What is a birth plan and should I make one?

Updated: May 26

TLDR: A birth plan is a written document that outlines preferences and requests a pregnant person has for before, during, and after labour/ delivery. It is completely up to the pregnant person on whether they want to make a birth plan or not, but it can be a great way to ease stress and fears about childbirth, and help pregnant folks have agency in the process. Keep reading for more info about why you may or may not want to make a birth plan.

Positionality Statement: My name is Brittany Pompilii and my pronouns are she/her. I reside on the traditional territory of the Haudenosaunee, Anishinabewaki, Attiwonderonk, Mississauga, and the Mississaugas of the Credit First Nations peoples. This land is currently known as Niagara, Ontario. As the author of this post, I acknowledge that my privilege, and therefore my experiences, inform my perspectives on the Western healthcare system. Furthermore, I have never been pregnant or experienced childbirth, therefore I do not intend to speak on behalf of women who have experienced pregnancy and childbirth. As a research team member, I am committed to using my research and writing skills to help all women access public health information - a right that all women are entitled to yet do not always receive. I hope that one day, the public health system represents all peoples’ experiences and treats all people equitably. With this post, I intend to provide accurate information to inform folks on the importance of writing a birth plan, and whether birth plans are the best option for pregnant folks’ childbirth experiences.


What is a birth plan?

A birth plan is an optional, written document that pregnant folks can create for or in collaboration with care providers to refer to as a guide for one’s labour and childbirth experience. The goal of a birth plan is to ensure pregnant folks have a voice during labour and childbirth. A birth plan helps expectant folks clearly communicate their goals, expectations, and visions for before, during, and after labour and delivery (2*).

Creating a birth plan is available for both vaginal childbirth and Caesarean section (also known as C-section) deliveries. In addition, birth plans may be used within different birthing contexts with various care providers such as midwives, doulas, family practitioners, maternal-fetal medicine specialists, pediatricians, neonatologists, and obstetrician-gynaecologists (also known as OBGYNs) (1). Essentially, any care provider who may be involved in the labour or childbirth process can follow the requests of an individual’s birth plan.


Generally, birth plans include a pregnant person’s wishes for:

  • Where to give birth

  • Example: Giving birth at a hospital, a birthing center, or one’s home

  • Labour environment

  • Example: Having the lights dimmed during childbirth

  • Who will attend the birth

  • Example: Spouse, friend, family member

  • Pain management

  • Example: Plans to receive an epidural

  • Delivery preferences

  • Example: Getting an episiotomy

  • After-delivery preferences

  • Example: Immediate care for the baby (i.e. vitamins)

An epidural is an anesthetic administered into a pregnant person’s lower spine during labour to reduce pain and discomfort during childbirth (6*).

An episiotomy is a surgical incision between the vaginal opening and the anus to enlarge the vaginal opening. This procedure can be requested by the pregnant individual to potentially avoid the discomfort of vaginal tearing during childbirth (5*).

This list above is not exhaustive; anything related to childbirth may be included in a birth plan. Want a friend to cut the umbilical cord? Would you like to hold the baby immediately after birth? Have fears about childbirth and would like more support before, during, and after delivery? Include it!


To learn about how to create a birth plan and how to advocate for your birth plan, see our article here.


Why make a birth plan?

Making a birth plan allows pregnant folks to make informed decisions about their bodies during labour and childbirth. This process can help facilitate open discussion and communication between the pregnant individual and the caregiving team (3*; 4*). Developing a birth plan has been shown to reduce women’s fear, anxieties, and misconceptions around childbirth, and increase patient satisfaction with delivery (3*; 4*). Pregnant folks report feeling more at ease going into delivery after making a birth plan. Even if the delivery does not go ‘according to plan’, pregnant folks have expressed positive experiences with having a birth plan in place regardless (4*; 6*).


Note: In practice, birth plans are not followed as specified if the patient experiences complications, higher risks, and/or would like to change plans in the moment.

Birth plans can also be used as an empowerment tool for pregnant folks and their supports (e.g. friends, family, partner(s)) to have choice, control, and agency during labour and childbirth (5*; 6*). In Canada, pregnant folks have reported feeling a lack of agency or control during labour and childbirth. In 2006-2007, approximately 20% of women indicated their birth experiences were “neither positive nor negative” or “somewhat or very negative” (7*) with respect to how care providers treated them during childbirth. Conversely, women reported that writing a birth plan fostered positive pregnancy, birthing, and postpartum experiences, as the plan helped them feel more supported and in control (2*).

Why might you not make a birth plan?

Some folks have reported that writing a birth plan was not helpful for their birthing experiences, since unexpected situations can arise during labour and childbirth which make the birth plan invalid or unusable. This can lead to feelings of failure or disappointment after delivery. Furthermore, some folks expressed that they would not want to create a birth plan in case it went against what was best for the baby (5*; 6*).

These concerns are understandable; however, birth plans are not set in stone and can be altered or discarded altogether at any time before, during, or after childbirth. Flexibility is an important part of making a birth plan, and accounting for the dynamic nature of childbirth and delivery in the birth plan can ease the anxiety around unexpected situations. For example, you can assign an individual to help you make last-minute decisions during delivery, if needed. You can also consult a medical professional trained in delivering babies, such as a midwife, to develop a birth plan together; they can help you make a realistic and feasible birth plan based on your personal health needs and birthing situation (4*; 5*).

Overall, making a birth plan is not a requirement for giving birth; it is completely your choice as a childbearing person.


*These sources do not specify the gender identity of the women included. Historical representation leads us to believe only cisgender women were included.


If you have any feedback on this post or any of the content created by missINFORMED, please reach out to us at info@missinformed.ca. We appreciate and welcome all feedback as we are committed to continuous growth and improvement of our organization.


References

1. Cortezzo DE, Bowers K, Meyer MC. Birth planning in uncertain or life-limiting fetal diagnoses: Perspectives of physicians and parents. J Palliat Med. 2019 Oct 25; 22(11); 1337-1345.

2. Cook K, Loomis C. The impact of choice and control on women’s childbirth experiences. J Perinat Educ. 2012; 21(3); 158-168.

3. Mei JY, Afshar YR, Wong M, Gregory K, Kilpatrick SJ, Esakoff TF. Birth experience satisfaction among birth plan mothers [5]. J Obstet Gynecol. 2015 May 2; 125; 2S.

4. Whitford HM, Entwhistle VA, van Teijlingen E, Aitchison PE, Davison T, Humphrey T, et al. Use of a birth plan with woman-held maternity records: A qualitative study with women and staff in Northeast Scotland. Birth. 2014 Sept; 41(3); 283-289.

5. Divall B, Spiby H, Nolan M, Slade P. Plans, preferences or going with the flow: An online exploration of women's views and experiences of birth plans. Midwifery. 2017 July 31; 54; 29-34.

6. Westergren A, Edin K, Walsh D, Christianson M. Autonomous and dependent - The dichotomy of birth: A feminist analysis of birth plans in Sweden. 2018 Oct 16. Midwifery; 68; 56-64.

7. Public Health Agency of Canada. What mothers say: The Canadian Maternity Experiences Survey [Internet]. Ottawa: 2009. Available from: https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/rhs-ssg/pdf/survey-eng.pdf.




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