Obstetric Lie #94: We Care About Your Birth Plan

Ahhh, the birth plan.

I admit, I teach about how to make one. I talk about them. I encourage them. I actually think the birth plan is an important tool. BUT- let me tell you why.

A birth plan IS:

-A way for you to figure out what you really want, what is most important to you and to organize your thoughts.

-It can help you visualize your "ideal" birth and then find out if your care provider/birth place is on board with your desires.

-It can help you communicate in an organized way your desires and needs without forgetting something during your visit.

-A birth plan can help you and your partner talk about things, realize where you agree and differ and really discover the many many choices that pop up once you have conceived a child.

A birth plan is NOT:

- A guarantee that your provider will do anything that you have in it. (Yes, this is true even if they nod and smile, even if they give it lip service and even if they sign it.)

-It is not a non-combative, "I'm afraid of you and your white coat and I don't really want to question your authority" way to communicate with your care provider and magically get all your deepest desires fulfilled.

-It is not a force field surrounding you from typical, routine, and stupid hospital interventions.

-It it is also not a way to somehow control the birth experience.

Here are a few things to keep in mind as you make and execute a birth plan.

~If you are scared to death of your birth place because of X number of factors (call rotation, c-section rate, epidural rate, pitocin rate, etc), then please be honest with yourself about this. It is hard but you need to realize that your birth plan will not protect you from typical procedures. This is especially true with ROUTINE things that are done to EVERYBODY.

For example, I lived near a hospital in Texas with the highest c-section rate in the state. They also had everybody deliver on their back, everybody got an IV and all babies were separated from their mothers at exactly one hour post-partum.

You could write a beautiful, researched, glowing pink birth plan on real lace and scent it with your mothers perfume. It would be unique and sincere and eloquent. It would not however change their routine procedures and it would probably not spare you from an unnecessary cesarean surgery. The only thing that could do that would be running like hell away from that hospital. (By the way, always nice to tell them why you are leaving because in obstetrics, money talks. If enough people take their money elsewhere, then things will change.)

~Just because your care provider "agrees" to your birth plan, does not mean he will be agreeable when you are actually having your baby.

I really don't like to scare pregnant women because there is so much fear out there already. A birth class should empower a woman to be fearless about birth. This is really hard to balance though when it comes to the realities of modern obstetrics.

The truth is that many care providers have no problem with natural birth.....IN THEORY. It is fine if it works out- but most of them almost never see it work out. Their training is often in the problems and how to spot them. That means that all women are inevitably looked at as:
a) walking time bombs or
b) a potential lawsuit.

This isn't out of meanness, it is just a matter of training and caution and a deeply ingrained distrust in the natural process.

So, handing this person your special piece of paper is not enough. You must really talk to them. REALLY TALK. Ask real questions. (Think percentages, "when was the last time X happened", or "what would you do in this situation", type of questions.)

Next- get real answers from your care provider. A brushed off hurried answer may very well come back to haunt you. Vague is bad. A dismissive "Only when necessary" is also a warning sign. It might be an awkward visit. This person does know a TON more than you or me about anatomy and pathology. They went to school for a very very long time. They do have an intimidating array of knowledge which should be respected. It is better to have a awkward visit that makes you change providers than a horrid birth that makes you cry.

True Confession-
I only had a birth plan for my first birth, which was in the hospital. My other two I felt so at peace with my choice and my care provider that it didn't even occur to me to write one. I also had long visits with my midwives where I got to talk to them about my concerns and get their answers.

So, one of the end messages on birth plans is this: while they are great for a lot of things, if you really need one to protect you from your care provider, then what you need most is not a birth plan, but a different birth place or care provider.

I have a sneaking suspicion that the current acceptance (in some places) of birth plans is either lip service only or a clever marketing tool to get women to feel more comfortable when they should be running for the hills.

My dream is for women to be able to advocate for themselves throughout the process of pregnancy, labor and birth. My hope is that they can be kind but firm in their needs and desires. My desire is that they will be honest with themselves about the risks and benefits of delivering their babies in different places and that they will have the courage to birth in an environment that is supportive, not just in word, but in deed.


