The subject of birth plans comes up quite often for pregnant women. Do I or don’t I? The idea of a birth plan is becoming increasingly “mainstream” and more women and their partners are starting to think about birth preferences. Even so, I am always surprised when the question “What should I put in my birth plan?” gets multiple replies along the lines of “Don’t bother; you don’t know what will happen.” While hardly scientific, my personal observation suggests that more women actually advise against writing a birth plan than advocate for it. But why?
I think the anti-birth plan sentiment floating around is symptomatic of the larger problems around birth in the U.S. (specifically the passive role women are too frequently asked to take in their own births – see my recent review of Jennifer Block’s Pushed). But lest I go off on too great of a tangent, I’ll focus on rebutting the the idea that birth is too unpredictable to plan for – and arguing for the value and importance of putting together a birth plan for every birthing mother regardless of the birth choices she makes.
“Don’t bother; you don’t know what will happen.”
It’s quite true that labor and birth is full of the unexpected, something I know full well from personal experience. But does that mean we shouldn’t plan and prepare for it? Think of all the life events that aren’t entirely in our control that we plan for: A vacation – no way to control for the weather, cancellations, a sudden illness, attractions being closed – and yet we typically put together some idea of what we’d like our vacation to look like. How many brides spend months planning every detail of their weddings? And even so, something always goes “off-plan.” Many expectant mothers spend months researching all manner of baby gear, not knowing if baby will like this swing or that bouncer or the $10 exercise ball best. Rarely are our plans perfectly executed, but that doesn’t mean that the ACT of planning wasn’t worthwhile or purposeful.
Perhaps part of the problem is the idea that a birth plan is supposed to be an instruction manual to follow. It’s not. It’s a way to organize preferences. But more importantly, it’s a way for mamas-to-be and their partners to carefully consider all the options available to them. There are a lot of choices offered to women around birth – meaning there’s a lot of research to be done if one wishes to be fully informed. When I was pregnant with Callum, I was pretty sure that I wanted a med-free birth. But given that I knew “anything could happen,” I felt it was important to do some research into the the different options available to me.
In my own planning, I found Henci Goer’s The Thinking Woman’s Guide to a Better Birth a nice, even-handed look at the pros and cons of various birth interventions. Although Goer is pretty clearly in the “less-interventions = better birth” camp (which meshed with my personal birth goals), it was still a nice way to consider all the possibilities. Unfortunately, the book hasn’t been updated recently so it doesn’t reference birth research from the past decade. A more up-to-date option is Penny Simpkin’s Pregnancy, Childbirth, and the Newborn which offers sample birth plans for a variety of settings and situations in addition to information about various birth interventions. Finally, the website Childbirth Connection is a great starting point for examining evidence based childbirth practices.
In some ways, writing a birth plan is a part of the “informed consent” process that should happen before any medical procedure. I’d argue that medical providers have a duty to, for example, tell their birthing patients that the hands and knees or squatting positions open the pelvis up far more than lying on one’s back – and that the epidural may make it difficult to use those positions meaning a prolonged or even “failed” labor. But many providers don’t volunteer such information. Writing a birth plan should at the least raise those questions for the mother. If in writing a birth plan you consider “well, what position do I want to labor in?” you may then have that discussion with your provider or do a little research on your own (or better yet, both!). And then whatever choice you make about labor positions is an informed one – not one that was imposed upon you. If you decide that you’d like to get an epidural during labor, writing a birth plan makes that decision an informed one made after weighing pros and cons and deciding what is best for you. Even if you are having a planned c-section, a birth plan matters as you still have choices about your care – a voice in what happens to you.
Labor is intense – physically and emotionally – it’s hardly the time for a woman to be able to make rational choices quickly. In fact, some birth researchers argue that asking a woman in labor to think actually distracts from the birth process – basically, birth is sort of a primal thing that requires a laboring woman to block out thinking and listen to her body and instinct. It’s not the time to ask me how I feel about procedure X. But if in the process of writing a birth plan I’ve considered procedure X, when I’d be open to it or what alternatives I’d rather have instead, and I’ve communicated that both in writing and to my partner (and doula and care provider), then I don’t have to think about it while in labor.
Birth plans don’t have to be fancy. They don’t need to take a certain format. They aren’t a mile-long list of demands to hand over to your provider. Write them in the way that makes sense to you. Maybe it’s a list. Maybe it’s filling out one of the dozens of forms available online. Maybe it’s writing a story about how you imagine your birth. Whatever it is, it should start a conversation, get you thinking, and help you become informed. Yes, you should discuss your preferences with your provider. Doing so doesn’t make you pushy or “that patient” – your provider is there to provide for you! Yes, you should know that anything is possible. But if you’ve made a birth plan, you also know that you are confident and prepared.