Every pregnancy guide tells you to write a birth plan. There are templates everywhere. But I’m here to tell you: Birth Plans are bunk. Sort of.
The idea behind birth plans is a good one. The birth plan is intended to communicate one’s wishes for birth to the doctor, midwife and nurses caring for the birthing person.
The birth plan would look be a list of options the labouring woman wanted to pursue for her birth and a selection of things that weren’t welcome. It might be in point form or it might be written out in paragraphs. Sometimes it is even organized into categories that follow the progress of labour from the start of dilation through to the birth of the baby and will likely also include instructions for the initial first few hours of the baby’s life.
This birth plan is always a document. It’s a physical thing that gets created, printed out and presented to the birth caregiver. Some pregnant people will bring it to a prenatal checkup as a way to gain the approval for their plan by their healthcare provider. Some pack it into their hospital supplies and offer it to nurses, residents and OBs caring for them in the moment.
Such plans are greeted with a mixture of reactions by medical professionals. They want to help their patients have great births but they know very well that little about birthing is predictable. And they are busy caring for multiple people which makes it hard to devote time to reading through birth plans which can sometimes take up multiple pages.
For the pregnant woman, however, the birth plan offers a chance to gather their thoughts, focus in on what their ideal birth would look like and set boundaries around choices. The problem happens when she starts to think of the birth plan as a contract.
Birth is unpredictable and no birth plan is ever able to be adhered to 100%. A woman cannot expect her OB to honour her birth plan of no IV medication when a woman develops a fever after her waters have been broken for many hours and she requires fluids and antibiotics in labour, for example. And noone can predict if and when things like that might happen.
A birth plan is a flawed communications tool. After being admitted to hospital, nurses, midwives and doctors will be asking for verbal consent every step of the way. And a woman needs to verbally affirm many choices before she finally goes home with her newborn baby. The reality is that even when the answers to various questions of care lie within the birth plan document, the maternity care staff will still have to get verbal consent for every choice during labour and birth.
The birth plan is, ultimately, false hope for the birth giver.
So, what is a pregnant person to do when facing a birth full of unknowns that will have dozens of choices and options to sort through, consider and then choose?
As a long time doula serving hundreds of families in and around Hamilton both at home and in hospital I suggest a birth doula to help you organise your ideas around birth planning and preferences. In your prenatal meetings the doula talks to you about what your ideal birth looks like and what choices you would like to make. They discuss what birth looks like in Hamilton, drawing on the doula’s experience with the protocols at area hospitals. They can create a basic list of guiding principles for your birth and postpartum. Finally they discuss how to best communicate that to the client’s healthcare team.
Our doulas works with you to help you feel confident in your choices but also understand when those choices may need to be flexible enough to adapt to the changing path of birth. Together you will explore how to gather the information needed to make decisions during labour, negotiate options, and advocate for yourself in the birth room with confidence.
In the end, we’re not saying don’t write a birth plan. We’re saying that plans can fall apart so be flexible. Know what you’d ideally like and what you’d ideally like to avoid. Focus on birth preferences. Make sure everyone on your birth team knows your preferences by telling them in your own words what your birth preferences are.