Even before I became a doula, a sturdy birth advocate lurked deep inside me, armed with soapbox in one hand and more than my share of ‘tude in the other. Since childhood, I have had a strong sense of justice - of right and wrong - and a desire to give voice to those who are trampled by the “system.” I went through my hippie, political phase in college, equally annoying friend and foe with my mouthy opinions. Though my picket signs are long gone, the same desire to see women empowered to advocate for themselves still burns strong in my soul.
I love lists. Maybe it’s the slightly-OCD, control-loving quirks in my personality. Perhaps it’s my passion for over communicating, [one of my husband’s favorite qualities I possess]. I do not like to be misunderstood, nor do I like for things to happen outside of my control. So, naturally, when I became a doula, I assumed the Birth Plan was my client’s (and my own) golden ticket to make all their birth dreams come true.
But what if the birth plan isn’t all it’s cracked up to be?
Four Problems with the Birth Plan
1. The Name.
Birth PLAN implies that we somehow have the autonomy to ensure our plan comes to pass. Even though, as mothers and doulas, we may not intend to create this impression, we may be creating expectations that we have more control than we actually do. One of the basic tenants of birth is that, in many ways, you are not in control. Your body labors most effectively when you release your need for control and allow it to do it’s thang.
2. The tone and length can create hostility with the hospital staff.
Because many Birth Plans are composed assuming that the birthing mother is going to have to fight for her right to have or decline certain procedures or practices, it can immediately create an “us” and “them” mentality with hospital staff. Instead of seeing themselves as part of your birth team, doctors, midwives and nurses may assume you see them as the enemy, and, therefore, may behave more coldly or [even unintentionally] distance themselves. This is not to say you should not advocate for yourself nor ensure you know your rights, options and implications, only to keep in mind that everyone will benefit if you see your medical staff as partners not the adversary.
3. Creating unmet expectations —> Birth Trauma.
We all want healthy babies on the other side of our birth, and many of us have very specific expectations as to how we would like to get to that end goal. Whether it’s research, our social circle, or a care provider, the pressures others place on us and we place on ourselves can lead to shame, alienation and postpartum mood challenges when our Birth Plan doesn’t go as planned. Exploring your choices is ESSENTIAL to ensuring you are prepared for birth; however, holding any of those options too tightly may result in disillusionment, self doubt and birth trauma.
4. The Unicorn of an “ideal birth.”
Monet recently wrote a powerful article on the Dangerous Myth of an Ideal Birth. This article resonated with countless mothers and birth workers, as so many of us have observed or experienced abuse or marginalization in response to our birth experiences. Part of the problem with placing a Birth Plan on a pedestal is that we just painted our “ideal birth experience,” and therefore, anything that falls short of that may be internalized as a failure. Whether it is your first or fifth baby, each labor and birth hold the potential to be dramatically different. Recognizing the flexibility that birth forces us to have is essential to finding peace during your birthing experience, regardless of how our plans may change. Unexpected induction, long labor requiring an epidural to rest, cesarean for transverse positioning…there are countless reasons our birthing “plans” may be forced to change. A doula can play a vital role in helping you explore realistic options BEFORE birth, ensuring you are equipped no matter what decisions you’re faced with.
Can We Fix the Problem
Pam England, author of Birthing from Within, encourages pregnant moms to face their “Birth Tigers” as part of their birthing preparation process. Our Birth Tigers represent our deepest fears in labor and birth. Whether it is an unplanned medical intervention, a certain doctor being on call, or going into labor before or after your due date, any manner of unexpected change in our “birth plan” can lead to anxiety. Anxiety increases the release of stress hormones like cortisol which can significantly lengthen or inhibit the progress of labor.
Steps to Facing Your Birth Tigers
Your greatest fear in birth may not be the same as the most severely negative thing that can happen to you (i.e. death or death of your child). Instead, it may be something extremely personal to you, your life-experience and personal context. Perhaps you have an uncanny fear of needles, so the thought of an epidural makes you want to scream. Whereas, the idea of a cesarean birth doesn’t really concern you. Regardless of what it is, facing it before birth is essential:
1. Identify the Tiger [fear].
2. Explore the source of the fear.
Why do I have this fear? Is it related to or triggered by something in my past? Is there some unaddressed pain or experience I need to explore before going into labor?
3. Create a plan in the event that your fear comes to pass.
How will you deal with this reality? What can you do to ensure you maintain as peaceful-a-birthing environment as possible? What specific steps can you take today to prepare for walking through the Tiger?
4. Envision yourself experiencing your Tiger, conquering the fear, and coming out on the other side safe, peaceful and empowered.
5. Ensure your birth team is aware of your Tiger and your plan to conquer it.
Avoiding our fears does not make them less likely to happen, just as preparing for them doesn’t make them more likely to happen. On the contrary, if we have never explored our Tigers we may be left unequipped to handle the situation. We may find ourselves at the mercy of a high-pressure birthing environment and may struggled to identify the “best” decision at the time.
Reframing the Birth Plan
No, I don’t want you to stop creating Birth Plans - it’s a powerful practice to explore your options and determine what evidence-based research supports. It can also help you identify your Birth Tigers.
So, yes, let’s keep creating them. With a few conditions.
Let’s write them in a spirit of conviviality, and with the understanding that we must maintain flexibility during each labor. Whether you are a pregnant mom or a doula supporting a family, we must face our greatest Birth Tigers to dissolve the control they have over us.
And can we call them “birth preferences,” or a “wish list,” or some other clever euphemism for Birth Plan? I know it seems knit picky, but rebranding it in a more realistic way can go far to determine how tightly we hold onto our checklist.
Keep learning, keep researching, keep forming opinions. Never stop advocating for yourself and your wishes - just do all you can to keep your wishes from turning into wounds.
Next post, we’ll be talking about the steps to writing an effective, gracious Birthing Preferences List…
[Pregnant in Colorado and in need of a doula? We're here to help! Check out our team and drop us a line - I would love to chat through your birth with you personally to match you with one of our amazing doulas.]