People are usually in one of two minds about writing a birth plan, or as some prefer to call it, their ‘birth intentions’ or ‘birth preferences’.
Some people think a birth plan is an important part of pre-birth preparation.
Others think it’s a complete waste of time.
However, I think they are very useful and important, but first, i’ll explain why some people think its a waste of time.
Birth Plan – Is It All In The Name?
The two words, birth and plan, were always going to cause debate from the start.
Who could possibly PLAN the way their birth is going to unfold?
Birth doesn’t always go to ‘plan’, so some people think the whole exercise is a waste of time. I’ve even heard feedback from many midwives and obstetricians who think they are too.
On the other hand, there are others who think having a ‘birth plan’, with that very name, is an important part of birthing women reclaiming power, giving them the right to have choice and the birth they hope for. They even feel that the words ‘intentions’ or ‘preferences’ are not strong enough words to convey that power and choice they believe all should have.
Unfortunately, often these birth plans have come from internet sites which are inflexible and some have options, drug names or terms which are not even applicable to Australia. These forms of birth plans have drop down menus, click or tick boxes which put all the things you chose into a template with your own name on it. Very simple and a clever idea at first thought, but also very impersonal, no room for writing your own extra comments or ideas – so they are not ideal.
These sorts of plans might give you an idea of what to put as your birth intentions, but I do strongly encourage women to research the full extent of their options and what they truly want for birth. An important part of this is to also know reasons why they want what they do (e.g. I don’t want an epidural because I want an active labour, which is proven to shorten labour and it’s less painful than being on my back plus the benefits for my baby).
Get yourself informed and empowered and write your own – it’s easier than you think and you don’t need a medical degree! It might seem like a difficult thing to do at first, not knowing what you want, but once you have read the right books and consulted all the right sources, then decided what you would like, it’s much easier.
If you aren’t sure which books to read, check out my top, recommended birth books, which only contains books I know will inspire, empower and inform you. You can read any of those books with confidence. A great book specific to birth plans is Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth by the fabulous Dr. Marsden Wagner.
Why Birth Plans Are Great!
There are so many reasons to be writing out your birth preferences.
#1: You Get To Explore How You Feel About Birth
And not only that, but you get to research the many options you have available to you for the birth.
Ideally you have already done some research and read empowering and informative books so you know the importance of your choices. If you haven’t yet, it’s a great time to start, no matter how pregnant you might be. Just reading books like ‘Up The Duff’ or ‘What to Expect When You Are Expecting,’ is nowhere near enough, yet so many women seem to choose these two books. They might be enjoyable reading for some, but they will not adequately prepare you for birth.
#2: Your Partner / Support Person Will Get To Know What You Want Too
It’s all well and good chatting to everyone about what you want, but having it on paper for them to look over and remind themselves is a great idea. Sometimes the whole adrenaline rush of labour can even send a partner with the very best of memories out the window, and you can easily forget what you have learnt or been asked to remember. Just saying to your partner, ‘Look, all you need to know is I don’t want an epidural!,’ can lead to stress later when he/she is confronted with having to help make a decision about something unrelated, when it’s something you haven’t had time to discuss previously. Being put on the spot in labour can be frightening for them: having to make a decision while mum-to-be is having contractions and you just don’t know what to say! So this will help your support people to help you.
#3: Because You Have Choice and You Hold The Keys Of Consent
Many women believe they wont have much of a say as to how things will go in labour. The fact is, medical procedures legally need your consent. Doctors or midwives can’t do anything you refuse or say no to (they could get sued) — you have a right to say no. This is your body, your baby and if you have done your reading, you will have more power, because information is power.
From doing your research, you will uncover things no-one else is likely to tell you. For example, electronic fetal monitoring machines can have a very high inaccuracy rate. When those machines show false positive results, you may end up with a c-section. Another example is women being told about the risk of uterine rupture (which is actually very low at less than 1%) when she has her hopes set on a VBAC (vaginal birth after c-section). But it’s rarely mentioned if your care provider wants to book you in for an induction of labour, which also carries a risk of rupture.
Having your birth plan ready to hand to your care provider reminds them that you have choice in all of this, and their role is to help you achieve it as best possible. You are the reason they are in business – you do not need to be grateful simply for the fact they are there and educated. So don’t think you must be a good patient and comply with all demands or suggestions. Don’t feel bad asking questions about what they are asking you to do. Always reaffirm what you want from your birth experience until you are content with the answer. If they can’t be patient and supportive of you now, how will they behave during labour? It’s fine to get a second opinion or change your care at any time if you feel unsupported. Remember – you will remember this experience forever, and perhaps more importantly, how you felt at the time.
