The pro’s and cons of writing a birth plan

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The pro’s and cons of writing a birth plan

The following is a student blog post by Karen Green

Do I need to write a birth plan?

I have had 3 babies and I didn’t write a birth plan for any of them. In retrospect, did I need to? I would say no. From the start of each pregnancy, I chose birth attendants and birthing contexts where I knew we were on the same page. I knew this because we spoke extensively about natural birth and birthing procedures and we agreed on everything. So in my case, writing a birth plan seemed redundant. Having said that, even though I didn’t put anything down on paper, I certainly set an intention for what I wanted. Those intentions were verbalized, I discussed and conferred with my partner and birth attendants, and details were thought through and decided upon. So, I don’t think everyone needs to write a birth plan but I think we do need to have a clear vision of what we want to experience when we birth and a birth plan can help us define that vision. And in certain situations, a birth plan is essential!

Setting the course for the birth you want

The process of creating a birth plan is a way to define how you want to experience the birth of your baby. It is a way for you to integrate what you learn along the way, in particular if you take a childbirth preparation course and encounter details you never knew existed. For example, the effects of bright light on oxytocin production, upright birth, delayed cord-clamping, etc. As you encounter these details in a course, or by your own inquiries, they need to be incorporated into a constant-updating of the vision you are creating of the birth day. Whether you put this down on paper or whether you do this by dialoguing with your partner and birth attendants, it needs to go beyond just “knowing about it” to including it as part of your experience.

The first stage of defining the birth you want can be reduced to two choices; where and with whom. Choosing the context for your birth is a vital part to having the experience you want. If you don’t want a medicalized birth, don’t birth in a hospital with a team that uses medicalized birthing tools. If you want a natural birth, choose a context where the team trusts natural birth fully and has natural tools to assist your birth. Choosing the context is perhaps one of the earliest decisions you can make which will ultimately shape what happens on the day you birth. Choosing the birth attendant is often tied to the context itself. WHO will be there to receive your baby? If you feel safer in the hands of an obstetrician but want a natural birth, you will need to make sure that your obstetrician has the natural birthing tools and experience you expect from him/her. And this is where the vision of the birth needs to be defined with care.

birthplan

Are we on the same page?

We have to be very careful with birth vocabulary. What I mean by natural birth is not what another person means by natural birth. This is where discussion and active listening are vital. Nobody is out there to ruin your birth experience but birthing really puts our belief systems on the table. Do I trust my body and this natural process of birth? Do I embrace the idea of labor pains? Do I trust fully that I am capable of this process? Am I completely convinced that my body is designed to do this and nature has a grand plan that will help me throughout? Does my doctor or birth attendant trust this process as much as I do? Or, does he or she feel fearful about letting mother-nature do what it’s designed to do? Is he or she fearful to stand back and admire the amazing power of natural birth? Does he or she feel the need to be hands-on and intervene when there is anything that provokes fear in him or her? I hope with all these questions you get my point. We can very often assume that the person we are talking to is on the same page as us, but unless we ask a lot of questions and listen very carefully to what they say, we may find that we are not. And often, that discovery can happen when you are 10cm dilated and it is too late to choose a different team.

So when DO I need to write a birth plan?

Not everyone gets to choose their ideal birthing situation. It really depends where you live in the world. It doesn’t even matter so much which country you live in, but rather what options are available in your area. You may not have access to anything but a hospital birth where you live, with no home attending midwives around. THIS is when a birth plan is very helpful. It sets down on paper what each party is expecting. You may not be reading the same books as your obstetrician or birth attendant, or even the hospital where they work, and you may have very different ideas about certain procedures. This is when a birth plan is a way to strike a deal that works for both before the birth happens. You can put on paper how you feel about the use of synthetic oxytocin (Pitocin), being able to move freely during labor, the use of the epidural, the amount of time labor can take, who can be with you, birthing positions, cord-clamping and all the other details relevant to your birthing context to make sure that procedures are not used simply because of protocol but rather by conscious choice and in agreement with your birth attendant.

What should a birth plan look like?

