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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 to have her third baby via VBAC: ‘He asked me, in quite a dramatic tone, “What is more important to you, a natural birth, or being a mother to your other children?” and as he did so he looked very pointedly at my husband as if to say, “take charge of her”.’ Michelle’s story is reminiscent of the remarks of Irish obstetrician Dr Donal O’Sullivan who caused controversy when he said during a radio interview in 1996 that, if a woman wanted a home birth, her husband ought to put a harness on her and drive her to hospital like cattle.[12]

A part of me, even then, could not tolerate passivity, but I identified that part with the ‘unwomanly’ and in becoming a mother I was trying to affirm myself as a ‘womanly woman’. If passivity was required, I would conform myself to the expectation.

Adrienne Rich, Of Woman Born[13]

Telling women not to try to plan birth but instead to focus on the end result carries the underlying message that a woman in labour must ultimately sacrifice herself – her hopes, needs, desires, dignity or even her life – in order to save her baby. This is interesting, because, although you might assume most women would happily give their lives for their unborn if they had to, this is not always the case. If you ask pregnant women – and their partners – this rather unpleasant question, ‘You can only save one, who do you save?’ they will almost overwhelmingly tell you, ‘the woman’. And yet, for historical, moral and religious reasons that we will explore later in this book, maternity care can often be clouded by the notion that the safety of the baby always takes precedence.