Krista Eger said…
I was at a birth a few months ago where the nurse looked at the birth plan AFTER the baby was born and I actually heard her say "yeah we've got to make sure we're doing what you want" after they had made excuse after excuse for separating, suctioning, poking the baby. I was furious, but couldn't do anything because I was the doula not the patient. It was awful.
I always tell people that I had a home birth because I hate birth plans. I shouldn't have to write out a list of things that the nurses and doctor should already know. I'm not writing a chore list for a child. These are educated adults. I did write a birth plan for an emergency transfer to the hospital and it was a lot nicer than I wanted it to be. Luckily I didn't have to use it. All I used was my voice to my midwife that had common sense. It seemed to work just perfectly!
Unknown said…
I came to the conclusion if I was with the right provider, I wouldn't need a birth plan; a good tool but not needed. Your ideas of birth should be similar and respected. The communication should come easy where you can be honest. There shouldn't be fear.
I had a birth plan for my VBAC because I feared having a repeat of what happened before. In the last weeks of pregnancy, my acceptable birth plan that needed just a few tweeks turned into a ranting, ridiculous, delusional piece of paper that was sure to be ignored... I never went back and had an unassisted home birth.
Momma Jorje said…
Well said! I had a birth plan with my last 2 births. I did Bradley with both. Most recently:

A relative that works in an OB ward shot down the very idea of a Birth Plan and said that the nurses ALL consider them failure plans or something of the like. I was *pissed*. And offended.

My doctor encouraged me to create a birth plan. Though I never thought of WHY or where that would best be used. We went over it with him a couple of times. Once we got to the hospital with it (multiple copies), the response from the nurses were mixed. One shot it down, just as my aunt had done. I argued that my doctor had requested it.

In the end, my doctor was on board and very helpful with getting the hospital staff to follow our requests. We even managed to avoid some routine stuff.

It is a really good communication tool, though. I think classes that encourage their use need to be more clear about their purpose, though. You can't walk into the hospital and expect everyone to bend to your requests automatically.
Christina said…
The biggest, most important thing I had on my birth plan, in capital letters and highlighted, was DO NOT USE LATEX ON ME. Mostly the entire thing was health/safety issues for me. I pasted copies of it all over the place. My OB knew it, and was very outspoken about it. I had them put an allergy bracelet on me. I still ended up with latex tape on my arm and couldn't figure out why I was having trouble breathing and my arm was swollen up like a balloon. I won't be birthing in a hospital this time.
Rachel said…
As a nurse that respects normal physiological birth, I have to say I love when women come in with birth plans. It helps me understand where they are coming from and, yes, any particular need or desire they have. That said, I know I am in the minority. I think it is good to work through one and bring it in as long as you aren't using it as your weapon::)...Because I do agree with you, that if they are using it to somehow shield themselves, then they need to think about why they are giving birth where they are, and with the care provider they have.

But I would like women to know that there are nurses like me, that do like to know what you want. Like if you would rather not have an episotomy or have the cord clamped later, or not to mention pain medication at all. It does help me to better meat your needs.
Lauren Rechelle said…
This comment has been removed by the author.
Lauren Rechelle said…
I actually don't agree with you. I think that is all depends on your team and birth place.

About a month prior to my due date I gave my OB my birth plan. She didn't try to talk me out of anything, she supported every choice we made, even the ones that were unconventional. It listed everything I could think of for my child's birth day. I was in the hospital for almost 30 hours before my son was finally born and EVERY nurse who walked in my room had my birth plan memorized.

I was induced and on pitocin, but my plan was still to have my son naturally, and even though tons of people had told me before I went to the hospital that it was going to be too painful to do it without pain meds, I still wanted to do it naturally.

I had made it very clear how I wanted my pain managed on my birth plan, and when my nurse came in I asked her how long she thought I would last before I started asking for an epidural - her answer, "You're birth plan says no epidural, and I believe you are plenty strong enough to do without it, even on pitocin."

It's all about doing your research. Any woman who can do the research to make a birth plan, has the intelligence to do the research on their birthing team and hospital/birth place.

