Informed Birth Planning
Catherine Bell is the creator of the informed birth planning guide Plan Bellabirth: Informed Birth Planning, available from Bellabirth. Through Bellabirth, her mission is to provide all women with the means to make informed decisions regarding their pregnancy care, labour, birth and parenting.
Today we’ll be talking about birth plans. If you’re pregnant, particularly for the first time, I bet you’ve been thinking about a birth plan. Maybe someone’s told you they’re a waste of time, maybe someone else is telling you that you have to have one. Maybe you’re just not sure what you should actually put into a birth plan and what you should leave out. Today we’re going to be talking to Catherine Bell, and she’s going to be telling us all that you need to know about birth planning. Catherine is the creator of the informed birth planning guide, Plan Bellabirth: Informed Birth Planning. Her mission is to provide all women with the means to make informed decisions regarding their pregnancy care, labour, birth and parenting.
Newborn Mothers: Thank you for coming on the show, Catherine.
Catherine Bell: No worries. Happy to be here.
NM: Catherine, do you want to introduce yourself and what you do?
CB: I am Catherine Bell. I work with Bellabirth, which is my own invention. And it came about because when I was becoming a mother myself I was frustrated at how difficult it was to find information, and I didn’t want other mums to have to reinvent the wheel. And then I discovered that there was already a place for women like me who wanted to do this, and it was called being a doula. So I started to pursue that and it all grew from there. It’s been an interesting journey that has lead to Bellabirth: Informed Birth Planning, which is defining my life at the moment.
NM: It’s great. So people who are listening at home and maybe haven’t thought about this topic. Can you explain what a birth plan actually is?
CB: Generally speaking, a birth plan is a written document that a women provides to her caregivers, which outlines her intentions during birth. They’re often used by women who have very clear ideas about how they wish to be treated and what intimate treatments they want to be offered, or not, during labour and in the hours post birth. For most, a birth plan is really just given lip service. It’s a tick box approach to birth preparation. If you have a look online you’ll come across lots of pro formas and templates to fill in, which can be helpful to come up with how to set out a birth plan and what a birth plan might look like.
But a birth plan is really only as good as the research that is put into that birth plan. And unfortunately for most women, they don’t know where to get started. They don’t know which questions they need to be asking in order to get a birth plan under way. So it can become very much a case of, oh look, here’s a template I’ll just print that off and take that in. That sounds pretty good. And unfortunately if you haven’t put any research into that birth plan, the one that you might take in with you ends up getting thrown out the window. So there’s a little bit of a bad reputation for birth plans, and you’ll hear a lot people say that they don’t bother writing one because it just gets thrown out the window. What my mission has been is to try and educate people on what a birth plan really is, and what’s actually involved in writing a birth plan. I put together a guide called Bellabirth: Informed Birth Planning, so that women can find out the questions that they need to ask ahead of time and start putting together a birth plan that is personalised and actually meaningful for them. And it will be different for each woman.
The birth plan itself, is a written document that you hand in to your care providers. But birth planning is the process of behind that birth plan, and that’s what is absolutely essential for all birthing planners to put together. And it’s put together in conjunction with the care provider. It’s really important to take your half-written birth to your antenatal appointments and run it by your care providers, because you might find that there are things that you have put in your birth plan that are actually not relevant to the place that you’re giving birth. For example, a lot of the templates you might find online will be based on American birthing systems. And there are quite a few routine procedures that happen for women in America that actually don’t happen here in Australia.
NM: What I’m hearing you so is, when people are looking on the Internet. If there’s pregnant women listening and they’ve found these forms they tick which things they want and which they don’t, what you do differently is you can step them through the pros and cons of each of those different options. And also help to step them through the process of okaying that all with their healthcare provider and finding out what’ relevant and what’s not.
NM: Say a woman has spent all this time and done up her birth plan, what if things go wrong? What if it gets to the big day and things don’t go to plan? I know a lot of people ask this question, doesn’t a birth plan just set women up for disappointment?
