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…)


In her 2007 article for the journal Birth Penny Simkin laments that the value of the birth plan remains a topic for debate. As she puts it, the central question is “should women have the right to directly express their concerns and preferences and have them heeded by clinical care givers?”. And here, in 2021, 14 years later, I hear her. Last week, during International Day of the Midwife, a highly distasteful meme circulated lampooning women who present midwives with birth plans. A pregnant client of mine was recently told, on stating that she may wish to decline a common post-birth assessment, that 'we do do this, yes, and you won't even noticed after you've had your baby'. A thread in our FB group, The Good Birth Group, demonstrated quite how common careless and insensitive reactions to birth plans really are. Do we really believe it's acceptable to question whether women should have an opinion? To clearly state what is important to them? To want to be seen as unique individuals and offered genuine and appropriate care when they are at their most vulnerable?


As a doula I too frequently hear of women who felt utterly de-humanised during their labours and births, and it is this horror which the birth plan should excise from maternity services. The point of the birth plan is not to determine what will or will not happen during this notoriously reflexive and unpredictable process. It's to make connection. To be have your fears and aspirations heard, recognised and acted on, whether your birth is following the path you had hoped or not. The women and families I know who invest time and effort into writing their birth plans don't expect to cheat the practical realities of physiology and the institution of the NHS. Simply: they want compassionate care.




For more Penny Simkin visit Pennysimkin.com. I think her reflections on pain and suffering in birth are particularly thought-provoking.


Hypnobirthing classes with Charlie and Laura resume in July 2021. Book your place now by emailing charlie@thegoodbirthpractice.co.uk. To find our more about birth and post-natal doula support from Charlie, Laura and Ruth, email charlie@thegoodbirthpractice.co.uk

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