What is a Birth Plan Exactly?
by Becca Gordon
Pregnant folks, have you all been told to write a birth plan? Have you seen funny mock birth plans on the internet? Does it seems strange to you to try to lay out a plan for something as unpredictable as labor? Did your hospital or birth center provide you with the layout for a birth plan? Have you felt nervous about crafting a plan for labor? Wonder what medical staff really thinks when they read your plan?
My Thoughts on Birth Plans
As a doula and educator, I get asked questions about birth plans all the time - should we have one? Will it help me? What should I include? What happens if the plan needs to change?
I have definitely seen both sides of this conversation. I have been with clients who had a birth plan that divided their birth team, rather than bringing them together. I have had clients with a birth plan who felt discouraged when unplanned medical intervention became necessary. I have also been with clients who could have deeply benefited from having a birth plan that could have helped their care team understand their backgrounds, concerns, and wishes more clearly. Like all of the other questions related to pregnancy and birth, there is no black and white answer when it comes to birth plans. They work for some families and not for others.
But, actually, there is no such thing as a birth plan. “Birth plan” sounds catchy, but you can’t plan labor. It is unpredictable and involves so many factors outside of anyone’s control. For that reason, when we are talking birth plans, I prefer to call them “birth preferences”. Preferences are inherently flexible and can change based on your needs and desires changing in the moment, or as your situation changes. Writing down their birth preferences, rather than a birth plan, gives the parents room to change their mind as the process unfolds, and helps prevent couples looking back on their “plan” and feeling upset that their birth did not happen according to plan.
So, what are the benefits to creating a birth preferences document?
A birth preferences document can be a way for your care team to better understand you and your wishes. It can be an introduction to you and your family for anyone who may be at your birth who has not had the opportunity to meet and get to know you prior to the day of your baby’s birth (like nurses, midwife’s assistants, or back up care providers if your care provider is not there on the day of your baby’s birth). It can help you provide basic information about what you are hoping for from your birth experience to those who can help you achieve those things. For instance, I have had clients who had aversions to needles, a partner who fainted at the sight of blood, a history of sexual abuse. Those are all big things anyone involved in someone’s care on the day of birth should know, but might not if they weren’t spelled out in some way. Even if you don't feel you have any of those big ticket items to share, there are usually specifics of who you are as a couple and your personal history that are relevant for those who will be supporting you through something as intense and transformative as labor and birth.
It can prevent you from having to answer a lot of questions on the day of your birth. A birth preferences sheet can explain your basic wishes so you don’t have to be explaining things while you are having contractions. For example, no one wants to have to remember to ask for optimal cord clamping or delaying newborn procedures at the moment of birth. Having these preferences codified in written form can help everyone on your care team be on the same page, even as the somewhat chaotic moments surrounding birth occur.
Creating a birth preferences document prenatally and discussing it with your care provider can also help you initiate dialogue surrounding your hopes for your birth or go deeper with that dialogue if you’ve already started discussing it. Several of my clients have realized when discussing birth preferences late in their third trimester that their care provider was not on the same page with their preferences for labor and have switched care providers in time for their baby’s birth. Without having brought in their birth preferences to an appointment, they might never have had those needed conversations.
Well, all of that sounds good, so what are the risks to creating a birth preferences sheet?
There are some medical staff who dislike them. Personally, I kind of see it as a red flag if someone doesn’t want to know what you prefer, but I do hear from some nurses and care providers that they don’t find them useful. There is a wonderful hospital based practice in my area that consists of a partnership between an OB and a midwife. They attend over 95% of their own patients’ births between the two of them, and develop a deep relationship with those in their care. They expressly prefer their clients not to bring in a written birth plan as they feel like it causes consternation among the nurses at their hospital, and makes their job more challenging. Overall, though, I think we can revolutionize the way staff relate to birth plans by making the plan more realistic and flexible, not by doing away with them entirely.
It is easy to get attached to the plan. Even if we call them birth preferences, some families will feel as though they failed if their birth preferences change amidst labor, or if medical intervention beyond their preferences becomes necessary. This is the biggest drawback to crafting birth preferences, in my opinion. It is hard once you’ve considered all of your options and written everything down to then be willing to let your preferences go out the window when necessary.
So, what are your options? Well, you could create a birth preferences document as an exercise and not utilize it. You could have a more casual conversation with your care team and family about it. Some of my clients have created one, brought it to their prenatal visits, discussed it with their care team, and then brought it to the birth, but not given it out like candy unless it was asked for or they felt it necessary. Some of my clients create a postpartum preferences plan that just focuses on their preferences for the third stage and early postpartum period, when things are pretty hectic and a lot can be going on at once. Some of my clients who are planning to give birth at home or a birth center create a transfer of care letter in lieu of a birth preferences document which would be to give the hospital staff, in case of transfer during labor or after. Think outside the box - you don’t have to do the same cut and paste birth plan as everyone else, or use the one that your care provider gave you or the one you found in your favorite pregnancy book.
Some simple guidelines would be:
Start with a discussion. Sit down with your partner and discuss your main priorities for your labor, birth and immediate postpartum experience. These priorities will be different for every birthing couple.
Brainstorm things that might happen during your birth which might get in the way of those priorities without medical need. You can dig deeper into what those things are by taking childbirth education classes and talking with your care team, your doula, and women in your community who have recently given birth.
Keep your preferences list short (one page in legible typeface) and easy to read. I’m a big fan of bullet points. Focus on your most important priorities and only include things that would come up during labor or the immediate postpartum period (not things that would be decided upon prenatally or would have time and space for discussion postpartum). Think of your birth preferences as a way for staff to get to know you and your mission statement for your birth.
Try to be friendly and positive. Humor is great. Pictures work wonders.
Re-read your document and make sure it comes from the heart and really reflects what you are hoping to have during your birth experience.
Be flexible. Once you’ve crafted your birth preferences, do your own work around being willing to let things go. Track your tigers prenatally and know what might trigger you during labor or beyond and know that, whether you create a birth preferences list or not, and whether you have your preferred birth experience or not, you are still doing something miraculous as you welcome your new baby.
Think of your birth preferences document as a flexible tool to keep your birth team aware of your desires. Birth can be extremely unpredictable and somethings situations will change quickly. Use your birth preferences document as a guideline for the way you want to labor, but also a way to answer important health questions which may come up. It may be difficult to communicate, once you’ve transitioned into active labor. Remember to focus your energy on the life altering experience you are having.
So, in summary, just like every other choice you will be making about your labor, birth, and parenting choices, it is really up to you whether having a written birth preferences is right for your birth. Whether or not you choose to have birth preferences or not, keep an open line of communication with your care team during labor and allow yourself the flexibility and grace to decide what is best for you and your family in the moment.