The Truth About Birth Plans

Recently on Twitter, an Australian anesthetist openly mocked women’s birth plans.

The anesthetist tweeted about an article that claimed women with birth plans were unsatisfied with their experience, and that the c-section rate remained the same.

She was joined by other doctors, who also expressed their disdain of women with birth plans.

One medical professional commented: “Isn’t there that joke – the length of the birth plan directly correlates with the length of the cesarean scar?” The anesthetist responded, “I’ll be using that one!”

The backlash has been considerable. Many have condemned the extremely unprofessional comments and the blatant lack of respect for women’s birthrights. There have also been calls for complaints to be made to the Australian Medical Board and the Australian Health Practitioner Regulation Agency.

The Truth About Birth Plans

Birth plans came into vogue over thirty years ago. Women today rely on them as a means of outlining their hopes for the birth of their babies.

Unfortunately, many maternity providers tend to view birth plans as a pathway to disappointment.

Fewer than 2% of women have intervention-free births, and about 30% of women describe birth as traumatic. Clearly, there’s a need to understand why women make birth plans, and how useful they really are.

What’s A Birth Plan?

It’s pretty simple. A birth plan is a way of communicating how a woman wants to give birth to her baby, and her expectations about her treatment during labor and birth.

A birth plan is designed to help a woman work through her options. Ideally, it provides her with the opportunity to become informed and prepared for her labor, and to discuss her expectations with her care provider.

Some birth plans are very simple; others can be quite detailed, covering all contingencies and possible deviations.

Why Have A Birth Plan?

If you ask experienced mamas whether it’s worth having a birth plan, you might get different answers.

Some women will say a birth plan is absolutely essential. Others will tell you it’s great to have an idea of what you want, but you shouldn’t be disappointed if it doesn’t work out. And then there’s the ‘go with the flow’ crowd, who advocate for throwing the birth plan in the bin and winging your way through birth.

In my experience as a birth educator and doula, these answers depend a great deal on whether a woman was treated as the key decision-maker during her pregnancy and birth care.

Birth plans should be the end result of a woman’s journey during pregnancy when she has decided what sort of birth she wants, where it will take place, and who will facilitate the birth.

Healthy women who have a normal pregnancy deserve to have a normal, uncomplicated birth. For most women, that’s the plan.

Unfortunately, the decisions about where and with whom the birth will take place to have a far larger impact than many women realize.

Birth plans are written at the end of pregnancy when the undermining of a woman’s wishes and hopes is almost complete.

Birth plans then become a desperate ‘hope to achieve’ plan.

Who And Where Affects How

Care providers might encourage birth plans, and a woman might genuinely believe her midwife or doctor will carefully read and accept everything on her list.

Afterward, however, when things don’t work out the way she had hoped, and the new mother is bitterly disappointed her birth wasn’t exactly as she’d planned, it’s often the birth plan that gets the blame.

Birth plans reflect a woman’s desire for what will happen at the birth, but her preferences and wishes might not align with those of her care provider or with the birth setting. That creates a conflict of interest and, in most cases, the woman doesn’t get to decide what’s best for her.

If there is an unplanned c-section, or other interventions, the woman is led to believe her birth plan let her down. This implies she failed at giving birth.

How you give birth will be determined largely by the birth setting and care provider you choose.

Women who choose midwifery-led models of care – such as birth centers or birth at home – are less likely to experience interventions and are the most likely to feel positive about their birth experience.

Private hospitals have the highest rates of interventions and c-sections in Australia. Obstetricians are specialists trained in high-risk pregnancy and surgery.

Public hospitals have lower rates of interventions and c-sections. However, women have fewer opportunities to develop a relationship with a care provider, and hospital policies take precedence over women’s choices.

Hospital settings aren’t conducive environments for normal, undisturbed labor. They’re staffed with people who don’t know the birthing women, and they are under pressure for risk assessment at all times. None of these factors bodes well for having any of your birth preferences met.

Choosing the setting and care provider that reflects your desire for a normal, intervention-free birth will give you the best chance of achieving it.

Do Care Providers Like Birth Plans?

The first response to this should be ‘It doesn’t matter’.

But unfortunately, we know the way care providers respond to birth plans really does make a difference.

Dig deep enough and you will start to see the disdain many care providers have for women who attempt to ‘own’ their birth experience.

Birth plans are banned in some hospitals, and care providers either dismiss them openly, or quietly disregard them.

Or as we’ve seen recently, they are openly mocked by health professionals on social media.

