So why ARE you writing that birth plan?
Is it because it was recommended in your antenatal class?
Or because your midwife asked if you’ve got one?
Maybe because you know it’s a pregnancy rite of passage?
These are all fair reasons. But when you sit alone with a pen and paper – or a blinking fresh Word document – what do you want your birth plan to do for you?
If you Google ‘birth plan template UK’ you’ll get nearly 16 million returns – and frankly most of the ones you click on will be largely the same. Some are functional, pragmatic tables to be filled in. Others are prettied up and easier on the eye. The NHS template is over 10 pages long and has all the charm of a post-Brexit import form.
While the designs may differ, they all share the same framework : a long list of preferences, monitoring, interventions and contingencies for you to either consent to or decline. They are basic checklists. An advance review of the things midwives may offer or suggest to you. Underneath that seemingly orderly admin is the lurking implication that by agreeing to, or refusing, these things you’ll be able to control the path your birth takes and guarantee a 'good' outcome.
As you've probably already guessed, it just isn't that simple. As a starter for 10, here are three obvious problems:
1. Birth plans don't typically recognise that choices are offered typically offered as a result of perceptions of risk (however variable and biased those perceptions may be). Nor do they acknowledge the truth that those perceptions of risk change the framework of your decision-making - and be under no illusion how different it feels at the sharp end, when you’re as full as an egg, tired, anxious and highly hormonal.
2. The standard focus of birth plans on your own choices and preferences doesn’t allow for the impact of the other influencing factors outside your control, and often beyond your awareness[1]
3. The birth plan itself doesn’t help you to access the things that in my experience women value more highly than the processes of birth – human connection, care, dignity and respect.
The truth is, despite all the birth plan templates you can find online, despite all the recommendations to write one, birth plans have a dreadful reputation for a good reason. Writing a plan that determines your preferences for how often your cervix is assessed for dilation, or which drugs you want, or where you want to birth your baby… this simply does not guarantee your birth will follow that path. Worse still, is the underlying, universal truth that these things don’t matter anywhere near as much as good, old-fashioned care and connection. So a birth plan that ties you to your 32-week-pregnant-selfs decision to say ‘yes’ or ‘no’ to monitoring, intervention, place or drugs may just hinder you, rather than help.
When you look at the birth plan that you’re probably already beginning to formulate, I suggest taking a slightly different approach. It is so important to be well informed about how birth happens physiologically (and how that can change in different environments), but these aren't the factors that will determine whether you experience your birth positively or not. So instead of thinking about what you do or do not want to happen, consider how you do or do not want to feel. These steps can help;
First ask yourself what you are really concerned about. Take some time to think carefully about what matters most to you; what makes you feel most anxious and scared, and what you think ‘good’ might look like. Try to really clarify what this feels like, rather than what it looks like. I’m prepared to hazard a guess that you want to feel reassured, safe and cared for, and these things take priority over anything else.
Second, ask yourself if you’re confident that your antenatal classes, reading or prep has prepared you – and your partner – to discuss your options with your midwife, and to make informed decisions on that day. Do you think you’re confident enough to ask the questions you need answers to so you feel confident in your choices and understand the implications of them? Are you practically and psychologically ready to be flexible if you need to be? To handle changing plans and contingencies?
Finally , and maybe most importantly, does your birth plan tell your midwife how you want to crack through your labour? Are you someone who wants to be left in peace, or someone who values the reassurance of skilled midwife? Do you need to know the full picture to feel comfortable and secure? Or are you happy to trust their clinical judgement and follow their recommendations?
Writing a birth plan should not be your primary focus. Step away from the templates. Stop worrying about how you’ll control what happens. Turn your attention to what you really want your birth to feel like. Write to your midwives as individuals and make sure they know about you.
Most importantly, write your birth plan, not anyone else's.
For Pocket Doula care, and individual 121 birth planning sessions, email Charlie at charlie@thegoodbirthpractice.co.uk
[1] This is another blog for another day... however, it's worth noting that academic studies over 20+ years have identified that birth plans can be a hindrance rather than a help. In fact they can give doctors the heebie-jeebies (even though you'd think that planning for such an enormous embodied event is quite a normal response). This is something unfortunately you have no control over, but it's worth knowing that some doctors have concerns that mothers with birth plans are inflexible, unwilling to yield to concerns, unrealistic about the process and intensity of birth and unduly concerned with 'minor matters' (which, let's be honest, is a pretty clear declaration of bias). (Lopez-Gimeno, 2021; DeBaets, 2016; Dombroski 2016; Whitford and Hillan, 1998)
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