How To Create A Realistic Birth Plan

Sarah Austin wanted to have an unmedicated vaginal delivery, so she and her partner wrote a two-page birth plan at the urging of their nurse midwife. Included in it was the possibility that she might have a caesarean, and how she hoped it would be handled if so. “I considered a C-section not the desired outcome,” says Austin, “but a possible outcome.”

That possibility became a reality when Austin spiked a fever after 24 hours of active labour. “We had a conversation about whether a C-section was the right move, and we decided it was,” says Austin. She was “disappointed that it happened,” and the recovery was harder than it would have been, but she says she “didn’t feel conflicted about the decision.”

That’s an important distinction, says Megan Brown, a doula and founder of Emerge Birth Services, a childbirth preparation and support company in Atlanta. “Focusing on outcomes is what can set a mum and a family up for failure,” says Brown, especially when there is so much messaging about having the “best” birth and doing the “right” things to prepare for it.

“Women are told to just use positive thinking to ‘trust in birth’ and ‘trust your body,’” says Pam England, creator of the Birthing from Within series of childbirth classes whose first birth (intended to be at home) ended in a caesarean.

This kind of “magical thinking,” says England, clashes directly with the medicalized industry of giving birth in the United States in which 40% of women are induced and a third deliver by caesarean. So, if women have births different from what they had hoped for, they often blame themselves for being “weak” or “failing,” says England.

And that disappointment — or even trauma — can put a woman at risk for developing a perinatal mood or anxiety disorder.

That’s why England and Brown, whose classes are based on the Birthing from Within model, recommend getting really clear about what you can control, what you can’t, and preparing for all of it.

Take a childbirth education class

“Taking a childbirth education course is a great way to prepare for labour and birth,” says Brown. She recommends looking for classes that offer a broad preparation for birth, as opposed to focusing on just one method or those classes provided by hospitals. “Hospital birth classes tend to teach parents how to be good patients and are good for the medical part. An unaffiliated childbirth education course can dive a little bit deeper and spend more time on the mental and emotional preparation as well.”

Plan your support

“Make a list of what’s really important to you and ask if your provider will honour those things,” says Brown. If they won’t? “It’s never too late to switch providers.” And make sure that your provider “doesn’t just give lip service to your wishes, but actively encourages you to put in place supports to make them happen,” recommends Lauren Abrams, CNM, director of midwifery at Mount Sinai Hospital in Manhattan.

“If you want to have an unmedicated birth, the number one thing you can do is to get a doula,” says Abrams. The research backs her up, according to Emily Oster, PhD, author of Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong—and What You Really Need to Know. In one study, women were randomly assigned a doula when they checked into the hospital, while other women gave birth without one. “Women who were assigned to the doula had lower levels of epidurals and C-sections,” says Oster.

Places to find a doula include doulamatch.net, The Childbirth and Postpartum Professionals Organisation (CAPPA), and DONA International. Often, new or training doulas who are still completing their hours for certification will offer lower fees.

Another important tool for experiencing an unmedicated or vaginal birth, says Brown, is to work on positioning your baby for delivery. She recommends using the techniques and resources on spinningbabies.com and adds that “every woman who is pregnant and intends on having any sort of birth needs to focus on optimal fetal position.”

Focus on your environment and your coping tools

“You can’t control your birth in the way it unfolds and progresses,” says Brown. “But you can control your environment—who’s in the room, what kinds of tools you are using. Ultimately, you are setting up an environment that is ideal to labour and birth in and then just allowing birth to unfold as it needs to.”

Additionally, Brown recommends researching and practicing several different pain coping tools, so that if one does not work for you in labour, you have other options to turn to.

See your birth plan as a conversation-starter

When you consider the biologically monumental task you are undertaking—growing a person inside of you and then pushing him or her out of a rather small opening in your body and into the world—the idea that you can really plan for how that will go seems a little bit of a, well, stretch.

“A birth plan is a good place to start,” says Brown. “You can say, ‘This is what we plan on, but we understand this is just a set of guidelines that may or may not be applicable once birthing begins.’” Then use it as a way to open up conversations with your providers before birth, so you can make sure they are supportive of your wishes and will work to help you achieve them.

Keep it short and focused

“Start off by saying, ‘My birth plan is to do my very best,’” recommends England. “Then pick one thing that is most important to you and ask for that, like, ‘I don’t want to be offered drugs every time someone enters the room. I’ll ask for drugs if I need them.’ The shorter the plan is, the greater the chance your providers will read it and help you work toward it.” Austin’s plan included the sentence, “I don’t want anything being done to me without having information.”

Think about Plans B and C 

“What you really want is a birth framework,” recommends Oster, who, besides researching labour and delivery as an economist, has been through it twice herself. “It’s like a game tree: ‘If this happens, then this is what I would like to do.’”

Think about one or two things you hope won’t happen, and then prepare for them, recommends England. “Some people are afraid of needles and really don’t want an IV. Some people are terrified of a long labour.” If you open yourself up to thinking about how you will handle those situations should they arise (maybe learning some breathing techniques if your hoped-for epidural is delayed, for instance), it will help them feel less scary and help you maintain a feeling of control.

That was Austin’s approach to the possibility of a caesarean birth. “Having talked it through in advance made a big difference,” says Austin. “We had thought about how we could make it as pleasant an experience as possible.” Looking back, she says, “I feel like I can reconcile it not being my first choice, with having made an informed choice.”

That’s exactly why Brown walks her students through every aspect of a caesarean and why she makes a point of calling it a caesarean birth rather than a C-section. “I believe that whether you birth vaginally or via caesarean, a woman is still birthing her child. And, although it is major abdominal surgery, being more aware of what that kind of birth looks and feels like makes you able to make this decision without as much fear.”

Expect uncertainty

“In our society, everybody wants to ‘keep their shit together,’” says England. “We want to look good, know what we are doing, be informed, and have everything go exactly as planned. In birth that isn’t what we should be striving for. We should look for the moment when we didn’t know what to do, when we didn’t know what to expect from ourselves.” The very act of being open to uncertainty—expecting it, even—can help it be way less scary if it happens.

And when you think about how life-changing birth is, it makes sense that it would come with a whole range of experiences and emotions and not just follow the Hollywood script we have all come to expect.

“Even with hundreds of years of research in obstetrics, we don’t know what starts labour,” Abrams says. “So, it’s unpredictable, and you have to get into the mindset of letting go. It’s going to happen when it’s going to happen. It’s going to be what it’s going to be.”