CB: Absolutely, that’s one of the most important questions that someone can ask. Why would I bother writing a birth plan? How can I predict what’s going to happen? What if something goes wrong? And that’s where the informed birth planning process really comes into its own. You do write your birth plan based on what your ideal outcome might be, or what you’re expected outcome might be. And for most women that will be a natural birth, no dramas, there’s nothing to indicate that things won’t go according to plan. But when you’re doing informed birth planning, you have to consider all your contingencies. So, you answer all those what if questions well in advance of labour.
Usually around week 32 to 38, definitely by week 38, you would want to have your birth plan finalised. Over those series of weeks where you have your antenatal appointments, you would ask your care providers questions about what happens if I go over my due date, for example. What will happen? Is your hospital likely to insist on an induction at a certain point? Or will that be something that you get to have a lot more say in. You might have a birth centre arrangement, where they will allow you to birth in the birth centre up to 42 weeks, and as you approach that later date, it’s important to know what will happen. Does that mean I have to change location? Will I change care providers at the point? And if I do get induced, what kind of options are available to me? Make sure that you ask a lot of those what if questions in advance, so that if something does go wrong or not according to plan, you’re still following your map that you’ve come up with. You’ll have considered your what ifs, and you’ll be making an informed decision during the labour.
Your support will be on board with all of these contingency plans, so they’ll know what point in labour you’ve moved from your ideal plan, and you’re now operating on your contingency plan. An informed birth plan actually covers many different scenarios. It’s a plan that doesn’t get thrown out, because you move from one section of your plan to a different section of your plan. The beauty of this is that you don’t end up with on-the-spot decisions where the decision is usually made based on fear or uncertainty, where there’s a lot of pressure and it’s a really time-intense situation.
The really important part of an informed birth plan is taking some time to really consider that contingency plan, so that if things do go wrong, you’re not put on the spot and you can stay calm. In my experience I’ve found that people who have spent some time considering those what ifs and putting in place the support networks that they need, they often never have to use their contingency plan because they’re calm and prepared for anything. So they actually relax a lot more and feel supported, so birth plays out in a less dramatic way because mum is relaxed and feels safe. It’s often when we are afraid that things tend to go amiss, or feel like they’re going wrong. Often it’s a matter of perception, and with an informed birth plan you’ve considered those scenarios. It doesn’t feel wrong because you’re still in charge and in control of each decision as it comes up.
NM: That sounds so useful. You’ve told me a lot so far of what is important to consider in plan. What do people leave out? What are the common mistakes that most pregnant women make when they’re planning their birth, that mean that actually the birth plans don’t work?
CB: Generally I’ve found that the plans that don’t work fall into four different categories. The first of those categories is the really vague or uncommitted plan. This is the plan that generally looks like, I would like a natural birth unless intervention is deemed necessary. That’s pretty much the extent of the plan. This is a pretty standard approach for most first time mums, because they don’t know how they’re going to react in labour. They haven’t experienced it before, so it’s really difficult to say, I know that I’m going to want to be left alone. Or yep, sign me up for the epidural, I know what my pain threshold is and it’s not good. It’s not going to be pretty, let’s go that way. They tend to take the go-with-flow approach, which in itself is not too bad, but it can often mean that birth happens to them rather than because of them And that can be a little bit daunting and scary. Often, that kind of approach to birth doesn’t leave a mum feeling in control and often the partner or support person is just isn’t wanted. So they’re putting all their trust in their care providers, so often they end up on a conveyor belt style and approach to birth.
The second category is the free online template. As I mentioned, with Google you’ll find dozens of templates where you can just tick the boxes, fill in the missing blank. Often this is something that might happen. It’s week 38, someone mentioned that I should get a birth plan sorted, click Google, oh look there’s one, that looks pretty good, and print it off. And often the problem with that approach is that not much thought has gone into workability. It hasn’t been run past the care providers, so often once they get into labour and hand over their birth plan, their care providers read through it and say, this sort of thing doesn’t happen here anyway. So it gets pushed to the side because it becomes pretty apparent that the parents haven’t really put much thought into that plan.
