A better name for birth plans

Here’s a sort of personal crusade that I’m on as a doula: Let’s stop calling it a “birth plan” and name it what it actually is: “birth preferences.”

Why not call it a plan? The obvious answer is, you can’t plan your birth. You don’t know when it will start or how it will end, and you don’t know much about what will happen in between. All the childbirth education in the world can’t tell you what contractions actually feel like, who will pop in and out of your room during labor, how many hours you’ll be hanging out at 5cm, or which nurse is going to be holding your leg while you push.

Another reason: “Birth plan” has, unfortunately, become a dirty word for some care providers. I’ve heard of outright hostility toward birth plans—a sign on an OB’s waiting room wall that said “If you have a birth plan, you are not in the right office.” I’ve more often noticed a certain amusement on the part of nurses and doctors—as though women with birth plans that don’t come true are getting a little bit of comeuppance. The joke goes that the longer the birth plan, the less likely it is to pan out.

Well, it’s unfortunate that that attitude, to any degree, exists. But it does. Maybe calling the document “birth preferences” could ease some of the friction.

As a doula, I interact with birth preferences in several ways. One, I help my clients create the document—or at least we talk through what would go into it, so that they can be sure they’re informed. Two, I encourage them to give copies to their doctors and have copies sent to the hospital. Three, I keep those preferences in mind during the labor so that I can remind my clients if things start to stray from what they’d said they wanted. Example: A client is being coached by a nurse during the pushing stage, but her birth preferences said she wanted to push without direction. I can address my client (between contractions!) and say “Your birth preferences said that you wanted to push without direction—are you OK with this?”

Especially for first-time moms, it’s an important experience to figure out what their preferences are. I think “birth preferences” is the most accurate way for moms to think about this document they’re writing. You educate yourself, you discuss options with your doctor, and you put your wishes in writing so that everybody on the team knows what you want. Then you prepare to let go and see what happens.



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