Regardless of what a woman decides to call her birth plan, she can expect to receive subtle discouragement at every turn, because birth is ‘unpredictable’, and you ‘can’t really plan for it anyway’. She will be urged to ‘go with the flow’, rather than try to ‘control’ what happens to her in labour: but whose ‘flow’? As midwife and academic Dr Elizabeth Newnham puts it, ‘Going with the flow is fine, as long as it’s the physiological flow, not the institutional flow.’[8] Debby Gould and Melissa Bruijn, founders of the Australian birth trauma organisation BirthTalk agree: ‘Most women’s interpretation of “going with the flow” is “to put ourselves in the hands of our health carers, and accept the interventions they suggest as inevitable, unquestionable and in our best interests”. Every week we talk with women whose birth plan was to “go with the flow”. And now they are contacting us for support after a traumatic birth.’[9]
Encouragement to take a passive role in birth is everywhere, but if a woman does push ahead and make a birth plan she may find the cultural prediction that it’s ‘pointless’ coming true: in a 2016 survey from Positive Birth Movement and Channel Mum, nearly 75 per cent of respondents said that they made a birth plan, but only half of this group said that their birth plan was read by professionals, and 42 per cent said that their plan was not adhered to.[10] In some cases, plans simply have to change: you cannot have a home water birth if you develop placenta praevia, for example, but women understand these situations and when they complain about their birth plans being disregarded, this is not the kind of example they are giving. Rather, they talk about plans not being read due to a hospital shift change or because they are ‘too long’, or aspects of their plan which could have held in almost any situation, such as optimal clamping, minimal talking in their birth space, or keeping their placenta, not being observed, or being told at the last minute that what they are requesting is not possible, or even not allowed.
MAKING A BIRTH PLAN LIKE A FEMINIST
There is a point in making a birth plan
Don’t let anyone tell you otherwise. There are also ways that you can approach making that plan that will make it a valid and useful document. Firstly, know that you matter. What you want matters. You are important and your needs are important. This is your body, and your birth.
Knowledge is power
The process of making a plan will in itself educate you on your options and get you thinking about what YOU want – that’s a reason to make one right there.
Shoot for the moon but also consider the stars
Just as you plan to party on the beach but know where the nearest cafe is if it rains, you should also think about birth plans in this way. Make a Plan A that sums up your hopes for your ideal birth. Don’t be afraid to have a strong vision of what you want – with birth, as with all other areas of your life, a strong vision can help you reach your goal – but it’s not a guarantee. So, once you’ve got that vision, make contingency plans – a Plan B (and maybe a C or D). Think about what you might want if birth deviates in any way from Plan A. Consider as many eventualities as you can.
Ask for what you want even if it is not what others want
Only one person can have this baby, and that’s you. Because of this, you absolutely get to call the shots on how and where you want it to happen. This is about you, and what you need. If you think your mum being in the room will make you feel loved and safe, great. If you think it will make you feel self-conscious and anxious – she’s barred. If you want a certain type of birth – be that a home birth or a caesarean – but family members don’t agree, show them the evidence behind your choice, and stick to your guns. It’s your party.
A birth plan is not ‘all or nothing’
There are some parts of a plan that should only go out the window in exceptional circumstances. For example, if you want skin-to-skin contact immediately after your baby is born, or optimal clamping, this should be available in almost every circumstance. Make sure you are clear with your partner and your care providers that, even if your birth veers a long way off track, there are still some choices that you want to be honoured, no matter what.
Make a full plan for caesarean, whether you hope to have one or not
There are lots of choices that you can make if your birth takes place in the operating theatre. Learn about ‘woman-centred caesarean’ and think about what might be important to you in a surgical birth. Then make a full caesarean plan.
Make a postnatal plan
Think about what you want the first hour after birth to be like and lay out what is important to you in that time as part of your plan. You may also like to make a separate postnatal plan too, with a clear idea of how you are going to navigate the first few weeks with your baby, and a list of useful numbers for help and support with feeding.
Get it read, get it signed!
Make sure that everyone involved in your birth reads your birth plan in advance of your labour. Your partner, doula, and any other birth supporters need to have a clear idea of what you want on the day. Discuss your plan in advance with health care providers especially if you have specific needs or requests that deviate from the norm. Ask them to record details of conversations and decisions you have made in your notes and to sign your birth plan. These discussions will help your care providers to demonstrate that they have fulfilled their obligation to have a balanced and individual discussion with you about your personal circumstances and risk factors, and you can demonstrate that you have understood the information given to you and that your wishes have been documented. Your birth plan will not have legal status, but it is still evidence that your views and preferences have been discussed and noted.
In the worst of cases, birth plans – and the questions to care providers that usually accompany them – can be interpreted as a sign of lack of care or ill will towards the unborn child, of being a ‘bad mother’, because of course, as a woman is repeatedly told, what happens in the birth is unimportant, as long as there is a healthy baby at the end of it. ‘I wanted to know more about why they wanted to induce me, but in the end the doctor just said, “You’ve waited a long time for this baby, haven’t you?” ’, Laura from the UK told me. ‘He was questioning my desire to be a mother, he was questioning how much I cared about my baby, and even how much I wanted them to live. It was a horrible moment but at that point I decided to comply with the hospital’s wishes.’
Some birth workers refer to this practice as ‘playing the dead baby card’,[11] and it is certainly a dimension of the current fear-based climate that can be very effective in silencing a woman who is trying to argue her right to make her own choices about her body. Michelle Quashie, a mum of four from London, recalls her obstetrician similarly ‘shroud waving’ when she was determined