Planning for the unpredictable

Labour and birth are unpredicatable. Anything can happen. Babies can get themselves into the most awkward positions and need a little help and women can become exhausted for a variety of reasons. I was discussing the concept of writing a birth plan with my current NCT group earlier this week. The general consensus was that this was a good idea and for a number of reasons.

It is true to say that there is often doubt about the usefulness of a birth plan as there will be people who say they encourage unrealistic expectations and can lead to a sense of failure if  not followed. At the end of the day, however, a birth plan is only a piece of paper. The trick is to write it in such a way that disappointment is avoided.

First, why commit pen to paper in the first place? An obvious answer is that midwives expect one. Most Hospital notes have a section dedicated to writing a birthplan, whether a simple checklist, suggestions for things to think about or even, at best, the latter followed by a sheet or two of blank paper. Research tells us that women are least satisfied by having a list to tick off as it limits their choices and they don’t really take on board what they are in effect signing up to. Starting from scratch, allowing them to prioritise their wishes, gives them a sense of ownership and is much more empowering.

So who benefits from the birthplan? Clearly it can be a useful exercise for women as it gives them an opportunity to think through important issues beforehand. However, it is probably the birth partner who has most to gain as they are the ones who will have the responsibility for conveying the woman’s wishes to her care-givers in labour. And why? According to Michel Odent, French obstetrician, even asking a labouring woman her name can bring her out of her zone, can force her into her conscious, analytical brain and therefore disturb the delicate balance of hormones that is keeping labour going.

It is all too easy to get bogged down on what is not wanted. In a study comparing practice in America and the Netherlands, the conclusion was that, in America,  where there was a high expectation that labour would be difficult and help would be needed, more pain relief was required and there was an increase in associated intervention. We know that women who are taught the ins and outs of how epidurals work, for example, are more likely to have one.

In Maggie Howell’s book “Effective Birth Preparation” she takes a different view altogether, introducing the concept of a mind-map, focusing on how a woman would like to be thinking, responding, feeling and acting during her labour. It is not a plan as such or even a wish-list but a way of focusing on the positives, whether actions or reactions.

Whatever the approach it is always best to keep an open mind. It probably is a good idea to at least have a conversation with whoever will be at the birth. I can recall 16 years ago during my last pregnancy being roundly told off by a midwife when she discovered I hadn’t written one myself. I blithely thought that as an already experienced NCT antenatal teacher I didn’t need one but of course it was my husband who had the task of talking it though, not me. So we sat down and discussed a few options; possibly the most important consideration is that it is written together. In the same way that it is hard to navigate one’s way around a supermarket using someone else’s list, it is much more effective if the person who will be using it is there at its inception!

And remember, it is JUST a piece of paper.



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