Why We Should Use The Term “Birth Plan” Instead of “Birth Preferences” and Why It Matters

Sharing is caring!

As a mama of three myself and a labor and delivery nurse, I can tell you that I have a LOT of experience with birth plans. If you have an idea of what a birth plan is or might be, or if you’ve written a birth plan in the past, I can almost guarantee that I’ve seen a birth plan just like it. 

I’ve seen the one paragraph birth plan. I’ve seen the 7 page birth plan and I’ve seen everything in between. 

And with all of the birth plan experience I have under my belt, the good, bad, and the ugly, I will still say…I can't stress enough how important it is to have a thought-out birth plan in place. But not just any birth plan.  There are definitely unhelpful birth plans floating around out there. 

 So today we are going to talk about how you can create a plan for your birth that actually works for you and benefits your experience. This episode will help you stay on track with what’s helpful and beneficial and steer clear of the harmful, redundant, or counterproductive territory that birth plans sometimes live in. 

Click here to scroll to the bottom of this post to see the quick-look podcast show notes for this episode.

What is a birth plan?

So the first thing that I think it is important to set straight is what a birth plan really is and what it’s not. I think this might just be where the confusion sets in the most, actually.

A birth plan is essentially a communication tool between you and your provider, you and your nurse, you and your partner AND you and yourself. It’s a reminder for yourself and your team about what kind of birth you’re striving for and what you’re willing to do in order to get there.

It’s not a contract and it’s certainly not binding. It’s not something that your provider or your nurse is going to sign or promise. It’s not a guarantee. It’s a plan.

Your birth plan is mostly for YOU. What are YOU going to do. What are YOU going to try. What are YOU going to accept first? And when you put something on your birth plan that you want to do, it’s up to you to do it. And if you put something on your birth plan that you want to avoid, what are YOU going to do instead in order to feel safe and comfortable declining it?

Who is a birth plan for

Having a birth plan, although isn’t required by any means, is for everyone and in my opinion, is an essential piece of your labor preparation. 

If you are going to give birth, then you have a birth plan. You do! It might be in your head or in your imagination but it’s there. You have expectations whether you’re conscious of them or not. And you’ll be faced with them when labor or birth begins to stray to scary places outside of your comfort zone. 

So, a birth plan isn’t just a piece of paper that gets stuck inside your chart. It’s a plan in your head, it’s the plan that you’ve discussed with your provider, it’s the plan that you’ve talked through with your partner, and it’s the way you envision your birth when you think about how it might unfold. And this applies to every pregnant woman regardless of what the plan entails. 

Planning a C-section on Thursday at 1 pm, getting anesthesia, remaining awake during your procedure, getting stitches to sew you up, and then reuniting with baby in recovery is a plan. So yes, C-section mamas, you have a plan. Showing up for your induction, planning to get an epidural when the pain becomes to much, Pitocin to get contractions moving, AROM to get things to speed up, letting my nurses tell me when and how to push, and then holding my baby immediately after birth…that’s a plan. So induction mamas, you belong here too. 

Getting to the hospital in active labor, having intermittent monitoring, showering during labor, using counter pressure and aromatherapy to decrease pain, pushing in multiple positions and then breastfeeding immediately after birth…that’s a plan. 

But for some reason, only that third one gets glares and push back that sounds like “Well, birth plans never go as expected SOOOO”. 

But what if you are Disappointed…

Well guess what. Have you ever heard about epidurals not working? Or epidurals being one sided? C-Sections having to be under general anesthesia because the spinal wasn’t working properly? Or babies being whisked away to NICU because of respiratory distress and mom being unable to hold her baby right after birth?  These things happen ALL THE TIME. The plan didn’t go as planned. Right? It’s possible for literally any person with any plan to have their birth stray from what we imagined. 

But does that mean that we shouldn’t work towards the birth we’ve been hoping for? Because it MIGHT not happen that way? 

OR should we, instead, look into what we can DO and how we can PREPARE to make our experience MOST LIKE the vision in our head? 

A birth plan does not make you more prone to changes in your birth. A birth plan does not set you up for more problems OR more disappointment. Quite frankly, when done correctly, it does just the opposite. It allows you to think about what you want in each stage and phase of labor. It gives you the opportunity to have a plan b, c, and d if needed because you know what your options are and how you feel about those options.

Why it’s not a “preference list”

Although I have always and will always call it a birth plan, more and more lately I see “birth preferences” or your “preference list”. But come on, this is not just a list of things that you’d prefer. Not if you’ve done it right! It’s not a list of things that sound nice. This is not just a list of hopes and dreams. It’s not a list of things you’d like to happen or a description of your ideal birth.

