Telling women not to make a birth plan is akin to telling them to batten down the hatches, because birth is always disastrous. It makes women more afraid of birth than necessary. But a birth plan is misrepresented by this advice. Birth plans are about planning for all potential outcomes, birth VISIONS are about focusing on the positive end goal and the straight forward journey.
I had a friend who made a birth plan. It said she didn’t want to be induced, she wanted minimal vaginal exams, she wanted to move freely and use the shower for pain relief, and she wanted delayed cord clamping. That was about it.
She showed it to her hospital midwife and the midwife laughed and told her to tear it up. “Birth plans always go out the window, they’re a waste of the paper they’re printed on”. And indeed her birth plan DID go out the window.
Her plan went out the window because the hospital she had chosen to give birth at had very high rates of intervention, and because after the midwife told her not to bother, she didn’t. Needless to say the vision she had for birth went right out the window along with the torn up plan. My friend didn’t know that the recommendations that were made were optional, nor that they were hospital protocol, not medical necessity.
What neither my friend nor I understood back then was that a birth plan isn’t about writing a few pretty ideas down on paper and hoping for the best, it’s about actually PLANNING for birth. Planning for birth is about knowing what makes interventions necessary, not just stating that you don’t want them.
The reality is that for a select group of women, intervention is necessary. The trick to birth planning is to KNOW when an intervention is going to be beneficial, and when it will simply introduce risks. It’s about having a plan for if you go post dates, if you have a slow labour, if you or your baby have an unforeseen health issue … you’ve got a plan at the ready.
Creating a solid birth plan involves learning all about the benefits and risks of the interventions and testing that you may be offered. It’s about knowing when intervention is prudent, and questioning when the recommended interventions are just the routine that your care provider uses to ensure quality control amongst multiple women.
If we are well informed about the appropriate use of intervention then we have a greater chance of avoiding unnecessary interventions, and accepting necessary ones should the need present.
The idea that women who have birth plans are foolish, is outdated and paternalistic. A well informed woman with a birth plan may be upset that her birth vision did not eventuate, but she will also be prepared for it. That’s WHY she makes a plan.
A solid birth plan should consist of several separate parts:
- A full length plan including WHY you want things the way you do. This is just for you and your birth support team. Include in this part of the plan all the things to ease comfort (dim lighting, waterbirth, music, etc) and all the reasons that you would consent to interventions.
- A short sweet plan to show staff at the hospital (If you’re having a homebirth this should be a transfer plan) This has no unnecessary words because you want staff to remember it, and you understand that they are busy with multiple women.
- A caesarean plan. Include in this things like delayed cord clamping, your preference for vaccines, skin to skin in recovery – health permitting, the type of anaesthesia you prefer, and the method of stitching you want, who will go with the baby to NICU and who will stay with you etc.
By all means have a vision of how you want your birth to go, it would probably be hard not to, but having a solid plan means you’re more likely to achieve your birth vision because the plan helps keep you on track as much as your health allows. It also means that you are better prepared for it if things go off course. Many women visualise their births during pregnancy, and that’s a great thing to do, but it can not replace the importance of a solid plan that takes into consideration as many possible circumstances as you can imagine.