The outspoken anesthetist further commented, “How about we all just hope for a healthy mum and healthy baby? Less focus on the experience, more focus on the outcome?” This attitude demonstrates she has fallen into the common belief: only a healthy baby and mother matter when it comes to birth.

This approach to maternity care causes the greatest number of problems. It dismisses an important concept: how a woman feels about her birth experience has very real consequences for her long-term health and wellbeing.

On the day, care providers work towards the best possible physical outcome. But the time preceding birth also matters, and it has the greatest impact on how a mother will feel about the actual experience.

When care providers support and respect a woman’s right to determine what her birth experience will be like, the results speak for themselves.

Women who might end up with a different birth outcome can still feel positive about the decision process. They will feel supported by their care providers, rather than coerced into making choices they hadn’t been informed about.

The lack of professionalism, respect, and understanding of women’s birth rights this medical professional and her colleagues have shown has caused widespread outrage.

Probably the most telling point that comes from this open mockery of birth plans is that it exposes the truth of how attitude translates into care.

Care providers who are dismissive of birth plans and the women who make them won’t provide the same level of care as those health providers who genuinely support women in achieving their birth plans.

It also starkly highlights the irony of telling women hospital is the ‘safest’ place to give birth.

In fact, they need to be heavily armed with knowledge, and fully prepared to advocate for every step of the process. And then, of course, they might be mocked for wanting to have a positive birth.

They will also be highly unlikely to achieve a normal birth. In a hospital setting, estimates suggest only 2% of women actually have an intervention-free birth.

Are Birth Plans Necessary?

A birth plan can help you become informed and prepared, so you’re aware of your choices and can advocate for yourself if the option arises during labor.

But none of this will help if you don’t do the necessary work beforehand. It’s very difficult to make informed decisions during labor if you don’t have the support and knowledge required.

Making a birth plan should be the first thing you do after finding out you’re pregnant. It’s a way to map out what kind of birth you want and naturally leads you to become informed about birth.

With this knowledge, you’re empowered to make decisions about the person, and the place, most likely to support you to achieve a positive birth.

A birth plan can also be an evaluation tool to explore what options are available to you if things change.

Complications could develop, and make your pregnancy high risk. You might have planned a natural birth at home, for example, but you could develop pre-eclampsia and need to be induced.

If you have the tools to discuss the risks and benefits of your care with your care provider, it will help you make the best decisions for you and your baby.

Should We Change The Name?

Some health professionals, doulas, and birth educators advise women to use the term ‘birth preferences/wishes’. It seems wise to avoid using the word ‘plan’, which can imply you’re too rigid and focused on the end result, rather than having a safe birth and a healthy baby.

But changing the term has the potential to imply a woman isn’t really fussed about how her birth works out. Neither does it acknowledge the major problem about birth plans: the one place they are most needed is the same place they’re least likely to be listened to.

Care providers tell women birth is unpredictable. This implies uncertainty and danger in not knowing exactly what’s going to happen next.

The truth is, the labor process has been overrun by medical expectations of things that might go wrong, and where the blame will be laid if potential disasters actually happen. This approach completely disregards the established concept that every birth is individual.

In the optimal environment, such as the home, most women will give birth successfully – with or without a birth plan. That is the beauty of being informed and supported by care providers who are facilitators of normal birth. During pregnancy, you prepare for birth as it should be.

There is no need to plan for environmental stressors and hostile staff that are present in a hospital setting. You shouldn’t have to prepare to battle your way through negotiations about your own care. You shouldn’t have to advocate for care that helps you give birth better.

In Milli Hills’ article ‘Stop Telling Women That Birth Plans Are Pointless’ (30 Jan 2015, Best Daily), she shares a stunning quote from Cristen Pascucci, Vice-President of Improving Birth:

“Why do we use language that says pregnant women are expected to defer to hospitals, but hospitals aren’t expected to defer to pregnant women – even though pregnant women hold the legal and moral authority over their own childbirths? Maybe we should start calling hospital policies ‘Hospital Preferences’, and our birth plans our ‘Birth Policies’ “.

This sums up why birth plans need to be an integral part of the collaboration between a woman and her care provider. It puts the focus back on the woman as the key decision-maker, and offers care providers the opportunity to provide genuine women-centered care.

Perhaps when care providers stop treating women’s birthrights as an inconvenience and a hassle, the need for birth plans will disappear.

Recommended Reading:

• Birth Trauma  – What Is It And Where Can I Get Support?
• Undisturbed Labour – What Is It And Why Aim For One?