The third type of plan that tends to get ignored is the declaration of war. This is a plan that often gets put together by a mother who has experienced a traumatic birth previously, and feels very threatened by the birthing environment that she is going into, and also feels that her options are quite limited. Perhaps she couldn’t have the birth that she ideally wanted, but she’s going to do her best to try and claim the birth that she knows she deserves. Often the language of that birth plan comes across as quite aggressive. Unfortunately I have heard midwives and care providers scoff at a plan that comes across quite aggressive, and then line the mother up for the works. I don’t think this is something that they intend to do, it’s not like the mother walks in and they go, oh good, this one’s got a birth plan, let’s give her everything we’ve got. I think that they’ve recognised that a person who has a birth plan that is quite aggressive, is often a person who hasn’t addressed their fears and anxieties that they might have around that birth. Because that mother’s holding onto a lot of fear and anxiety, she’s more likely to end up needing the interventions that she’s trying to avoid.
And the fourth category, is the inflexible plan. This is the plan that hasn’t considered contingency. It’s just absolute, this is the birth I’m going to have no matter what, so that in time that birth deviates from that ideal. It’s considered a failed plan that just gets put to the wayside. Plans like this often, unless by absolute luck the birth has played out according the ideal plan, if the plan does deviate the mother is often left feeling dissatisfied or even traumatised by the experience. That can carry over into how she feels as a mother. She might not have as much confidence, she might second guess herself a lot, and that can make it difficult for her to relax and really enjoy mothering.
As we all know, mothering is a very personal journey. There’s as many ways to mother as there are children born, but we need support along the way. Feeling confident in ourselves makes a massive difference, so by having a birth plan that sets us up to fail, such as those four categories that I just mentioned, it can often carry over into the mothering, where the mother starts off her journey already doubting herself and thinking, oh gosh, how could I get that so wrong. When she hasn’t got it wrong, it’s just that perhaps she didn’t ask the right questions because she didn’t know the questions to ask.
Have a think about these things. Find out a bit about them so that you can prepare. Unfortunately for a lot of women, the first time they hear about something is when it’s actually happening, so it hasn’t been included in their plan. It does end up feeling as if their plan has failed, when in actual fact it hasn’t. What the mother feels at the end of the birth experience, no matter how it played out, is what matters. So it’s really important that a mother feels that her plan has been honoured and that she has been treated with the respect that she deserves.
NM: I think you make a really good point there. I think really a good birth outcome is the mother feeling like she’s in some way in control of the situation. I think that what happens a lot today, whatever physical thing happens, is not the point. I know lots of women who’ve ended up having unexpected Cesareans and felt really good about that decision afterwards because they felt like it was there, they understood what was happening, they understood why. Ultimately it was their choice and they felt like they were in control. I think anything, even if a birth goes the way that someone else thinks it should go, but if the woman didn’t feel like it was actually her choice then that can be really tough.
CB: Absolutely. It makes an enormous difference at the end of the day.
NM: I’ve got one last question for you. What should be included in the birth plan? I love those four categories, by the way! So, we’re not going to do any of them now that we’ve been listening to those mistakes. What should we be doing instead?
CB: An informed birth plan is an original document. The first thing is, don’t follow somebody else’s template or plan. By all means use them as a way of working out how you would like to set up your final document, but the informed birth plan that you writs is an original document. It’s developed over several antenatal appointments in conjunction with your care providers. You need to ask lots of questions, and you need to really listen to how your care providers answer those questions. How does that make you feel? Do you feel safe? Do you feel like you’re being supported? Are you being respected? Is this happening to you or because of you? How are you feeling on reflection when you come away from your antenatal appointment? Did you feel you were given enough time to consider your options? Weigh up your risks and benefits so that you can make truly informed decisions.
