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Embarking on the journey of pregnancy after loss is one in which requires courage, love, and self-reflection. As a doula that supports these (and many other types of births), I often get the question both from fellow birth professionals and families, “what needs to be different in preparing for a rainbow birth?” One of my greatest recommendations is to create birth preferences, whether it simply be a discussion or, even better, written down on paper. *As a note, this is not a “birth plan” but rather a tool for communicating needs, choices, and sharing parts of your story (we know all too well that things rarely go as “planned”).

None of the work of building a birth preferences can be done without first reflecting on previous birthing experiences. No matter the gestational age of your baby when loss occurred, there are many parallels to the “normal” so many of us wish for. It’s often some family’s first encounter with the medical community, their first opportunity to make big choices about parenting, their first time loving someone in a deep and unconditional way, and their first time witnessing labor/birth in any capacity. It is only after sitting with the perceived good and bad parts of this experience that a mother and her support system can move through the trauma and decipher what parts they want to carry or avoid in their rainbow pregnancy, labor, birth, and postpartum.

These specific parts of past experiences are often so different from woman to woman and family to family. Having the same hospital room or the same care provider may feel incredibly comforting for some, while for others it may be a trigger that can deeply impact the rainbow experience (and these thoughts often vary, even between members of the same couple). It’s important to consider these pieces because we know that emotion affects how women labor, and negative emotion can prevent progress which can in turn lead to potentially unnecessary interventions. Conversations surrounding birth preferences helps to “air out” these individualities and therefore lead to a more empowered experience for the entire family.

The creation of birth preferences also opens up a dialogue with one another and with staff. It can be difficult to decide how much or how little discussion of previous loss experiences get shared along the rainbow journey. How does it feel to bring pictures or mementos of your baby gone too soon? Do we want hospital or midwifery staff to see them/comment on them? What will they think? In my professional experience, staff (in particular nurses) want to know how to best support their patients. They want to know the parts of the story that will help you feel cared for and special, mostly because that’s important to getting quality care. It’s the labor team having a discussion ahead of time that helps smooth out some of this uncertainty and awkwardness of communication.

And finally, birth preferences offer a way to make choices and to feel different about the labor/birth/immediate postpartum experience. We know that there is truly little we are in control of along this path; however, there are some places that education of choice can lead to feeling more empowered and positive. At worst, it can at least help to reduce the “if we had only known” moments after the experience is over. As so many of us know, it’s those “would-ifs” that can become unbearable over time.  It’s important to know there is room for preference no matter the birthing experience; un-medicated, medicated, planned surgical, unplanned surgical, home, hospital, NICU stay, etc.

Overall, discussion and communication of birth preferences has the potential to smooth some of the wrinkles in pregnancy after loss. It won’t ever change the bricks that need to be laid, but it will hopefully let you create a path with a few less bumps.


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