Preparing for birth and reducing the risk of birth trauma

What "birth trauma" actually means

Birth experiences are deeply personal and aren't defined by clinical outcomes alone. Feeling heard, respected, having choice and being actively involved in your care is just as important as whether there are medical complications involved. Because birth can be an intense process, prioritizing clear communication and shared decision-making is a powerful way to protect your sense of safety and support throughout the journey.

Why preparation matters and what it can't do

Birth is unpredictable, so preparation isn't always about creating the perfect birth experience. It's about helping you feel more informed, flexible and able to navigate whatever unfolds. It can help to start by thinking about what a "good" birth would mean for you. A positive birth experience looks different for everyone. For some people, it's about feeling calm and supported. For others, it's about having information, pain relief or certain people present. Preparing for birth involves considering not only the practical information, but also your physical and emotional needs. Here we discuss tips and tools for birth planning: informationally, physically and emotionally.

Everyone brings their own history, experiences and concerns into pregnancy and birth, and these can shape what support feels most helpful to you. Previous births, fertility journeys, pregnancy after loss, anxiety, past experiences with healthcare or other life experiences may influence how you approach labour. If there are aspects of your history that feel important to you, it can be helpful to talk about them with your care provider during pregnancy so that your preferences and support needs are understood before labour begins.

The birth plan: A tool, not a script

A birth plan isn't a contract, but it does two useful things: it helps you learn more about the options available to you during birth, and tells your support people and healthcare team what would help you feel most supported.

A few practical notes:

• If possible, choose a provider who respects your preferences and discuss these preferences during your prenatal appointments. If you don't feel heard during pregnancy, it's unlikely you'll feel heard during labour or postpartum.
• Keep your birth plan to one page: short enough that someone can scan it quickly
• Make sure the support people who will be with you during the birth understand your preferences and priorities
• Share it with your provider at around 36 weeks; if you have a midwifery or Family-Centred Maternity Care team, this is a natural part of your care
• Bring a few printed copies to the hospital or birth centre to share with the team caring for you

Your birth plan can include what matters most to you, such as relevant details about your medical or life history, your preferences for your birthing environment (lighting, music, privacy), how you would like healthcare providers to communicate with you and your support people, preferred pain relief options, movement and labour positions, how your baby is monitored and your preferences if a caesarean becomes necessary.

NOTE: This is a general overview of birth preparation, meant as a starting point rather than a complete guide. Many people find it helpful to explore their options more deeply through a birth preparation class or with the support of a doula.

Continuous support during labour is associated with more positive birth experiences for many people. This support might come from a partner, a family member, a friend, a doula or another trusted person. Having a support person knowledgeable in birth, like a doula or experienced midwife, provides measurable medical benefits, including shorter labour, reduced use of pain medication and a lower likelihood of cesarean.

Preparing to make decisions under pressure

In labour, choices aren't always offered as calm, unhurried conversations. They can arrive fast and carry a lot of weight. Many people find that in the intensity of labour, even neutral-sounding words (such as "we would like to monitor the baby," "we need to speed this labour up") can sound like a requirement, rather than a choice.

You have the right to understand what’s happening and the rationale behind recommendations. You can always ask for more information or time to better understand and make informed decisions. Practising a few phrases now can help:

• “Please explain to me what’s happening”
• “Please explain to me the rationale behind what you’re recommending”
• "Can you give me a moment to think?"
• "What are my options right now?"
• "Is this urgent, or do we have time?"

It can also help to notice the difference between pressure and support. Pressure often feels like repeated recommendations without space to process. Support feels like clear information, options and time to ask questions so that you can actively participate in your birth through informed decision-making.

Some common interventions are often used as routine care. However, routine doesn’t always mean necessary in every situation. Understanding this ahead of time can help you ask informed questions about whether it is recommended in your specific situation:

• “Is this a routine procedure, or is this something you’re recommending specifically for me?”

When something is suggested that wasn’t part of your plan, you don’t usually need to decide immediately (unless it’s an emergency). The BRAIN framework can help structure your questions:

B - Benefits What are the benefits of this option?

R - Risks What are the possible risks for my baby or me?

A - Alternatives Is there anything else we could try instead?

I - Intuition What does my gut feeling say right now?

N - Nothing What happens if we wait?

If the situation is not urgent, there’s often time to talk through options using the BRAIN framework. This helps turn a fast-moving moment into a more informed decision, rather than one made under pressure.

If you are the non-birthing parent or birth support person: your role isn’t to make decisions, but to stay calm and help protect space for the birthing person to do so. You may notice the room speeding up or language becoming more urgent before they do. It can help to agree on a simple signal ahead of time that means “we need a moment.” In that moment, you can say: “Can we have a moment to talk this through?” That small pause can help return a sense of control right when things feel most rushed.

Preparing emotionally, not just practically

Alongside practical preparation, it can be helpful to reflect on what helps you feel grounded, safe and supported. This isn’t about controlling how birth unfolds, but about understanding what supports you internally as things change.

These reflective questions can be a starting point:

Your sense of safety and comfort

• What helps me feel calm, safe and supported?
• What in my environment might help (lighting, music, privacy)?
• What helps my body feel more comfortable (pillows, clothing, snacks, movement)?

Support people

• Who do I want with me during labour, and why?
• What role do I want them to play?

Flexibility and change

• What might help me feel grounded if things don’t go as planned?
• What kind of support would I want if decisions need to be made quickly?

Inner support

• What self-talk or coping techniques can I use to help me get through hard moments?

There are no right or wrong answers here. The goal is simply to build awareness of what helps you feel supported, so you can return to it when labour becomes intense or unpredictable. Many people benefit from working with a support person, like a doula or counsellor experienced in birth preparation, who can help them work through these questions to protect their emotional wellbeing in birth.

When fear is more than nerves

Some nervousness and fear about birth is to be expected. But a severe, persistent fear of childbirth is different.

It can be recognized and treated, and is worth raising early. You don't have to wait until you're in a crisis. Talking therapies — particularly approaches with elements of cognitive behavioural therapy (CBT), a type of talk therapy that helps you notice and shift unhelpful thought patterns — are good support for a severe fear of childbirth, and there are recognized treatment options for trauma after a birth.

A provider, midwife or perinatal mental health service can help with this. If you don't have a family doctor, you can start with our [Services Finder] to connect with perinatal supports near you.

If you haven't yet, write down two or three things that matter most to you about how the birth goes. Sharing them with your support person and your care provider is a useful next step.

This article was developed using sourced educational content from Canadian Perinatal Mental Health Trainings (CPMHT), and informed by the collective knowledge and expertise of CPMHT professionals and Karen Clarke, BA, MSW, RSW, Doula (Open Book Doula, Counselling and Consulting Services), as well as the following cited research and clinical practice guidelines: