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Why Birth Plans Are Useless (Do This Instead)

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When you first become pregnant, labor seems a million months away.

But a few ultrasounds later and you’re sporting a watermelon-sized bump.

Even if you’ve taken classes, read books, and talked to friends, nothing can truly prepare you for labor.

And that’s scary, right?

Enter: The birth plan.

What is a birth plan?

A birth plan is a document you’re supposed to draft and hand off to your nurse when you arrive at the hospital.

It tells your medical team exactly how you’d like childbirth to go down– relaxing music, dim lights, breathwork and massages, immediate skin-to-skin contact, and the list goes on and on.

Writing it up can make you feel more in control and calmer about your impending due date.

The problem? Birth plans don’t work. At least not like you’re hoping they will.

Why birth plans aren’t effective

During my first pregnancy, I mentioned to my OB that I was getting ready to write my birth plan.

His response in a nutshell? Don’t. He indicated that some nurses get offended by birth plans and that handing one off to the staff could set up an adversarial tone.

Offending people when in throes of labor shouldn’t really be your top concern though, right? Who cares if a nurse thinks you’re woo-woo for wanting to listen to acoustic guitar tunes while panting like a labradoodle in the desert?

But there’s another, bigger reason that writing a birth plan is a waste of time:

Birth plans don’t get followed.

I don’t know a single person who said that their doctor or nurses referenced their birth plan even one time during their delivery.

When it comes to bringing a baby into the world, things can move fast. There isn’t time to look up your thoughts on episiotomies and forceps as your little one’s head starts to emerge.

And if you or your baby’s vitals drop, you’ll be sprinted off to the operating room for a c-section in under 60 seconds flat. No joke– those hospital peeps don’t mess around when lives are on the line.

And even during labor, when you wrote in your birth plan that you didn’t want any pain management medication or to have your mom in the room, you could (and probably will) change your mind.

Because you don’t know what you really want until you’re in the situation.

When I had my first child, we packed massage tools, magazines, and music to use during labor.

I asked for a certain type of fetal monitor that would allow me to walk around. I was 100 percent certain this baby was coming out vaginally and that I wouldn’t need an epidural.

After all, my mom had me after six hours of labor at a birthing clinic with no pain meds. She even went home that same day.

But nothing went as planned. My little girl was turned the wrong way and got stuck in the birth canal. After three hours of pushing (with her head so close to coming out!) we ended up in the operating room.

We never touched the stuff we brought with us and I did ask for and receive an epidural during labor (because back labor is the stuff of nightmares).

The bottom line: The unexpected is bound to happen. Being open to things not going exactly as you planned will keep you from feeling disappointed.

It’ll also make it easier for your medical team to give you the best possible care.

What’s better than a birth plan?

Even though there’s no point in giving a written birth plan to your doctor or nurses, thinking about and knowing your birthing preferences is still important.

Here’s why:

You can tell them to your husband, doula, or another support person. Your support person can communicate your wishes in real-time to your medical team.

It can be difficult to make decisions or express them yourself in the heat of labor. But if your labor room advocate (i.e. husband, doula, mom, etc.) knows your concerns and preferences, they can speak up for you.

For example, your doctor might want to give you Pitocin to speed up labor. If that’s an intervention that you didn’t want, your advocate can question the recommendation.

Perhaps ask the doctor why it’s important right now? Is it possible to hold off? Are there any natural alternatives?

Since your support person is clued into your desires, they can see if there are options that better align with your wishes.

And if not, at least you’ll have an understanding of why the intervention is crucial.

What you should tell your advocate

During my first labor, my husband was like a deer caught in headlights.

He just nodded when the doctor or nurses told us what they wanted to do, and I was too wrapped up in my contractions to say, “Hold it. Hold everything!”

So I made sure that for the second delivery, my husband knew exactly what I wanted him to do. I even typed up a cheat sheet for him.

Here are some of the things to discuss with your support person:

  • The best ways to encourage and motivate you (even give your support person the language to use like, “you’re doing great!”)
  • Your birthing preferences on things like pain management, interventions, immediate skin-to-skin contact, and newborn care
  • When you want your support person to question the medical team about recommendations that go against your preferences
  • When to intervene (e.g. shutting down the negative, “you’re not pushing hard enough” comments from nurses or doctors or telling family you need time to rest)
  • The type of support you’d like in the delivery room like doing breathing exercises with you, holding your legs, turning off cell phone notifications, and not leaving your bedside to talk to family in the waiting room (because, inevitably, that’s when the doctor or nurse will come in to discuss something)

Go into labor with the expectation that a healthy delivery is the top priority for you and your medical team.

Know that doctors and nurses want you to feel good about your birth experience too.

It’s ok to question their recommendations and to choose something different (but still safe!) than their initial suggestion. That’s where having a well-informed, assertive, and questioning in-room advocate can make the entire experience smoother, happier, and more empowering for you.

Having a voice who cares only about you and your concerns is stronger than any piece of paper.

Pin for later? Share why birth plans don’t work and what to do instead with other moms!

a woman that supports women

Monday 1st of November 2021

every pregnant woman knows their best laid plans can change. the “just you wait” narrative needs to be stopped as it does nothing but instill fear, self doubt and insecurity in the birthing process. no, women should not care about offending when stating their preferences in labour or in life. this advice is what leads to birth trauma. please encourage and support women on a platform like this.

