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The Birth Plan Story
Written by Deb Gowen, CNM

How did the “birth plan” idea become prevalent? Let’s look at the changes in the provision of birth care that occurred in the United States early in the 20th century. Birth moved from the home to the hospital. We developed more sophisticated pain relief options. Forceps were widely used to assist in difficult births at first, and later, virtually all births, and physicians were almost universally the birth attendants, thus increasing their workload. Eventually, what had begun as sometimes useful options and innovations began to be viewed in the medical community as necessary, mandatory. This continued until the 1960’s-1970’s.

In step with the civil rights and feminists movements of the time, women in the late 1960’s and early 70’s began to reject this attitude and demand information and choice in birth. Childbirth Education classes began to rise in popularity, as they provided proof of this preparation, and increased the possibility that a woman would be allowed to labor in her own way, with a companion of her choice at her side.

So, what purpose does a birth plan serve now?

The main purpose of a “birth plan,” also called “birth preferences,” is to let us know who you are, and what your ideal birth would be like. The birth plan often specifies a labor coach, often a husband or partner, to both support her in labor and to protect her rights of refusal. A few paragraphs or “bullets” should be enough, and then it can get discussed further at your prenatal visits in the last 4 weeks.
Some suggestions for things to include follow.

• We would like to know your style for coping. Do you like lots of verbal encouragement or not much? Are you an “explanations” type of person or a “just tell me what to do”? Are you an “unmedicated no matter what” or an “epidural as soon as possible” or somewhere in between? How vigorously would you like us to try to dissuade you from medication if you ask for it? Do you want the midwife by your side as much as possible, or would you prefer to spend much of your labor privately with your partner, knowing your midwife is nearby?
• What, if anything, do you think will make the birth more special for you? Our general practice is to keep the lights fairly low, voices calm and quiet, non directive as far as positions, no routine episiotomies, and the baby placed on mom immediately at birth, unless medically necessary to go to pediatrics. Do you or your partner want to help receive the baby into your hands? Is there a particular piece of music you’d like to hear? If you don’t know the baby’s gender, whom do you want to announce it?
• Who will your birth companions be? Will they need special care? Are there people – family or friends – who wish to be present, but in whose presence you would not feel comfortable? You are the most important person in this endeavor, and your physical and psychological well being is paramount.
• Newborn care: circumcision, eye care, type of feeding, rooming in (which we encourage)
• Early discharge?

Your Birth Preferences help us to know you, so we can best support you at a time when you may not feel like talking and telling us these things. We want you to feel confident that even in a large group practice, the midwife attending you will know something about you, which is as important to your care as all our midwifery expertise.

Related Reading:
Click here to see a sample Birth Plan

Starting your own birth plan? Take a look at our template for some ideas

Read "A Letter to My Daughter" by Flavia Goncalves