Is a "Birth Plan" an oxymoron?

hosp birth

In a word, yes. 
The nature of birth is that it never really goes exactly as planned. And that’s okay, it's normal.
But do I still encourage people to write themselves a birth plan? Yes!
Drafting a birth plan can be, if nothing else, a helpful exercise just for you (and your partner).
It’s a chance to ask yourself:

  • How do I imagine my ideal birth?
  • How much do I understand about common practices at my hospital/with my health care practitioner (HCP)?
  • What am I worried about?
  • What decisions do I want to be actively involved in at every step, and what things do I simply trust my HCP to use their best judgement for?

It can be unsettling to have a sense of being “in the dark” about your birth options, and it can be overwhelming to have “too much” information. The goal is to find the balance that works for you.

There are a number for labour and birth-related topics that you may have a preference about:

  • Who you want to attend your birth (partner, other family, doula, birth photographer, midwifery or medical students, etc)

  • Whether you are planning birth centre (with midwives) or hospital birth (with any HCP), when you would want to transfer from home to the place you plan to birth

  • Management if you are Group B Strep (GBS) positive

  • Prelabour rupture of membranes (PROM/water breaking before contractions start)

  • What coping techniques you've prepared to use like water (tub or shower), self-hypnosis, or a TENS machine

  • When (if) you are offered pharmaceutical pain management (like an epidural, narcotics, nitrous oxide gas)

  • Labour augmentation options (artificially breaking your waters, or use of synthetic oxytocin by IV to help move the labour along) 

  • Positions would you like to try for labour and birth

  • Any words or suggestions you do or do not want to hear

  • If indications arise for an assisted vaginal delivery (vacuum or forceps) or an abdominal delivery (C-section) (Is there anything the OB can do to make it more "gentle"?)

  • Cord clamping, use of cord blood, and cord cutting (can your HCP do it, or would you like someone else to? What are options in the case of an abdominal birth?)

  • Breastfeeding and formula feeding

  • Keeping your placenta (for encapsulation or another personal use)

  • If and when newborn medications will be give (vitamin K and eye ointment, vaccine if you have Hep B)

When you want reliable information, take a look on these websites. (In most cases I’ve linked to the area of the website I suspect will be most useful to you.)


Writing at "Birth Plan"

More accurately, some people will call it a "birth preferences document" or a "birth wishlist" to help manage expectations ("plan" sounds more finite, less flexible), but "birth plan" is really the most popular term.

My recommendation would be to have a one page birth plan, written for your HCP,  outlining your preferences should they differ from common practice (like religious or spiritual observances or more holistic approaches), or should things go sideways from what you’d imagined.

For example, I felt strongly about my child getting all of her cord blood, so I wrote (and discussed with my midwife) that I didn’t want the cord to be cut for at least 10 minutes after the birth. We did however discuss that if she needed urgent resuscitative measures and keeping the cord intact would prevent the care team from doing their job effectively, my request could be set aside.

An example of a strictly visual plan, which may not be clear enough to be effective. (Source unknown)

An example of a strictly visual plan, which may not be clear enough to be effective. (Source unknown)

The general consensus among practitioners that I’ve spoken with is that a one-page “plan” at your birth stands a better chance of being read than something very extensive and wordy. I also see the benefit in a visual birth plan for easy reference, but it can be too vague to be useful. 

Another example: Although generally undesired, it's actually not very helpful to say "no episiotomy" on a birth plan, because increasingly these days the agreement among HCPs is that an epis is best avoided unless clinically and urgently needed. Putting "no circumcision" on your birth plan is also unnecessary, as this procedure is no longer routine, and if done won't happen until about a week postpartum. Do ask your HCP for clarification on these things.

With my clients, I create document that includes both icons and writing, and my clinical baby catching background helps me give you more meaningful guidance on how best to communicate your wishes.

The following are a few documents that might help or inspire you to create your plan if you want to DIY:

Ideally, your HCP (as well as your partner and doula) would review what you’ve written in detail and clarify their understanding, and communicate to you what they believe is possible or not possible. They will likely document that you reviewed it together, and keep a copy in your chart. Still, you are responsible for bringing the final plan to your birth (bring a few copies, just in case) and informing any HCPs involved in your care about it.

You might also consider drafting an Advanced Care Plan document. It would be impossible to consider and research all the possible outcomes of everything big and small related to your birth, but it might be clear to you that you are more in the “I trust my HCP to do the best thing for me and my baby” camp vs the “I want to be in on every decision, big or small” camp.

I hope these are useful starting points for gaining a greater sense of empowerment as you prepare for your birth. I’d be happy to provide you with further support. Don’t hesitate to get in touch.