Preparing To Write Your Birth Preferences
It's important to consider our births, and how we hope for them to go, and then communicate this to our care team.
Birth planning (or as we prefer to call it, ‘birth preferences’ or ‘birth values’) involves establishing what we want in our labour and birth. It looks at places, pain relief, type of delivery, medical consent, and partners.
Typical birth plans focus on the 'whats' and the 'physical wants'. They communicate what we want to happen, but not necessarily why we need this to happen. They don’t often look at what it is that we value and what emotional needs need to be met. Purely practical birth plans can risk us becoming rigid in what happens and disempower ourselves and our care team to know how to best support us and protect our labour and births, even if challenges arise or it goes off course. When we only plan out the birth we want, we can find ourselves feeling disappointed, out of control and even traumatised as it unfolds differently. and even traumatised as it unfolds differently.
Birth trauma is less about what happens and more about how you feel. A few cases of birth trauma are never fully avoidable as a whole, but a lot of cases are. We hope preparing this way will help empower you and protect you and your baby during labour and birth.
We want to shift the focus to our 'whys' and 'emotional needs'. Doing this allows us to look beneath and behind what we want, and helps us to stay empowered, adaptable and resilient when the 'whats' of our birth don’t go to “plan”. It helps us to hopefully love our births, even if they look totally different to how we wanted.
We prefer to use the terms ‘birth preferences’ or ‘birth values’ which communicate a less rigid approach and include the deeper needs and ‘whys’ of our labour and birth. You are more than welcome to call this your ‘birth plan’!
Here are some ideas on how to reflect on and prepare to write your birth plan. Below are some questions to consider which use very basic examples to help you to understand how we can be thinking about this.
1) What does My dream birth look like?
We’ve all thought about our birth. We imagine where we want to be, who we want there, what pain relief we may want to explore, what we want in our environment, etc. We may see it play out in our heads, dreaming about the journey we take during labour to meet our baby. From person to person, this will look different.
E.g. I want an elective gentle c-section where I allow my body to birth my baby. I want skin-to-skin with my baby. I want to delay all checks with my baby.
2) What emotional needs and values Am I seeking to meet through this?
When we think about the ‘whats’, we can now reflect and dig deeper as to why we want these things. Consciously or subconsciously, there are likely to be deeper emotional needs and values that lead us to choose certain things during our labours and birth - generally, like most choices we make in life! Understanding ourselves and what our deeper needs and values are can allow us to open ourselves up to be practically adaptable, yet remain empowered, and resilient and feel safe, cared for and loved if things happen differently. It means those caring for us can make changes to ensure our emotional needs and values can be met. Most importantly, those caring for you can be empowered to help you achieve what you want and give you what you emotionally need and value.
E.g. I want an elective c-section because I need to avoid reliving previous trauma during my birth. I want a gentle c-section whereby I birth my baby abdominally because I need to feel empowered, in control and calm during my birth. I want to feel the pride and connection of bringing my baby from inside of me up onto my chest as it would be with a vaginal birth. I want skin-to-skin and to delay all checks with the baby because I need to feel connected, safe and empowered as my baby’s mother, unless it’s a matter of life and death.
Once you begin to understand emotional needs behind what you want, we can then begin to write about worst-case scenarios.
3) What do I want to avoid and what is My worst-case scenario?
No one likes to think about worst-case scenarios. We all want to avoid them, and for the vast majority of us, we won’t have to go through them. As with our dream birth ‘whats’ and ‘wants’, when we imagine what a worst-case scenario looks like for us, we can prepare for all the ways we and our care team can continue to empower us, care for us and bring a sense of safety to us. We can give ourselves and our care team the best chance to meet our deeper emotional needs and uphold our values when circumstances differ from what we may have wanted. What we know about birth trauma is that it is far less to do with what happens and more to do with how you feel.
E.g. My worst-case scenario is a vaginal delivery, and being separated from my baby straight after birth. I don’t want to feel lesser capable in my birth than those who birth vaginally, and I don’t want to feel disempowered as a new mum. I want to avoid having people neglecting to communicate what’s happening or creating a sense of panic and chaos in my birth space.
