Before I go into the question of whether having a birth plan is foolish, let's ask the question: What is a birth plan? A birth plan is a document that essentially is created by the birthing person to express their wishes for labour, birth and the hours after their baby is born. It is usually given to the labour and delivery team, so that they understand the birthing person's wishes and preferences. It might also be stuck to the door of the birthing room so that anyone entering can read it or it might be handed over to staff as they attend the labour. Often, it is discussed in advance with your midwife or obstetrician. It may be a plan that’s agreed by all parties or it might be that there are elements that aren’t mutually agreed upon, however as the birthing person has legal autonomy over what happens to their body, it is a good place to document anything that might fall outside of hospital protocol.
In this blog, before tackling the big question above, I will start with a little generalised history of midwifery and birth, which hopefully will give some understanding of why we are at the point of considering whether Birth Plans are a foolish concept. I will then discuss the research I have looked at, followed by what I believe is a gaping hole in the existing research, and finally my conclusion to the question, Is Having a Birth Plan Foolish?
Until the advent of the NHS in 1942 most babies were born at home with community midwives, family or neighbours in attendance, and knowledge was passed down the generations. Of course when there were problems there was very little that could be done unless the family could afford a doctor. Some local authorities did operate local hospitals. There was no real need to have a birth plan, because generally daughters did what they learnt from mothers/aunts/cousins/sisters/neighbours.
The 1902 Midwife act made midwifery a recognised profession with appropriate training and though the role of midwives had been around for millenia, up until this point, midwives tended to be women that had birthed their own children and supported others through birth, learning from other wise women and on the job so to speak.
By the 1950s most births took place in hospitals and while women could now obtain pain relief and many medical complications of birth could be resolved, births were becoming increasingly obstetric led. “Just in case” approaches were used which quickly started to undermine the perception that a woman's body was, in most cases, perfectly designed to give birth. Births in hospitals were not remotely optimal for natural birth, with women expected to be in bed and laying on their back so that midwives and Drs could conveniently see what was going on. In the UK, women were even shaved and would have had an enema. Wards were bright and there were strict nursing protocols. Women were expected to do what they were told without question. Birth continued to be pathologised with forceps and episiotomies used routinely because women were told there they weren't capable.
The true meaning of the title Midwife was being eroded in an ironic way. From Middle English, Mid meant With and Wif meant Women - With Women. The medicalisation of birth took midwives far from their namesake, looking more like obstetric nurses that we still see today in parts of America.
In 1959, Grantley Dick Read wrote Childbirth Without Fear, and in 1975 Frederick Leboyer published Birth Without Violence, and over time there commenced a revival in calmer, gentler birth with more consideration of mother and baby. By the 1970s, dads were encouraged to be present at the birth and started to attend antenatal classes. Indeed in 1956 the NCT was established by Prunella Briance after being inspired by Grantley Dick-Read.
Also in the 1970’s French obstetrician Michel Odent had been watching women birth and learning. He noticed that when the birthing environment replicated an environment that a woman would want to make love in, no medical intervention was necessary. The pool birthing room was so popular that women would frequently get into the pool before it was even full. In fact, many women traveled hundreds of miles to birth at his unit in Pithiviers because they wanted this kind of birth experience.
Similar pushback was happening in America with the fabulous Ina May Gaskin who alongside her husband Stephen founded The Farm, a commune where the midwives of the Farm created one of the earliest out of hospital birthing centres. Outcomes at The Farm Midwifery Center were incredible - They state that Since the seventies, The Farm Midwifery Center has delivered over 3,000 babies, with 95% of them born at home (many, in the Farm’s birth cabins), a Cesarean section rate of 1.7% and a 5% rate of hospital transfer in case of emergencies with zero maternal deaths and two infant deaths in that time. They also have had success delivering breech babies and twins vaginally. Compared with statistics from the rest of the country, their success rate is staggering.
Back at home in the UK, Penny Simkin, a physical therapist, was supporting births as a Doula and encouraging informed decision making between birthing women and caregivers. As well as Penny, Sheila Kitzinger was leading the use of them. Birth plans were accepted “as part of the scene” in the United Kingdom (UK) (Kitzinger, 1992 p.36). UK maternity care was largely midwife-led, and birth plans were incorporated as an opportunity to discuss, educate, and get to know women as individuals (Kitzinger, 1992).
Some birthing staff weren’t welcoming of birth plans, feeling that they set women up for failure. They felt that women's expectations of a certain type of birth were unrealistic.
One review of care and support of women in labour concluded that clear communication, physical comfort and emotional reassurance were essential requirements for reduced anxiety and a positive birth experience. One element alongside many other important aspects, such as freedom to be mobile during labour, concluded that where the use of a birth plan was used for shared decision making with care providers, ‘women and partners valued shared decision- making and communication with providers, contributing to a more positive birthing experience.’
Shanmugam Rajendran, S., K, D. and Ramu, B. (2024) Care and support for women during labour: A Review, Bioinformation. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11953555/ (Accessed: 09 February 2026).
As I scanned through articles, studies and findings around whether birth plans were a good thing or not, I found that there were nuances in the answer. From how the plan was completed, i.e was it a generic document issued by the hospital, that everyone filled in, or was it a document created with thought and intention that really offered the possibility of the personalised care that it should. Was it discussed in detail with care providers with fully informed shared decision making taking place so that the parents felt their wishes were taken into consideration. Or was it given a cursory glance and put to the side. Were paths discussed should the progression of labour deviate from the plan, i.e if a natural home birth was planned and a situation presented, meaning a transfer to hospital was required, were realistic paths discussed such as ‘in the event that you and your baby are at risk, and baby needs to be born quickly, even in an emergency situation, the midwife will continue to communicate in lay terms what is happening’, or ‘if baby is being born by emergency caesarian section, as baby is being born, endeavours will be made to drop the drape so that you can still see your baby be born’.