It’s a reminder of what the plan is…

What you’ve been striving for throughout your pregnancy, what you’ve been working for, and a reflection of what you’ve learned about birth thus far. It’s not a preference list. But I understand where you’re coming from when you use a “preference list” instead of birth plan. You want to be flexible and I love that. You’re acknowledging that your birth plan are the things you hope for but you understand that things might change. This is a great mindset.

But you’re missing something….

A preference list holds no power

Having a preference doesn’t have any power. It doesn’t DO anything for you. Writing down that you prefer to have your baby in the morning and not at night doesn’t make that any more likely to happen, right? The same goes for anything else on your birth plan. Writing down your preferences looks nice and sounds nice but it doesn’t mean much about how your birth is actually going to play out.

But if you’re thinking, yeah, but birth plan sounds so rigid, things change all of the time during labor and birth, right? So Having a plan that’s set in stone is foolish because it might change and then you’ll be disappointed. I hear you. But just like a birth plan is NOT a preference list, it’s also not a “birth prediction”. It’s not a “birth rule”.

Instead, it’s a plan. Maybe it’s plan A, yeah. Maybe it’s plan A, B, and C. But it’s a plan.

Why shouldn't we call it a “Birth Preferences” list?

When I google the definition of plan, this is what I got “a detailed proposal for doing or achieving something.” or “an intention or decision about what one is going to do.”. And there is SO much yes there. It reflects your intention which puts YOU in the driver’s seat. It’s a PROPOSAL for doing or achieving something. YES! It’s a proposal. Maybe I’ll call it a birth proposal from now on because that’s exactly what it is.

So let’s look up the definition of proposal. “a plan or suggestion, especially a formal or written one, put forward for consideration or discussion by others.”. Are you with me? It’s perfection. So, yeah. Your birth plan is so much more than a preference list. It’s a plan or suggestion put forward for consideration during your birth. Consideration by you and your team. Looking back at your birth plan while in labor will help you consider what you wanted to try, what you were hoping to do, and what you were trying to avoid and probably most importantly HOW you were going to avoid it.

But let’s do one more search. When I looked up what is a birth plan, there is a variety of different things that pop up but here are a few “ a set of instructions you make about your baby's birth” “a document that communicates your preferences and expectations about the birth of your baby to your healthcare team.” I’m not a fan of either of these definitions of a birth plan but I do like this one “A birth plan is a tool to help you get educated and organized on your options and preferences before the big delivery day.” That one got closer.

It really is a tool. It’s not something that you print off of someone’s free thing online and then mark a bunch of boxes that sound better than the other boxes. It’s a tool to help you get educated and organized about your options and preferences. But that means that you have to do some work in order to know and understand those options and make informed choices about which options are best for you and how you will go about achieving your preference. 

The negative connotation around “birth plans”

Well, the thing is, birth plans get a bad rep because many (not all) birth plans that show up in the hospital expose how uninformed these parents are about birth. It’s either a checklist of boxes provided by whoever created the birth plan and then the mama just looked at it and checked whichever boxes sounded the best, or it was a detailed list of demands that don’t make any sense. The worst is when as the nurse, I want to clarify what something means on their birth plan and they don’t even know what I’m talking about because they don’t actually know what’s on their birth plan, or they don’t know what it means to have that on their birth plan. 

Another reason that birth plans get a bad rep is when they come with the attitude that we, the hospital staff, are against them. And the birth plan is a wall between us, like it’s almost used as a weapon or a defense in some way. This is more sad than it is frustrating because I’ll speak for myself, I LOVE birth. And I love to celebrate with the families that I help. I love to help them achieve the birth that they desire and show them how they can reach their goals that they’re striving for and show them tricks, strategies or suggestions to help them get there safely. But because I’m on the other side of the curtain, they look at me like I’m trying to manipulate them or I’m trying to coerce them into doing something against their wishes. 

And that’s why some nurses out there look at a birth plan and scoff. Because the mamas that come in either declining everything just because they can and they saw it on TikTok but they don’t actually understand what they are declining, why, or how it will change their birth OR they come in treating the birth plan as a weapon against the enemy…us. 

Neither of which should be the goal of your birth plan. Instead, allow it to be what it was intended to be. A tool. A proposal. A plan

How to use your birth preferences as a tool

A birth plan CAN absolutely be more than just a long list of things you don’t want. It can be a tool in your birth that actually helps you achieve the things on the list. But in order to do that, you actually need to put in more work than checking boxes. 

Step 1: Discovery

Step one is discovery, it would be best to take a birth course so that you start to know what you don’t know and start to figure out what kind of birth you’re working towards. But even if a birth course isn’t in the cards for you, there are still ways that you can sort through information yourself to make sure you’re aware of what options you have and how you feel about those options.

