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Why Pregnant People Need to Start Saying Birth *Plan* Again

doctor, nurse, pregnant person, birth plan, prenatal, appointment
The Hypocrisy of Birth Plans

When I was pregnant, I took a mini class on how to make a birth plan that providers will listen to. One of the first things I was advised in that class was to not say “plan” because the provider might feel some type of way, or because you might feel like a failure. At the time, that made sense because I wanted to show my provider that I was a reasonable person and willing to have conversations about different decisions I might need to make…and I didn’t want to feel like a failure.

As a doula, I have seen that most providers continue to encourage pregnant people to make "preferences" so that if things don't go according to the plan, they don’t get upset. In some cases, I have also seen this conversation provide an opportunity for providers to steer my clients in the direction they feel more comfortable in, thereby ignoring my clients' original wishes in favor of the more mainstream, and perhaps less potentially litigious option.

I have also seen people who decide to not make a plan at all or to have a very minimal birth preference list because they were afraid of their wishes not coming to fruition. They were afraid of feeling like they failed.

Over time, I’ve come to realize that when people are encouraged from the start to just assume nothing will go to plan, that sets folks up for a very defeatist attitude for the rest of their pregnancy and birth. That’s when I start hearing, “I just want to get out of this with a healthy baby” or “healthy birthing person, healthy baby.” But don’t pregnant people and their families deserve so much more than that?

The word “preferences” has a totally different vibe than “plan” that I just can’t get behind anymore.

Why the hell can we make dinner plans, game plans, college plans, career plans, retirement plans, business plans, PLANS OF CARE, but pregnant people shouldn't say "birth plan"? My guess is the patriarchy, *insert world's largest side eye* but that's another conversation for another day.

Let’s be honest- your birth plan is 99% guaranteed to change at least a little bit, but that's okay! If you were working towards obtaining a teaching degree by going to school to learn how to be a teacher, you wouldn’t say, “my preferences are to graduate college, complete an internship and get a job within the next 5 years.” You’d say that’s your plan. If you decide one year into your teaching program that you’d rather pursue acting, you didn’t fail at being a teacher, your plan simply changed. It happens!

Back to birth- Obviously, if there are safety concerns, you’re going to listen to your care provider’s advice and follow it if it seems like the best option. At the end of the day, the whole purpose of a plan is to simply figure out what you want.

You're allowed to really want things in birth, just like every other aspect of your life. Knowing what you want helps you figure out how to get it and take steps to make it happen. It gives you something to look forward to and it should ideally come with some ideas on how to pivot if things need to be adjusted. Having a plan and keeping your goals in mind gives you the power to make decisions you can feel good about no matter what they end up being because you’re making them with the complete understanding of what you want for yourself and your baby. In addition, it helps you feel like you are a part of the decision making and not just being strung along an experience that doesn’t at all feel like yours. That matters!

I understand that folks are trying to help pregnant people come away from their births feeling good and at peace with whatever happens. But it is so important to understand that you can feel disappointed about what happens without equating that to the idea that you’ve failed. The two are not related. In fact, the real issue here is our birth culture. I can only speak on the birth culture in the US, but y’all, it is so broken.

First, we need more providers who don’t have an attitude if someone presents a birth plan or wants to do something less common. Don't get me wrong- many providers are great with birth plans! On the other hand, some say they are but really aren’t, and some just straight up don’t like them and will tell you to your face. This is unfortunate since birth plans can be a great communication tool between the birthing person and their provider (or providers if there are many people in a practice which is very common here). I have found people to have the most success if the plan is looked at together by both parties well before the birth so that further conversations can be held if either person has questions or requires any further clarifications. AND! Both parties need to listen to what the other is saying, always keeping in mind that the birthing person has the final say officially and unofficially.

Second, we as a society need to lift our birthing people up during this whole process and encourage them to ask and work for what they want. No more, “What?! Why would you do that?”, no more telling horror stories or telling other people what they are or are not capable of in your opinion. We also need to change our hospital culture here in the US to facilitate getting birthing people what they are asking for (like more waterbirths, family-centered cesareans, and eating or drinking in response to hunger or thirst) instead of sticking with archaic policies that go against what our bodies are inclined to do during this process (like pushing on your back instead of all fours). We desperately need more education so that providers and others in the community better understand how to support pregnant and laboring people.

Additionally, if something doesn't go to plan, we need to focus more on how to ensure the birthing person receives more well-rounded care than just the bare minimum of ensuring their survival. They deserve to feel well after the birth not just physically, but emotionally, intellectually, and spiritually. When people are not adequately supported and allowed to express their most honest thoughts after the birth, that’s when feelings of failure are able to creep in unchecked. It’s not enough to say things like, “just focus on your healthy baby” or “at least everyone’s okay.” People need validation and space to work through what they're feeling after the birth without judgement or minimalization of their feelings.

We all have huge wins and losses throughout life. If things don’t go the way you hoped, it can be frustrating or even devastating. Even so, by encouraging birthing people to make a passive wish list of birth preferences instead of going after what they truly hope for during the birth of their baby, I think we’re doing our pregnant people a huge disservice all in the name of trying to shield them from possibly feeling like a failure.

A birth plan is not a contract, and it is not a promise. It is an extremely valuable tool you can use to help guide the decisions you make during pregnancy and birth so that you can increase your likelihood of achieving the birth of your dreams.

Tl;dr: Make that Birth Plan, fam.




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