The pros and cons of birth plans

By Katie Roebuck

September 18, 2018

I am the mother of two children, an RN, Prenatal Educator, Lactation Counsellor, and Sleep Coach. My nursing career has been focused on Maternity and Obstetrics. I am based in the Niagara Region and I enjoy helping moms reach their goals with pregnancy and motherhood!

If you or anyone you know has ever worked in a birthing unit, you will probably hear the theory that the more lengthy and complex a moms’ birth plan, the more lengthy and complex her birth will be.

I’ve been a labour and delivery nurse for over 10 years now and I have definitely seen that theory become truth. I have seen a wide variety of birth plans – ones that come in binders with multiple pages including a list of people who will be in attendance, to the songs that must be played at certain moments during the labour and birth. I’ve also seen very simple ones, the simplest being  “have a healthy baby and live to tell the tale” typed on it.

Birth plans can sometimes be a controversial topic. Some people, both parents and health care providers, feel very strongly about having a well laid out birth plan that covers every detail. Women have been giving birth for centuries and should be allowed to do so as they wish.

That is a statement I mostly agree with.

However, one thing I personally feel that is missed by parents-to-be is that they are not truly in charge of the birth. It’s not the doctor, nurses, or midwives either.

It’s the baby.

Many times throughout my career I have seen a birth become complicated and interventions are needed, and it has nothing to do with the woman in labour. One of the hardest part of obstetrics is that there is a whole other patient, a whole other human being who we cannot talk to, touch, or truly assess until the moment of birth. The only way baby can communicate to us about his or her health is though a health care provider’s skilled interpretation of ultrasounds and fetal heart rate tracings.

A perfect example is a woman whose labour was progressing well, but the baby’s heart rate was showing signs of distress and delivery was needed. The umbilical cord was wrapped around the baby, becoming compressed during each contraction and therefore causing the distress. This is something that is very common and cannot be prevented, but can be a cause of interventions that have nothing to do with mom and how she is labouring.

So what about birth plans?

Honestly, the more you write down, the higher the chance things will not go as you had planned. Think of it like planning a huge event such as a wedding – did every single detail go off without a hitch? Probably not. But you got married for the marriage, not just the wedding day.

Instead of “birth plan,” I prefer the term”birth wish list.” Things you wish to happen in your birth, while leaving room for change. Because ultimately, the plan should be to have a healthy mom and a healthy baby at the end of the labour process.

So how do you write a birth wish list?

First, make some notes about what you would like to try to happen and what you would prefer to avoid. Things like avoiding cesarean sections and episiotomies are common to see on a wish list, and as a labour nurse, I’d like to avoid them too because recovery takes longer. There’s no harm in writing it down, just know that we try to do what we can to avoid certain interventions too.

Second, bring your list and discuss it with your healthcare provider. There may be certain hospital policies that must be followed, regardless of what you have on your list, such as how many people you can have in the room at the birth and the use of photography. Your healthcare provider will be able to tell you if there is anything ‘worrisome’ on your list and discuss it with you at your appointment.

Third, take a good prenatal class. Most women I work with want to avoid assisted births such as vacuum, forceps, or cesarean. However, I’m a firm believer in being informed, so these things are still covered in my prenatal classes. That way if interventions are needed during the labour process, you are educated on what is happening and why.

Finally, when you arrive in the labour ward, have your primary nurse or midwife review your wish list. They may ask some questions about certain requests you have made and discuss them with you. We are not questioning you, we are just making sure that your wishes are well informed and based on science and not Google.

I always tell parents that during a birth the goal of everyone involved should be a healthy mom and a healthy baby. If we can get you the birth you wished for during that process, then that’s a massive bonus. This is not meant to be harsh, or to take away a woman’s right to birth how she wishes, but it is a statement I make after over a decade of bringing babies into the world and the knowledge of how drastically things can change during pregnancy, labour and birth.

Entering your birth with an informed mind and open heart may allow you to have a positive birth experience, even if things don’t go exactly how you may have wished.

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