To Write a Birth Plan or Not?

Denise BrusveenBirth Plan, Doctor, Hospital Birth, Midwife, Pregnancy

childbirth classes birth planDo you REALLY need a birth plan? Well, no. But I’ll tell you what you SHOULD for sure have! In my experience, some medical professionals tend to dislike birth plans and even mock them. You may have even been told not to bother writing one. I’ve heard comments that range from, “The longer the birth plan, the longer the labor.” to “I don’t know why people write birth plans anyway because nothing about labor is predictable.”

I’ve got to agree with the last part of the last statement (labor is unpredictable), but I wholeheartedly disagree with the rest. I know exactly why people write birth plans and why I encourage them to. I have never seen the length of the birth plan correspond to the length of labor. There are so many reasons that both labors AND birth plans differ in length! I also think that maybe a birth plan isn’t right for everyone.

What’s that you say?! Yup, I think sometimes people get too caught up in the words. Anybody who has ever read a birth plan written by one of my childbirth class students or doula clients can easily see that they’re not making any predictions about how they expect their labor to unfold. It’s not at all a plan in that sense. What it IS, is a plan of how they want to handle choices that come their way. How they want to be treated. How they want to be spoken to, or not spoken to. Every single one of those things IS within their control.

A few years ago, I decided to start suggesting other terms in place of “birth plan” for my students and clients, wondering if perhaps they would be better received by medical professionals. And indeed they were! One of my students reported back to me that the charge nurse came to her room after her birth and told her that she was so thrilled to see that she had not come in with a birth plan. She instead had labeled it “Birth Preferences” at the top. The nurse felt that was so much more reasonable. The kicker? My student used one of the examples I share in my classes nearly verbatim but changed “plan” to “preferences.” There was virtually NOTHING different about the rest of it!

This brings me to another point. That nurse wasn’t even the nurse working with my student during her labor. She had never met her before coming into her room after the birth was already over, and yet she still made a judgement about the value of the paper she had put together based on the two words at the top.

In an ideal world, you would know everyone who will be at your birth. The reality is that unless you’re having a homebirth, that isn’t going to happen. You won’t have met your nurse ahead of time. And you may or may not have met the doctor or midwife previously (or gotten to know him or her well). It’s unfortunate that some of them judge you based on the two words written at the top of the communication tool you hand them when you arrive at the hospital, but it’s reality. It’s all the more reason to put that plan or list of preferences together in the first place.

That’s still not where the biggest value lies though. It lies in the process of communication between you and your partner. I never recommend filling out the hospital’s version of a birth plan for a couple of reasons. First, they only give you the options they want you to think you have. Second, it doesn’t require as much critical thought on your part. When you write your preferences from scratch (even if you use examples from others for help), it requires more discussion. You come to an agreement with each other, and you stand more firm in your decision to include each bullet point you type out. You whittle your list down to one front side of one page, so that every single thing on that page represents your top priorities.

For some, those top priorities might include having a birth environment that is relaxing, while others might prioritize mentioning that they want as few medical interventions as possible. Still others might talk about how they want to be involved with all decision making and give their consent for each and every decision/procedure, even the stuff that is “standard hospital procedure.” People’s priorities vary based on past experiences, stories they have heard from friends and family, or even just the way they live their lives. There is SO MUCH value in the process and what you write down.

I am always thrilled when nurses ask my clients if they have a birth plan and then read through it right in front of them and ask clarifying questions if necessary. I hear reports that most doctors and midwives are equally receptive during prenatal visits. Prenatal visits are an excellent time to test whether you are really on the same page as your provider. If they keep pushing you off when you bring up writing a birth plan or they tell you they’ll look at it at your next appointment, this is a big red flag that they have no intention to let you have any say in how your birth goes. They want you to lower your expectations for your birth and put all your trust in them to do it their way. If they tell you that it’s not worth writing one because it won’t change your birth outcome, they’re absolutely wrong.

It’s possible that something totally out of your control will come up and require medical intervention, but if you are able to be involved in the decision-making, if you feel empowered during your birth, and you know that the intervention is necessary, then you’re going to feel so much better about your birth outcome than someone whose birth just happened to them.

Take the time. Talk with each other. Research your options. Write them down. And whatever you decide to call that sheet of paper – birth plan, birth preferences, birth vision, or something else completely – know that it does have value. You might learn about options you didn’t know you had. It might put you on the same page on topics you didn’t know you disagreed on. It might teach you that you need to find a new doctor or midwife while there is still time, or it might confirm that you’re right where you need to be, that you are on the same page, and that you feel prepared – however your labor unfolds.

Happy writing!