You have 9 months to spend getting to know your doctor, and every hospital and women's center give tours and detailed lists of things they provide and services offered.
Mandy said…
As a doula and CBE, I try to make this as perfectly clear as I can: Your birth plan is for YOU! It's for your husband or your mother to know when to advocate for you. It's for your doula to REMIND you to advocate for yourself. It's a written recall of why you are here and what you wanted this birth to be! It's about knowing the risks and benefits BEFORE the politics and pressure of protocol; and deciding which you can live with no matter the outcome. It's about the bottom line: KNOW WHAT YOU CHOOSE!
Sven & Trin said…
I agree. I took the time to really think about what I wanted to include in my birth plan and what I wanted in my experience as a first time mom. I also knew that a birth plan is kind of seen as a suggestion of what you'd like. My husband is military and I had (1) one option of where I could deliver our son. Not only that, but the many ways I was limited in my pain management further encouraged me to go natural. My choices were pretty much natural or epidural and I'm not playing that game. Everything worked out in the end. My L&D was enjoyable, though many things on my birth plan weren't addressed, I was sure to make the most important issues (to my husband and I) happen.
Sam I Am said…
I had no birth plan for my third (VBA2C). Just to give baby 42 weeks to arrive before I sceduled a c-section. The OB wrote up a long double sided birth plan for me to be in my notes at the hospital if she was not on when I went into labour. Funny thing is that I went into labour at 41 / 8. The midwife got the OB's birth plan the following day and she just laughed as baby came in a hurry and after a 2 hour labour he was born at home. So no need for the OB's birth plan.
It was great not having a birth plan as such and just going with what felt right at the time as I hadn't planned on a home birth but as baby was in a hurry it just happened and it was by far the best birth ever.
I had birth plans for my first and I felt like such a failure when I ended up having a c-section. My second I didn't have one as such other than to attempt a VBAC and a few other things, but that went out the window as soon as I arrived at the hospital and he ended up being a c-section as well.
But third time around I had a Midwife I trusted and we had spoken lots about having a VBA2C so i knew what to expect and just went into the labour open minded.
Anonymous said…
I don't entirely agree. Although a birth plan is not a guarantee, it can be helpful provided that you trust your doctor.

I avoided both an IV and a hep lock BECAUSE I had it in my signed birth plan. I did not get the routine vaginal exams BECAUSE in my signed birth plan, it stated that vaginal exams were only to be performed at my request. My doctor did delayed cord clamping even though he could have clamped and cut right away, as immediately after the birth of your child you are in a different world and not even aware of a lot that is going on. I was momentarily snapped out of that alternate world because my doctor was holding the limp, white cord for me to see and requested permission to cut it as it had stopped pulsating. My doctor was kind enough to repeat to the nurses that I did not consent to the eye ointment, hep b, or vit k.

So yes, there are lots of things that birth plans are not, but they can be helpful if your caregiver is on board. If it's signed, it shows the authorization of your doctor. A nurse cannot argue with that. However, a birth plan cannot advocate for you. It's just for backup :)
melissa v. said…
This is a great post! I agree that a birth plan is not a shield and will likely not protect you from anything if you are using it that way.

I used it to help my NURSE get to know me for my hospital VBACs. In Canada our midwives have hospital and home privleges (at least in my part of Canada they do) so my midwife knew me really well and knew exactly what I wanted and I certainly didn't write the plan for her. I wrote it for my nurse, so she would know that I'm not a run of the mill patient. I'm VBAC. I don't do continuous EFM. I don't do IVs. I don't use pain meds. I also told them a tiny bit about my family, how many kids I have, and who would be at the birth. Just so they are prepared and stuff. Not to shield me (my midwife was pretty good at that), but to give a quick rundown of who I am, what I like, and what I'm aiming for.

It worked well for me. I also had a post partum plan for my 4th baby. I had gestational diabetes and didn't want formula anywhere near my baby so I wrote a post partum plan that detailed what I would and wouldn't consent to (including clearly outlining that without written, signed consent from myself or my husband, my daughter was NOT to recieve formula. PERIOD.). That was reassuring for me because I was so adamant about breastmilk only for my already vulnerable GD baby.

She didn't need it, but I felt it offered some protection by making it so very clear exactly what we wanted. How can staff work to treat me the way I want if they don't know what that is??? It's not a guarantee, but it gets us closer to our wishes being carried out.


melissa v. said…
Also, my midwife MADE the nurse read my birth plan when we arrived at the hospital. It can't work if no one reads it! =)