Birth Plan Basics

Once unheard of, it is now routine to hear “this is a copy of my birth plan” as a woman is admitted to L&D. There is a lot of info (and opinions) out there about birth plans. This post is intended as a primer to get you pointed in the right direction.

Often explained as a document outlining how you wish your childbirth experience to go, the birth plan is much more:

The birth plan is way to prepare for your birth: properly prepared, it will require discussion with your care providers and likely personal research and reading. It will allow you to seriously consider how you feel about medications, interventions, procedures, and yes, emergency situations should they arise. It will give you an opportunity to talk with your partner about his/her hopes and fears and to communicate about what is important to you both.

The birth plan is a communication tool: hopefully it will clearly and succinctly spell out your wishes and expectations not just for your childbirth experience, but for the safety of your baby and yourself. It can function as a reminder to your care provider of things you may have talked about weeks before. The birth plan can have the power to speak for you despite staff shift changes, whether or not you have an advocate there for you (partner, family, friend or doula) and whether or not you are in a condition to speak for yourself.

The birth plan is not a frivolous wish list: it is a simple one page statement outlining what you are ok with and what you are not ok with. Birth plan detractors seem to feel that a birth plan reflects a selfish mom’s over-attachment to her own experience. However, we all have the right to informed consent when it comes to medical procedures and your birth plan should focus on this aspect rather than getting caught up in small details like whether or not you want to have your ipod in the room.

The birth plan unfortunately is not a legal document: there will be hospitals and staff members and births where the birth plan does not get followed. Make sure to go over it with your care provider ahead of time. Is your care provider comfortable with the plan? Find out if the points you’ve made are even possible at the place where you are delivering – does hospital protocol even allow everything you’ve outlined? Bring multiple copies with you to give out. Be prepared for shift changes. Remember that circumstances might arise that you didn’t consider ahead of time and some parts of the plan might not get adhered to.

The birth plan is not a road map: no one can really plan out their birth. Birth is almost always surprising in some way. It is hard not to get caught up in your vision of the ideal birth but birth is unpredictable. Remember to account for things you hope will not happen. The birth plan should not become a way to cling to control. Carefully consider the points on your birth plan and thoughtfully write it out. And then, hand it to your partner and let go of the plan so you can embrace the unknowable aspect of birth.

Should You Write A Birth Plan?

I was doing some research for a page on Birth Plans (for the business which I founded and have now sold: www.sweethomebirth.com) and was surprised this past week when I went to get a haircut (gasp!) and read Modern times: Don’t be so pushy – Making a “birth plan” is about more than being prepared. It’s about being in control. Here’s why letting go of all that is way harder – and that much better by Katrina Onstad in Chatelaine at the salon.

I couldn’t decide how I felt about the piece. On the one hand, here was a mainstream national magazine that was talking about midwifery in a very off-hand way, as if it is becoming the norm and I do agree with the main message which is that “sometimes the best plan is no plan at all.” It’s important to not get too caught up in the whole plan part of the birth plan because, well, we really can’t plan our births. She is right to say that when it comes to birth we have to expect the unexpected and not get overly attached to our vision of the ideal birth.

But then again, something rubbed me the wrong way. I mean, it was easy for her to say that the best plan is no plan at all when she had lucked out with an unmedicated natural birth which left her feeling like she “had birthed the universe”. A beautiful way to put it, but not necessarily how other mothers feel when they end up with a horrifying intervention-filled birth. The author suggests that the reason these mothers feel disappointed is because they have too many expectations going into it. Plan or no plan, aren’t these mothers entitled to mourn unnecessary medical interventions? Perhaps Ms. Onstad would be writing a completely different article had she endured a 36 hour labour that ended in a cesarean birth while under general anesthetic. You can bet she’d be researching and making birth plans for her second birth.

There is something hypocritical about this romanticization of her own birth when the article’s theme clearly seems to be that “the romanticization of the birth moment is not good for women” (as quoted by cesarean mom Judith). This statement erroneously puts the blame for all these disappointed women on the women themselves, for having plans and expectations. Despite mentioning the rising rates and risks of cesarean birth, Onstad neglects to suppose that labor mis-managment and the cascade of interventions could be the culprits for all the disappointment.

Finally, Onstad makes a huge mistake by thinking that creating a birth plan to speak for you regarding your consent to medical procedures equates to an inability to submit to the forces of labour. She says:

I was completely and totally out of control, but that moment of submission – totally without any expectation of anything – held the greatest power I’ve ever experienced.

Is it not possible to still have that moment of submission while ensuring that your medical rights aren’t violated? What if Onstad’s birth had left her feeling that all her power had been stripped from her, that her body had been violated, or that she couldn’t protect her baby from painful or scary procedures?

The difference in these two situations is that in one case the mother submits to the forces of labour, her birth and nature and in the other the mother must submit to the power of the medical system, which unfortunately isn’t omniscient. Having a birth plan is a way of exercising your right to informed consent in your most vulnerable moments, not a way to avoid submitting to the unknowable.

I was divided over whether or not to post the article but I couldn’t stop thinking about it, particularly because I loved the dialogue between the article and a blog post I found from one of the commenters.

Phd in Parenting wrote a lovely thoughtful (and a little irate) piece in response to the Chatelaine article. She makes an extremely valid point that when you trust your care provider and are anticipating birthing with a midwife, whose model allows for submission to, not management of, the birth process, you perhaps don’t need a birth plan. But for anyone else, especially those birthing within obstetrics, a birth plan is a wise decision.

I wanted to recommend both of these as a great read together. It will really get you thinking about how you feel about birth plans. I have to say that personally, I think that rather than expecting the unexpected, it’s wiser to plan for the unexpected. Then you can submit to the birth process, knowing that your care providers will respect your wishes regardless of what happens.