A Birth Plan is not a wish list

When I was pregnant with my first I worried about giving birth a lot. A lot! I worried about what labor would be like. Would I be able to handle the pain of contractions? Would I choose an epidural? Would I end up with a cesarean? 

At the same time, I was feeling overwhelmed by the sheer enormity of what was about to happen and anxious about all the unknowns of parenthood. Would I be a good mother? How would breastfeeding go? Would both me and the baby be ok? 

It felt strange to have a little person growing inside me, so connected and yet also, somehow, so far away. Who was I in this new body of mine? Who were they? Would I even like the changes they brought? For me pregnancy felt like in-between state – a journey that had yet to reach its destination. How could I prepare my heart and soul for that designation without a guide to show me how to safely navigate the journey?

Often, I sat alone with all these concerns and feelings. I was unsure even how to put them into words, how to let my husband know what it was like to be transformed into a mother, mind, body and soul. And without these words, it was difficult for me to plan for parenthood beyond purchasing the material items we would need to care for a baby.

I was also worried about giving birth because I am a survivor of sexual assault. I had a body that knew what it was like to feel invaded, to be out of control, and to be silenced. I knew that birth did not have to be re-traumatizing, but I worried that it might leave me feeling broken. I wanted a birth that would help me reclaim my body. A healing birth. I wanted to birth in power. 

And yet, there were few resources out there for people like me - a few bog posts, a few news articles, a website or two that focused on trauma after the birth. But very little that told me how to prepare for birth and new motherhood as a survivor. There was a gap in information, services, and provider training.

Then, I got lucky. Toward the end of my pregnancy, I found out that my wonderful childbirth educator had been trained to give survivor consultations by Penny Simkin and Phyllis Klaus in their “When Survivors Give Birth” workshop. This workshop teaches birth workers to support survivors of sexual abuse. That said, individualized birth planning can be incredibly helpful whether your experience is of sexual abuse, physical abuse, emotional abuse, sexual assault, rape, domestic violence, medical trauma, grief, miscarriage, stillbirth, infant loss, previous birth trauma, mental illness, or even if you are just afraid of giving birth.

And so, with the guidance and support of my childbirth educator, I worked out what aspects of birth I might find challenging, and came up with strategies to help me cope. It felt so empowering to face my fears. I made a wonderful birth plan… 

And then… 

And then, I made a mistake. I couldn’t decide whether to disclose my sexual assault in that document and that indecision meant that I did not share anything at all. I chose not to give my birth plan with my midwife and I ‘forgot’ to bring it with me to my birth.

And this was a real mistake. By not sharing my birth plan, I did not get my birth team on board with how I needed to be treated during birth. I did not use my birth plan to communicate how they could best support me - and in the end, I did not receive trauma-informed care.

What I didn’t understand was that the key to a good birth plan was not just knowing what your preferences are, but also providing insight as to why those preferences have been formed. This may look like disclosing a history of sexual abuse, loss, or other trauma, but it may also look like stating that you have a type A personality, that you are really afraid of needles, or that you ask a lot of questions.

Of course opening up about a history of trauma can be incredibly impactful. I wish I had felt able to do that first time around. If you choose to do this, you do not have to go into details; simply stating “I am a survivor. Please help me by seeking my consent before any procedure” can carries weight.

But you may not wish to disclose this information. And that’s absolutely fine. I get it. My hesitancy to do so stopped me from sharing my birth plan in its entirety. So, think about what else you might be able to share. Be as open and vulnerable as you feel comfortable. Can you communicate whether you are particularly fearful about childbirth? If you have anxiety or depression? Perhaps you can let people know that you have found procedures such as vaginal exams challenging or painful in the past.

Alternatively, you might write “I have a good reason to be concerned that certain procedures or events during childbirth may be particularly challenging for me. Please do what you can to follow my birth plan and talk with me so that I can make informed decisions if my choices can no longer be safely followed.”

The most powerful thing you could write on a birth plan if you are anxious about giving birth might be exactly that: “I am anxious about giving birth.”

I believe it is time to reclaim the power of birth plans. Instead of thinking about them as a wish list, inessential preferences, or an attempt to control what cannot be controlled, we need to think of them as letters of communication between you and your birth team. Your birth plan should convey vital information that your team needs to know so that they can provide supportive and empathic care even when things don’t go according to plan. The key to a good birth plan is not your particular choices, but whether it gives you a voice.

#resilientbirth #whensurvivorsgivebirth #healingbirth #afraidtogivebirth #birthplans #birthplanconsultations #rethinkbirthplans

– Justine