Ask the expert: Do I really need a birth plan?
Is a birth plan really necessary, or just nice to have? If you’re pregnant, you’ve probably heard of birth plans. But what is it? What should be in it? Do you even really need one? Zealand writer and midwife Kathy Fray weighs in with her opinion.
Q: I’m pregnant and writing my birth plan, and the template my midwife gave me is very clinical and more focused on the baby and the birth than on me. Can you give advice on writing a mother-centred birth plan, and what kinds of things it could include?
Almost every modern book on childbirth instructs you to write down your own birth plan. But what are they really, and how necessary are they?
Birth plans became popular in the “women’s lib” 1970s and the “go-girl” 1980s, when sensible birthing practices were sometimes battling with rigid protocols of archaic hospitals. But to be honest, today in NZ, with our internationally respected continuity-of-care LMC system, and midwifery-led maternity healthcare, the necessity of a detailed birth plan is questionable these days.
You see, as a pregnant woman, you are getting to know your LMC over months of one-on-one appointments, and during that time. your personal labour and birth “wish list” of consents and declines legally should all have been covered off in discussions, and documented into your clinical notes. That’s part of the role of an LMC.
However, after a dozen years of attending births, the three exceptions I would say are:
- Women who don’t have a 24-7 on-call LMC (as there is a shortage), and they instead simply have a daytime-only community midwife, and will be attended on the day by whatever hospital-based shift-working midwife is rostered on the birthing suite at the time. When you arrive into the delivery unit huffing and puffing, it can be helpful to that core midwife to be handed your birth plan.
- Women striving for a natural labour and normal birth, who are low-risk with no specific medical complexities, but have opted to pay for a private obstetrician LMC. In my observation, these women tend to have an increased chance of interventions, due particularly to the oftentimes almost routine encouragement of an epidural, and the subsequent cascade of complications that spinal anaesthesia can impact on the natural process of cervical dilation and fetal descent.
- Women giving birth in America (!) – because natural birth there is routinely perceived as primitive and unnecessary hippy ridiculousness.
If you do feel the need to write down a birth plan, then it should include the fundamentals of your decisions, such as who is cutting the cord, if you’re keeping the placenta, whether baby is/isn’t having Vitamin K, your pain management preferences, and any special religious or cultural requests. In an ideal world, you should be feeling that you don’t need to write down any more specific dos and don’ts as to how you wish to receive care, as the variables are SO enormous.
Preferably, by the time your baby is at term, you should be feeling complete confidence and utter trust that your LMC understands you as a person, and plain “gets” you. But if it is getting closer to your estimated due date (EDD), and you’re becoming increasingly aware how “un-bonded” you are feeling with your LMC, then it is not too late to change carers – you can do that any time. It is your right. And as LMCs, we all appreciate we won’t always “gel” with every single client we deal with.
I guess, to be honest, my other grave concern with overly-detailed birth plans, is the potential for them later to become a “document of disappointment” when the labour took a completely different journey. So in general, my best advice is: Avoid rigidity, stay as flexible as you can, to allow for the unexpected (bad and good).
Kathy Fray (kathyfray.com) is a New Zealand writer and midwife, author of the best-selling OH BABY… Birth, Babies & Motherhood Uncensored, and internationally popular OH GROW UP… Toddlers to PreTeens Decoded, and body-mind-spirit manuscript award-winning OH GOD – WHAT THE HELL DO I TELL THEM?! Guide for vaguely spiritual Parents. You can catch Kathy, as well as many other parenting experts talking live from the Seminar Room at New Zealand’s biggest baby event, the Baby Show, which takes place between 18-20 August at the ASB Showgrounds. Buy tickets today at www.babyshow.co.nz.