Birth plans – yay or nay

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The topic of birth plans tends to draw strong opinions.  Women and professionals alike tend to adopt very firm and often fixed views as to whether a birth plan is a recipe for disaster or a blueprint for a positive experience.  Maybe the answer is not the concept but the name – plan.  The dictionary states that a plan is:

  1.  detailed proposal for doing or achieving something.
  2. an intention or decision about what one is going to do

Neither of these definitions really ‘fit’ with intention of what birth plans should be.  It is fairly difficult to make an intention or decision about the beginning, or in fact the end of life.  Of course there are exceptions, but in general nature has an impact of most bodily functions, when we get a period, when we pass urine, how our heart beats, when and how we die.  And birth is similar.  There are many elements that cannot be controlled.  However this does not mean that there is no point in stating your preferences, your desires, your strategies and your goals.  In fact never in your life is there are more important experience to determine what your priorities are as they will profoundly impact your experience, your recovery, your start to mothering and how your baby responds in the days and weeks that follow.  Therefore the most important thing for each and every woman and family is to have an idea of priorities and this is what forms the basis of what is typically called a birth plan.  A better term is perhaps birth preferences, or birth priorities or even a birth map.

The process of determining what matters to you is as important as actually writing it down and communicating it.  Society has very limited ideas about what is possible in birth.  The predominant views are developed through exposure from the media and often the focus is on difficulty and trauma.  It is important to use your pregnancy, to use independent education, to find your place in the various birth philosophies that abound.  This is not as easy as it sounds as the rhetoric sometimes ignores the sad reality that many people – including very experienced health professionals – have never seen a physiological birth even if they have practiced for a long time.  This means that it may be difficult to gather information on all the options available.  Digging into the options will be the first part of the birth preference journey.  It also provides an understanding of why birth preferences are needed in the first place.

Birthing in Australia varies.  Some models of maternity care offer you the chance to know your care provider – an obstetrician, a midwife, maybe a GP – in these situations you have the chance to discuss, explore, document and confirm the areas of importance for you, your partner and your family.  In these situations your care provider will, hopefully, understand you as a person.  Particularly where you have known your midwife it is likely that you will have discussed how you want to be supported in labour, what your thoughts about comfort measures and drugs are, what you want in terms of who touches your baby, whether baby is skin to skin after birth, what your plans for feeding are, what types of injections you want your baby to have or not have.  The list of possibilities is endless and better unpacked before you are impacted by endorphins and, hopefully in your ‘zone’ – a trance like state where answering questions is difficult and thinking and talking removes some of the protective hormonal elements.  Having a list of well developed preferences that you and your midwife have worked through, with enough contingency ideas for when things don’t go to plan, will provide some sense of comfort and confidence in the process.

However, the vast majority of women are cared for in labour predominantly by people they have not met.  Women receiving private obstetric care generally do not have a midwife they know with them in labour.  The obstetrician will attend for short periods during labour and for the birth but the midwife is the person who is with you for the most time. In the public hospital system you have a myriad of different health professionals who you mostly don’t know. These aspects are why birth preferences, plans, or whatever you want to call them become critical.

There are many different levels that a birth preference list can take.  A process where you sit down and discuss what is really critical, what is important, and what is just a wish may help work out the layers.  Whilst there are examples above, the main idea is to comment on what you can plan with some very broad examples including basic things like your partner remaining with you, your baby being skin to skin, delaying cord clamping if possible, not being naked, being able to eat and drink as long as possible.  Depending how strongly you feel on things you may say ‘if this, then this, and if that, then that’.  Providing context on the above this could be ‘if I have a vaginal birth I want delayed cord clamping, if I have a caesarean I would like delayed cord clamping for one minute to be discussed’.  Another example could be ‘I would like my baby skin to skin straight from birth and to remain with me until it feeds.  If my baby needs care I would like that by my bedside.  If this is not going to occur I would like this discussed with me.’  These strategies lay out at what level you want all elements discussed.  Of course, many things you want discussed should be part of informed consent, but stating them makes it very clear to any care provider the level of communication you are seeking.

Of course all professionals do not behave in the same way.  Some professionals do not agree with birth plans – and use the process to undermine education and planning.  Of course, it is not possible to make an intention or decision about what is going to HAPPEN in birth, but you can definitely decide what you will do!  Your birth plan may be as simple as “I want every intervention discussed using the BRAIN acronym – provide me with the benefits, risks, alternatives and then let me use my intuition and ability to say ‘no’ to decide how I would like to move forward”.  Making sure you are clear on what you consider interventions and what you are happy to consider normal process is important at this point.  For example some practitioners might consider continuously monitoring your baby normal process.  Therefore it is totally important to make sure everyone is on the same page from the word go.

The controversy over birth planning is unlikely to go away any time soon.  What is changing is the level of control women are seeking and the depth of information and choice over their bodies that women want and deserve.  Knowing what you want, communicating it and understanding your points of variance are very important parts of your confident birthing journey and entry in to mothering.




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