Birth Preferences or Birth Plan? It's not the word it's what you do with it.

Birth Preferences or Birth Plan? 

It’s not the word, it’s what you do with it. 

If I were giving birth today I’d be terrified, and completely overwhelmed by information.  When I had my eldest, who will be 21 in a few weeks, we didn’t even have Facebook.  Reading that sentence back it seems impossible that a world existed without social media when my children were born.  

But social media does exist,  and it means that the landscape around birth has changed enormously.  There are so many opinions, photographs, video footage and tips for having a great birth that for some it can lead to a state of overwhelm, inertia and fear.     

Scrolling this week, I noticed a post that said birthkeepers, birth workers and HCPs that use the term birth preferences were “grooming”. The post in questions said that women “are encouraged to create short, snappy, illustrated, super-fun plans in the hope that practitioners would have a look at it, people in the industry are being groomed to disregard this document and clients are being groomed to placate this nonsense” [sic]. 

I want to be very clear; I do see the reasoning behind this thinking –  I agree that women can be coerced into unnecessary interventions, leading to outcomes they didn’t expect and that these can be physically violent.  I’m not shying away from that.  I’ve seen coercion in its worst forms, not just in the birth room but across health care.  

Standing outside a room once, I strongly fended off a paediatrician, waving a set of birth preferences, carefully researched by the woman for the exact scenario she found herself in. The paediatrician later spoke to me and confessed that their own fear, not the evidence, had driven them to push back on the woman's preferences.  I’ve seen midwives defending women's birth preferences, by not allowing doctors to come into a room. I’ve also seen midwives barely glance at birth preferences, and for me it’s not so much the words but the actions that matter. 

Is the use of birth preferences a form of grooming?

Over the next few days, I read a few more inflammatory posts with the word grooming. By now not only did I feel  a strong visceral response to the flippant use of the word grooming, but I was also slightly bemused by the fact that the word preferences was seen as some evil grooming doctrine by birth workers. 

The Oxford Dictionary defines grooming as “the action of attempting to form a relationship with a child or young person, with the intention of sexually assaulting them or inducing them to commit an illegal act such as selling drugs or joining a terrorist organisation”. 

Having worked with women who have been sexually groomed at a young age I felt sick reading this. The word is powerful, evocative and triggering for many women.   Attributing it to birth workers who are helping women to navigate a very difficult birth landscape, with carefully researched birth preferences, is fear mongering and a misappropriation of the word grooming.  

If I were pregnant, had experienced true grooming by a sexual predator and read those words I would feel not only frightened but sick with fear.  If I were vulnerable I would feel even more vulnerable. If I were a birth worker who had experienced grooming I would feel devastated.

Now let’s get back to the word, preferences.  I started using this twenty years ago instead of plan as it gives you flexibility and balance. It doesn’t mean that you are going with the flow but it does mean that you have space to change based on how you are feeling on the day.  

One person who had shared the post in question had written.” This!.....Only you can know what’s right for you both in advance and moment by moment. Being prepared to navigate the tricky stuff or even being prepared to overcome a diversion is not the same as going with the flow”.   

Hmm, I thought this was exactly the flexibility that preferences were trying to ensure? 

The intention of preferences can be very positive. Without interference and intervention births would largely be straightforward, I absolutely agree with that, but there are some that wouldn’t be. There are a small percentage of births and babies that need help, but fear of missing those few births, and babies, can lead to intervention for many. There is no doubt that the level of intervention is far higher than it should be and that many women, too many women, are experiencing iatrogenic harm because of this.

How can plans for birth change?

In the event that things do change, or interventions are suggested, preferences allow you space to keep you aligned as closely as possible with your expectations of birth. 

You may love the idea of a pool but hate water on the day.  You may think that the light touch massage you have practiced is going to feel fabulous and then decide you hate it.  It may be that you don’t want gas and air but decide you want it on the day. 

The word preferences say it’s ok to change your mind. It doesn’t mean it’s ok for others to change it for you.  

Preferences are also about realism. If you have planned a pool birth, get to the hospital and they are all occupied, no one is going to be able to magic a birth pool out of thin air.  If a birth pool is an absolute non-negotiable for you and it’s a possibility that they won’t be availablel, then you should have a home birth or find somewhere that will guarantee you a pool.  Writing your preferences helps you reflect on these important aspects of the birth. 

A good set of birth preferences can be short, and smart.   

I had one client whose preferences were a few lines.   

“Don’t offer me anything, don’t talk to me, keep people out of the room, you can listen in every 20 minutes.  I do not want to be touched or examined, offered pain relief or given instructions on how to push. If I change my mind on anything I will let you know. If anything changes speak to my partner first.” 

Birth plans are just the beginning you have to learn how to use them!

More important than words on any birth plan, is teaching you and their partners how to prepare for birth, to ask the questions that get better outcomes and to recognise when coercion is happening.  Birth plan/preferences/decisions mean nothing if you aren’t equipped to ask the important questions, or feel able to challenge things that go against what you intend for the birth.  

Whatever it’s called, in whichever format, you have to be prepared and equipped to assert the intentions on it.  

If someone tells you something has changed, or they want to do something differently, the subtext could come across that something is wrong. This can activate the fight or flight response, the sympathetic nervous system, which makes it harder to make decisions that matter. When the sympathetic nervous system is activated blood rushes to the heart, legs and arms so we can  fight or run away. Your brain, and the ability to make informed decisions is compromised. In my classes I have an exercise when I put couples under time pressure to answer questions they know the answer to, and they find it really hard to think clearly. 

How to notice coercion

Forget about the wording, it comes down to how you stay rooted in your birth preferences for the birth. How do you ask questions and make decisions from a place of knowledge when feeling fear? At the heart of everything is the immutable “no one should be able to make someone do something they don’t want.” 

You should be far more wary of language like:

“oh we could just try that…”, 

“oh your waters have broken, but I see you don’t want to be induced, we can give you 24 hours”

Perhaps if you have “no vaginal examinations” on your birth preferences….a phrase like “I can see that you want to get in the pool, let’s examine you first and see if you’re ready” should be a red flag.

"We'll just ask you partner to wait outside the room while the doctor is here as there's not much space."

"I'm just going to...."

Short on time? read my top tips. 

Name them plan/preferences/wishes/decisions, they can be as long, short or as colourful they like. 

Always remember that flexibility in intention also matters when it comes to birth, and the words, “No, I do not consent.” are as powerful as ever. 

My top 5 tips for staying close to what you want for birth

1. write a plan/preferences/decisions and do it well before the birth, not a last minute “oh I’ve only got a couple of weeks, I’d better get a few things down”. Reflect on them nearer the birth as things can change based on what you have learned or experienced. 
2. Make sure you partner is fully versed in what you want/don’t want and why. The partner needs to learn about coercive language and feel confident in advocating for you. 

Understanding coercive language

Tips on consent

3. Go through your birth preferences with your midwife

4. Book an appointment with a doula or independent midwife to go through your birth preferences, they may give you some tips and hints on how to stay as close to it as possible. 

5. Learn techniques to stimulate your vagus nerve which supports decision making. This can include deep breathing, yawning, butterfly hugs, hypnosis, massage and mindfulness based techniques. 

You can learn more on my Mindful Hypnobirthing course, with details on how to write a values based birth preferences alongside techniques to get you into a calm and confidence headspace for informed decision making. 

Click here to see what's included