Plan Schman?

I recently came across a blog post on the subject of birth plans and whether it’s worth writing them. (Full disclosure: I now can’t find the original post, or I would link to it here…). As a doula, I have always encouraged my clients to write birth plans and I believe that there are very real benefits and little to no risk, as long as you recognize why you’re writing it and acknowledge both your hopes and your fears while doing so.

Many medical professionals caution against writing birth plans, because of the worry that if things don’t go according to plan, the result will be disappointment. As the post I referred to above noted, this is a somewhat bizarre double-standard when considered in relation to other life events. For instance, I recently got married. My husband and I planned the day very carefully over the course of many months. We chose between a banquet style meal and a cocktail dinner; an indoor ceremony and an outdoor ceremony; an off-the-rack dress or a custom-made frock; religious or non-religious ceremony; etc. The list could go on for pages as anyone who has had a wedding can relate to I’m sure. Some of the choices my husband and I made were easy to make and easily realized. Others left things up to chance – for example, we wanted to do our photos in the outdoor garden and on the dock. If it had rained, would we have been disappointed at the necessary change to our plan? Of course we would have been, but we were prepared for that possibility and rolled with it. Similarly, when we plan our careers, we have a vision, an ideal in mind. Two years into my career as a doula, I’d hoped to be financially self-sufficient, needing neither my husband’s income nor a second part-time job in order to make ends meet. I’m not there yet. Does that bum me out? Sure. Of course it does, but I work towards my revised goals and find gratitude in the successes I have had. The difference is that no one warns you not to plan your wedding or your career path. Everyone knows that sometimes things don’t go according to plan, whether because of Mother Nature or other factors. We all accept that despite our best-laid plans, things won’t always go our way, but we continue to plan because we realize that it is the only way to actively move forward, to at least try to achieve the things we want. We can’t always get what we want, but if we don’t take the time to think about what it is that we want, we’re pretty much guaranteed not to.There is no good reason to make women expect failure from their birth any more than they should expect to fail in any other realm.

A birth plan is not meant to be a set of foolproof instructions for our babies, our bodies, our caregivers and Mother Nature. It’s a way of carefully considering and evaluating our options, a communication tool and a visualization aid. A good birth plan includes contingency plans. A good birth plan includes consideration of the things we don’t want, which gives us space to accept the fact that that might be the end result anyway. Ultimately, that acceptance may even be the thing that prevents those unwanted outcomes!

An exercise in exploring your options

Whenever I take on the task of planning any life event, I try to think of things in the order in which they’ll occur. When it comes to birth, this means thinking about early labour first. What will it look like? Who will be there and how do I want them to treat me? Where will ‘there’ be? What would make me feel good? What will help me to conserve energy and reduce stress to make the later stages easier? What do my healthcare providers expect of me during this stage? How do I feel about those expectations? Etc. Moving on from early labour, you can then proceed to active labour, transition, pushing and third stage. Once you’ve answered those questions, you can then question your answers. Are my wishes realistic given my personality, my pregnancy, my living situation, my choice of birth place, my choice of healthcare provider? What might prevent these wishes from becoming reality? Are there things I can do prenatally to increase their likelihood? What if things change – what would the alternative look like? How do I feel about that alternative? What kinds of questions might I ask in the moment if someone suggests that my plans might need to change?

Going through this process on your own, with your partner and with your doula may reveal questions you didn’t know you had. It may bring to light options that you didn’t know were available. It may also bring to light policies that you didn’t know your healthcare provider or birth setting had. Most importantly, it may reveal feelings that you didn’t know you had about any of these things. Once those feelings have been realized, you can then explore them, work through them, cope with them. You can do all of this before birth, meaning that you won’t have to cope with them as surprising revelations if your plans do change when the time comes. Dealing with things before you have a newborn, before you’re dealing with postpartum hormonal changes, before you and your baby are learning how to breastfeed together is going to be a whole lot easier than waiting until you’ve got other challenges in front of you.

Communicating with your caregivers

Once you’ve drafted your plan and accepted your feelings about it and about possible alternatives to it, you’ll share it with your doctor or midwife. You may find that some aspects of it are part of their normal routine, which may be reassuring. Conversely, you may find that some aspects are in contrast with their own practice or with the policies of the hospital or birth centre where you plan to deliver. This will give you an opportunity to talk to them about your preferences (including your reasons behind them) and your right to refuse interventions that you do not want. They may give you information that affects your reasoning or your feelings. This may make you want to alter your plan, or it may not, but either way you’ll have more knowledge than you had before. Your healthcare provider will also have more knowledge – about you as a person and about your preferences for your birth. You may decide to change practitioners if you find that your provider is not respectful of your preferences or not willing to hear what you have to say. Again, the key here is dealing with these things before you’re in labour or at home with a newborn.

The other key aspect of a birth plan as a communication tool is that it lets your care provider know that you have a voice and that you are prepared to use it. Many people are willing to go along with whatever a medical professional says, simply because of the degree on their wall. If you’re not one such person, it’s important that your doctor or midwife knows that about you in advance. They need to know that you want the information, that you expect  to be asked and to be given the space and time to make careful decisions, that you know your rights. It’s easy to see how a practitioner who has dealt with acquiescing, submissive, never-questioning patients for years on end might come to expect that from all of their patients. If you don’t want to be seen that way, discussing your birth plan is a great way of demonstrating that, of making your voice heard, of setting up healthy expectations.

One caveat: it is important to express your preferences, to ask your questions and to advocate for yourself, but this can almost always be done in a cooperative and friendly tone. Aggressive communication tends to lead to more of the same. You’ll catch more flies with honey than with vinegar. Be open-minded and respectful and your provider will be more included to treat you in the same way.

Visualizing your birth, your way

As with anything in life, you can’t control birth. The best approach to birth is usually the most open, the most willing to relinquish control. That doesn’t mean relinquishing control to other people, it means relinquishing control to your body. Go with what your body is telling you (even if it conflicts with what you planned) and birth will go more smoothly. That being said, visualizing your birth going smoothly and according to your preferences will help to make that a reality. Many women have a hard time imagining their births; by developing a birth plan you’re painting a picture for yourself. If you’re an images person, you can create visual images (either in your mind or by literally drawing them) that correspond to aspects of your written plan. If you’re more of a words person, tell yourself the story of your birth as you would like it to unfold. The birth plan itself may be brief, technical and to the point, but you can create a corresponding narrative for yourself that is filled with beautiful details, adjectives, emotions and colour. You can even incorporate your other senses! Write your story out, then have your partner or doula read it to you while you inhale a favourite, soothing scent or while you soak in a relaxing tub or sip herbal tea. When you’re in labour you can use those smells, sensations and tastes to evoke the beauty and positivity of your story, which will help to keep you focused and relaxed.

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Writing a birth plan does not guarantee that it will become a reality, but that doesn’t mean it doesn’t have tangible benefits for you and your birth experience. Avoiding planning because of a fear of disappointment only increases the likelihood that your birth will wind up going according to someone else’s plan, rather than your own.

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