See our must read article on consent during birth and what to do if your care provider is not listening.
#4: Well Written Plans Cover All Scenarios
How can someone say to you, “You can’t PLAN your birth!” when you have covered your preferences for normal birth, pain relief, c-section and others?
If all scenarios are covered, you can simply reply, “My care provider will know what I want to happen in any given situation as I have researched and noted my preferences.”
What Do Midwives Think of Birth Preferences?
You might wonder what midwives think of birth plans, since they are the care providers who will attend to you for most of your labour when birthing in hospital.
I asked some midwives what they thought of the birth plans they are seeing of late. Here are some replies:
“I wrote a ‘birth plan’ for both of my own births. I had three plans – the ‘ideal birth’ the ‘if i need to transfer/intervention birth’ and the ‘c-section birth.’ In each I put what my preferences were, i.e. if I had an epidural I did not want a routine IDC. Also my wishes if i had a caesarean were that the drape be dropped so that we could watch the baby being born and discover the sex ourselves. I found it very useful to present to the birth centre and my private obstetrician (who would be my doctor if I transfered to the main hospital).
For me they both went the ‘ideal birth’ way. As a midwife (working in a private hospital) I find that the birth plans that our women come through with are often difficult for the women to follow as they seem to not prepare themselves physically (i.e. yoga etc.) or mentally for what labour is all about. They also expect that their partner will always be able to support this ‘plan’. I think that following through with the birth plan is difficult without an extra support person (doula etc).”
“Some of the ones that I have seen filtering through lately have looked as though they were more likely obtained off an American website rather than ideas that the parents have truly thought of and decided upon for their birth and infant. I wonder if at times the women truly know what they are saying yes and no to.
I would like to see more birth intentions written in dot form with a request and then possibly an explanation. The explanation not to explain themselves but more so to demonstrate to the midwife or other health professional that they are making an informed choice. Also they are getting a little long lately – one page is best especially when they come into hospital in established labour so that you can quickly read it and get on with trying to implement and assist them with their preferences and intentions.”
“I think writing a birth plan is a great way for a woman to think of her choices and force her to research and consider different options. Even if the birth plan stayed in her bag she has already gained so much by writing it. I have been planning to set up one of those interactive birth plans on internet with lots of links for more information on each topic. I see it as a tool to help women learn of their options.”
“I like birth plans for a few reasons:
#1. they show the women that they do have a choice in things … alot of women still assume they have to do whatever they’re told.
#2. my experience is that if the woman states what she wants verbally it is easier for others to ignore it, or it gets lost in change of staff whereas if it’s written it’s given more respect.
#3. If a copy of the birth plan is in the woman’s notes prior to birth and the staff are able to read it before the woman comes in, sometimes it results in the most appropriate midwife being able to care for that woman. That is, midwives who aren’t comfortable with the birth plan asking for someone else to care for the woman. (I know this doesn’t reflect well on midwives as far as giving woman centred care, but the woman benefits if she ends up with a different midwife who will respect her wishes).”
Start With A Great Introduction
Some prefer to use the terms ‘birth intentions’ or ‘birth preferences’ as it sounds much more gentle and flexible. It doesn’t sound like a rigid blueprint for exactly what you want. It’s about what you prefer, it’s flexible and takes all situations into account.
So, now you have a great title, that’s the first bit done! Next comes the way you introduce your birth preferences, which can make a huge difference in how the rest of it is received and accepted.
One of the women I supported wrote her birth preferences and it was absolutely brilliant, so I now offer this as a template to all the other women I support. It’s received so well by midwives, obstetricians and women themselves. It introduces the birth preferences with:
“We’re hoping for a natural childbirth without unnecessary intervention or the use of drugs. We have asked a Birth Attendant (doula) to be present at the birth to help us work towards this. We appreciate your support with our birth preferences.
This plan represents our preferences; however we recognise that in the event of unforeseen difficulties it may need to be re-negotiated. In this eventuality please discuss all procedure options with us and our Birth Attendant.”
You can see that those two simple paragraphs are going to be much more helpful and will ensure that your birth preferences are taken seriously – because it’s not unreasonable and inflexible.
At one birth I attended, I handed a copy of my client’s birth preferences to the midwife, as I wasn’t sure they had a copy. She mumbled something about things not always going to plan, so I explained it wasn’t a birth plan, these were the woman’s, ‘birth preferences’. Immediately it sparked her interest and she even commented on what a good idea it was. So I asked her to ‘pass it on’ about birth preferences!
6 Important Tips When Writing Your Own Birth Plan
Here are 6 of the most important tips to remember when writing your own birth plan:
#1: Don’t Forget The Three S’s!
