4 reality checks when creating a birth plan
Preparing for Birth
It’s been over 25 years since I began working in maternity care advocacy and I’ve seen significant change including an increased awareness of choices, growth within health care systems, resistance within health care systems, and meaningful initiatives such as the Baby Friendly Hospital Initiative. Some take hold while others come and go. What I’ve found doesn’t change are the foundational tasks of ‘readying’ for birth and parenting. I see soon-to-be parents:
- Embarking on a learning process to become informed and empowered about options
- Seeking collaborative and supportive relationships with others, including their health care team, professional caregivers and support providers, as well as with their chosen birth partners
- Envisioning their needs and finding ways to effectively communicate them
- Building their confidence, determination and trust in themselves and the process of birth
- Learning how to let go into life as it is, and not how we wish it would be
Birth plans as a tool for exploring options and for having conversations
Birth plan? Birth intentions? Birth wishes? No matter what we call it, it’s beneficial to have a thoughtful review of what options align with our hopes for this important life event. It’s also essential to have a thoughtful approach toward communication between you and your chosen medical care team and support people. If there are concerns that a birth plan can interfere with that communication, it would be unhelpful. But it doesn’t have to be that way.
Some form of birth planning/wishing/intending can help guide the development of those foundations I’ve highlighted above. I’ve used the phrase “birth plan” in pretty much the same way since the beginning of my career. It isn’t a script or a way to dictate the day like one would organize a wedding. Instead, a ‘birth plan’ is a process for exploring birth options. It’s a way to have dialogue with partners and birth attendants about your needs, hopes and fears as they become apparent. This process may result in some form of written communication, or it may not. It should serve the learning process, offer image-making scenarios, provide confidence, and hopefully, support rather than weaken the quality of letting go and accepting what is happening in that moment.
4 Reality checks when creating birth plans/wishes
1. Positive Communication leads to more positive results.
Resistance is a human response that even the most skillful of us, including your doctors and nurses, will experience.
Shove a plan in someone’s hand and spit out a list of things you don’t want… and you’ll likely get a very predictable response. Resistance.
Start building a dialogue around your deepest values, hopes and wishes—and be curious about the same for your partner, and your support team’s wishes for you—and you’re likely to find common ground.
There are some communication tips that can support your conversations with your health care team and are more likely to lead to being heard and supported with what matters most to you. For example, be clear about your goals so you can better guide your conversations. Avoid negative communication (I don’t want…) and use positive “I” focused statements (I would really like…). Come to the conversation with curiosity without expectations of what you think it should be, and be present in the moment.
You can also get support from your labor support doula and providers for suggestions on how to build a great team approach for your birth. We suggest these conversations with your health care provider take place late in the second trimester or early in the third trimester of your pregnancy.
2. You can’t always get what (ALL) you want.
I think it can be of value early on to start letting go of having it all figured out. For starters, you might not have all of the options available that appeal to you, or for all possible scenarios.
I remember working with a new mother who shared that she had a great low-risk team assembled for her planned low-risk birth. However, at the last minute the baby was observed to be breech and the hospital and her providers did not have the specialized skills to offer the option of a safe, breech vaginal birth. Consequently, a cesarean birth was the only choice she was given. Upon reflection, she wondered whether she should have chosen a doctor she had met earlier in her pregnancy who specialized in high-risk births, and was one of a handful of practitioners at that time who would consider managing a vaginal breech delivery. If she had done that…maybe her daughter could have been born vaginally.
She concluded that, of course, she couldn’t anticipate everything that might happen and that she had made the right choice in that moment. Also, the team she did go with gave considerably more personalized care and she could see that they played a significant role in helping her to approach birth confidently and without fear. She understood that she never could have anticipated that last minute ‘turn’ of events. At the end of the day, what mattered most was the fact that she was surrounded by a team that really cared about her. And so, even as she faced the surgical delivery, she wasn’t afraid.
3. Listening Time is Limited
When it comes to communicating with your health team, it’s helpful to be aware of the limitations that exist within the system itself. One of those limitations is time. Your doctor or midwife may have a deep well of caring, but the time they have to give each person is a limited commodity.
In our close relationships we know we need to be realistic about time and the capacity for listening. We don’t expect to have any ‘important talks’ when there is just 5 minutes before we have to leave for a scheduled appointment. We also turn to others for some of our needs, so that no one person is expected to meet them all. We can take that same wisdom into our health care provider relationships. If you’ve hired a doula, talk with them about all of your questions. You’ll find that they can help you winnow down your long list to a few key topics for your next doctor or midwife appointment. When it comes to processing a nagging worry or making sense of conflicting advice, they’re able to give you spacious listening and reflecting time. Your doula won’t tell you what to do, but they can give you some directly relevant resources. They can also help you with reassurance and perspective based on their experience with many providers.
4. Balanced expectations—AKA ‘Picking your Battles’—is important.
The thing that can make a birth plan an epic failure is when there are so many detailed requests that the health care team walks away feeling that THEY will fail you. I know, this may often be communicated in careless ways. For example, they may roll their eyes or tell you that the longer your birth plan is, the greater your chance of a cesarean birth. This can feel quite threatening.
But, I believe what’s at the heart of this is both a human desire to be generous and caring AND a human need for self-protection, reliability and safety.
Think about it…
Have you ever had someone come to you with an expectation that you couldn’t meet? A family member who makes a request that is impossible to achieve without disappointing another person, or giving up time and energy that you feel you don’t have? Or a project that requires more time, expertise, or resources than you felt you could give, or where your manager asks you to surmount obstacles that feel unrealistic? Have you ever been asked to put your reputation or your values aside to go against work rules or policies?
Take a moment to really imagine at least one of these scenarios and you’ll likely feel the urge to meet another’s request. You may feel yourself cringing or getting angry. You may even ask yourself, “Why are they putting me in this situation?” Now think about your healthcare team. Part of the reactivity may exist not because they are dismissing you, but rather because they WANT to give you what you need but feel the tension of not being able to so. And, to be fair, reactivity may also exist because many of us seek routine in the workplace and going outside of that routine can be challenging.
Let’s be clear. I AM NOT inviting us to get wrapped up in identifying with the needs of others over our own needs. I AM NOT advocating that we don’t ask for what we need because it might offend someone or we’ll be viewed as a ‘problem patient’. I am inviting us to consider HOW to make our requests heard and to focus on what we most need and wish for.
Here’s the other thing…some of the interventions you might not want may actually help to keep your team’s stress levels down. This means they can make informed recommendations rather than execute decisions based on fear or the need for control. For example, letting the nurse check heart tones or put on a monitor when they are tracking the baby may not be what you planned for, but it can provide information that might reassure everyone and keep the focus away from the ticking clock which may be what is the most important to you for your birth. Agreeing to certain tests later in your pregnancy might give your doctor or midwife the confidence they need to back down on the post-date induction. Consider what you can do in the spirit of letting go so the team’s comfort zone expands rather than contracts. Be open to the possibility that your preferences may change as you move through pregnancy, labor and delivery.
The ‘birth plan’ is an opportunity to have a thoughtful review of what options align with our hopes for this important life event and how we can communicate that to our healthcare team. Establishing good communication and trust with your team, over the course of your pregnancy, allows you to focus on the day-to-day joys and challenges. The childbearing year is an invitation that helps us to deepen our trust in ourselves as well as our ability to let go and reframe expectations. These qualities also prove to be very helpful for the parenting we will do in the years to come!
Karen Laing, IBCLC, HC, Founder of Birthways and WisdomWay Institute