How to write a birth plan that doesn’t offend your doctor

Let’s play a word association game. Ready? BIRTH PLAN…

Some people hear this word and think about a streamlined game plan for labor—a pick list of delivery do’s and don’ts that ensure everyone is on the same page regarding “the ideal birth.”

Other people (most likely, your Ob/Gyn) hear it and cringe. This is because the thought that birth can be reliably curated and predictably de-medicalized is both misguided and even offensive to medical personnel who have your best interest in mind. (Hang in here with me for a sec.)

The issue is not with who cuts the cord, which scent is diffused during the birth, or how many labor balls on which you plan to bounce, but rather with the idea that routinely refusing medical recommendations is wise. Sure, women have been birthing outside of hospitals and without medications for millennia. Birth is and will always be “natural,” but Nature, it turns out, is kind of a bitch and used to kill lots of women.

In obstetrics we know all too well that a beautiful, routine birth can turn on a dime, and we know from years of treating similar patients and seeing various outcomes that certain recommendations exist for very legit reasons. As a former mentor of mine once put it, “When shit hits the fan in OB, it hits it hard and fast.”

Maybe here is a good place to disclose that I was a doula in a former life. Before becoming an Ob/Gyn, I believed unwaveringly in the birth plan as a means to an end. Now with years more experience and with the skills to better predict who will and won’t need medical intervention, I understand that the ideal birth plan is one of flexibility and trust. You can absolutely still have birth preferences and ideals, and have them without pushing back against common place safety recommendations. So here, friends, is a list of recommendations for how best to do that and get the best of both worlds.

Birth Plan DO’s:

• DO consult your Ob/Gyn or midwife provider while drafting the plan to ensure that nothing on it would potentially decrease the safety of both you and the baby. This is a conversation between team members.
• DO remember that birth can be predictably unpredictable. If something deviates from how you thought it would go, it’s NOT your fault. What will be, will be and flexibility is key.
• DO know that your medical team wants what is best for you and your family. We are all on the same team. If you find that this is not true with your particular nurse, midwife, or doctor, ask for a different one.
• DO remember that medicine today is not the patriarchal system it was with your parent’s generation. Medical decisions should be made as a team with you and your partner, and with open discussion as much as possible. This is a team sport.
• DO include on your birth plan special or ceremonious extras that may not be routine for everyone (for example, I want a special song playing during the birth, or I want to wrap my baby in a special blanket I brought from home)

Birth Plan DON’TS:

• DON’T assume that your midwife or doctor is working against you or has ulterior motives. Yours and your baby’s health are our only motives.
• DON’T always believe what you read online. The internet is full of misleading, exaggerated, or just plain false information about labor & delivery. Some examples of falsehoods:
  • Epidurals do not cause permanent back pain (pregnancy does)
  • Epidurals will not stall out your labor. There is research, in fact, that it may make the very beginning of labor go a little slower, but not active labor.
  • You are not less than for needing an epidural. Think about this: L&D is the ONLY place in the hospital where when people are in pain, it is okay to let it go untreated. If we managed pain that way in other parts of the hospital, we’d all be shut down. For some reason however, when we think of childbirth pain, this is something that needs to be endured without medication. Pain is pain and if you need an epidural to manage it, that is perfectly fine.
  • Pitocin is not the enemy. Sure, if you don’t need it, you shouldn’t get it, but there are very clear guidelines about when and how much of it to give that are based on sound science. One of the biggest mistakes I’ve seen with birth plans is continuously refusing to start Pitocin when a labor is stalled, which ultimately can lead to much longer than normal labors, uterine infection, infection in the baby, postpartum hemorrhage, C-section, and even hysterectomy. Pitocin has a time and a place, and can actually help you avoid a C-section, believe it or not.
  • We will not routinely cut an episiotomy. That’s old school.
  • Most hospitals now are routinely encouraging skin to skin with the baby and delayed cord clamping!
• DON’T feel like you have to fill in every fill-in-the-blank answer on a form birth plan. If a particular item doesn’t matter to you, don’t worry, the birth will go on.
• DON’T forget the end goal here: healthy mom, healthy baby. Regardless of what does or doesn’t happen during birth, the most important thing is the safe delivery of your new family. We can help you do this beautifully and with the following mantra: flexibility, open-mindedness, trust, and love.

Lastly, don’t forget to listen in on our BIRTH PLAN episode here for more fun tips and tricks to creating the perfect plan!