sort of format.  Others prefer a more narrative approach.  The best birth plans are created through a process:  research the options, visualize your ideal birth, and then create your wish list.  You may have a more detailed, narrative style plan for you and your partner to work with in the weeks leading up to birth and then a shorter, more direct list style plan to give your providers during labor.  Remember, a birth plan is important not just at birth to communicate your wishes (which a more direct style plan is good for), but also to help you and your partner (in conjunction with your provider) work out what sorts of choices you plan to make regarding your labor before you ever get to that point.

There are many birth plan templates available on the web that might help you get a start on writing your own.  And you should, of course, include your provider in the conversation.  Use your birth plan as a way to both prepare for the journey of labor ahead – and to get excited about the powerful experience of giving birth!

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Published in Birth Health pregnancy

One Comment

  1. Kassandra

    Kassandra

    I think a birth plan is great. I totally agree but you are forgetting some essential elements of that birth plan. As a nurse I can tell you that in the average american hospital if you walk in with a birth plan you will (unfortunately) be laughed at. Granted they will wait until you are out of ear shot to do so. They will stick that neatly printed piece of paper in the chart close it and it will more than likely be spoken of no more.
    You need to do some research as a new parent and make sure you find a hospital that is will to accommodate your birthing needs. Just as a mother who wishes to have a epidural to assist with pain through out her pregnancy would not choose a home birth option; a mother who wishes a more “natural” birth plan should not choose to have her baby at a facility with a 40% caesarean section rate- not if there is an alternative available.
    You need to do your research and your partner too. This step is oh so important. When you are in labor you are focused on the sensation. It is brain over-load you have little left over for processing medical advice. Get your birth partner involved. Make sure they know what you want and they are not afraid to speak up. Ask questions and if the answer if definitive then decline! I have seen more mommies than I can count be pulled from their birth plans and allow IV’s, fluids, epidurals, pitocin etc etc to happen. When you ask why and they tell you “its to stay hydrated” thats not an answer, oral hydration (ie drinking) is a clear/safe even recommended alternative to IV fluids. I dont think I could stress this enough. Make sure you and your birth partner know your plans, have done your research and make sure they are willing to stick to your guns even when you cannot. As long as baby and momma are healthy and safe do not let a health care professional tell you the “right” way to do what is natural for you.

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