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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!

15 Comments

  1. 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!

  2. 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.

    • 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!

  3. MrsCottonCurls Reply

    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.

  4. 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!!

  5. Yea Wendy, if you get a bad nurse, it totally effects your experience. The nurses really make or break a birthing experience. I had a real bad “egg” of a nurse for my first. She was rough with me, curt and didn't seem to care about my comfort or state of mind one bit. Even my husband noticed how uncaring she seemed. I know she was a bad apple because when other nurses would come to relieve her for a break they were wonderful. All of them, except her. I should have complained afterward.

  6. SOOOO, I agree with scratching the birth plan. Looking back in retrospect, I really think that the most important thing is that you have someone in the room with you that can communicate for you and voice your concerns. You truely arent thinking straight when youre in labor and having a middleman in essential. My hubby was fantastic at this. With my second labor I had a nurse that was a complete tool and my husband and sisters had to get very stern with her because she wasnt a “DOER”. I was getting pissed and frustrated and having my loved ones there to put this incompitant woman in her place, was amazing.
    -wendy-

  7. Great conversation gals! Bloomer, thanks for giving us insight on the other side of the birthing process from a L&D nurse's perspective. I have to say that when I was wheeled into the operating room for my c-section (first surgery in my life), I felt so calmed. The room was packed with kind female faces (covered in masks), all focused on the well-being of my child and I. I knew that I was being completely cared for. It was a good feeling, especially at the point where I was willing to give up.

  8. Great idea, Kristi!! Thanks for the suggestion. And yes, I totally agree that midwives and doulas should be covered by medical insurance. In fact, my second birth I had a midwife who practiced in a group with OBGyns. It was great because she was covered by insurance and also we knew that we would be prepared if I ended up needing a c-section again. Which I did.

    Meanwhile, I just also wanted to respond to bloomer above by saying that while I totally respect everyone in the medical profession and she sounds like a very kind and informed care-giver, I think the idea of birth planning is important becuase many people do not realize that they can be involved in making choices as to how they will birth.

    The c-section rate in this country is at an all time high (1 in 3 birth end in c-section in the US, and the WHO says that countries with more than %15 of births resulting in c-section puts women and babies at risk.

    Many women do not realize that medical interventions during birth actually increase one's risk for delivery by c-section. It is important that all women are informed about the benefits of natural birth so that they can make their own choices as to how they would like to approach their labor and birthing experience.

    I absolutely agree that it is always important to recognize that birth cannot and will not always go according to plan. But education and planning, with a healthy dose of expecting the unexpected, can really improve a woman's chance to advocate for a birth experience that is safer and healthier for herself and her unborn child.

  9. I guess as a mother of two, and a former Labor and Delivery nurse, I should probably offer my opinions on this very heated topic. I'm sure I will probably offend many of you, but I feel that the other side of the story should be represented.

    I can appreciate and understand a mother's desire to have her wishes understood regarding the delivery of her baby, but let me just explain a few reasons why the medical profession tends to view birth plans negatively.
    First of all, coming in with a plan that states exactly how your birthing experience should go will only set you up for disappointment. Very rarely does a labor and delivery go exactly as planned. If a mother walks in the door expecting her birthing experience to be one way, and it ends up being completely opposite to that, it seems that there is always a high level of anger and resentment towards the hospital, medical, and nursing staff. I really don't think that is fair.

    There are so many factors to take into consideration during a delivery that the general public usually isn't even aware of. The doctors and nurses are trained to know what to do in emergencies. A lot of times, the staff has to be firm and direct during stressful situations because the reality is, when things go bad during a delivery, they can go seriously bad really quickly. Sometimes stopping to have a calm, informative conversation just isn't possible. It could mean the difference between a good and a bad outcome. Obviously the staff does their best to keep everyone informed of what is going on at all times, but if things seem as if they are a little rushed and short, there is usually good reason for it. Now I'm not saying that everyone has great bedside manner at all times, because that is not the case. There are always going to be those miserable, crabby people who would rather be reading a magazine or taking a nap. There is no excuse for that. I would complain about them too. I'm just trying to defend the staff that are genuinely trying to do what's best.

    The bottom line is that at the end of the day, everyone is there to ensure good outcomes for both the mother and baby. We all want everyone leaving the hospital healthy and happy. Isn't that more important that following some plan out of a book? I could honestly go on and on all day regarding this topic, but since I know my opinion is not a popular one, I will stop. I just wanted to add an opposing viewpoint.

  10. Cool Whip Mommy – I read a lot about doulas and would have liked to explore having one, especially for the first. But, I didn't want to pay for it (shouldn't insurance cover midwives and doulas?) and I also didn't want to offend my husband (like he wasn't good enough support for me). You should do an entire article for SK on doulas. How to find one that fits with your personality and desires, is properly trained, how using once decreases the likelihood of having medical interventions, etc. I'm sure your friend would love to be quoted!

  11. Totally agree with your thoughts about bed-side advocates. I still like the idea of writing a birth plan to get thoughts together and truly understand your options though. I think that too many people don't even realize they even have options. On the other hand, the doula is the main thing missing from my articles at SK. Unfortunately, they are only to be 400 words long and I didn't feel like I could fit all I had to say about doulas into my article. But I do think that having a birth advocate is the #1 thing you can do to help yourself stay true to your original birthing intentions. My best friend is a doula and she is AMAZING. Though it wouldn't have changed the outcome in either of my births because I had c-sections for both based on pre-labor complications, I would've loved to have a doula anyway looking back. Great post, Kristi!! You are such a great help to all us moms out here.

  12. Oh my gosh Mandyland, I was right there with you. Whatever it took to get the baby out, I was ok with it. Just get 'er done!

  13. With my son I had a birth plan, complete with amount of time I wanted to labor prior to drugs – and yes, I was open about wanting an epidural. I had five copies neatly bound and color-coded. One copy went to my doctor who, very nicely, said thank you and put it in my file. One copy for for us. And the other three for the nurses on D Day.

    And…the epidural didn't work, I didn't progress and I ended up with an emergency c-section. By the time we got to that point, my birth plan was shredded and if my doctor has said that she was going to use a chainsaw and tylenol, I would have agreed.

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