Birth Plans - Perspectives From a Midwife and Childbirth Educator
Birth plans are a frequently discussed topic in childbirth education classes, in birthing spaces, and even in day-to-day conversations. As your belly expands, so does the curiosity of those around you, and it is not always welcome. That being said, the topic feels nearly unavoidable. So, let’s talk about it.
It’s hard to talk about this in a way that is completely unbiased because, well, we all have our biases and individual anecdotal experiences. My background is as a licensed midwife attending home births and freestanding birth center births. I am also a childbirth educator and initially trained with Lamaze, although that’s not really the model I use to teach childbirth education classes anymore.
First, what’s in a birth plan? This is a non-exhaustive list of topics often in the birth plan: ambiance, support people, pain management, labor and birth positions, fetal monitoring options, interventions such as AROM (Artificial Rupture of Membranes AKA breaking your water) and episiotomy, methods of pushing, who is catching the baby, umbilical cord clamping, newborn medications and procedures, lactation, and more.
Here’s my nuanced take: Sometimes birth plans set people up for failure. There’s a lot to be said about overplanning, underpreparing, and the grief that comes with an unfulfilled plan.
At the same time, I hold true that sometimes birth plans are empowering and result in a very positive experience. That often goes hand in hand with other types of preparation for birth, but not always.
The first half of this blog post with discuss my gripes with birth plans, and pitfalls I have seen over the years. The second half will discuss recommendations for improvement and resources. And, remember, this is my opinion based on my anecdotal experience. It is okay if your experience differs. Informed and empowered choice is most important, above all. My hope is that this information will help you decide what is best for you and your family. My hope is that you will feel more educated and empowered after reading this.
Birth Plans - My Complaints & Cautions
Sometimes birth plans lure people into a false sense of preparation.
It can tempt people to create unrealistic, inflexible expectations.
There can be grief when the plan doesn’t work out as envisioned.
Some providers won’t read them.
Let’s break this down one by one.
Sometimes birth plans lure people into a false sense of preparation.
There are two ways I have seen this play out. The first scenario is that someone, often a first time birth-giver, chooses to forgo a childbirth education class and only makes a birth plan. There are many free templates and examples online that people will borrow to make their own birth plan. One of the issues with this is that people can select preferences that they are uninformed about. This can result in dissatisfaction with their birth experience. Sharing your birth plan with your provider in advance allows them to ask questions and clarify the birth plan that you’ve created.
Creating a birth plan is not the same thing as preparing for labor. The birth plan is meant to be a guide, not a rulebook. Labor is an endurance game, especially if you are birthing unmedicated. It’s not just about knowing what you want, it’s about knowing how to get there. The second scenario that I’ve encountered is someone who truly believes that their birth plan and support people are all they need. These folks tend to be quite confident, and I’ve found that they also tend to be enmeshed in certain social media communities that promote only needing an innate trust in your body to give birth. Trust your body, but also please understand that labor and birth are unpredictable and external forces cannot always control the outcome.
It can tempt people to create unrealistic, inflexible expectations.
It is wonderful to know what you want, and to be assertive about it! It is not wonderful to be inflexible. Maybe you’ve really done their research through a childbirth education class, or other reputable resources. That being said, there can be a trap here, too. Overattachment to a dreamy birth can have emotional and medical consequences.
Delaying necessary medical care because it contradicts the birth plan can be harmful in the short or long term. The stress of deciding whether or not to alter the birth plan is not conducive to the labor process. Sometimes, decisions have to be made quickly. When the birther and their support team are set in achieving the birth plan as written, this can hinder urgent decision making. Changing the birth plan can result in grief that lasts for weeks, months, or years. More on that below.
There can be grief when the plan doesn’t work out as envisioned.
This is by far the most common issue I see with birth plans, and my biggest gripe with them. Having a baby is a unique, special time in someone’s life. There is often a lot of anticipation, nerves, and desires. Some people’s birth plan is simply “healthy parent, healthy baby”. Other’s is pages of wants and needs. Know what you want. Be firm in it. But, please have an open mind. Find a provider that you trust, so if they must guide you away from your original birth plan, you know it was a shared decision made in the best interest of you and your baby.
When heaps of emotions have been piled onto the birth plan, grief is likely to ensue. All the states I’ve worked as a midwife in have caps at 42 weeks gestation, meaning once you hit that point you must transfer care to the hospital. You have the right to decline a hospital induction, but past 42 weeks licensed midwives cannot deliver your baby. This is absolutely heartbreaking when it happens. There have been many times where we did everything possible to put someone into labor: membrane sweeps, herbs, tinctures, foley balloons, nipple stimulation, castor oil, and more! Yet, still, things did not kick into gear. Changing birth locations is a big deal. Grief is normal. That being said, a rigid birth plan doesn’t help. I have worked with clients who were adamant about not transferring to the hospital. When they had to for one reason or another, they had a very hard time coping. Often these folks had not considered how a hospital birth plan would look. They would continue fantasizing about an out of hospital birth, about getting back to their original birth plan.
