People are usually in one of two minds about writing a ‘birth plan’, which I prefer to call, ‘birth intentions’ or ‘birth preferences’. Some think it’s an important part of pre-birth preparation and others think it’s a complete waste of time. Personally I think they are very useful and important, but first, I’ll explain why some people think its a waste of time.
It’s All In The Name?
The two words ‘Birth Plan’ were always going to cause debate from the start. Who out there can PLAN the way their birth is going to go? 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 forms of birth 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, the BellyBelly Online Store ONLY has books that we know will inspire, empower and inform you, so you can read any of those books with confidence. A great book specific to birth plans, is Creating Your Birth Plan by Dr. Marsden Wagner.
Why Birth Plans Are Great!
There are so many reasons to be writing out your birth intentions.
1. You get to explore how you feel about birth and which of the many options you would like 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 will not tell you the things you really need to know.
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 POWER.
Most women think that they wont have any say in how things will go in labour. The fact is, medical procedures ARE optional, they can’t do anything to you that you don’t want (they could get sued!) and 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 reading and research, you will uncover things no-one else will tell you, for example, machines that monitor you in labour can have up to a 50% inaccuracy rate, can show false positives and make it more likely you will have a caesarean with continuous monitoring. Having your birth intentions to hand to a midwife or obstetrician reminds them that you have choice in all of this, and their role is to help you achieve that. You are the reason they are in business – you do not need to ‘be grateful’ simply for the fact that they are there and educated so you should ‘behave’ or comply. 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.
4. Well written birth intentions cover all scenarios.
How can someone then say to you, ‘You can’t PLAN your birth!’ when you have covered your preferences for normal birth, pain relief, caesarean etc. If all scenarios are covered, you can simply reply, ‘My carer 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 Plans?
I asked some midwives what they thought of birth plans. 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 transferred 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… a lot 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).”
A Great Introduction
As I mentioned above, I prefer to use the terms ‘birth intentions’ or ‘birth preferences’ and hopefully one day, we can change to using this wording instead. It sounds much more gentle and flexible – not like a blueprint for exactly what you want or something you have planned to happen. 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, the nitty gritty of the birth you would ideally like to have, 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: