Getting All the Ducks in a Row - Birth Plans

When you go on vacation, you map out the route.  When you go to the grocery store, you make a list.  When women are pregnant, it is logical to make a birth plan on paper.  Many expectant mothers make plans in their heads but to share their thoughts with those that will be supporting them through the process makes good sense.

According to Medline Plus, a service of the US National Library of Medicine and the National Institutes

of Health, birth plans are good tools to help expectant mothers think and learn about what might happen during the birthing process and afterwards.  As childbirth educators or doulas, we often play a vital role in assisting in information gathering and decision processing for birth plans.  Bailey stated that as a component of childbirth preparation, a birth plan can be a medium to improve patient-provider communication regarding a desired labor and birth experience and improved satisfaction with care.

Pregnant women often create birth plans to specify their preferences for the birthing process.  When nurses implement and advocate for women’s birth plans, it increases women’s autonomy and decision making in the process and can lead to greater patient satisfaction. (Anderson)

Again, satisfaction.

Yet, in many situations, birth plans are treated like a plan to fail.  Lothian points to the tension between health professionals and patients caused by birth plans and that it might reflect the larger problem with contemporary maternity care: conflicting beliefs about birth, what constitutes safe/effective care and ethical issues related to informed consent and informed refusal.  Lothian goes on to suggest that birth plans should focus on three patient-focus questions:

1. What will I do to stay confident and feel safe?
2. What will I do to find comfort in response to my contractions?
3. Who will support me through labor and what will I need from them?

A childbirth educator’s guidance in birth plan preparation is key.  In searching the Internet, web-based birth plans typically do not give adequate (if any) explanation of terms or options.  They  lack the depth to explore the Ripple Effect™ of interventions, nor do they include what Lothian called informed refusal conditions.   Multiple pages in length, web-based birth plans often are too long for hospital staff to read and may evoke feelings that the laboring women is trying to tell them how to do their job.  Wagner and Gunning suggest that a birth plan is an approach to labor, rather than a term for a specific kind of outcome.  Childbirth educators, counseling expectant mothers, can ensure this flexibility.

A vital piece to understanding of birth plans by the expectant mother is the concept of informed consent and the five questions that should be asked/answered.  These five questions can provide a memory hook by the acronym BRAIN.  Asking these five questions when there are exceptions to be made to the birth plan can also ease flexibility.

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