When Your Birth Plan Changes: Why Continuity Matters

2 days ago

6 min read

When we talk about birth planning, of course we're going to talk about the birth you want.

I want to know your wishes, what's important to you, what you're hoping for and how you picture your birth. You might be planning a home birth or water birth. You might want to give birth on a midwifery-led unit, or you may already know that labour ward is the right place for you and your baby.

Wherever you're planning to give birth, we'll plan positively for the birth you want.

But good birth planning isn't only about talking about the birth we hope will happen.

For me, good communication throughout the antenatal period is one of the most important parts of the care I provide.

Because the reality is that we can't predict exactly how any labour is going to unfold.

You can have a straightforward pregnancy, be considered low risk and have a really clear idea of how you'd like to give birth, and circumstances can still change.

We don't know exactly how your body is going to respond to labour. We don't know how your baby is going to respond to contractions. We don't know how labour is going to progress until you're actually in it.

And that applies whether it's your first baby or your fourth.

Having had a straightforward vaginal birth before doesn't guarantee that the next birth will unfold in the same way.

That's not me being negative about birth.

It's about being honest, prepared and realistic while still planning positively for the birth you want.

Good birth planning includes the ‘what ifs’

During your pregnancy, we'll talk about your preferences, but we'll also talk about some of the different directions birth can take.

That will look different for every woman.

If you're planning a home birth, we might talk about the reasons I could recommend transferring into hospital and what that would look like.

If you're planning to give birth on a midwifery-led unit, we can talk about circumstances that might mean moving to labour ward.

If you're already planning a labour ward birth, your plans can still change. Labour may progress differently from how we'd expected, an intervention you hadn't planned for might be recommended, or there may be concerns about how you or your baby are coping with labour.

And sometimes a caesarean birth becomes part of the conversation, even though it wasn't part of the birth you'd imagined.

Talking about these possibilities during pregnancy isn't about expecting something to go wrong. It's about making sure we've had open and honest conversations about birth before you're actually in labour.

We can talk about what different situations might look like, why recommendations might be made and what choices you may have if circumstances change.

You don't need to remember every detail of every conversation we have. That's not the point. I'll still be there to explain what's happening, answer your questions and talk things through with you at the time.

But it means that if your birth does take a different direction, we're not necessarily having that conversation for the very first time while you're in labour.

Being prepared for something doesn't mean we're expecting it to happen.

For me, it's simply part of good antenatal care and positive birth planning.

If your birth plan changes, you still have choices

Sometimes things change quite quickly during pregnancy or labour.

There may be new information about you or your baby. Someone may recommend an intervention you hadn't planned for. You might need to move from one place of birth to another. A caesarean birth might suddenly become part of the conversation.

When that happens, my role isn't to make the decision for you.

My role is to help you understand what's happening.

Why is something being recommended?

What has changed?

What are the benefits and risks?

What are the alternatives?

Do we need to make a decision now, or is there time to think and talk?

And how do you feel about what's being suggested?

There will be situations where something needs to happen quickly, particularly in an emergency. There will also be situations where there is more time to ask questions, consider the information and make a decision.

Sometimes, once we have all the information in front of us, the plan we made during pregnancy genuinely does need to change.

That doesn't mean you've failed and it definitely doesn't mean that all of your other choices suddenly disappear.

Independent midwife providing antenatal care in Essex

A change of plan doesn't mean starting again

This is where I think continuity can make such a difference.

If we've spent some of your pregnancy together, by the time you go into labour I know you.

I know the birth you've been hoping for. I know what's important to you. I know the conversations we've had, the things you're worried about and the things that help you feel safe and you know me too.

That matters whether we're at home, on a birth centre or on labour ward.

If you're planning a home birth and we need to transfer into hospital, I can continue supporting you alongside the NHS team.

If you're already in hospital and your care needs to move from a midwifery-led setting to labour ward, I'm still there.

And if you're already on labour ward and the plan changes again, perhaps because an assisted birth or caesarean birth is now being discussed, we haven't suddenly lost everything we've talked about throughout your pregnancy.

The circumstances may have changed but our relationship hasn't.

One change doesn't mean everything has to change

Sometimes one part of the plan has to change, but that doesn't necessarily mean everything that's important to you has to change with it.

Perhaps you want your partner closely involved.

Maybe it's really important that things are explained to you before they're done.

You may have preferences around examinations, pain relief, movement, the environment, skin-to-skin, delayed cord clamping or feeding.

What's possible will always depend on what's happening at the time, particularly if something becomes urgent.

But if one part of your birth plan changes, we can still ask:

What still matters to you, and what can we still do?

That might look very different depending on the circumstances.

The important thing is that you're still a person with preferences and choices, not simply a clinical situation that needs managing.

Sometimes you just need somebody who knows you

When plans change during labour, there can suddenly be a lot going on.

There may be different people coming into the room. You might be asked questions or given new information while you're contracting, tired, in pain or worried about your baby.

That's a difficult time to suddenly have to explain who you are, what you've planned and why something matters to you.

Because we've already had those conversations during pregnancy, I know the backstory.

I'm not there to talk over you or make decisions on your behalf.

Sometimes my role might be helping you make sense of what you've just been told.

Sometimes it might be asking for something to be explained again.

Sometimes it's reminding you of a conversation we've already had.

Sometimes it's helping you work out what questions you want to ask.

And sometimes it's simply being the familiar person in the room when everything else suddenly feels unfamiliar.

A positive birth doesn't have to mean everything went to plan

I think we can sometimes get caught up in the idea that a positive birth has to look a certain way.

It doesn't.

A home birth can be positive.

A birth centre birth can be positive.

A labour ward birth can be positive.

An induction can be positive.

An assisted birth can be positive.

A caesarean birth can be positive.

That being said not every difficult experience should be reframed as positive, and it certainly doesn't mean somebody should be told, “At least you and the baby are okay.”

How you felt during your birth matters.

A birth can take a completely different direction from the one you originally planned and you can still come away feeling that you were listened to, involved in decisions and treated with respect.

We can't control every part of birth but what we can do is communicate well, prepare properly and keep you involved in your care if circumstances change.

This is why the antenatal relationship matters so much to me

Continuity of care isn't only about having the same midwife there on the day you give birth.

For me, a huge part of it is everything we've done before labour even begins.

It's the conversations we've had.

It's knowing what you want.

It's talking honestly about the different directions birth can take.

It's making sure you understand your choices.

And it's building enough of a relationship that if I ever do have to say to you, “Things have changed and I think we need to talk about a different plan,” you know where that's coming from.

No midwife can guarantee how your birth will unfold, wherever you're planning to give birth.

What I can do is plan positively with you for the birth you want, prepare you honestly for the things we hope we won't need, and continue to support you if the plan changes.

For me, that's part of what being with woman really means.

Not just being there when everything goes exactly as we'd hoped.

Being there when it doesn't, too.