Why You Should NOT Write a Birth Plan

“The only birth plan I care about is having a baby, one way or another.” “Keep your birth plan to yourself.” “Women with birth plans are the ones who end up with caesarean sections.” I often hear these statements from Obstetric Nurses, Obstetricians, or mothers quoting what they were told by their providers. To be fair, this is not necessarily the popular opinion of the obstetric field, but it is not a rare view either.   When I first started serving in the birth industry I was shocked at these cynical statements, but as I gained more friends and colleagues in this field, and observed the way birth plans are commonly used by expectant parents, I started to realise where these statements are coming from. This led me to change the way I explain birth plans; even changing the terminology I use. I now encourage families to make birth PACTs (Pre-Approved Communication Tools) rather than birth plans.

I have to make a confession first. Hi, my name is Jade and I am a planner. I plan everything. I make lists. I like to check things off my list. I use plans like a builder uses blueprints. They guide my life and become frustrated when my plans do not work out.

This way of thinking about birth plans is why they can create more problems than they solve. The truth is that birth (and life for that matter) often does not go exactly how we planned. Even highly experienced birth professionals cannot say how a labour will progress. Even if all goes well and interventions are not necessary during birth, it may not go the way you planned. If you use a birth plan like a checklist- counting everything as a win or loss for each item on your list- you are likely to find yourself stressed out. When we feel stressed our body releases powerful hormones that prepare us for overcoming the obstacle causing duress. These hormones are important when we need to negotiate, run away or defend ourselves. However, during labour, these same hormones can stop, slow or change our labour patterns completely.

To understand this let’s consider other mammals during labour. If you were a cute little cat in labour and a vicious dog suddenly approached you, these wonderful stress hormones would kick in and stop your labour completely so that you could get up and run to safety. These processes are meant to keep us alive. As a human labouring under the safe supervision of your birth team, the same type of hormone release can be experienced when you feel stress about whether things on your birth plan are happening they way you planned. This means that when we compare our reality with our plan during the course of labour, we could begin to feel stressed if it is not exactly like we hoped. This stress can actually cause more complications in our labour leading to more interventions. In this way, the medical professionals who say that women with birth plans are more likely to have interventions can actually be correct.

So why even bother writing a birth plan if it only causes problems? Well, that takes us back to the actual purpose of the birth plan. During labour, the mother will generally cope best if she is allowed to focus on relaxing her body, mind and spirit. There are many excellent medically proven reasons for this, but that is another topic- although one reason goes back to the stress hormone variable we discussed earlier. Discussing our goals, views and desires while trying to relax is not always effective; not to mention that once labour really gets going the contractions alone make communication near impossible. In other words, labour is not a time when mum can communicate well. This is not an issue if the mother is surrounded by people that know her feelings and desires about birth. Therefore, the mother with a homebirth midwife may not need a birth plan. However, for the majority of mothers who will labour and birth in a hospital, a birth plan serves the purpose of offering a little bit of insight into the views, dreams, and desires of the mother when she is not able to communicate well herself. This is important in a hospital setting because most of your interactions during labour will be with nursing staff you have never met and generally the physician or midwife will be whoever happens to be on duty.

Unfortunately, birth plans have come to be used as checklists or blue prints, rather than as communication tools. This is why I have changed the terminology I use with my students and clients. The birth PACT is purely a Jade-ism I created to explain what the birth plan was always meant to be: a Pre-Approved Communication Tool (PACT). For me, terminology influences how I think about things. So if I make a plan- I anticipate following it through like a checklist; but a PACT is a communication tool.

To make a PACT you need to keep in mind a few key things. First, it should not be a book. When staff is coming in and out and caring for multiple people at a time, they do not have the time to read and process a novel; one page is plenty. Second, it needs to be written in an easy to read format. A nurse in a dim hospital room will have a more difficult time reading a paragraph formatted PACT. Instead, try large easy-to-read font and bullet points arranged under headings; it might look more like an outline than a report. Third, tone of voice is impossible to discern in written communication. Therefore, if you hand a list of simple bullet points written in absolutes to a nurse it could seem more like a list of demands rather than an attempt at helping them understand your goals. To avoid this potential source of conflict, avoid absolutes. Use language such as “we would like” or “we hope” instead of “we want” or “never.” Also, consider a short introduction that states your happiness with their facility and your confidence in their efforts to make this a safe and empowering experience for you and your bub. It may be helpful to add a short conclusion that emphasizes your desire for safety first and your willingness to be flexible. Finally, there is the Pre-Approved part. Bring your PACT with you to a prenatal appointment and ask your care provider to review it and discuss any questions or concerns they have with you. This gives them an opportunity to point out vague language that may need to be changed to make your desire more clear. Additionally, they can inform you of any unrealistic goals in your PACT. For example, not every hospital has an option for water birth, so if your birth PACT includes giving birth in a tub you will need to change your goals, or change facilities.

Once you written your PACT, had it reviewed by your care provider, made any revisions needed and received approval, the only thing remaining is to hand a copy to the staff when you arrive in labour, and never look at it again. You know your goals and desires; you do not need to see your PACT to remind yourself. Instead, focus on relaxing and giving birth!

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