For me, a huge glaring hole in the research seems to be whether the parent has the knowledge of how to create a personalised birth plan, and this seems to me a rather important variable as to whether they would receive the generic birth plan or if they are likely to do their own investigation into what they would like and what it means. Where parents are lucky enough to have a midwife that is fully supportive of offering informed consent (and has the time to discuss it and then implement it), or where parents might employ a birth Doula to inform them of their choices and go on to advocate for them at the birth, or where they have invested in birth preparation classes or a programme that discusses the importance of gaining knowledge, questioning and holding their own boundaries, it seems to me that these scenarios offer a huge advantage to the parents and would likely lead to them feeling heard and respected in the birth choices and as a consequence feel more positive about their birth experience.
Today our midwifery system is more stretched than ever. Vocal and well respected midwives such as Leah Hazard are campaigning hard on behalf of midwives to be treated with dignity and respect in their role and the hours of work that they are expected to carry out. Midwives are telling stories of multiple back to back shifts without a break, no time for toilet breaks, and coercion by management to comply and keep going under threat of their jobs. The inability of the NHS to retain existing midwives because of the continued under-funding for recruitment of midwives, presents a self perpetuating situation that is spiralling at what feels like an exponential rate. The less midwives there are, the more stretched the existing ones are, the more midwives leave and so forth.
Why do I mention this? Because if a midwife doesn’t have time to pee, how on earth are they meant to have the time to go through and support the wishes of parents in their birth plan. I have no doubt that that is the level of service they wish to provide, but the system needs mothers in and out as quickly as possible, because there aren’t enough midwives. With caesarian section rates in parts of the country reaching in excess of 45%, in all honesty women and birthing people have to advocate for themselves in the most radical way. Otherwise the service they receive from the moment they walk into hospital is a service that primarily serves the needs of the hospital.
It is, to my mind, with maternity services as stretched as they are, essential that parents advocate for themselves, even when they are told ‘no’, because they are legally entitled to personalise respectful care. Starting with a clear idea of what you do and don't want, forms the foundation to build the confidence that you must carry into your birthing space.
And so, in response to my question, Is Having a Birth Plan Foolish? My opinion is categorically ‘NO’. Now more than ever, in my opinion, you would be naive not to have at least a basic birth plan in place.
In conclusion, if we accept that obstetric intervention of birth has a causal impact on the emotional outcome of women and families as can be seen repeatedly from public input into the 2024 cross party Birth Trauma Enquiry report spearheaded by Theo Clarke. Additionally, if we understand that the bleeding out of essential, confident, physiological midwifery knowledge, because of the turnover of midwives (You can’t plug the outward flow of generations of experience and knowledge with new, inexperienced midwives who are learning in an obstetric led environment where completely hands off birth is a rarity), which means that there is an undermining of the power of women's ability to birth. Essentially women need to know the law and their legal rights, and they need to confidently hold their boundaries in what could be an exhausting way if not well managed.
I get it, the system is moving with what it has available, and that is because of lack of investment directly into retaining existing midwives, stripped back services are pushing midwives to breaking point, and this is not what they went into midwifery for.
And so, if a midwife is pushing for an intervention because birth isn’t progressing quickly enough for the hospital timeline, and the mother says ‘no’, she absolutely has to stand firm so that the midwife is able to say, I asked mother 3 times for consent to induce, mother is saying, that the repeated questioning for consent is coercive and so we must support her decision or we risk finding ourselves in a highly litigious situation. The foundations of those birth intentions must lay with the birth plan/preferences, and I highly recommend that the birth partner also takes notes of events as birth progresses. The birth plan becomes the document that can be used to signpost birthworkers to time and again. ‘You will see from my birth plan that I do not consent to internal examinations’, ‘you are telling me that baby’s heart rate is healthy and I am doing well and so again, I refer you to my birth plan and I do not consent to an internal examination’, ‘you have again asked to perform an internal examination without giving me an evidence based reason why it is necessary. I again refer you to my birth plan and if you or your colleagues ask me again, I shall consider it as coercive in nature’.
Sadly we are living in an era where we must fight for the rights of our bodies, and in doing so we must force midwives to respect our boundaries even when they are being told by management that they must intervene to speed things up. Getting the balance right is hard because the enemy isn’t the birthing person or the midwife, and so a strategy is needed to support both. We might call it an underground rebellion. But ultimately, you are only responsible for you and your baby, and as such you must follow your instincts, use your ability to question, look into the research that is available, read books that drip feed into your subconscious how capable your body is, hold your boundaries and understand that maternity services are not there for your best interest, rather to get in and out quickly.
If you think that you and your birth partner might not know where to start with advocating for yourself, and if you have the resources, you could look at recruiting a really good independent midwife. As the experienced midwives leave the NHS, lots are choosing to come home to what they know and believe, by handing birth back to the birthing person. You could also recruit a Doula. Whilst they cannot act as a midwife, they can support you in understanding, planning and even advocating for you in birth. They will provide emotional and practical support during birth too. Or you can do a birth prep course like my Mama Bear Birth Prep, which really opens your eyes to what you need to know, coaches you in holding your boundaries, communicating what you want, knowing your legal rights, understanding coercion and consent, asking questions, knowing what to do when things aren’t going to plan and so much more. If this sounds like something you are interested in, book a free 20min consultation here so that we can discuss whether my offerings are the right fit for you.