Why I don't write birth plans.

Why I don't write birth plans.

Over the years, I've moved away from birth plans. A plan implies that if we just make the right choices and feel really strongly about those choices, then we can control what happens during birth. And the thing is, that birth is unpredictable, in good ways, and sometimes in nerve-wracking ways, and there's a risk in having a plan. That risk is, if my birth doesn't go according to my plan, then I'm a failure/stupid/bad or whatever; the point is, there ends up being shame involved. 

But let me make one thing clear; not adhering to a plan doesn't mean that we shouldn't learn about the choices available to us in pregnancy, labor, birth, and postpartum. No! It's worthwhile to truly investigate your options (and there are options that aren't even presented as options, but rather as hospital protocol, but which absolutely are choices that you can make). And part of this is learning the circumstances in which an intervention is an appropriate choice. 

When we think of our options as black and white, they become embedded with positive and negative values. If you look around, you'll notice that this is 110% true of anything involving pregnancy/birth/parenting. Like:

  • unmedicated birth = ridiculous, painful and unnecessary, why be a victim?
  • medicated birth = unnatural, bad for me, bad for my baby, i was weak, i wasn't strong enough, brave enough, i failed
  • natural birth = right, good, beautiful, healthy, holistic, but this sets up anything that isn't "natural" as wrong, unhealthy, medical, etc. (And what does "natural" mean? It means different things to different people!)
  • cesarean birth = failure, weakness.

What I've seen attending out of hospital births is that there are, occasionally, times and places when the right intervention can mean having a vaginal birth, and that sometimes, a cesarean is the right way for a baby to be born. It's helped me to step back and look at interventions as tools in a toolkit; at the right time, they can be a savvy and helpful choice. But, when they're routine, they do more harm than good.

So, letting go of a plan means letting go of the illusion of control.

There's a big difference between losing control, and letting go of control.

Losing control can mean floundering through the experience of birth, not being sure of one's choices, feeling pressured to do what someone else wants you to do, and doing something that doesn't feel right. It can mean not being on the same page as your partner, because they feel really overwhelmed and confused. It can mean losing control over one's one physical autonomy, like being touched in ways that aren't okay, like powerlessness. Losing control can feel scary, really scary. 

Letting go of control means experiencing the profound release of birth, of acknowledging that there's unpredictability in how it will feel, look, sound, and be. And that's okay! Birth is what it is. And that's not a bad thing. There's a point in labor where many people feel like they just can't do it anymore, and then, you know what? They do. They do it. They step out into that swirling void of sensation and find their strength--which looks like so many different things--which looks like every single individual and their unique birth--and when they do, there is opportunity for transcendence and power.

The key is informed choice. 

So in lieu of birth plans, what I recommend is to set intentions and establish your preferences. There will also be some things you can make pretty clear choices about, like, if and when you want your baby to receive a Hepatitis B vaccine, for example. But some things are deeply contextual. Like, what if your water breaks before you go into labor? How long does your provider want you to wait? At what point will they get super serious about inducing your labor? How does that change things. It's stuff like that which can really throw off a birth plan.

What I'll offer is this:

  1. What intentions do you have for your birth? What do you believe about your body? What do you believe about birth?
  2. How do you want to feel emotionally during your labor, and what are the conditions that best meet those desires? (For example, if you want to feel supported, what does support look like to you and your partner? If you want to feel grounded by your community, what might that look like? Is your vision of birth supported by your provider? Do you need a different provider?)
  3. What are the choices that you can make, and what are the benefits and risks of each? (For example: genetic counseling, ultrasounds, gestational diabetes screening, GBS screening, induction, labor augmentation, pain management, pushing, VBAC, post-term pregnancy, pre-labor rupture of membranes, cesarean birth, optimal cord clamping, eye ointment for the newborn, newborn bathing, vitamin K for the newborn, Hep B vaccine, bathing the newborn, breastfeeding, and so on...).

Obviously, you're not going to hand your midwife or OB a vision board for your birth (but if you do, make sure there's glitter. Lots of glitter).

Some of this is an exercise for you to reflect on your birth, some of it should be conversations with your partner or support person, some of it should be reflecting on your own emotions/fears/sense of limitations/etc but it should result in two things:

  1. Concrete, practical conversations with your provider about the choices you're making and the choices that they would make in given contexts;
  2. A piece of paper with those choices written out clearly and succinctly, so that your provider and nurses can quickly recall what you want and don't want when you're in labor.

You can do this yourself, but if you want some help, reach out! I offer birth consultations to families all over the world. We can go over your options and create a set of preferences that honor your intentions, so you can do birth like

Header photo credit: Joe Green

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