The Birth Plan

A birth plan is essentially a letter to caregivers and nurses, describing the expectant parents’ concerns, fears and wishes, and how the mother and her partner would prefer that the labor and birth be managed and why. Some people prefer terms like “preference list,” “goal sheet,” or “wish list” to “birth plan.” Whatever it is called, it is a chance to tell the medical professionals about themselves and their priorities and needs. It is not a contract or a list of demands; it is an expression of preferences on negotiable topics. There are several advantages to birth plans.

  • Advantages to the couple. Preparing a birth plan requires thought on how the mother and her partner will cope with the unpredictability, pain, and stress that are part of childbirth. It requires that a couple find out, think about, and discuss the available options. It helps clarify their needs and preferences. A birth plan helps the expectant mother and her partner work together.
  • Advantages to the doctor or midwife. A birth plan helps the doctor or midwife understand the family’s goals and expectations and allows the caregiver to assist in preparing a realistic plan that all find satisfactory.
  • Advantages to the nursing staff. The birth plan helps the nurses to become acquainted with the mother and her partner and helps individualize their care. A birth plan tells them important things about the new family—concerns and what is really wanted, as decided by them when they were calm and able to think clearly. If the nurses know what is important to a new mother and her partner, they are more able to help fulfill their wishes and expectations.

How to prepare a birth plan

The success of a birth plan depends on the couple being realistic, flexible, informed and able to communicate well. It also depends on the caregiver being open to the couple’s participation and to individualizing care to meet their needs. The four steps to preparing a birth plan are:

Step 1: Discover your preferred approach to maternity care. Ask yourself “Of these two basic approaches to maternity care, which is closer to my way of thinking about birth?”

  1. I will feel more secure if I can participate fully in my labor, making decisions and using self-help measures to handle my pain and to promote labor progress, (unless there is a medical reason to do otherwise). This is called the “self-reliant approach.”
  2. I will feel more secure if I rely on my expert caregivers in managing my labor and relieving my pain. I will do what is asked of me and want to be informed of what to expect and of the reasons behind clinical decisions. This is called the “caregiver-reliant approach.”

If neither of these basic approaches quite reflects your point of view, try to put into words the amount of participation you would like and the role you would like the professionals to play.

Step 2: Learn about options and identify preferences. This step may seem quite overwhelming at first, because there are so many options. There are many sources of help—childbirth preparation books, your caregiver, friends, childbirth education classes, and hospital tours. Pregnancy, Childbirth, and the Newborn has a comprehensive worksheet for preparing your birth plan (pp. 160 – 165) that makes this process much easier, and ensure that you know all your options.

 You may discover, as you learn about the options and picture yourself in labor, that the options you prefer do not reflect the approach you selected in Step 1. If needed revise your preferred approach. This process may help you clarify your values and may also reveal any basic differences of opinion between your partner and yourself. It is desirable to discover and resolve such differences ahead of time.

Step 3: Discuss your rough draft with caregiver. Prepare a rough draft using the birth plan form from the 2001 edition of Pregnancy, Childbirth and the Newborn. Discuss it with your caregiver. This is when you will find out whether your caregiver supports your wishes and how compatible your wishes are with your caregiver’s and the hospital’s usual practices. Remember that some of the options you want may not be available to you. Birth plans are collaborative, and include input from three of the important players in the birth drama—you, your partner, and your caregiver. It is not usually possible to get direct input from the nursing staff before labor.

Step 4. Prepare the final draft of your birth plan. The last step in preparing your birth plan is to revise your rough draft into a final draft, incorporating what you discussed with your caregiver and others. Once completed, make copies for yourselves, your caregiver, the nurses, your doula, and an extra, just in case one is misplaced. Be sure to have yours with you in labor.

 The birth plan allows a couple to summarize their preferences and other important personal information. It does not need to (nor should it) be a list of procedures that are and are not acceptable, since circumstances vary and some “unacceptable” procedures may become necessary if particular problems arise. Expectant parents should put themselves in the caregiver’s place. From the caregiver’s point of view, is the birth plan friendly, respectful, flexible (that is, indicating awareness that labor is not always normal or predictable), and reflective of a spirit of mutual trust and collaboration?

Congratulations, you’ve written a birth plan.

 

© Excerpt from Pregnancy, Childbirth and the Newborn. c. 2001