Is it time to ditch birth plans?

An article in the Lifestyle section of the Sydney Morning Herald on November 20, 2019, says it is.


In the article, The 'birth plan' is a shortcut to disappointment, time to ditch it', Polly Dunning explains the birth plan has served its purpose as it has brought women back into the conversation about their bodies and what happens to them at birth, however only 58% of childbearing women feel like they got the birth they wanted and one in three women emerge from their experience traumatised. Dunning writes that the birth plan has failed women, causing unrealistic expectations and there is no consistency in how they are written, nor how they are utilised by health professionals.

Catherine Bell of bellabirth

I was talking with Catherine Bell, a researcher, doula and author/creator of The Birth Map who has been quoted in the article in the Sydney Morning Herald about this idea of ditching the birth plan.

Catherine said

 Birth plans were introduced in the 1980's to address the decreased sense of agency experienced by pregnant women with the increased medicalisation of birth. Intended as a communication tool, but falling way short as many plans are ignored or mocked, are created in isolation or using a template. Women are told to 'be flexible' which is code to 'comply'. They are encouraged to use 'preferences' or state 'wishes'. 

Working with women and their families during pregnancy, exploring hopes, fears, dreams and desires finding out what women want, exploring ways to enable and facilitate what women want is at the heart of midwifery continuity of care. The evidence is compelling and clear that women, their babies and their families are more satisfied, healthier, happier and more able to have the birth they want than women engaged with the fragmented maternity care system. Governments are yet to fully fund a maternity care system that has continuity of midwifery care as its 'norm'. Even though the latest Australian National Strategy for Maternity Care has 'woman-centred care' as its heading, it is still talking about health professionals of choice; not a firm commitment to providing best practice care and a health system reorganisaton of services to ensure every woman has her own midwife.

In the article by Dunning, Catherine was quoted talking about the difference between informed consent and informed decision-making.  The distinction is an important one.  We see informed consent in action when an anaesthetist, called to do an epidural in a difficult labour, runs through all the risks, benefits and contraindications for the stressed and often distressed woman to obtain her consent for the procedure. We see the same dynamic with medical interventions of all kinds in the fragmented maternity care system.

Informed decision making, however, is a process of providing unbiased, evidence-based information to women and their families ahead of time, having ongoing conversations to explore thoughts, feelings, fears and interests in a calm relaxed and thorough manner, considering alternatives and 'what ifs'.  As mentioned above, this process is at the heart of continuity of midwifery care.

As less than 10% of Australian women have access to continuity of midwifery care, Catherine has developed the birth cartography approach to birth preparation. "Like an Advanced Care Directive, this approach boldly goes where no birth plan has gone before". The birth map process enables couples to explore the evidence and their thoughts and feelings, consider alternatives and think about different pathways that may open up during labour, birth and beyond - to consider their options ahead of that all-consuming process of welcoming a newborn earthside.

Catherine invites you to look at her website for further useful information about birth maps. Catherine's website is found at www.bellabirth.org

Used with permission