Sosh | Mommy Crib Notes

Monday 1st of November 2021

Hello! The point of this post isn’t to tell pregnant women they shouldn’t state their preferences. That is absolutely important. The author’s intentions are also not to instill fear or self-doubt. Rather, her main point is that birth plans don’t always work out in a hospital setting because they sometimes are not followed. She believes having a well-informed advocate (like a spouse or support partner) can be a better alternative than a piece of paper. Thanks for stopping by and sharing your thoughts!

Sierrah

Tuesday 9th of July 2019

During my first pregnancy I typed up my birth plan and never got around to printing it out. I agree it’s nice to have an idea of what you want but you never know how your birth is going to go. Great post!

Barbara

Monday 20th of August 2012

I agree that an understanding and vocal advocate is your best resource but in my experience, a birth plan can be useful too.

With my first, my water broke at 34.5 weeks. I was 6cm by the time I convinced the L&D staff that I was really in labor (I was handling the pain beautifully...I've had periods worse than that!) and got into a room. When my OB walked in and ordered them to start pitocin, I begged her to wait a couple of hours and see how I progressed on my own but her words were "You're 6 weeks early, your water's broken...birth plan's out the window, this is MY show now!" My husband was terrified and basically cowered in a corner watching the whole thing. Within minutes of starting the pitocin, my blood pressure was through the roof, I was vomiting, hyperventilating, and nearly unconscious just from the pain. The baby was also in distress. Somehow I managed to speak enough to ask for pain meds so the nurse tried to check to see how far along I was. The baby's head was already crowning! The doctor ran in the room to catch him and laughed "Well I guess you were right...you didn't need the pitocin after all!" I wound up with a fourth-degree tear, hemorrhaging, and some other problems which I'm convinced would not have happened if they hadn't basically blown the baby out of me. He was coming fast on his own and as long as things stayed as they were, there would have been no problem with watching and waiting a couple of hours to see if intervention was necessary. Unfortunately, I didn't have an advocate to speak up for me.

With my second son, I arrived at the hospital with a Sprite in my hand. As I was being checked in, the nurse asked me if I'd had anything to eat or drink today. I pointed to the Sprite and she freaked out saying hospital policy was nothing but ice chips. I told her my teeth are extremely sensitive to cold and I can't "do" ice chips...that my midwife had said I could eat or drink whatever I felt like during labor. She continued to argue with me, even physically trying to take the drink out of my hand. Finally, I told her that when my MW told me to get rid of it, I would, until then, the conversation was over. She left the room, came back a few minutes later and said "I'm so sorry...I spoke to your MW and I didn't realize you had a birth plan. Do you have a copy of that for me? And then she asked me if I wanted a regular lunch tray or clear liquids." The thing is, I didn't have a birth plan...I had talked to my MW about lots of things and she knew that basically I wanted to be left alone and allowed to do what felt natural. I didn't figure I needed to write it out. But apparently having it written down with her signature made a difference to the nurses. Without that, I was just being combative...once they realized that my MW was on-board with my choices, they were completely different about it.

I'm expecting my third baby any day now. My new husband has three children, all scheduled C-sections, so this is a new experience for him but he's got the Papa Bear hat all ready to go. He and I have discussed at great lengths all of our hopes and fears and how we'd like for things to go as well as the things we're just not willing to budge on. I've also written a very short and sweet birth plan that basically says as long as things are going well, I want to be allowed to do what works for me. If things are not going well, I want to know what my options are and be allowed to discuss with my husband and make our own decision (within reason, of course). My MW has signed off on that so that the nurses can know I'm not just making up my own rules. I've gone into more detail with my MW about some of the specifics (NO pitocin unless it's life or death...I'm not opposed to pain meds but because of a bad spinal tap several years ago, I have an irrational fear of epidural...that kind of thing) but I don't want to be one of "those women" who goes in with a 5-page list of demands.

Kiralyn

Monday 20th of August 2012

Wow, Barbara, I can't believe your first experience! That is what makes women run to midwives! A friend of mine recently had her second child with a midwife, at a hospital, and said it was a world of difference and she'd never do it any other way. If I were to get pregnant again, I would absolutely use a midwife.

Thank you so much for sharing your story. I think your latest approach is the perfect way to go - you've covered all your bases and are being respectful of the medical community's authority (when it comes to emergencies), but staunch about how you want to be treated (with respect) employing the help of your husband, midwife and birth plan. Kudos!

MrsCottonCurls

Friday 10th of February 2012

While I understand where Bloomer is coming from, I think she missed the point. Like Organic Motherhood with CoolWhip said, it's not about demands, but choices. Everyone knows that things don't always go as planned. It's just about knowing what your options are in case a decision needs to be made. You should always be open to go with what you and your baby need. But at least having your thoughts written out for the simple things should alleviate any confusion during the birth on what the mother's true desires are.

parenting ad absurdum

Monday 15th of November 2010

Kristi - what an awesome and inclusive post. My first birth went completely in opposition to my plan. I actually WANTED an epidural and didn't get one for NINE HOURS OF ACTIVE LABOR (yes, still scarred), and my second went beautifully. Experience is key!!