Rethinking Birth Plans

by Christine D’Esposito

Many parents want to write a birth plan before their labor. This may be something they do on their own, or with the guidance of their medical care provider or doula. While writing a birth plan does offer the opportunity to explore birth options and preferences, it also runs the risk of fostering a rigid mindset, giving parents a false sense of control over their experiences and outcomes, and encouraging the belief that options can be chosen ahead of time, like picking items off a menu.

Consider adding the following Birthing from Within frameworks and processes to support parents in examining their birth wishes.

1.Bring solution-focused dialogue and a coping mindset into the conversation.

Most approaches to birth plans are outcome-focused and problem-focused. In essence, they tend to ask parents to think of everything they hope won’t happen and put it in writing, with the implication that this action alone is a meaningful step towards preventing unwished-for events. Of course it does make sense for parents to think about what they do and do not want in the birth experience. But there are two difficulties. First, simply articulating these wishes may not make a significant difference in whether or not they occur. Second, a single-minded focus on identifying wishes often closes off consideration of how to cope with situations that do not fit into those wishes.

With a solution-focused approach and a coping mindset, a birth worker can help parents with both of these issues. First, they can help parents think about what concrete strategies might exist to move them towards their desire. “What might I do now to increase my chances of birthing without pain medication?” “What are some practices that I can learn now that might help me in labor?” Second, they can gently guide parents to explore what they might do if their precise wishes do not come to pass, or if their wishes change over the course of the labor. “How might my partner and I work with an epidural if it were to become necessary?” “What kind of support might I need if I am not feeling aligned with my medical caregivers in the moment?”

2. Use role playing to explore informed consent and in-the-moment decision making.

Sometimes even the most outspoken of people have a hard time advocating for themselves or remembering all of the details in a high-stakes situation. When we build time for role play into our sessions with parents, it gives them an opportunity to practice responding, both in order to build experiential and muscle memory of such dialogues and to help them explore the understanding that these exchanges may not always go to plan.

3. Talk about the Next Best Thing.

Again, there’s nothing wrong with parents naming the things that they hope won’t happen. Once they have done this, and considered what they can do to further their desired goals, however, it’s also important to explore the possibility that one or more of those things might happen. A gentle, concrete, and solution-focused way to do this is to introduce the concept of the Next Best Thing. In the event that the thing parents are hoping to avoid actually does happen, what might they do next to move through it, cope, or stay connected to themselves, their baby, and their partner? How might they still welcome their baby, even if the labor or birth outcome doesn’t look like what they imagined? When parents take time to think about the unexpected, they are more able to tap into their own resourcefulness and resilience.

4. Anchor the new learning with Birth Art.

Birth art gives parents the opportunity to experience the unknown in small, low-stakes ways that can prepare them for the bigger unknowns of birth. In addition, moving from just talking about these possibilities to exploring them with their bodies gives them a different way of understanding how they cope with surprise and discomfort. As they shift between outward, brain-based knowing and inner, embodied knowing, they have the opportunity to discover their own potential to find and create ways to navigate the transformative unknown.

There's no doubt that birth plans are a part of the cultural landscape today. Shifting the lens on birth plans can turn them into a useful part of prenatal preparation. By building in concrete coping strategies, experiential learning, exploration of the unexpected, and practice navigating the unknown, the birth worker can transform a “plan” from an imaginative wish list to a powerful tool of resilience.

Learn more about Birthing from Within’s unique and powerful training for birth workers, or find a BfW trained birth worker for your own journey.