Your birth plan and compassionate care

This is Penny Simkin.

In 1980 she and her colleague Carla Reinke wrote a pamphlet called ‘Planning Your Baby’s Birth’. This was perhaps the first formal document explaining what a birth plan is, and how it might improve your experience. Penny describes the intent of the birth plan as a way for parents to become informed, to develop polite and friendly ways to express their preferences and to be flexible enough to accommodate both straightforward and more complicated labours. Being written, it could be shared with the midwife and kept in the notes for other medics to read should they become involved in a woman's care.

As early as 1982, in the same journal, the concept of the birth plan was being challenged. Medics were concerned that parents might become inflexible or defensive if the course of the birth deviated from that laid out in the plan. Some felt their expertise and experience was under threat from self-taught lay-people, who did not understand the complexities of birth. However, the word was out, and more and more women wanted to define their choices and preferences in a birth plan. Before long, obstetric institutions had caught on too, and began to develop their own proforma birth plans (particularly in the US, where birth is a profit-centre). These were formatted to exhibit the choices which were available (and, of course, to exclude those which weren’t…)