4) How can adaptations be made during My worst-case scenario to meet My needs and values?
Now that we understand what our emotional needs and values are, we can take a look at our worst-case scenario and think about ways in which our emotional needs and values can be met. How can we continue to have safety and the care we need when things don’t go to plan? How can my desires be upheld? What adaptations can be made that are within your rights, even if they fall outside of hospital policy?
E.g. If I end up birthing vaginally before I am able to have my c-sections, I need those around me to understand the impact this may have on me. I need to feel safe, validated, supported and loved by being given trauma-informed care and postpartum psychological support through a referral and birth debrief. I need all measures taken to ensure my baby is kept close to me by delaying newborn checks, checking Apgar scores while I have skin-to-skin and having the baby placed immediately onto my chest. Should my baby need some help to breathe, please keep the baby connected to me via the cord, or kept near or on me. I need my care team to calmly explain to me what’s happening and allow me to give informed consent. I need encouragement and validation from my partner and midwife to know I made choices that were right for me and that I cannot fail at birth simply because it may not fit the physiological norm.
I am considered low-risk and therefore urged to have a vaginal delivery at home or a birth centre. Though, due to my previous trauma, my individual needs and values mean that a c-section would have a far less negative psychological impact on me, even if it is not advised under NICE guidelines and hospital policy. I need a trauma-informed care team to understand my fears, listen to my needs and work collaboratively with me to ensure I have a positive empowering birth which minimises psychological trauma. Many hospitals are able to do fetal medical assistance and/or resuscitation with a baby still attached to the mother - elective surgery will allow us to work together to plan how the theatre team can plan for this.
6) In What ways can I communicate these to create trust, openness and teamwork?
When communicating your needs and values in your birth preferences, consider the way you articulate yourself and how it will impact those who seek to listen to you, work with you and support you in it. Your words are powerful and how you write your birth preferences can communicate to them your attitude and willingness to allow them to support you. They are your team and want what’s best for you. They are people with the privilege to be there on one of the most special days of your life. It matters that you can all work well together, enjoy your birth and feel safe, loved, and cared for.
E.g. In a birth centre vaginal birth plan, instead of saying ‘I refuse to push on my back…’ or ‘I don’t want you to force me to stay on the bed during labour’, think about phrases that communicate exactly what you need in a tone which is collaborative, respectful and creates a relationship of trust and teamwork. Perhaps something such as, ‘I would love your help with avoiding birthing on my back’ and ‘Please support me with keeping mobile, upright and comfortable’.
You can communicate the same message in totally different ways - one being distrusting, closed off and fear-based/defensive/offensive; the other being collaborative, open and trusting them to meet you where you’re at with all your fear and concerns. You can be firm, concise and deliberate while remaining kind, respectful and open to building trust.
Now you’ve thought about what it is you want, need and value, we can start to form your birth preferences…
Keep your eyes out for our template to help you do this coming soon!
A little note about your care team…
Your care team are there to support you. They are real people who do their job because they care about it, you, your partner and your baby. It’s important to understand the NHS maternity system here in the UK to prepare more for potential challenges (which we will talk about at another point). There are plenty of ways in which the NHS (or other care systems around the globe) aren’t perfect and needs reform. The NHS maternity system needs much more staffing, support and funding. The majority of midwives, nurses, doctors, etc, are incredible, skilled people who are doing their best to do their job well, and protect and care for their patients, team and themselves in the process. Those overseeing your birth preferences should do all they can to help you to achieve the birth you want and meet your emotional needs and values if challenges arise. Great care should take into account the best evidence available, clinical expertise and your individual needs and values. Any caregiver who makes you feel unsafe, unloved and uncared for should not be responsible for your care, and you have every right to request someone else. If your birth preferences are disregarded, invalidated or belittled, speak up. this may just be another bad day at the office for them, but you will remember this day for the rest of your life. You deserve better, even if simply just because it’s your legal right.