How to Advocate for Your Choices and Communicate Your Preferences to Your Provider with the Support of Your Doula
Pregnancy, labor, and delivery make up some of the most impactful and vulnerable moments of a birthing person’s life. While for many, labor and birth bring joy and celebration, the experience can also include feelings of lack of autonomy and control over the decisions being made in the delivery process.
The National Institutes of Health reports that up to 45% of birthing people experience birth trauma, or emotional or physical distress, during or after delivery. Rates of birth trauma are higher among birthing people of color and birthing people with lower socioeconomic status (SES). Birthing people of color and lower socioeconomic status birthing people report higher rates of mistreatment by hospital staff and lower hospital quality of care.
Contributors to birth trauma include, but are not limited to, not having the birth experience or support from a care team you chose or hoped for, not having your bodily autonomy respected during labor and birth, experiencing complications (mild or severe) during labor and delivery, suffering a birth injury, or experiencing an emergency C-section or other intervention.
Every birthing person should have every effort made toward actualizing their autonomy in their care before, during and after the perinatal period. Utilizing a solid communication tool and sharing it with a supportive care team who can help advocate for you, including your doula, is a step toward ensuring that your desires are heard and your autonomy is respected. Many in the birth world call this a birth plan. We know labor and birth often do not go to plan, so we like to think of this as birth preferences.
Birth preferences explained
Developing a narrative of your birth preferences can be as simple as an outline of what you would like to happen during labor and delivery – from who is in the room with you and position of labor, to medical interventions and post-birth care and more. The concept of birth plans was born in the late 20th century as a response to the overmedicalization of birth and underappreciation of decision autonomy for birthing people.
Exploring your preferences when it comes to labor and birth can not only help you reflect on what your preferences are, but also communicate with your care team and plan for any unexpected decision points that may occur during labor and delivery. The purpose of outlining your birth preferences is to help you feel in control, confident, respected, and in safe hands during the course of your care.
What can you include in your birth preferences?
Your birth preferences can include several sections that outline your health history, as well as your preferences for each stage of labor and delivery. Here are some considerations to make as you reflect on your outline.
We recommend that the first section of your birth preferences include information about you: your name, preferred pronouns, the name of your provider, your planned place of delivery, and information about who will be in the room with you during your birth. You can also include information about your doula, as well as how many times you have previously given birth, how many older children you have, and which language you prefer to converse and receive information in.
During labor
Next, reflect on your environmental preferences. Would you prefer dim or bright lighting? Would you like to wear your own clothing during birth? Would you like the option to eat and drink during labor? Would you like music and/or aromatherapy during your labor and birth? Would you like your support team with you during the whole process?
As you continue planning, consider your preferences for labor. Would you prefer to allow your labor to begin on its own? As you labor, would you like to use a birth ball or receive a perineal massage upon crowning? Would you like to push in positions of your choosing? How much interruption during labor from medical staff are you comfortable with? How would you like staff to interact with you or introduce themselves when they enter the room? Do you prefer to minimize interactions whenever possible?
Medical interventions
Exploring medical interventions can be a great opportunity to learn from your doula and your provider about what interventions may come up during labor.
If applicable, consider your preferences for labor induction or augmentation. There are several methods of labor induction and augmentation that healthcare providers may offer: mechanical options, such as a foley balloon or catheter; pharmacological options, such as misoprostol, cytotec or pitocin; amniotomy, or the artificial rupture of membranes; or a membrane sweep.
Additionally, reflect on your preferences for pain management. You may have the option to utilize an epidural or intravenous narcotics to manage pain during labor and birth. Consider if you are comfortable with pharmacological interventions like these. Other options include massage and counter-pressure, hydrotherapy in a bath or shower, nitrous oxide (if available), sterile water blocks (if available), access to a birthing tub (if available), or the opportunity for free movement during labor.
Your birth preferences can also include your preferences for other types of medical interventions. Assuming you and your baby are okay, throughout your labor, would you like to receive continuous IV fluids and/or electronic fetal monitoring (continuously or intermittently). Are you comfortable with routine vaginal exams and how would you like to express consent for them? Do you prefer to follow your body’s urge to push as compared to directed pushing from a healthcare professional, during delivery? If offered, what are your preferences for the use of medical devices like forceps or a vacuum-assisted delivery, as well as interventions like an episiotomy or a Cesarean section?
Newborn care
Your birth preferences should also include several preferences for what happens after you deliver your baby. Consider who you would like to cut your baby’s umbilical cord. Following birth, would you like immediate skin-to-skin contact with your baby, as well as delayed bathing and/or placental cord clamping? What are your preferences for infant feeding (bottle, formula, breast/chest milk)? Would you prefer exclusive breastfeeding, or would you prefer your baby to be supplemented with formula or glucose water if their blood sugar shows low? Following birth, would you prefer private bonding time with your baby, and would you prefer your baby rooms in with you (sleeps in a bassinet in the same room when you sleep)?
Following birth, there are also several medical interventions a healthcare professional may offer for your baby, such as a hepatitis B vaccine, eye ointment, a vitamin K shot, and circumcision (for babies born with male sex genitalia). Reflect on what types of interventions you prefer for your baby.
Planning for the unknown
Ideally, your labor and delivery will be smooth and complication-free. The presence of well-thought-out birth preferences and a supportive care team can be a tool to help that happen. However, it is always important to consider what happens in the event of a change in plans. How might your labor preferences change if an unexpected complication happens or an unplanned intervention – such as a C-section – becomes necessary? Will your partner or doula be allowed into the operating room with you? Reflect on what alternatives might look like, and discuss with your birth support team what your expectations are in case decisions need to be made quickly.
If there is anything else that is important to you, or anything else you would like your care team to know, include it in your preferences. It is important that your birth preferences reflect your preferences and the autonomy you have in decision making for your labor and delivery experience. Know that you can change your birth preferences as you labor if your body signals to you that something is not feeling as expected. Birth preferences can change and autonomy in those changes can be exercised, provided both you and your baby are not at medical risk.
How to advocate for your personal birth preferences
Remember that outlining your birth preferences is not just a document. It is a guide to how you want and define safe and respectful care during one of the most important and vulnerable points in your life. Advocating for yourself and what you need protects your autonomy, your choice to forego unwanted medical procedures and interventions, and even your right to change your intended preferences as you journey through your labor.
The right support team can help you advocate for yourself before, during, and after labor and delivery. Finding a care team – whether in a hospital, freestanding birth center, or other location – who values and respects you, validates your worries and pain, answers your questions, and honors your past experiences (and potentially, previous birth trauma), is an important step in building this team. Family and friends, if you choose, can also make up an important part of this support system for you.
For many birthing people, working with a doula can positively impact birth experiences and advocacy surrounding one’s birth decisions. Doula support during the perinatal period is associated with a reduction in anxiety and stress, as well as a reduction in the use of medical interventions like C-sections in low-risk births.
As you progress through your pregnancy, doulas can help you answer any questions you have, guide you through your decision making as you develop your birth plan and during labor, as well as advocate directly for your intended birth preferences with your care team. The literature also shows that doulas are well-equipped to manage changes in clinical circumstances and birthing person preferences during labor and delivery.
Talk to your healthcare providers, your family and friend support systems, and your doula about your birth preferences. If you need more information to make a decision regarding understanding and outlining your birth preferences, reach out to your provider or doula. If designing a plan feels overwhelming, or if you have questions about what certain parts of your plan mean, your support team can help you design preferences that feel right for you. If your birth preferences need to change for your health or your baby’s, your team can stand with you as you navigate any unexpected circumstances while keeping in mind the intentions and preferences you have when bringing your child into the world.