The Birth Map: Boldly Going Where No Birth Plan Has Gone Before - a review

Complete list of book reviews on the AIMS website

AIMS Journal, 2021, Vol 33, No 4

To read or download this Journal in a magazine format on ISSUU, please click here.

By Catherine Bell Published by Bella Birth ISBN: 9781714387175 151 pages Publisher’s recommended price £18.07 Find this book on Amazon

Reviewed for AIMS by Charlotte Tonkin Edun

Since Penny Simkin and Carla Reinke wrote ‘Planning Your Baby’s Birth’ in 1980, birth plans have formed a definite field of battle in the ‘Birth Wars’. As early as 1982 medics were raising concerns in academic journals, expressing disquiet about the potential birth plans introduced for parental inflexibility, defensiveness and unrealistic expectations (for which read: concerns that birth plans would subvert their authoritative knowledge and paternalistic control). 42 years on, despite Better Births and Give Birth Like a Feminist, there are still those who criticise birth plans as being the preserve of the ‘candles and sandals’ brigade, a triumph of naïve hope over reality. The phrase ‘it all goes out of the window’ is a familiar refrain for pregnant women, subjected to the horror stories of their traumatised peers, and in truth it is evident that writing a birth plan is no guarantee of a positive birth experience.

It is in this context that Catherine Bell – Australia-based ‘birth cartographer’ – brings forth her new book The Birth Map. Boldly going where no birth plan has gone before. It is indeed a bold claim, as the literature on birth plans is not lacking – Google returns 18,400,000 results for ‘UK birth plan template’. However, Catherine Bell does succeed in offering both a refreshing perspective and a functional framework for ‘first-timers’ (or at least ‘first-time-birth-planners’).

Bell sets aside the standard chronological birth plan format, which works in a direct line from latent phase to the Golden Hour. Her Birth Map encourages parents-to-be to conceptualise their birth planning as a sort of spider-diagram, a logical and accessible way to think about options, alternatives and preferences. A benefit of this is that both ‘expected’ and ‘contingency’ outcomes are considered and catalogued in an equally integral, non-hierarchical way, which invites the reader to suspend their judgement about – and therefore their emotional attachment to – what is the ‘best’ way to have their baby. I anticipate this might be more useful in real life than a standard, linear birth plan.

The book is a practical and sensible guide to informed and personalised birth preparation. Although there is an evident preference towards an approach that highly values a straightforward and undisturbed birth, the focus remains consistently on knowledge acquisition and clear communication with care providers, rather than outcomes. Bell maintains a firm but gentle insistence that while birth ‘might not be predictable, it is preparable.’ (p43). Whatever path a birth takes, the ‘informed decisions’ developed during birth mapping can be applied, and Bell emphasises the grounded and rational nature of these, over the more vague and dismissible ‘wishes’ or ‘preferences’ (p44). In this, her clarification of the constituent parts of informed decision making (p27) is helpful, as are her realistic reflections on the implications of intervention (p29) and her insistence that all birth options are valid, so long as the mother feels ‘safe, comfortable and supported’ (p45). ‘Each point…[in your birth map]…is an Informed Decision’, she says. ‘You don’t need to expand it with justification.’ Helpfully, Bell constantly contextualises the Birth Map, with references to further reading and alternative resources (although how helpful these are to a UK audience relying on free-at-the-point-of use NHS care is questionable). She further exhorts her readers to consider their options as whole humans, reflecting on their attitudes prior to pregnancy and thinking ahead to parenthood. Nearly a third of the book covers ‘Beyond Birth’, a vital reminder that the hard work doesn’t stop here.

However, while The Birth Map talks practical sense, I felt that it lacks some embodied reality. For example, when recommending appropriate clothing (p56), Bell describes how women may ‘feel hot’ during labour… in my experience, what most labouring women experience is a searing internal furnace. More substantively, as with most birth plans, Bell’s focus is arguably on the overt and obvious: those decisions that can be navigated rationally and calmly, and the complex, the emotional and the nuanced are neglected. Despite references to ‘detours and alternative routes…unexpected obstacle(s)’ there’s nothing here about how the process of birth itself, the roller-coaster of hormones, emotions and physical exertion, can effect decisions, nor yet the more shaded subtexts and subtle influences, such as heavy traffic en route to the birth place, the looming clock on the wall marking ‘progress’, or the act of coercion with kindness.

The challenge all birth plan formats face is how to prepare women to navigate issues that are not in their control. Those who know birth recognise that outcomes are influenced by the philosophy of care on the day^[1]. A truly bold approach to birth planning might include information on the responsibility of clinicians and care providers to keep labouring women safe, secure and truly cared for. Of course, this is unrealistic in a system staffed by traumatised midwives and closely managed medics, and I don’t hold Catherine Bell to account for this. However, as a birth worker I confess I did not feel The Birth Map boldly resolved the dilemma that consumes so many of us: how do we encourage women to demand what ought to be available to them while also bracing them for the reality?

All that said, The Birth Map is a constructive and pragmatic addition to the birth preparation canon and provides much food for thought. For anyone interested in the possibilities and politics of effective birth preparation, this text would make for an interesting and enjoyable read.

Reviewer Bio: Charlotte Tonkin Edun is a birth doula & hypnobirthing practitioner in Kent. She is writing an MA exploring women's experiences of birth plans at the Centre for Women's in Studies at the University of York.