How to Write a Birth Plan that Actually Works

By Lauren McClain

“Birth is not only about making babies. It’s about making mothers; strong, competent, capable mothers who trust themselves and believe in their own inner strength.” – Barbara Katz Rothman

I’ve had an aversion to birth plans that’s been quietly eating away at me for quite some time. They rarely have the intended consequences for anyone involved. They seem to reinforce the illusion of control and a fixed mindset in couples.

The cautions I have about writing birth plans do not mean I entirely dismiss the idea. A birth plan is not silly, or annoying, or evidence of your ‘high maintenence’ patient profile, as many doctors and nurses in maternity care see them.

A well-devised, thought-out birth plan means that someone cares enough about what happens on their Birth Day to make this effort. It’s a good sign. But it’s a marker, not an answer.

Birth plans at large are one way that consumers have been fighting back against a maternity system that doesn’t really care for them. They express resistance to the normal, impersonal, factory-style approaches most hospitals take to labor and delivery.

But birth plans, as we’ve been writing and using them, do not provide a calmer, easier birth experience so they are not getting us what we want.

Here’s what birth plans do that we want to keep:

• Birth plans express that you have preferences about how you are treated and what happens.
• Prenatally, they help you formulate what those preferences are and (hopefully) why.
• Writing the plan and having it helps make sure you, your partner, and/or doula, are on the same page.
• Writing up the plan is a way of acknowledging to yourself that you do have some control and are not just at the whim of your provider or fate. You have choices and you know it.

As Diana Korte (author of the VBAC Handbook) said, “If I don’t know my options, I don’t have any.” The mainstream approach to childbirth is to show up at the hospital when you’re told to or when you are uncomfortable with contractions. From there, most couples just do as they’re instructed and trust the staff.

Let me be very clear: This is fine. If your main goal is to not be responsible or have to make decisions, and you just want to get through it, medical professionals can and will do that for you. If are not disappointed, scared or saddened by any obstetric interventions that you can think of, letting them take the reins does work.

For any laboring mother, at some point she will be done thinking, done making decisions and done fighting. For some people, that’s before it even begins. For others, it’s during transition. Most are somewhere in-between (After about 15 hours seems a popular time to let it go.) And when that time comes, whoever you have selected to be your provider may need to make a decision that changes the course of your labor. That’s why who you choose to be there is vitally important.

This brings us to the steps to write a birth plan that works:

A.    Choose a provider who will work for you, not on you.

You shouldn’t have to have a birth plan. That should not be your job. You pay someone (probably through your insurance) to take care of you and help you and baby stay safe. It should be their job to know what you want and do their best to see that you get it. Make sure you have these conversations before it’s ‘too late.’

For my HBAC, I chose a midwife who I trusted implicitly. If she told me I needed to go to the hospital, or be induced, or have a cesarean, I’d believe her. I didn’t need a birth plan because I knew she’d be with and for me the whole time. The way she usually did things was the way I wanted things done.

No matter what happened, I could see my way to no regrets.

People do not get heartbreak, depression, anxiety, PTSD, or rage postpartum from births that don’t turn out exactly how they pictured them. Those feelings of trauma and victimization happen when they aren’t treated lovingly and their wishes aren’t respected.

You don’t have to get what you want, but what you want does have to be respected. Choose your provider wisely, and talk to them about your birth wishes.

B.    Be flexible and keep an open mind as you write.

The stress of holding a vice-like grip on your birth wishes will inhibit your hormones and hamper your experience. If you want to have a low-intervention or easier birth, don’t become attached to one way.

One problem with birth plans is being hyper cognizant of what you wanted not happening. When your wishes are not granted, one after another, you begin to feel victimized by the experience itself.

Like everything that’s a big deal, birth is unpredictable. As Jessie Harold says in her Birth Principles Workbook (Pathways 55), “Nothing that requires our bravery, our advocacy, our hard work, and our determination, and potentially results in our pride, our courage, and our connection to our power, is predictable. It is the act of stepping into the unknown—not the potential for pain or its intensity—that makes birth one of the most important rites of passage in the human experience.”

Birth is your motherhood origin story. Like becoming a superhero, this intense event makes you. A huge part of the intensity of birth is plunging into the unknown. Consider your ability to handle the unknown, to deal with change, plot twists, and whatever the universe throws at you. Consider what that means for what you want at the time of birth.

How do you write a flexible birth plan? Consider these approaches:

1. Don’t actually write it out.Something about committing measurable specifics to paper makes it harder to accept change as part of the process. Have a lot of conversations with your partner and provider about what you envision. Make sure you’re on the same page, and then let it go.
2. Make a listof things you don’t want to forget to ask for or refuse. Make a list of things you want to remember such as affirmations that resonate with you, quotes that make you feel good, notes of strength from people close to you, and images that invoke calm. Your plan can include a section of “ways to approach a plot twist,” where you list what will help you transition when you go off your chosen path.
3. Write your birth story instead of a birth plan. Write the story of your birth as you imagine it, including details about how you feel, what you do, how you move and what people around you say and do. When you finish, go through and highlight the items that you want others to keep in mind. Tell yourself your beautiful birth story a few times, or very often. Then make up your own adventure version. Imagine a plot twist at a few different places (breech baby, induction, car birth, baby goes to the NICU, a midwife arrives who you were hoping you wouldn’t get). Choose how you will respond to it. Who will hold you? What will they say? What feelings do you need to express and how? What do you still have?
4. Use Jessie Harold’s Birth Principles Workbook in issue 55 of Pathways magazine.

This brings us to part C of your birth plan that actually works.

C.    Have a way to get to plan B and C.

Writing out your second choices or what alternatives you are most OK with is a good mental exercise for planning, but not half as important as having a way to emotionally get to that alternate path.

I belong to a group called Homebirth Cesarean. It’s made up of people who planned home births and ended up with cesareans. It’s difficult to process, and sometimes takes years. Because anything can happen, everyone should have a plan C.

It’s not unreasonable to expect your birth to be wonderful. You can and should plan for that. I’ve had an ecstatic birth. I’d be happy to do it again. It can happen to you, too. Part of the reason it went so well for me, I think, was that I had a much more flexible mindset. I had a provider I trusted implicitly, a Plan C, and the emotional and mental pathways for going there.

You need to prepare for things that you think of as bad. What don’t you want to happen? What can you do if it does? Can you get to a place where whatever needs to happen is OK?

Talk to your birth team about what might happen and how you can approach it, emotionally. What can you tell yourself to make it OK for the moment? Make a plan for what coping with going off plan A looks like. Affirmations, EFT, hugs, time to cry, letting your thoughts out to your doula. What is your plan for when something goes away from your original wishes?

The takeaway message

Be open to where birth takes you. It’s not about being open to where a doctor wants you to go, but where your own body and baby are taking you. Sometimes these two trajectories align. Sometimes they don’t. That’s where doing your research, planning and thinking ahead of time helps.

Use Jessie Harold’s Birth Principles Workbook to start the process. Do what you can. Plan. And then relax. See what you’re capable of. Enjoy the ride—even the tricky bits.

Happy Birth Day to you!

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Lauren is a childbirth educator (Birth Boot Camp) and the author of the Breech Baby Handbook. She owns Better Birth Graphics, a shop full of practical, intuitive birth media for professionals. Her work has been published in Mothering, Holistic Parenting Magazine, Birth Issues, True Birth, Mama Birth, and elsewhere. She lives in Maryland with her family of five.