Should you make a birth plan?

There’s a lot that’s said about birth plans. Are you thinking of making a birth plan but are not sure whether it’s right for you? Should you write a birth plan?

A couple of years ago I decided to read the autobiographical tale “It’s Going to Hurt” by Adam Kay.  In it he recounts his journey as a junior doctor, choosing to specialize in obstetrics and gynaecology.  It was interesting, and challenging, to read his thoughts around birth and how to support labouring women and people as an Obstetrician.  It’s perhaps not surprising that a lot of his views about birth are quite different to mine. 

In the book I was quite affected by a passage in which he wrote about a woman who came in with what he described as a nine-page long laminated birth plan. Kay writes, “Two centuries of obstetricians have found no way of predicting the course of a labour, but a certain denomination of floaty-dressed mother seems to think she can manage it easily. Needless to say, this particular woman’s birth plan has gone right up the fuck.”  Kay clearly does not believe in the value of a birth plan.

Some time ago we put a post on Instagram which got the most traction, comments, likes of anything we’d posted to that point.

The post was a comment, “The power of a birth plan isn’t the actual plan. It’s the process of becoming educated about all your options.” And I couldn’t agree more.   

I don’t love the word plan. I tend to talk about birth preferences or birth wishes with my clients.  Of course, birth plans aren’t quite like planning your wedding when you know that you’re going to enjoy canapés and champagne at 2.30pm, having said your vows at 1pm and knowing that speeches are scheduled to start at 4pm. It isn’t and cannot be like that.

So what is the value of a birth plan/preferences or wishes?

Spending time in pregnancy exploring your beliefs, feelings and options gives you a chance to educate and inform yourself, empowering you to make choices that feel right for you and your family.  It means that when you are in that birth situation for the first time the things that come up aren’t necessarily a complete surprise.

I would always encourage people, if they feel so inclined, to write things down in preparation for their birth. Not necessarily focusing on areas that are totally prescriptive such as “I will do this, I will do that”, as we don’t actually know how the body is going to respond or how we’re going to feel in labour, but with a focus on, “These are the things that matter to me”.

So, if it matters to you that there aren’t male medics in the room, let’s write it down. If you don’t want to have regular vaginal examinations (or any at all), let’s add this to the plan.

There may be very personal reasons behind someone’s decisions based on previous experiences.  No-one ever needs to justify their choices with care providers.  In the UK we have human rights when it comes to birthing. What happens to our body is our choice.  In my experience as a doula the people and families I have supported have often shared their reasons with me and therefore I have been able to advocate in the birth room.  After all, what do we want more than anything else? People being treated with compassionate and respectful care.

That is where a doula is so invaluable.  In the course of labour, which often has its interesting wiggles, turns and unpredictability, you have somebody there who is able to help you to make informed decisions, knowing how to access relevant, evidence-based information. Generally I like to chat through a lot of different options during pregnancy in preparation for a variety of paths that labour may follow.  A doula can also remind you of the conversations that you’ve had antenatally which is so helpful when trying to make decisions under pressure.

There are times in a labour when things deviate from the “plan” or something unexpected happens.  Understandably this can give rise to emotional responses, perhaps fear or worry, grief or sadness.  Having someone with you who knows your birth plan, your hopes, dreams and expectations is invaluable.  As doulas we go a step further – holding the space, listening, validating and acknowledging your feelings. 

Ultimately, the value of a birth plan for me is in supporting people to best prepare for their labour experience, taking in to account the many different options and variations there may be.  When these documents, which have often been thoughtfully and lovingly created, are read and understood it can lead to far more individualised care, rather than a conveyer belt approach which treats everyone the same.  We are not all the same – we are nuanced and have profoundly different experiences of life and we deserve to have the best possible experiences in birth.