As a doula, one of the most helpful tools I can share with my clients are birth plans, or as I like to call them, birth preferences, because let’s face it, we can’t really plan our birth but we can definitely prefer one thing over another. Having a client write out their birth preferences helps me better understand what they’re hoping to achieve during their birthing and lets me know how I can best assist them towards those goals. But, that’s just one facet to the power of birth preferences.
Far beyond being a way for me to understand what my client wants for their birth, birth preferences are a great tool for communicating with your support team.
When we think of a birth plan we often think of it as a sheet of paper that was put together one afternoon after downloading a template we found on some popular baby website full of colorful pictures or bullet points. But the truth of the matter is the birth plan that goes with you to your place of birth should be a final draft in a series of many rough drafts or outlines that has been worked on over the last few months of pregnancy.
I promise, I’m not trying to add the stress of homework assignments to the list of things you’re already busy doing while preparing for your baby. What I am suggesting is start thinking about your birth preferences early so you can figure out how best to achieve those preferences. For instance, try starting a list on your phone or in a notebook and as you think of something you’d like to look into or discuss with your provider, write it down. This can be the beginning of the rough draft that will eventually become your final draft.
Birth Preferences are very personal and unique to every pregnant person. I’ve seen preferences that are very brief and concise and others that are much more detailed.
And yet, one of the questions I often get asked is “do I really need a ‘birth plan'”? And my answer is always YES.
So why do I emphatically recommend putting together a list of your birth preferences? Well, there are a few reasons.
1. Gives you a chance to really visualize your birth
Have you stopped to imagine what your baby’s birth day will be like? Have you thought about how you’d like to be comforted? What your room will look like? Visualizing your birthing day with as much detail as possible- who’s there with you, what’s the temperature in the room, is it daytime, nighttime, etc.- and visualizing it often, helps to condition your mind to create it for you.
Take for example, athletes. It’s long been known that some of the most successful athletes use visualization to help them prepare for big games. They imagine themselves, in great detail, making big plays, running up and down the field, passing to a teammate and eventually winning the game.
Visualization helps us create an expectation. The more we focus on those expectations the more our minds work to make them our reality.
So now imagine how you see your birth and think about what you’ll need in order to make that expectation your reality; a birth ball, a doula, massage, dim lights, aromatherapy, nurses with low voices, etc. Then, write it into your preferences.
Remember, visualize your birth often and with great detail and you’ll more easily achieve that goal.
2. Helps your Partner know how they can support you
Preparing your preferences with your partner is a great way to help them better understand what you want during your birth and how they can support you.
Partners are far too often pushed to the side as an unnecessary player in the birth arena. And for some partners, this exclusion can be distressing and in some cases, traumatic.
Your partner is a tremendous asset to your birthing because they are the only other person in your birth room who can speak on your behalf in regards to your care, (not even your doula can do that) so it’s important that they are given the opportunity to be an active participant in the preparation for and the birthing itself.
Now, there are partners that feel more comfortable letting someone like a doula or the care provider take a more active role in the birth and those wishes should be respected. Your partner may have their own expectations so developing the birth preferences together will not only open up communication with each other but can also help you both determine how each other’s needs can best be met.
3. They can help you determine where, and with whom, your baby will be born.
Choosing your provider is one of, if not, the most important factor in whether or not your birth preferences will be met. And, depending on where the provider you choose has medical attending rights, this will also determine where your baby will be born.
Let’s say, for example, you’ve had your heart set on a water birth only to find out that the only facility that offers a water birth is located 2 hours away from home and the doctor you’ve chosen doesn’t attend there. Or, perhaps the facility is in town but outside of your insurance network. So basically, if your doctor is supportive of your water birth yet the hospital in which they have rights to attend doesn’t offer a water birth, you’re not having a water birth. At least not with that doctor or in that hospital.
One of the biggest misconceptions is that once you’ve chosen a provider, you’re stuck with that provider. And that’s simply not true. You have a right to change providers at any point in your pregnancy for any reason. Having said that, the doctor also has a right to not accept you as a patient at any point in your pregnancy. So while I don’t recommend changing doctors at 39 weeks pregnant, yes, it is possible.
So, why would someone consider changing providers? Just as there are many reasons we choose to stay with a provider there are many reasons we choose to switch. Going back to our water birth example, we may think Dr. X is amazing and wonderful but they don’t attend water births so, we may decide to find a different provider who does. Or, Dr. X is amazing and wonderful but they don’t attend water births so in order to keep Dr. X, we decide to forgo the water birth. These are very real options, among many others, and they are most definitely reason enough to change providers should you want to.
Just as important as who will be your provider is where your baby will be born. Dr. X may be amazing and wonderful and super supportive of your birth preferences but is the hospital they will be attending you at as supportive? Some doctors have attending rights at multiple hospitals allowing their patients to choose which facility best meets their needs. However, keep in mind that that same doctor’s standards of practice may vary depending on which facility they attend your birth because they are bound to each hospital’s policies and protocols.
Talking to your doctor about your birth preferences is a great way to open up the conversation and communicate to your doctor not only what you want during your birth but also how and if they can accommodate those preferences for you. Just as you and your partner have preferences, so too does your provider. Openly discussing your needs with them will help you find a common ground or, if necessary, help you decide whether or not to go with another provider.
Once you and your provider have settled on how your preferences will best be met, you can start to finalize your birth preferences making sure to leave space at the bottom for your provider to sign. Taking a signed copy of your birth preferences with you when you check in to your place of birth will let the nursing staff know that you’ve discussed your options with your provider which will help them understand how they can best support you as well.
4. They ensure you DO YOUR HOMEWORK!
Let’s be honest, birth plans aren’t always welcomed in a hospital setting because they’re too often seen as being these long lists of requests like “I’d like my baby to be born listening to a gentle waterfall playing in the background” or “I want everyone in the room to be wearing only white”, (granted, I’ve never seen either of these requests in a birth plan, but, as a doula, if this was in a client’s plan I’d do my best to honor their requests).
Unfortunately, I’ve seen and heard of far too many instances where nurses and even some doctors have scoffed at a mom when presenting her birth plan. I’ve seen eye-rolling, disregard, and downright disrespect. So why would I so strongly encourage you to create your birth preferences? Do I want you to succumb to the same ridicule? ABSOLUTELY NOT. Here’s the bottom line: if your provider has a problem with you having a birth plan that lays out what you would like for your birth and you’ve presented it to them so that you can both discuss your options, that is a problem.
I once had a client who’s provider gave her their birth plan for her birth. She promptly changed providers.
Now, here’s the thing, when a provider sees a birth plan, they may assume you’ve downloaded said plan from one of those aforementioned popular baby sites without necessarily researching what each option is much less the risks and benefits associated with them. And that, too, is a problem.
Ask yourself, do you really know the risks/benefits of delayed cord clamping? Do you really know the risks/benefits of a pitocin induction? Would you feel confident discussing the research that helped you make your decision to have a medicated/unmedicated birth with your provider? If you’ve answered no to any of these hypothetical questions, you need to DO YOUR HOMEWORK.
Doing your homework benefits you in many ways: you’ll learn all about your options and their risks and benefits, you may learn some things you hadn’t considered before, your provider will better understand how important your choices are and be more compelled to support them, and perhaps more importantly, you’ll be able to confidently give informed consent and informed refusal. That’s empowering!
It’s your birth, go ahead and take the wheel
So, more than being just a sheet of paper with your playlist options, baby feeding preferences and laboring position of choice, your birth preferences, or birth plan, is a way for you to step into the driver’s seat of your birth while everyone else goes along for the ride, having full confidence that you know the best route, as well as alternate routes just in case, to get to your desired birth.
Below you’ll find links to some of my favorite and trusted websites for reliable information about pregnancy and birth options you may consider. I also strongly recommend looking into childbirth education classes to help you learn more about your pregnancy and childbirth options.
Did you have a birth plan? What did your provider think? I’d love to hear about it in the comments.
Lety Knight Birth Services 