By Charlotte Tonkin Edun

Birth plans have become an essential part of having a baby – almost a pregnancy rite of passage. You’ll hear the most credible pregnancy and birth experts recommend them from the NCT to the NHS. Your antenatal midwife will suggest you write one, and your birth midwife will probably ask if you have one. Birth plans are – the theory goes – the best way to communicate your preferences about how you’d like your baby to be born to the people who’ll be supporting you on the day. 

And yet… writing a birth plan can bring a heavy dose of frustration and uncertainty. You don’t have to speak to many new families to hear things like  “my birth plan went out the window as soon as I got to hospital’,  or it was ‘a good birth, but didn’t go according to plan’. 

When Penny Simkin and Carla Reinke wrote their pamphlet describing the benefits of birth planning all the way back in 1980 they expected you’d know the people supporting your birth. They also expected you would be able to discuss your plans with them as many times as you want and need to over the course of your pregnancy. As you probably already know, that’s not the case in NHS maternity care today, where appointments are short, time is at a premium and you are very unlikely to have met your birth midwives before the day you labour. 

All this means you might feel some anxiety and uncertainty when you sit down to write your birth plan. It’s very clear that it’s your job to write a plan that is clear and effective, even though this may only be the first or second time you’ve written one. Not only that, but you’re realistic enough to know birth plans aren’t consistent at helping you have the birth you want. So what do you do? If you don’t write one how will people know what you want and need, and if you do aren’t you being a bit naïve? 

I’m going to be another one of those people who recommend you write one! However, I’m going to suggest a couple of re-frames for why you’re writing it and who you’re writing it for. Taking a slightly different approach may well help you write a birth plan that is appropriate, credible, relevant, reassuring to you, helpful to your birth partner and a good start to your time with the midwife who'll be supporting you.

Here are my top 5 tips; 

1. THINK BIRTH PLANNING, NOT BIRTH PLAN

The goal of writing a birth plan is not to have a list of ‘yes’s’ and ‘no’s’ to give to your midwives on the day your baby is born. Having an abridged birth plan to give to your birth midwife is sensible (see below), but I know from experience that that birth plan is just the tip of the iceberg of all your planning and preparation.  

The planning and preparation is what actually matters. This is where the value lies. All the time and energy you spend on reading, going to classes, and discussing with trusted partners means that should the time come during your labour when you have to make a decision, you are well prepared. You will feel well informed about how birth happens. You will feel confident that your birth partner is aligned with you and that you can rely on them for support. You will understand that decisions can have implications and feel prepared for them. You will have coping strategies to hand.  

Think of it like training for an event, or revising for an exam. The better prepared you are, the easier it is to manage unexpected changes on the day. 

2. THE BEST BIRTH PLANS ARE FLEXIBLE

As you acquire all that information, your ideas about what you want and need may well evolve and adapt. That’s normal and it’s healthy. I recommend you think about a birth plan that offers you coping strategies and practical plans for a variety of different paths on the day, rather than tying you in to ‘one perfect birth’. 

Particularly as the time for your baby to be born draws closer, you may find that adaptations to your plans allow you to feel more comfortable. As doula’s we know very well that birth can be a bit unpredictable. 

3. HAVE MORE THAN ONE BIRTH PLAN

Most advice about birth plans is to keep them short and sweet. But you are likely to have many more thoughts than you can fit into two pages of A4. Rather than trying to fit it all into a narrow template, I suggest you have three versions; (1) your own notes and reflections. These can be dynamic and changing and in any format you like. You might like a mind map. Or a Word document. Or notes on your phone. Whichever format you prefer this is your space to add notes, cross things out, and describe your anxieties and aspirations. (2) An aide memoir for your birth partner. The birth room can be challenging for partners, and it can be hard to remember the support you’d agreed to give. An aide memoir, written in partnership, gives you both reassurance and something to rely on. (3) The Midwife Birth Plan is the one we’re all most familiar with, and where a lot of the attention lies (see 4. Below). 

4. THE MIDWIFE BIRTH PLAN

The piece of paper you hand to your birth midwife is the beginning of your relationship with someone who is going to care for you in one of the most pivotal and transformational moments of your life. You are likely to remember her forever. You are going to be dependent on her at one of the most vulnerable periods of your life. Now isn’t the time to be shy. Use your birth plan as an opportunity to fast-track your relationship with her. This is really your chance to introduce yourselves as whole humans about to have a meaningful experience. You might want to tell them about your pregnancy journey. Or about your aspirations and anxieties. Or about past experiences that influence your decisions. Or maybe about how you and your partner prefer to make decisions. Tell them what matters to you. 

It is definitely helpful to include your preferences about various interventions associated with birth. You can have a separate, clear section that contains your preferences for all the with the anticipated information about pain relief, physiological or managed third stage, optimal cord clamping and Vitamin K. 

5. UNDERSTAND THE LIMITS TO YOUR RESPONSIBILITY

Perhaps the most important thing I’d like you to factor into your birth plan is: you are not a failure if your birth does not match the preferences you had when you wrote your birth plan. It is a sign of strength to be able to adapt confidently and appropriately to changing scenarios. This is called ‘situational decision making’ and it is a vital skill in birth and life in general. 

Even more importantly: it is not your failing if you wrote a birth plan with the aspiration of having a positive birth experience and were then traumatised. You were not naïve. You did not get it wrong. You were failed by the people who should have cared for you. You may now have more reason than most to write a plan, and you have the right to include every factor that will support you in having a positive birth this time around. Make Birth Better and the Birth Trauma Assocation have good information and resources that can help you with this. 

Taking this approach can be an excellent way to increase your confidence in your planning, and the final plans you write. However, if you find you aren’t getting the support you need for your unique plans from your midwife or your Trust, then contact your local Maternity and Neonatal Voices Partnership (MNVP). Every Trust should have one, and their role is to provide advocacy for women and families who are not getting what they need (as well as gathering your feedback about maternity care and working in partnership with the Trust to improve those services). You can find contact details for your local MNVP here. 

Very best wishes for your birth planning! 

Charlotte Tonkin Edun is a doula, antenatal and hypnobirthing teaching in Sevenoaks, Kent. She is the MNVP lead for Maidstone and Tunbridge Wells NHS Trust, and an AIMS volunteer. Her specialist interest is in birth planning and supporting women and families in balancing the practicalities of navigating NHS maternity care and the human realities of becoming a mother and growing a family. During 2020/2021 she wrote a Masters by Research at the Centre for Women’s Studies at the University of York examining what mothers intend to achieve when they write a birth plan.