The trials and tribulations of the Birth Plan

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How to write a meaningful birth plan.

The birth plan has become an integral part of our modern birth culture. Most women, particular women wishing for a natural birth, will document what they want and what they don’t want for their labour and birth. But is it beneficial to do this exercise (or might we even call it ritual?) and do medical caregivers read them and take them seriously? Or are women just setting themselves up for failure by thinking they can control their birth in this manner?

The practice of encouraging parents to write birth plans began with the positive intention of getting parents to take a more active role in their labour and birth, learning about their hospitals routines (mostly with the intentions of avoiding them) and creating a dialogue with doctors and midwives about their practices. All very positive stuff.

But these days it seems that writing a birth plan has taken on new meaning. Mostly, I am finding that women write a very defensive birth plan, stating all the things they don’t want. And then if things take a detour & the birth doesn’t go according to plan, many feel like failures and/or betrayed by caregivers, by partners and even by themselves. This could be known as the ‘birth plan trap’.

Ideally we wouldn’t need to write birth plans. If pregnant women had a real choice of birth place, as in hospitals with different philosophies, birth centers and homebirth, they would be able to choose a place that suited their values and situation. This would already make the need for a birth plan much smaller. And then, if women had access to continuity of care, to choosing her caregiver, so she felt confident that she was cared for in the best possible manner according to her own values, and was able to develop trust in that relationship during pregnancy, she might then be able to let go of control and just focus on her inner journey. Then the birth plan would be, pretty much, completely unnecessary.

But in today’s Australian birth culture, women don’t have this kind of choice. This means that they possibly go into birth without really agreeing with the philosophies of the birth place and caregiver, and they therefore feel like the need to be very assertive about their care.

After much thought, debate and discussion, also with myself, about birth plans and their benefits and traps, I have come to a place where I find the birth plan, if written in a particular manner, can be very beneficial, and that it is possible to mostly avoid the birth plan trap if a few things are carefully considered.

I now encourage women to write a birth plan, but always coming from the intention of helping her caregiver, whom she most likely won’t know, to understand how she, the birthing woman, feels supported, who she is and what is important to her. It is very important not to be too outcome focused, as of course birth can’t be controlled and nobody can know if an epidural might be needed, even if this is not what you wanted beforehand. Whenever we have to ‘let go’ of a sentence stating something we ‘don’t want’, it is a great opportunity to dig deeper and explore how this particular intervention or issue is a problem for us and how we might cope if this particular situation occurred.

It is nice for a midwife to know what a woman thinks about certain issues and how she feel supported. Plainly writing ‘I don’t want’ pain medication for instance, is unhelpful for partners and caregiver and birthing women themselves.  But writing that you are aware of all the medical pain relief options, and that you prefer them not to be offered, but will ask if you come to a point of needing them, can be very beneficial. It doesn’t mean that no one will offer them, but the chances are certainly higher. And you haven’t made an agreement with anyone, least of all yourself, that accepting pain relief is out of the question.

Another important point when writing a birth plan is to come to an understanding of how birth works, and therefore how intervention can lead to more intervention. If it is the epidural that is the big thing for you, then it is important to investigate when epidurals are mostly needed. This might lead to beneficial exploration and questioning on induction procedures and alternatives and research about overdue dates to minimise the possibilities of needing an epidural.

Again, rather than writing; “I don’t want to be induced”, and turning it into a positive statement like; “I am happy to let my baby come in its own time”, then there is still an option for choosing to be induced in an informed way without having ‘failed’, but still letting caregivers know that you are not one to choose induction without serious medical reasons.

Making decisions in labour and birth is very difficult. Some women go into labour with very little knowledge and very few tools to navigate our modern culture, and without questioning procedures and protocols at all. Others go into labour ready to fight and determined not to let anyone do anything or even come near them. Neither of these approaches are very beneficial for birth. Finding the balance, being present in the moment, asking lots of questions and then doing what is best for this situation and the moment is much gentler on you and more realistic too. You have to bear in mind how ridiculously difficult it is, if not impossible, to be rational when you are in labour land; in your “old” brain & doped by endorphins. This is why birth preparation is so important for partners, so they can be more ready to do the rational work to help make those decisions.

Understanding how the hospital works can be another excellent way to improve communication, partly on the day, but also in the language you choose to use in your birth plan. The rules and protocols applied in hospital (and during homebirths too) are a lot about responsibility and the avoiding the possibility of being sued. This means that hospitals and caregivers have to cover their backs first and foremost. And this creates worst case scenario caretaking at the best of times. If you are willing to sign and take on responsibility for decisions that goes against the stream, you might find staff very willing and accommodating and even exited.

And last but not least, I hear again and again about women, who were so set on a particular type of birth, that they didn’t look into less desirable options like cesarean birth for instance. Now, if a woman like this happens to need a cesarean she will probably feel very unprepared. Not looking at the difficult issues will not make them go away and not happen. It is great to use a cesarean birth plan to really be aware of your own feeling and thoughts, and then think through how a cesarean birth could be most positive for you.

Now after all that we obviously still have the problem of the birth plan being read and taken seriously. I find that if the birth plan is written in positive terms, in a manner of working together and respecting that you have chosen to birth under these peoples’ care (this doesn’t mean you have to do what they say, it is only in the attitude) then there is much more willingness to take a birth plan seriously. It is smart to make sure there is a copy in your file already, that you have one to hang up in the birth room, maybe even laminated, and preferably over the sink where caregivers wash their hands all the time. Have several copies in your bag to hand out to caregivers and shift-changing caregivers on the day as well.

So writing a birth plan takes a lot of thinking, exploring and investigating. I have only just touched on some of the issues here. There is exploring and investigating thing with your caregiver, but more importantly there is lots to be done within yourself. “How do I feel about this? How might this be a problem for me, if it happens?” It is a great tool to do your preparation with, if you allow yourself to dig deeper and touch the difficult issues it might bring up. Having some support doing this can make to process even more exiting.

But before we even get to the Birth Plan……..choose your birth place and caregivers wisely, shop around, talk to more obstetricians and midwives and hospitals, so your ‘external’ need for a birth plan is as small as possible.

 

 

Comments

  1. Karen Shlegeris

    21/03/2012

    Hi Pernille,
    What a wonderful article. It’s very clear and comprehensive and the information is so essential. You’re a beautiful writer and a lovely birth educator – go girl! Will I see you on Saturday at the Face of Birth movie? love Karenx

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Birth Connection is the online presence of Childbirth Educator, Advanced Doula, Birth Story Healer, & Birthing From Within mentor, Pernille Powell. Pernille is based on the Sunshine Coast in Queensland.

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