The Birth Plan, Demystified
Usually one of the first things that families want to discuss, the birth plan is often seen as the quintessential focal point of prenatal preparation. The birth plan is the essential oil of the pregnancy and birth pharmacopeia: highly concentrated, potent, taken from all of the various harvests of information, intuition, and preferences. Also like an essential oil, it can be too strong if too much is used, or if relied on too heavily. This blog post aims to view the birth plan in a holistic sense, to see it as part of the whole, and not the whole itself.
What is a birth plan?
A birth plan is a one-to-two page document that aims to inform your providers and care team about what your desires and goals are during labor and birth. It is also equally as much for you and your main support person to get to the root of what matters most to you both. Although “plan” is part of the name, I will use the language of “preferences” or “map” interchangeably with “plan”, to gently remind families that birth is a dance between holding true to what you want, staying empowered and determined; and also being open to how birth wants to move through you. I like the term “birth map”, because a map may show the way somewhere, but sometimes on our journeys we may choose to change our course.
What’s in a birth plan?
When supporting families with writing their birth map, I like to show many different examples of how they can look. They can be bullet points, a list, a narrative, organized into sections, or organized into “yeses” and “no’s”. Generally, they include the following:
Title: Your name or your family’s name, followed by “preferences, wishes, goals, plan, map” etc.
Who is on your care team: your main support person (partner/spouse, friend, parent), your doula, your provider, and often your baby’s future pediatrician if you have them picked out already. You can include baby, too, if you have a name picked out!
A short intro: Some families will choose to omit this to save space, but others find it important and include it. It can be just a few sentences on who you are, and a statement about what you want most from your birth, e.g., “calm, quiet, no rush.”
Important info: If there is anything that is crucial for your team to know, like a history of trauma, a preexisting injury, medications needed, or anything of that nature, it could be included up top and highlighted. Your place of birth should have that in your chart if you’ve shared it, but it is always good to have on your page as well if that feels supportive and comfortable.
Early labor: Your preferences for the early hours of labor, focusing on rest, nourishment, and calming activities.
Active labor: Your preferences on contraction intensity relief, touch or no touch, medication or no medication, affirmations, and how you would like to be addressed by your care team. Communication, communication, communication!
3rd stage, or pushing: Your preferences for what position you would like to be in, to have your perineum supported or to not be touched, to have photos or not, and where you would like baby to be placed immediately.
Postpartum and newborn care: Your preferences on cord clamping to be delayed or not, baby hat or no hat, active or passive management, newborn exam, shots, bathing or not, and baby feeding.
Sometimes, in case of emergency: Some families like to have multiple birth plans in the event of an unexpected change or outcome. For families choosing an out of hospital birth, many like to create a page in the event of a hospital transfer, so they are not blindsided by having a whole new care team. For some families, an unexpected Ceserean-centered or NICU-centered birth plan is desired.
Planned belly birth plan: If you know you plan to have your baby via belly birth (Ceserean), you can absolutely still have a birth plan! What music would you like to play? Do you want conversations to be kept at a minimum? Do you want photos? Do you want immediate skin to skin? Do you want a clear drape so you can see your baby being born? Belly birth or vaginal, it’s still your birth.
Feeling overwhelmed by all the things? This is where your support team comes in to help inform without judgement, and ground you in what feels the most empowering.
Crafting your birth plan
Surprisingly enough, that sense of overwhelm can be a good thing! It can mean that there are many doors open to you, and now is the time to learn and grow about what options you truly have. It’s an empowering place.
Books can be a great source of information for those that like to learn all the facts first about their birth choices. It’s important to find books that speak to you and your partner’s preferences, that focus on empowering information and choice, rather than shame, guilt, or blame. See my list of favorite resources at the end of this post.
Childbirth education classes are another wonderful resource in gathering information and beginning to craft your unique relationship with labor and birth. Not only will you get a plethora of important tips, tricks, and practices to try, you’ll also get plenty of information about what is standard practice at your location of birth and what options are available there. Your provider, place of birth, and doula will have suggestions on local childbirth education classes.
Doulas are also a very important piece of the birth plan! We provide information, practices, and tips also, and are skilled at putting families back in the center of their experience. Doulas empower and inform, as well as reflect, ask the deep important questions, and help families tap into their intuition.
An important piece in deciding what your preferences are is unpacking your relationship with birth itself: what family stories or traditions do you hold about birth? What experiences have you had? In what ways do you feel already transformed by birth? What do you do for yourself when you aren’t feeling well? What helps and what doesn’t? What are your fears, hopes, dreams, worries? This is, in my opinion, is a crucial piece. Because you are a whole person, in order to be the most confident in your preferences, it’s important to bring your whole self in. Sitting down with whoever your main support person is, along with your doula, can help these conversations blossom into a great jumping-off place.
Advocacy and the birth plan
Aside from being a way that partners can focus in on what preferences they have, birth preference pages are also a tool in advocating for yourself during labor and birth. Depending on where you give birth and who your provider is, there may be varying degrees of advocacy that are needed.
Let’s say an OB shift change happens at the hospital while you’re in labor. The new OB comes in and says something about wanting to change what is going on, or wants to do an intervention. Depending on the circumstances, this is where your birth map can be used. You or your partner or doula can point the OB to the page so they can read it. While they do that, you and your partner and doula can go through the B.R.A.I.N. acronym - benefits, risks, alternatives, intuition, (doing) nothing- and advocate for what you feel is best for your body, your baby, your birth.
Your doula should always be in full support of your birth preferences, even if they change from what you decided prenatally! A doula’s number one skill is to leave themself at the door and come in as a fully embodied listening, supportive, fierce yet gentle and non-violent advocate for what you need and want for your birth.
Bringing it home
Whether you are dreaming of a restful medicated hospital birth or a birth at home in your tub with a midwife, creating a birth plan or map can be a great tool in getting clear on what you want for your experience. When crafting a birth plan, keep in mind that it’s not really a “plan”, like dinner plans or travel plans. It’s more of a reflection, a guide, a map, and a tool for keeping your care team informed about what matters most to you. You may choose to write many, or not write one at all. What’s most important is that you are seen as a whole, that your preferences are respected and honored, and that a balance of staying empowered and also open to change is practiced prenatally. With support of your unique care team, a birth plan can be great medicine; something that nourishes and supports your whole being, not just one part of it.
My top 5 favorite resources for a birth map
My top 5 favorite books/resources for helping to create a birth plan are:
Becoming Mama, by Diana Spalding, Jill Koziol, and Liz Tenety
Pregnancy, Childbirth, and the Newborn, by Ann Keppler, Janet Whalley, and Penny Simkin
Ina May’s Guide to Childbirth, by Ina May Gaskin
Evidence Based Birth, https://evidencebasedbirth.com/
The Educated Birth, https://www.theeducatedbirth.com/