Once you’ve asked all these questions and contemplated all the different routine options that will come up, as well as some of the alternative that you might have discovered, your plan might outline some of the techniques that you plan to use during labour. Which means that your support people can follow that guide rather than interrupting you to ‘just check’. So you can disappear into the zone of birth and labour, and know that your support people are on board. Everybody’s really familiar with what you need to feel safe.
The first part of the plan is what you need generally. So this might be your general environment that helps you to feel safety. Do you need it to be a dim environment? Is there certain music that you need to listen to? Perhaps you’ve got a meditative CD, perhaps you’ve done hypnobirthing and you want to listen to that, perhaps you have a particular smell that you want to have around you, so you’ve got your aromatherapy arranged to be there. You need to know in advance that the hospital’s not going to prevent that. You need to have your care providers on board, that’s really important.
There might also be a statement about whether or not you want to have vaginal exams. You might choose to have none, you might choose to have them every hour, you might choose to have them if you feel like it. You might need to ask questions about how flexible your care providers are when it comes to that sort of thing. You might like to specify the types of positions that you would like to try. Perhaps you want to have an active birth and be able to move around freely. Perhaps you know that, if it’s not your first baby, that you’re just going to retreat to a corner and do your thing. If it’s not your first baby, you can be a lot more specific about what you think you’re going to need. If it’s your first baby, you might have a list of things that you want to try, and an order of things that you want to be offered. So if you’re goal is to have a natural birth, your techniques will begin with the more natural things. Perhaps you would like to try a bath or a shower, walking, rocking on the ball, before anybody offers you the gas or an epidural or something that’s a more medical-based approach to managing that labour.
Then you’ll go through to the second stage of labour, which is the pushing. Do you want to be cheered on? Do you want someone to direct your pushing? Do you need people to be quiet? What kind of management do you think you might like? There are dozens of questions to go through to help you come to where you might feel comfortable, and what seems to appeal to you. This might include that you don’t want your husband to see the business end of things, you maybe want him to stay near your head. Or maybe you know that he might faint, so you can actually state in there that it’s really important that, at this point, somebody just keeps an eye on daddy. These are all very personal situations that might come up, and if it’s important to you that something is paid attention to at this point. Someone who’s had previous trauma may know that this situation may cause them to be triggered back to that trauma. So it’s really important that they’ve discussed that with their care provider so that she’s safe.
Then there’s the third stage, which is the placenta and the cord management. So perhaps at this point the mother has considered delayed cord clamping, or even lotus birth. There’s are a lot of options here to be considered in the third stage management, including whether or not you receive an injection to assist with the birth of the placenta. So understanding what the purpose of these interventions are, and whether or not you want them is really important. If you choose not to consent to them, you need to make sure in advance that your care providers know that you want to deviate from routine procedures.
Then, of course, after that comes the first breast feed. The birth plan needs to consider well beyond the baby being born. We’re now into the first few hours of baby’s life. If breastfeeding is important to the mother, she might like to try baby led attachment. She may, in her contingency plan, may have covered in the event of a C-section how she would like to approach skin-to-skin contact with the baby. In the event that she needs to pump milk for her baby she can cover that in her birth plan.
The Australian Breastfeeding Association actually has a breastfeeding plan on their website that you can attach to your birth plan. Which can be really helpful, particularly to mothers who might be expecting a C-section or twins or triplets even, they can make sure that they’ve considered these more unusual approaches to breast feeding.
NM: Love that idea of having a breastfeeding plan added to your birth plan. I’ve actually never heard anyone say that before, but I think that’s absolutely brilliant.
CB: It is. And it makes a massive difference because, a bit like planning a wedding, you put all the details into the flowers and the dress and the shoes, the food that you’re going to put on the table. And then you get to the honeymoon and there’s a whole marriage that comes after the big party of the wedding. For a lot of people, once the honeymoon is over the reality of life clicks in, and breastfeeding is a little bit like that. A lot of people assume that breastfeeding is the easy part. Baby comes out, baby goes to boob and away we go! The first baby you see at a breast is often your own, so the Australian Breastfeeding Association has recognised that and provides a lot of information for mums, including breastfeeding classes that can be done antenatally. So that mums can make sure they’re prepared for that initial stage, the first six weeks after bub is born, to make sure that their support network is around them, and a bit of a reality check of what is normal baby behaviour as well.
