As a doula, I require all of my clients to put together a birth plan, discuss it with their care provider, and to provide me a hard copy. I make very few exceptions to this requirement. I believe firmly that a birth plan is a critical piece of the puzzle in good perinatal care.

As much as we want to believe that our prenatal care is individualized, it often is not. Even home birth midwives can get into a “this is how I always do it” habit, though that is far less likely. Still – I have learned to never take anything for granted when it comes to care providers.

I spend a good amount of time with each client in helping them form their own unique birth plan, and provide them with role-playing opportunities that teach them how to have open, honest, and clinical discussions with their provider about their individual needs. If I am hired late into the third trimester, that is almost all I end up doing prenatally – birth plan work.

It’s that important.

That said, I don’t particularly care for the term “Birth Plan,” and I use it only because that’s the common vernacular. I think the word “Plan” conjures up images of precise blueprints and/or legally binding documents. A birth plan is neither of those things, and the sooner we understand that, the better.

Instead, I believe that birth plans are tools designed to help you, your care provider, and any staff you encounter to communicate effectively about your individual needs and expectations regarding your care.

It provides a basic framework that helps your care provider and staff to better care for you, but it does not legally bind them to your every whim and wish.

Instead, a birth plan gives you and your care provider an opportunity to pursue individualized care together, and to be on the same page before you go into labor. It has the potential to build rapport, trust, and respect between you and your provider–a critical factor in enjoying a positive, healthy birth experience, no matter what the circumstances end up being.

For this reason, I really prefer the term “Birth Preferences,” “Birth Goals,” or even “Birth Desires.” Those make a lot more sense to me. When a birth plan is viewed this way, it is often much easier to mentally and emotionally process anything that derails those plans.

Birth is still unpredictable, and there are no guarantees, no matter how safe we have made it. The reality is that birth is like any major event we plan: There will always be at least one thing that does not go the way we expect it to, for good or ill.

Mommas get sick. Babies get sick. Babies get into funky positions. Mommas get exhausted. Heart rates get wonky. Side effects of drugs happen. Things stretch on longer than we thought, or go far faster than we anticipated.

Stuff happens.

Overall, birth is a safe and healthy process, but it has a lot of variables within a very wide range of Normal. Accepting that fact, and writing a birth plan with flexibility in mind is key to processing those funky things that happen during our births.

I find that the most flexibly written birth plans get the most respect from staff. They see clearly that my client has done her research, and has realistic expectations. Frankly, I find that my clients are more likely to get exactly what they want when their language is open and flexible.

I also find that when things get weird in a birth, staff and providers tend to bend over backwards to keep the spirit of the plan intact. They seem to view themselves as being on my client’s side, and try very hard to make it work within the parameters this particular labor has laid out for them.

My clients come out of these births processing all of it in a very healthy way. They understand that they don’t have to like what happened, but if they felt respected, understood, and as though their choices mattered, they are often okay in the long run. They understand that it’s okay not to be okay for awhile. They grieve the stuff they didn’t like, but are grateful for the support and good care they received within the circumstances their birth chose for them.

Care they might not have received had they not communicated clearly what they hoped for, ahead of time, via their birth plan.

So, when writing your birth plan, be careful about the language you use. Really examine how it comes across, and how you view your relationship with your care provider. Some basic tips:

• Open with a sentence like: “We understand that circumstances may arise that preclude the following desires, but we expect to be fully informed before consenting to any procedure that may be proposed, and we appreciate your help in achieving a healthy and pleasant birth.” This lets them know you understand that birth has a lot of variables, and that you are willing to work with the staff.
• Have a short introductory sentence or two explaining your overall desires. (Natural birth? Well-timed epidural?) The staff will automatically know what requests will go along with that, and you can eliminate a lot of specifics. For example: If you know you want an unmedicated birth, and state that fact right away, you won’t have to tell them you’ll want to move around, have dim lighting, etc…
• Keep it simple. It shouldn’t be more than one page long.
• Use bullet points and clinical language.
• Tailor it to your provider’s practices, as well as the protocols at your place of birth. If you know they do rooming-in, you don’t need to request it.
• Do your research. Take an independent childbirth class. Hire a doula.
• Take your first draft to your provider and ask specific questions. “Under what circumstances might you do an episiotomy?” This helps you know if something needs to be added or taken off the plan.
• Have a cesarean plan. Look up “Family-Centered Cesarean,” and choose your top 3-5 items you think might be important, and add those.

Be decisive and clear in your desires, but remember to stay open as well. Choose carefully your hills to die on, and let everything else go if it becomes necessary. Ask questions. Even if all you can think is to keep asking “Why?” That one word can gain you a lot more information when a decision becomes critical. Open your eyes, and walk forward confident in your desires, your ability to birth, and your ability to make good decisions for you and your baby.

You are already a good mother. Go for it.

I could write mountains of information on this subject, but this post would get too long. Did you write a birth plan? Why or why not? Do you feel your desires were respected? Do you feel it created a sense of cooperation with the staff who cared for you? Why or why not?

Grace & Peace,
Tiffany