Editor's Blog

Birth plans and normal birth

I have just finished reading Michel Odent’s book, ‘Do We Need Midwives?’ Its learned and challenging discussion of the multitude of threats facing normal birth in the 21st century, and of the unknown but potentially terrifying consequences of medicine’s attack on the species-protective mechanism of natural selection, provided an interesting background to a recent conversation with colleagues about birth plans.

‘Women are cynical about birth plans, and midwives see them as an insult,’ proclaimed one of my colleagues. I can remember when birth plans started to appear in the 1980s; as an antenatal teacher committed to helping women and their birth partners achieve the best possible start to parenthood, I saw birth plans as a tool for couples to express their preferences and participate in their own care. The people who came to my sessions were excited about drawing up a plan, and fruitful discussions took place about both what to include and how to phrase one’s preferences. Parents-to-be were generally aware of the need to be at least a little open-minded about labour, and not express their requests in too prescriptive a fashion. They were also very keen not to upset their midwife, because they saw her as an ally and didn’t want her to feel that they were doubting her commitment to supporting them.

Twenty years later, when my own daughter became pregnant, she didn’t see much point in writing a birth plan. She felt that ‘they (the professionals) would do what they would do’.

Listening to women attending my drop-in sessions today talking about their labours, the overwhelming theme seems to be that ‘the birth plan went out of the window almost as soon as labour began’ - either because labour was more difficult than anticipated or because the midwife didn’t look at the plan.

All of the above is worrying. It may well be that a written birth plan is not the best way for mothers and fathers to express their preferences. Odent would argue that a woman should not be engaging her neocortex to argue for or even discuss what she wants during labour; she should be dominated by the primitive parts of her brain responsible for producing oxytocin and melatonin. The midwife has enough policies and protocols to keep in mind without having to read yet another document as she dashes from one woman on the delivery suite to the next.

Women tell me that what they wrote on their birth plans wouldn’t have been possible because there were ‘problems’ during labour and pressing ‘medical reasons’ for doing x rather than the y that they had wanted, and so little or nothing of their birth plans came to pass.

Birth plans in and of themselves are not important. However, what is important is the number of women who, whether they wrote down their preferences or didn’t, do not have the labour and birth experience they would have liked. Surely not all of these women can have had such complicated labours that it was impossible for them to ‘be upright’; ‘use only gas and air’; ‘have intermittent monitoring’ or ‘use the birth pool’?

Are birth plans now simply showing up the gap between women’s aspirations and the reality of contemporary childbirth? Perhaps Odent is right and the adrenaline-stimulating events of the contemporary birth environment mean that it is increasingly difficult for women to generate sufficient oxytocin to facilitate a normal birth?



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