In an ideal world, every woman would have a known midwife (and, if needed, an obstetrician) throughout her pregnancy and birth. Over the several months, the woman and her health care providers (HCP) would have open and honest communication about her options and what her needs are to achieve her Plan A.
Ideally they would also have frank conversations about variations to ‘Plan A’ right through to ‘Plan C’. The woman will be familiar with the birth setting policies and how they vary from her Plan A. This process will mean that by the time the woman is in labour, she has formed a relationship with everyone and trusts that they understand her needs.
It’s unfortunate that very few women ever receive this gold standard of care. Most of our maternity services are fractured. At worst, a woman will see a different HCP at each visit and many different ones over her labour. At best, the mother-to-be may have access to a private midwife who provides continuity of care throughout pregnancy, birth and afterwards. However, even with a private midwife, the process of writing an effective birth plan can help bring together research and spark conversations during pregnancy. During labour it can act as a “prompt sheet” for the birth team. Even a private midwife or doula, who has several clients a month, may forget individual details ‘in the moment’.
- Is NOT a contract and there is no precedent in Australia where one has been used in court as evidence.
- Is not a substitute for open communication with your health care providers during pregnancy
- Does not override a health care providers obligations to inform you of your options i.e. If you write “I do not want vaginal exams during labour” on your birth plan, a midwife may still offer one according to policy or if there is a medical situation. If you decline her recommendation then she will note you declined her recommendation in her paperwork.
- Doesn't need you to write “Unless medically necessary”. If a medical need arises, the HCP will always discuss that need, regardless of what the birth plan states.
- Does not control the physical process of labour or provide an answer for every variation in labour.
- Doesn’t change the personality or standard practice of your health care providers. Women need to be able to “let go and be primal” and trust her health care providers during labour. If there is a personality conflict in pregnancy, there’s a pretty good chance that her primal self will have an issue too. If the HCP has clearly stated during pregnancy that they will not change a certain practice, a birth plan is not going to over-ride that conversation or policy. Both of these situations are clear indications that the woman will need to consider her other options of HCP’s during pregnancy or re-consider her stance on the issue.
What Should I Put on My Birth Plan
(No more than 1 page)
Title – My Birth Plan/Preferences/Wishes – whatever you want to call it. Some people don’t like the word “Plan” as it sounds too definite.
First Paragraph – A short paragraph which introduces your support team and is an overview of your birth plan.
- Introduce yourself, your partner and any other birth support and family.
- Summarise in 1-2 sentences your ideal birth
- If you’ve met any lovely midwives over your pregnancy, ask if they are available to support you. On the flip side, if you’ve met someone you really don't like, you can ask that they not attend your birth. Perhaps state some qualities in a midwife that you’d like (e.g. experienced in water birth; is very “hands off”; is experienced with epidurals etc)
- Ask that if things vary from your birth plan that you are given all your options and time along with your partner to make a decision.
For the rest of the Birth Plan break it down into stages with a handful of dot points underneath.
- First Stage
- Second Stage
- Third Stage
- Plan C (on a separate 8x5” card)
- You don’t need to write down anything that is standard policy
- Do write down anything that is extremely important to you. e.g. If you feel very strongly about immediate skin-to-skin contact with your baby then it’s always a good idea to have this in your birth plan. It may be standard policy, but your situation may change and your baby needs to be attended to before being placed on your chest. Your birth plan can remind the HCP to explain during the process why there is a change. Otherwise, standard practice will continue and you may not understand why it has changed and be unduly worried or upset.
Most birth plans could be summarised with :
“If you see that my labour is varying from my Plan A, please discuss in full all my options – including benefits, risks, alternatives (including more time) to your recommendations and give me time alone with my partner to make a decision.”