Best Laid (birth) Plans…

Or, “Rethinking the ‘BIRTH PLAN.'”

As more gestating parents become more aware that they have options in birth, more parents rely on “birth plans” to communicate how they want their birth to go.  But there’s a few problems with this.

The phrase “birth plan” is a misnomer.

Whether it’s a five-page form, a one-page list, or a fun minimalist poster, calling it a birth “plan” just isn’t quite right.  I like to call them “birth intentions” or “preferences”.  I’ve seen them called maps, visions and wish lists.  And that’s what they are.  It’s a collection of preferences, not an itinerary.  When we say “plan” over “preferences, we set ourselves up to be upset.

Birth plans are not a substitute for childbirth education and preparation.

Nowadays, we can go to just about any pregnancy-focused website and find a blank birth plan form.  These six-page monstrosities list options that sometimes are out of date or maybe not available in your city, state or even country.  (Sad but true: Nitrous Oxide as a pain management option is not currently available in South Texas.)  There is an attitude that by having decided which boxes to check, one knows their options.

It isn’t so!  Many childbirth preparation courses will help you understand different birth-related medical procedures and options available to you ahead of labor.  And a good class will give you and your birth partners the tools to make decisions when the work of labor and birth are taking their toll on you.  A well-prepared laboring pair is able to be flexible about the “plan” because they are ready to ask questions of their health care provider when changes in the plan come up and give their informed consent.  Modern childbirth preparation classes are as much about the mental and emotional preparation as they are about the physical and factual.

Birth plans are not a substitute for communication.

Some people never talk about their birth plans with their health care provider.  And maybe it’s because their doctor or midwife never asked if they had a birth plan… but do not assume that means your healthcare provider is on board with your plan.  Doctors, midwives and maternity care facilities draw upon their experience and philosophies towards birth and already have a baseline plan of action for patients giving birth.  Discussing your birth plan during prenatal care appointments gives both parents and their providers the chance to understand each other’s philosophies better.  And maybe if the parent’s attitudes and desires toward birth don’t mesh with their provider’s, there’s still time to seek out a provider who will.

So promise me parents, use your birth “plans” as a starting point to facilitate communication between you, the laboring parents, and your health care providers.  A doula or childbirth educator can help get you started.

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