Keep it short, sharp and shiny! Not many midwives or doctors have the time or care to read through a ten page document, so keep it one to two pages long at most, with your preferences in point form.
#2: Keep It Relevant
Sometimes I see birth plans written out which contain a great deal of things that the hospital doesn’t really deal with or need to know in a plan, which can create the bulk in your birth preferences. There are things you can leave out which you can rely on your support person for, for example all your preferences for pre-labour or early labour when you will be at home, or environmental preferences, like music and massage. Your support people can organise these as long as they are aware that’s what you’d like them to do.
#3: Emphasise Your Needs For Respect, Privacy And For All Procedures To Be Explained In Detail
One big point to consider is asking for the privacy to discuss any decisions needing to be made (for example if the doctor wants to put a drip up, monitoring etc) with your partner and/or any support people, doula etc. You can feel under so much pressure and not think it through properly if you have to make an instant decision with doctors or midwives watching and waiting. White coat syndrome can creep in and you don’t want to regret any decisions.
I’ve seen on several occasions now, uncalled for pressure being inflicted upon women: doctor after doctor coming in (or superiors being called in), all of them standing over women while they try to force an answer. So politely ask for 5 minutes privacy to make a decision and stand your ground, this behaviour (note: bullying) is not acceptable. Something to bear in mind is that it’s probably not a real emergency if they are standing there having a discussion with you – they’d be racing around doing something, wouldn’t they?! Or they would tell you, ’I’m sorry but we really don’t think this can wait 5 more minutes’. So you’ll get an idea how urgent their suggestion is just by saying that one line. You are a human giving birth to another – you have rights, so you should be treated with the respect and dignity that you deserve.
A great line from the brilliant documentary, The Business of Being Born, went something like this, (referring to an intervention suggestions): “A doctor could be standing there thinking he is offering a woman an option, but a woman sees an expert there telling her his expert opinion.” So it’s important to make sure you are clear on what’s going on. Also going against you is the fact that many doctors are trained in medical solutions to birth, whereas midwives and doulas are trained in normal/natural solutions which can be very helpful in the trickiest of situations. By no means am i saying ignore medical opinions here, use common sense. Most women prefer to try the least invasive option/procedure first, then work their way up if needed.
#4: Research Your Choices
You are more likely to stick to your birth plan if you know why you want what you do, as well as being able to show understanding and commitment to your choices.
As an example, your options for monitoring. So, you might be thinking, ‘Boring! Big deal’. Or, ‘Bring on all the monitoring possible, I want a safe baby!’ Intermittent doppler monitoring is standard care during labour, however some Obstetricians and/or hospitals prefer to use more restrictive and invasive procedures of monitoring which can affect the way you plan to labour and give birth. Continuous CTG monitoring which involves you being stuck in one position, strapped to a machine and usually on the bed, can be detrimental to the progress of labour – when you aren’t moving around, it’s harder for the baby to move into the right position too, not to mention more painful for you. The Cochrane Library, a regularly updated collection of evidence-based medicine databases, concludes where continuous CTG was used, there was:
“… no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography (CTG) was associated with an increase in caesarean sections and instrumental vaginal births. The real challenge is how best to convey this uncertainty to women to enable them to make an informed choice without compromising the normality of labour.”
“Data for subgroups of low-risk, high-risk, pre-term pregnancies and high quality trials were consistent with overall results. Access to fetal blood sampling did not appear to influence the difference in neonatal seizures nor any other pre-specified outcome.”
You can read the full report here.
So being armed with this sort of information can really help your plans for birth, as you will know a bit more about the facts, feel more confident and can respond or make a decision accordingly.
#5: Read Other’s Birth Preferences For Inspiration
If you are having trouble writing your Birth Intentions, you can download a copy I offer to all of my Birth Support clients; so far all have used it and edited it a little to their liking. Edit it as much as you feel necessary – this is your birth, not someone else’s.
Download BellyBelly’s birth plan template in Word format for editing, here: BellyBelly’s Birth Plan Template. (May not be distributed without permission).
#6: Surround Yourself With The Right People
Its very important to surround yourself with the people who will have your best interests and birth intentions at heart.
It’s no good having a very low or no intervention birth plan when you have made choices which are not in line with that, for example, giving birth at a private hospital or an obstetrician with a high intervention rate. The lowest rates of intervention happens at home with private midwives and with midwifery-led care, and the highest rates of intervention happen in private hospitals with private obstetricians. However this is not to say that you can’t have a natural birth in a hospital – you just need to prepare yourself and your support team very well and be prepared to firmly stand your ground.
© Copyright 2006 by Kelly Winder, All Rights Reserved. Article may not be copied in part or full without written permission.