I have attended postpartum visits where women would cry about their grief in change of plans. I attended a birth of a fourth time mother whose plan was to have the same birth she’d had for her last 3: smooth, quick, and at a birth center. She anticipated her labor to be 4 hours. Once we had reached nearly double that time she began to panic. A vaginal exam determined that the baby was ‘face presentation’ (i.e. head tilted all the way back so their face is the presenting part felt during an exam). It was going to take a lot of work to move this kiddo. She was too overwhelmed and ended up transferring to the hospital for a cesarean birth. Her grief was immense, although she was very happy to have her baby in her arms.
I have attended births of women who were physically strong, who had stamina for physical activity, and who did not see the need to intentionally prepare for labor. The endurance and stamina of physical activity is different than the endurance and preparation required for labor. Once labor started, they struggled. Almost every one ended in a hospital transfer for pain relief. They grieved their experience, and sometimes placed blame upon another person for the outcome.
As a final example, that could apply to any person giving birth, I have seen the grief of necessary medical care infringing upon the golden hour. The golden hour is the first hour of a newborn’s life. The family is bonding, the baby is getting skin to skin and starting to nurse, and it’s peaceful. It’s very good for parent-child attachment, among other things. However, sometimes when babies are born they struggle to “come around”. This often means they need medical intervention and support. What does that look like? Often, it means clamping and cutting the cord instantly, it means taking baby away from the parent to the warmer, it can even result in a longer separation if baby has to go to the NICU. This situation is already painful, even when the baby quickly makes it back to the parent’s arms. If delayed cord clamping, skin to skin, and rooming with the parents was on the birth plan, there can be additional grief that those things went out the window.
Grief is hard. It’s normal. It doesn’t need to be exacerbated by rigid birth plans, though. Resources will be linked at the end of this post. You are not alone.
Some providers won’t read them.
I have seen this primarily with hospital-based providers who are busy and/or whose personal philosophy doesn’t align with individualized care. This is particularly a problem if the plan is overly wordy, or more than one page. I will link some free and cheap templates below. If your care provider is busy and seems rushed, I highly recommend a short birth plan. There are ones that are picture based that work well for these scenarios.
I have seen many folks be immensely disappointed, and sometimes angry, that their provider seems to be ignoring their wishes. Ultimately, there is only so much you can do about that, but it’s still something to be aware of. Try to have your provider review it before birth. If there is a whiteboard in your hospital delivery room, write your top priority preferences on it. You can always request a patient advocate, any time of day if you need additional support. The hospital should always have one on staff, or you can hire an independent advocate that doesn’t work for the hospital (like me!).
Birth Preferences - A Better Alternative
Why Birth Preferences over Birth Plan? Does that slight change in language really matter? Yes, it absolutely does.
Think about it like this. An architect drafts a building plan. She doesn’t prefer it is done this way. She plans it this way, because if built incorrectly the building could be faulty, resulting in negative consequences. It has to be this way.
Now, the architect is going to make another building plan, but needs to check-in on available materials first. She would prefer Douglas Fir, but tailors her plan to allow for another wood type to take it’s place. Having an open mind about the materials allows her to flex and keep going without stress. A substitute would be acceptable, even if not ideal.
Language is everything. When someone plans something for months and it goes awry it is stress inducing. When they have preferences, they can be more flexible.
There is a game I like to play in my childbirth education classes because I feel it really hammers this concept home. Essentially, every pregnant person + their support person gets a small stack of cards with different birth preferences. They are instructed to choose the most important ones to them. Slowly, they must eliminate a preference until there are two left. This game is challenging for folks. It shows them that flexibility is important. Imagine feeling that stress in labor! I find that people are better prepared when confronted with the reality that birth can be unpredictable and requires flexibility.
Preparing for Labor and Birth - A Realistic Approach
I’ve harped a lot on the pitfalls of birth plans, and the idea of a language shift to birth preferences. Now, I want to talk about what preparing for labor and birth actually looks like. Below are some suggestions of places to start.
Grounding exercises (breathwork, hypnobirthing, etc.)
Endurance exercises to tolerate discomfort in labor (hands in ice water, etc.)
Physical movement (Spinning Babies, squats, yoga ball, walking, swimming, etc.)
Hire a doula! They’ll typically do a couple of prenatal and postpartum visits with you to help with birth prep and processing.
Take a childbirth education class! A well-trained instructor can make a huge difference. You should walk away feeling empowered and informed. It’s also a great bonding opportunity with your partner.
Bring in your birth support team! Teach them how to best comfort you. Do you like physical touch? Words of affirmation? Your comfort preferences may change in labor but they may not. Additionally, have you or your doula teach them how to do hip squeezes, rebozo shifting, etc. Teach them now so they can help you!
Practice flexibility. Consider alternative scenarios and how you can be best supported if plans change and your preferences have to go out the window.
Watch a variety of birth videos. Get comfortable with it and ensure your support team have watched some birth videos, too.
Make your list of birth preferences. Share it with your care team. Ask questions. Be informed!
As you gain all this information, trust yourself and your body! Fear can hinder the birth process. Remember your preferences, remember your flexibility, but also remember all the wisdom and skills you have learned along the way. You got this!
Resources
Birth Preferences Templates:
Preparing for Birth: