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Family Health Magazine - CHILDBIRTH

Birth Plans
Are they necessary?

Many pregnant women wonder, “Do I need to write a birth plan?” The answer is always the same – you can if you want, but you certainly do not have to write one. Most women do not. So how do you decide whether you want a birth plan?

What is a birth plan?

A birth plan is a written statement of your wishes for your labour and delivery. It might include almost anything that is important to you. Examples are what you would like to use to help with pain, whether you want to bring music to play in the delivery room, and whether you want the baby placed on your chest the moment it is born.

Some birth plans are just a few sentences, and others are several pages long. A birth plan is not a legal document or a contract. It just lists the choices that a woman would ideally make for her labour. It does not replace talking with your care provider about your preferences during your labour and delivery. Even if you have a birth plan, your doctor or midwife will still ask you to make decisions along the way.

Is writing a birth plan right for you?

It is certainly a good idea to talk to your doctor or midwife about what you want for your labour and delivery. However, there is debate about whether you should write down your wishes in a birth plan.

Some people feel that making a birth plan takes too much time, or is too much like homework. They may just want to discuss their wishes with their care provider without writing it all down. That is perfectly fine! In fact, it is what most people do. Others prefer to enter labour without any plans, just making decisions as they go along. Finally, some people do not have any strong preferences, and prefer to do whatever their care providers recommend.

Writing a birth plan has some benefits. It may help you think about what you might want in different situations. You may be reminded of things you still have questions about as you write it. Many couples find that writing the plan together helps them understand each other’s beliefs and ideas about labour and delivery. Probably the most important benefit is that a written birth plan helps communicate your wishes to those taking care of you in labour – your midwife, doctor, and nurses.

Any woman who has certain wishes for her labour should talk to her care providers. Ideally, this conversation should begin before labour starts, during your prenatal appointments. Some people find that having a written plan helps them remember everything they wanted to discuss when talking to the doctor or midwife. However, if you prefer to just talk about these points without writing them down, that is great too.

If you are taking prenatal classes or reading pregnancy books, you are learning a lot about what normally happens during labour and delivery. If you do not understand why things are done a certain way, please ask! Your prenatal class teacher can probably explain it, or your doctor or midwife can answer questions at your next prenatal visit.

Preferences

In some cases, there is flexibility in the way things are done. If you have a certain preference, talk to your care providers. They can often do it the way you want. In other cases, there is a very important reason why the doctor or midwife does things a certain way. Ask for an explanation of the reason. You can use all of this information to make up your mind about what you want during labour and delivery. Then, tell your care provider about your wishes, either verbally or in a written birth plan.

Most of the time, women’s preferences are very similar to those of their care providers. In this case, talking about your plans with your care providers will be easy. Tell them what you would like and the reasons why. Your care provider can point out areas that might be a problem, and explain the medical reasons for doing things a certain way. Usually, it is easy to reach an agreement and develop a plan with which everyone is comfortable. You may be surprised to learn that your care provider usually does things your way already! For instance, when all goes well, many doctors and midwives routinely put the baby onto the mother’s chest immediately after birth, and wait a while before cutting the cord. You may be concerned about other practices, such as an episiotomy (a cut made at the vaginal opening to help the baby fit through). Though it once was common routine, this procedure is rarely used these days unless there is a special reason.

In rare cases, you just may not be able to agree on a certain issue. Your doctor or midwife may feel strongly that something should be done a certain way, and you may feel strongly that you want it done differently. Sometimes, the care provider will agree to do things your way, but only after explaining all the risks and making sure you accept them. In rare cases, the doctor or midwife may refuse to do something that they think is too dangerous. Then you must decide whether you want to accept the recommendation, or try to find another doctor or midwife. However, those cases are very unusual. It is almost always possible to reach an agreement that works for everyone.

Labour and delivery are difficult to predict

Although disagreements can be difficult, they are not the biggest problem with written birth plans. The biggest issue is that it is impossible to predict what will happen during your labour and delivery. You can outline many things in your birth plan, and your care provider might agree that they are great ideas. However, nobody can promise that everything will go the way you want. The reason is simple - nobody knows for sure what your body will do, or how your baby will respond during your labour and delivery. Labour is not predictable, and every labour is different. You can never know ahead of time if unexpected things that you could not possibly plan for will arise.

A birth plan may make you feel more in control of your labour experience, but that sense of control can be an illusion. In reality, nature is always in control of the process. The only thing we can control is how we respond to what happens. A birth plan only helps you set guidelines for decisions. It is impossible to know exactly what decisions you will need to make until you see how your labour goes. No matter how carefully you plan, the reality of labour and birth is that it cannot always be planned! Some people do have exactly the labour they imagine, and everything goes according to plan. However, those deliveries are the exception rather than the rule.

The biggest problem with a birth plan is that it is impossible to predict what will happen during your labour and delivery.

Surprises and smooth sailing

In most cases, labour includes at least a few surprises. There is no way to include every possible situation in your birth plan. Sometimes the situation may even change in a way that completely changes your mind about what you want. For instance, a mom may show signs of infection in the uterus. An infection puts your baby at risk. In this case, inducing labour (starting it artificially), or even doing a caesarean section may be recommended. Though you may not have wanted either of these things, you must decide which is more important to you: your plan for a natural labour, or reducing the risk to your baby.

Plans do not only change when things go wrong. Some need adjustment because everything is going very well. For instance, you may have planned to have an epidural. If your labour goes very quickly and easily, or other methods of managing pain work well, you may decide that you do not need an epidural after all.

Healthy mom and healthy baby

Remember, the most important goal of labour and delivery is a healthy mom and a healthy baby. Some women feel they have failed if their labour does not go exactly the way they planned. If this happens to you, try to see the whole picture. Of course it is nice to have the labour experience you want, and in most cases your team works hard to accommodate your wishes. Still, what matters most is that you and your baby are healthy in the end.

Flexibility and communication

Since labour and birth are so unpredictable, it is very important that pregnant women and their caregivers are flexible. A birth plan can be a good guideline, but there are still many decisions to be made.

As it is so important to be flexible, many doctors, midwives, and nurses advise that having a written birth plan is not important. Good communication with your care provider is key, so that you understand what is happening and can make the best possible decisions. Write a birth plan if you find it helpful, but remember that things may happen during your labour that change your wishes. If you do choose to write one, consider it a way to help you talk with your care providers, rather than a set of carved-in-stone rules. Keep an open mind, and be ready for a few surprises along the way!

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
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