A common mistake that people make when writing a birth plan is that when they write it, they envision the hardest parts of labor. They envision what they will be doing when labor pain is at it’s peak. But labor is a whole lot more than managing pain or working through frequent contractions. The birth plan should start when the labor process begins…at the very beginning, when you’re at home, contracting here and there, and you have to make a choice about when to go to the hospital.

It should include what happens when you get to your birth space and what you expect during that process of transitioning from your comfort zone to this new environment. It should include that peak of labor that is in the forefront of your mind but not stop there. And if you don’t know what to expect in each of the stages and phases of labor or what might be offered or ordered for you, that’s what discovery is for. Become informed on what to expect so that you’re prepared to make those choices when the time comes. 

Step 2: Research

Step two is research. Research involves understanding what the risk, benefits, and alternatives are of each of the interventions you’re considering. Whether you’re hoping to try them or avoid them, you should know why they are used, what their benefit is, what their risk is to you, your baby, or your labor, and what alternatives there are to consider.

For example, If you’re considering declining cervical exams, think about why cervical exams are used. Why would someone offer you a cervical exam? What risk does a cervical exam pose to you, your baby, or your birth experience? What are the benefits? And then don’t forget…what is the alternative? An alternative to a cervical exam might be waiting for another time or it might be using your own emotional signposts to determine how your labor is progressing based off of how your reactions to labor have changed. But in order to do that, you’ll need to have a good idea about stages of labor and what signs consistently and reliably come up in a woman’s physical and emotional response at each stage.

How will you know something like that? Well, in step one, when you did discover using a birth course, that’s some of the important things you’re learning. And you’ll repeat this process through all of the points on your birth plan that mean something to you.   

Step 3: Take Action

And step three is find out what your action steps are for each bullet point. If you don’t want induction or augmentation interventions, what can you do in order to help progress your labor or encourage your body to continue to dilate? If you don’t want an epidural, what are you going to do to manage your pain as your contractions become more frequent, more intense, and closer together? If you don’t want an episiotomy, what are the action steps that you’re going to take to help your tissues be healthy, stretch to accommodate baby? What are you going to do to help encourage baby to turn and and rotate so that they can be born more smoothly and prevent tears? 

Going through these steps is essential when writing a birth plan that actually works for you and benefits your birth rather than a list of preferences that may or may not mean anything more to you than something that you hope will happen.

Let’s write birth plans that you can strive towards and understand on a level that helps you advocate for yourself throughout your labor and birth and helps you understand what you can do when labor starts to twist and change and when you experience labor differently than you originally thought. 

Why do birth preference lists get “thrown out the window”?

Calling it “birth preferences” gives you permission to just list out things you’d prefer without putting a plan in place for how you will achieve it or what you can do to keep your goals on track even when one thing changes here and there. 

I’m sure you’ve heard time and time again “my birth plan just got thrown out the window as soon as I got to the hospital”. But that’s not because you had a birth plan. It’s because you had birth preferences. You had a list of things that you’d like to have happen but no strategy for how you would advocate for those things or how you would achieve them so one by one like a cascade, your birth plans just tic tic tic are crossed out like they weren’t even Plan A but just a “nice idea.”

The Cascade of Interventions

if you come in without a plan, and policies or standard orders come your way, you won’t know the risk or the benefit or whether or not you actually need it and you won’t have a plan for what you’ll do instead… so you’ accept it. And then that intervention requires the next intervention and before you know it you’re deep in the cascade of interventions that you don't know how to stop from snowballing out of control until everything on your list has been crossed out. 

But remember. The cascade doesn’t hit everyone. You can and should look at each bullet point on your birth plan as an individual point. Just because you’ve accepted one intervention doesn’t mean that you have to accept all of them. Just because you got an epidural when you didn’t think you would doesn’t mean that you also have to be induced, you also have to accept every cervical exam they throw your way, and you have to push on your back. You know what I mean? Crossing out one piece of the plan and changing it to Plan B doesn’t mean that the whole plan is trash. It means that you’re flexible and you’re allowing things to change and you’re going with the flow of YOUR OWN BIRTH not the flow of someone’s work day. 

Conclusion

Create the mindset around your birth plan that YOU are in control of it. No one can provide you with the outcome you want. No want can promise or guarantee it. And no one can take it away. YOU get to make the choice about each bullet point on your list and decide when you’re standing firm and when you’ll be flexible based on the information you’ve received and what you believe to be the next best step in your most empowered birth, regardless of what was or is the plan. Remember that when things change, they can change slowly. When you bend, you can bend gently. When you have to sacrifice something, you don’t have to sacrifice everything. ESPECIALLY if you know what the options are in Plan B and you’ve learned what you can about birth so that even plan b isn’t scary and you know what you can do to still make it incredible.