• Joanna Brown

Midwife's Musing's - Birth Preferences




What are birth preferences and why do I need them?

Well this, if I might say, is a brilliant question! Have you ever heard of a birth plan?


A birth preferences list is exactly the same thing, just a slightly different name, and I'll explain why.

A birth plan and a birth preferences list is a document or a note women and their families have written, with their preferences and detailing what their wishes are surrounding different aspects of labour and birth. This will look different for everyone and there is no right or wrong answer. It could provide information about your thoughts regarding how you would like to feed your baby, your feelings surrounding pain relief during labour, and the list goes on. There's no hard and fast rule and so it can include anything that is particularly important for each individual woman and her family.

The key difference between a birth plan and a birth preference list is slight, but in my experience, hugely significant. The information on them can be exactly the same, but the significance is in how they are viewed and interpreted by the woman and her family. When we talk about birth plans they can seem fixed and set in place. Unfortunately with labour and birth, as much as I'd love to say this is the case, this isn't always true. Labour and birth can be completely unexpected. Things can happen that we don't plan. Baby's heart rates can suddenly drop, medical complications can occur, labour can progress faster or slower than we were expecting. We can also think through all the options, but then in the heat in the moment, find that what we thought would be helpful, is actually not helpful at all.

The key difference is then that when women and families put together a birth preferences list, they have taken time to think through all the options, and decide, in an ideal world, what they would prefer, but also recognise that this may change in the moment. It is less fixed and more fluid. This mind shift might sound slight, but I promise it's massive! Disappointment and feelings of failure (check out Midwife's Musings - I see you Mama, you did not fail!) in relation to birth can affect families and whilst there are many complex reasons for this, I've found that when women go into labour informed, but also recognising and prepared that there may be changes in their choices and experience, that these families are less likely to experience these feelings, or they experience them to a lesser extent.

Why is this important?

As a midwife, I absolutely love when my patients have been able to take some time to research into different options of the care that is available to them and then take time to think through, in an ideal situation, what they would their preferences would be. This way, I know that my patients have been empowered to make a decision which is right for them and their families and I can easily know what their wishes are and how I can best support them. Birth can be somewhat fast paced, and can require decisions to be made quickly and sometimes unexpectedly. If this is the case, if a woman and her family has taken time to think through what their feelings are about certain scenarios, then that is hugely helpful and means that they aren't having to make decisions about their care in the heat and rush of the moment without any previous thought.

When you're giving birth in a country that is not your passport country, there are also likely to be different options available for labour and birth. Taking the time to research what your options are and deciding what your preferences will be, will mean that you are able informed and helps to prepare you and your family for what to expect. It also gives you the opportunity to see whether what you would expect from yours or your friends or family member's experiences in you passport country, is also possible and available in your host country. My experience is that whilst some things I would expect as routine in my passport country, won't necessarily be so here in Uganda, but I was to ask in advance, there are usually ways (they might be slightly different to what you expect) to be able to facilitate most things. This could involve practises around delayed cord clamping, vitamin K injections for the baby, Group B Strep testing, and the list goes on. It isn't unusual, and is totally understandable, when certain tests or interventions are particularly important to a family, so it is definitely worth while to look into these, and find out if and how this can be facilitated ahead of time. What resources can I use to inform my preferences?

Your maternity care provider should be without a doubt your biggest resource in this area. Please do feel free to ask questions. Not only will they be able to provide you answers, but they will also

How do I write a birth preference list?

I'm glad you asked! Whilst there are so many different ways to do this, I've actually created one especially for you, which you can download for free from the Resources page. Take a look and use it to highlight the options that you think would be best for you and your family. Writing a birth preference list is often much simpler than it sounds. Have a sit down with your birth partner, chat together about the different options, what is important to you and why. That way, they can feel more a part of the process and also know how best to support you when your time comes.

It is also really important to talk to your maternity care provider about your birth preferences list as they can help discuss how they may be able to facilitate your wishes, particularly if it involves things that wouldn't necessarily be routine in your host country. In different countries and cultures these lists will likely be viewed differently. In the UK for example, it is normal for midwives to ask women if they have written one during their 36 week appointment. It is usually one of the first things that we will ask about or look for in a woman's notes when they arrive in labour. I am aware though this may not be seen in the same way in different cultures, for many different reasons. If this is the case, I still think it is important to write one, for all the reasons above, but you can keep this for your self, or your birth partner can keep it as a reminder of your wishes to help them advocate for you.

So why not check out the free pdf Birth preferences list, on the Resources page, that I've put together especially for you - I promise you won't regret it!

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