A birth plan can be descriptive or it can look like a checklist with clear statements of what you do and don’t want. A descriptive birth plan is you narrating how you want things to happen. The checklist birth plan looks more like a contract.

A descriptive birth plan goes one stage further than simply setting the intentions by actually putting them down on paper. One descriptive birth plan I read, written by a couple planning a home birth, helped them create a birth day that would be very different from the birth of their first baby (in hospital and medicalized). Their birth plan served as a way to clarify and organize how they wanted to experience this second birth, how grandparents and other family members would be involved. They reiterated procedures and processes already discussed with their midwife and doula. They stated their desire to use a birth pool for birthing rather than labor, they also put on paper their “plan B” choices, which is something that should be planned before the birth, not when the need arises. This gave them peace of mind and let the family know their role. The birth plan was also a way of saying “we’re ready” and sharing this with their midwife and doula. It was a process for the couple to work on together and gave them an opportunity to include details about the placenta which was recently acquired information. Since the couple wanted to make sure they would avoid what had occurred during the birth of their first baby, narrating it in their descriptive birth plan really helped them create a new birthing experience.

The birth plan when created as a contract, which outlines agreed procedures, can be a very helpful and supportive element when birthing in a hospital. Your desired natural birth needs to be put on paper as the hospital context rarely offers a truly natural birth. This is where “vaginal birth” and “natural birth” can be used to mean the same thing or two very different things. The contract therefore becomes a way to keep the course of your birth on track. You will likely have to make reference to most or all of the procedures that will be available to you so that those attending are aware of your choices. This is also when it is essential to see birth as a continuum and that not only does an obstetrician need to be involved, but also the paediatrician. As soon as birth ends, life outside the uterus begins. It may sound obvious, but I have encountered many couples who trusted the choice of the paediatrician to their obstetrician, only to discover that the paediatrician was not pro-breastfeeding, believed in early cord-clamping and whisked the baby away for various post-birth procedures that could in fact have been done with the baby lying on the mother’s chest. Creating a birth plan during the pregnancy can be a good way to define whether you have in fact chosen the appropriate birth attendant and context. If you discover that you really don’t share the same vision of birth, rather than fighting for what you want you could be better off looking elsewhere for a better match.

What might be the “con” of a birth plan?

It’s in the title so here it is. What I can see as the main “con” of a birth plan is the amount of expectation that goes into those details, which, in some cases, will not manifest. One soon-to-be-mother put so much effort into every detail, she had thought it all through for what was going to be her natural birth in a birth center. However, despite all the information she accrued and idealistic intentions she set, it ended in a scheduled caesarean because she did not go into labor by week 41. There were so many expectations, hopes and desires put on paper and what she experienced was so different that she felt truly let down. A birth plan can set us up for disappointment. It can also tie us to a certain way of birthing that may not be what we experience. With birth, it is difficult to imagine how we will feel. For example, the experience of my first baby made me want a water birth for my second. I had the pool for my second, and never got in. Rather I spent my whole time on the birth ball. My third birth was lovely. No pool and the birth ball for half the time. Lots of time on all fours on my bed. The risk of the birth plan is mentalizing a process which is involuntary, emotional and spiritual. So if you do choose to write a birth plan, I would highly recommend a birth plan as a way to choose the boat you want to get on, but don’t try to plan the weather! How you travel to your destination can be planned. The nuances of the trip can’t.

So I am going to write a birth plan

Wonderful! You are about to embark on the adventure of defining the birth you want, where you want it and who you want there. Now that you have decided to do so, you can look at existing examples online and I wish you all the best. Prepare yourself for the best experience you can hope for and surrender yourself to the journey!

Bio: Karen Green is a mother of 3, a childbirth educator and breastfeeding counsellor. Her toolkit for life and work includes Reiki, reflexology, homeopathy, EFT, dance, Pilates, fresh air and Mother Nature. She has lived in Mexico for 22 years and in 2010 began her project “Instinto Materno” to support pregnant couples, new parents and their babies in a holistic, natural way.

All student article posts are the expressions of the student who wrote them. We do not take responsibility for the content, these are done as part of the educational experience and we try to encourage students to use their voice and learn to connect with clients through blogging and social media.
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