The informed birth plan has now covered your general considerations, each stage of labour, including post birth and the early weeks. One of the things that I encourage mums to consider just before their baby is born, is having a pre-baby party. Some people call it a baby shower, some people call it a blessing way. It doesn’t really matter what you call it, the important thing is, you gather together the important people in your life and make sure that you’ve set yourself up with a really good support network. What a lot of mums find really helpful at this party is that everyone brings a meal to put into her freezer, so that in those early weeks she’s got delicious food in her freezer. And bet you’ve got some really good recipes that mums can follow.
CB: Not as detailed as what a postpartum doula would offer. But definitely to set mums along that path of really thinking about what they need post-birth. Having people say to them, how can I help you? And being really honest and saying, actually I’d really appreciate if you came and did some housework for me. Or of you’ve got older children, maybe someone can take them to have a play in the park while you have a rest with your baby. So you can concentrate on establishing breastfeeding, making sure you recover from your birth and bond with your baby. Just let the family really slow down on focus on meeting this new person in their world, and getting everybody to just breathe for a little while. Making sure that your support network honours that time.
NM: I think that’s really beautiful. I think to summarise everything that you’ve been saying, it’s about doing the planning and organising and thinking well ahead of time, so that once the big day comes, you really can just breathe, you can relax, you know all those tough decisions are made, you can switch off your brain.
CB: Absolutely. It makes such a difference, and the guide that I put together is definitely the thinking woman’s approach to birth. These are the club secrets that I wish I had known way back when I had my first baby. It’s taken three babies to put this guide together so that other women don’t have to start reinventing the wheel every time. It’s absolutely mind-boggling that our village has got to the point where it’s so big that we’ve lost that sense of community that often comes from a smaller village. So a lot of women, the first tiny baby that they hold is their own newborn, and they’ve got no idea what to do. Often the people around them are equally clueless, so the idea of the birth planning guide is to help mums find those support networks so that they’re tapping into those networks as early as possible. The first born is always the great experiment.
NM: It is. One of my favourite quotes is,
“You always burn the first pancake.”
CB: That’s right! I hope that my first born, I think that she’s off to a good start, but it’s a big deal having a baby, and the more help that you can muster around yourself the easier that journey is. And the more enjoyable.
NM: Thank you so much Catherine, I think people can really benefit from you as a mother of three. Obviously this is something you’ve particularly given a lot of thought. If someone is just going through all this for the first time, I really feel that having that big sister or a mentor, just someone who they can turn to go, what does Catherine say about this? You’ve got to step them through the whole process and I think it’s really fantastic.
CB: Absolutely. Everyone has to come to their own conclusion, but the questions are still the same. You have to ask the same questions, even though the answers will different and a very personal conclusion. Having those questions to start you off makes a massive difference.
NM: I totally agree. I know when I was pregnant the first time I didn’t know what I didn’t know!
NM: Thank you so much Catherine. Have you got anything else to add?
CB: No worries, thanks for having me. If your listeners would be so kind, I would love it they would check out my website, Bellabirth.
NM: I’ll leave a link just below if anyone wants to click through and have a look at Catherine’s birth planning guides.
CB: Awesome. Thank you.
Wow, thanks Catherine. I’m sure everyone at home is feeling a lot more confident about what they should be including in their birth plan, why they need to have a birth plan and what mistakes they can now avoid. If you have any questions about what to put in your birth plan, or anything about birth planning at all, please leave a comment below and Catherine will pop back and answer any questions at all that you have.
You can connect with Catherine via her website, Bellabirth. And if you’ve enjoyed this, there’s a signup box below. Just pop your email in and I’ll email you once a week with your free weekly pregnancy podcast.