A Birth Plan Isn’t What You Think It Is

Hard truth time: a “Birth Plan” isn’t really a birth plan.

Many people have already suspected as such, which is why it’s often reframed as “Birth Preferences” or “Birth Wishes,” yet remains in mostly the same format: a description of the ideal birth outcome, and procedures that won’t be accepted.

Your true birth plan involves the preparations you make for labor, birth, and postpartum. It’s about how you choose to assemble your birth team. It’s your understanding of your options and alternatives. It’s your growing comfort in speaking your truth clearly and assertively. It’s your self-care routine, how you’re being supported by others, your focus on learning, your practice of introspection.

Now, in its most beneficial application, a written “Birth Plan” represents who you are in contrast to everyone else who shares your due date. It shows what you’ve contemplated, envisioned, and become educated about for this birth. It’s a point of reference, reminding of your personal information, desires, and hard “No”s.

A Birth Plan is a communication tool, not a magic shield. It shouldn’t replace important conversations that need to happen with your birth team during pregnancy. And it does not speak for you; many people end up frustrated when they find themselves repeating what they’ve listed on the Plan. But it isn’t a stand-in for consent, or lack thereof; remember, a piece of paper comes with no guarantees. It can serve as an important part of manifesting a positive and healthy birth experience — but it cannot be the foundational building block.

A written Birth Plan can:

✔ help determine whether your birth place and provider are compatible with your needs

✔ aid in reminding of your wishes and preferences, especially if birthing in a hospital where you’ll be meeting L&D nurses for the first time

✔ be a good exercise in organizing your thoughts related to birth policies, procedures, and personal needs

✔ be useful in discussions with your partner about birth, so you can get on the same page

✔ illuminate areas you may want to revisit: gaps in preparation, traumas or fears that are asking to be seen, how you’re feeling about your prenatal care, etc.

Brainstorming Tips:

✔ First draft: list all the things. Think big picture. Determine what you feel strongly about, and what you’re neutral about. Then start eliminating. Which options are irrelevant (see more below)? Let ‘em go. Have you included any aspects that are unavoidable or uncontrollable? These deserve a place in conversation with your care provider, but not necessarily on the birth plan.

✔ Giving your L&D nurses / care provider a “list of demands” is unlikely to go over well. Instead, highlight what’s important – what your needs are, how you want to be supported, and anything that will make this experience as positive as possible for you. How can your birth team best help you? Are there any unwelcome modes of assistance they should know about ahead of time? Write down your ideas!

✔ Anything that is standard procedure can be left out (for example, if your birth place encourages eating during labor and you plan to snack throughout, no need to mention it). Same goes for anything irrelevant (for example, if your provider boasts a very low rate of performing episiotomy, you don’t need to write “No Episiotomy”). On the other hand, if there’s anything unique to you, put it on paper! (Let’s say you want your partner to catch the baby, or you request the word “waves” to be spoken in place of “contractions,” or you’d like certain music playing in active labor).  

Side note: If you realize you don’t consent to many of the standard procedures at your birth place, research other options in which you won’t expect a need to frequently say “No.”

✔ Keep your outline solution-focused, not problem-focused. Focus on what you DO want, not on everything you want to avoid. What do you want — and what can help you achieve this? For example, let’s say you want to feel relaxed and at peace, but the thought of medical interventions brings you anxiety. Instead of writing every intervention you can think of in a “No” column, think about what helps you feel relaxed — maybe quiet voices, massage, limited interruptions, music, whatever it might be for you — and write down 2-3 you know you’ll want to try first.

✔ That said… you can absolutely say NO to anything you want. For example: No vaginal exams for you? No explanation needed. Just say no. It’s your body, your baby, your birth, YOUR choice. You can list alternate ways you prefer to get similar information.

Side note: Please do inform your care provider of your wishes during pregnancy though, so you don’t find yourself struggling to be heard in labor. And find out how your provider handles a situation in which you change your mind in labor (let’s say prior to labor you were okay with the idea of vaginal exams, but you decide against it when labor hits. Will they respect your wishes or does it sound like they’ll give you heck over it?).

✔ For the final draft: keep it short, like a single page. If you find yourself “explaining” a lot as you write your birth plan, consider putting those extra words to better use by scheduling a sit-down appointment with your provider ASAP. If you feel the need to emphatically defend the wishes in your plan, think about why that might be. Do you feel your care provider is trustworthy, or have you noticed red flags? Do you feel safe with your birth team, or do you feel thrown off by the inclusion of a particular individual? Do you have specific concerns that haven’t been addressed verbally? Or maybe something else?

✔ If you’re confronted with strong feelings about something triggering or uncomfortable while writing your Birth Plan, this is a great opportunity to acknowledge, take note, and explore further. You may realize what you thought you wanted isn’t what you want after all. Or you may discover a certain fear is no longer so scary – refreshing!

Practical Stuff:

✔ Put your identifying / medical history at the top for ease of access. Include:

  • Your name
  • Partner’s name
  • Names of any attendants (doula, photographer, relative, etc).
  • Due date
  • Date of last menstrual period
  • Blood type
  • Social Security number
  • Insurance type
  • Emergency contact name & phone number

✔ I don’t recommend using icons / symbols / pictures on your Plan because they can be confusing and hard to decipher. Cutesy fonts can be hard to read as well. Sticking to a simple “Yes, Please” and “No, Thank You” column format in a tried-and-true legible font is usually your best bet.

✔ Make a separate plan for your baby in postpartum. A copy can be left on the baby warmer if birthing at a hospital (even if you don’t wish to use the warmer, as this is where the nurses typically arrange the newborn supplies). Here you can include anything pertaining specifically to baby’s care and treatment from birth onward.

✔ A “backup” plan for transfer or cesarean gives some people peace of mind, but causes anxiety and stress for others. This exercise should end up making you feel more confident, not more afraid — so follow your own lead on whether writing a Plan B would be beneficial. Always keep the backup plan separate from your primary plan.

✔ Remember that, in reality, birth is not an inherently “plannable” event. There is only so much that can be controlled about birth (try as some might). How will you surrender and accept the nature of birth as largely unpredictable? The insights that arise from this question will be key to successful birth planning. It’s a process of recognizing what you can control, and taking action – while also discovering the power in releasing the attempt to control that which is simply beyond your command.

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