What are mothers seeking to achieve when they write their birth plan?

The birth plan has become commonly accepted as the format by which mothers can communicate and exert their choices about, and therefore control over, their birth experience. However, it is evident from academic research and anecdotal evidence that birth plans are inconsistent in facilitating positive births. They are critiqued as setting unrealistic expectations for mothers and being the locus for tension and conflict. Building on existing research into the benefits of relational maternity care and based on analysis of feminist literature of the body, this qualitative study seeks to identify what women intend to achieve when – despite these common tensions - they write their birth plan.

Five themes emerged from semi-structured interviews with four multiparous women, and analysis of their birth plans, and three experienced midwives. These were, (1) the birth plan does not communicate the breadth and complexity of maternal antenatal planning; (2) the birth plan is intended as a message to midwives; (3) mothers apply learning from their childbirth career; (4) mothers value certainty more highly than uninhibited choice; (5) mothers intend to avoid bureaucratic care. In this study I propose that maternal birth planning is heavily influenced by neo-liberal logic of choice and personal responsibility. I propose that the provision of compassionate, individualised care that mothers seek is inhibited by institutional pathologisation of birth, which arises from a medico-scientific basis in dualism, and I ground this within Irigaray’s imaginaries of sexual difference.

Findings indicate that a shift in focus from ‘choice’ and ‘control’ to ‘connection’ and ‘certainty’ may improve the reputation of women’s planning for labour and birth, the relationship dynamic between mothers and care providers, and in turn individual childbirth experiences.