Ashley Stebbins, BSN, RN (she/her)
What Your L&D Nurse Wants You To Know About Birth Plans
You may have noticed a letter circulating the internet recently from a physician’s practice in New York. If you haven’t, the short of it is that they don’t like birth plans. They want to be able to practice in the way that they feel is best for you and your baby and that your job is to be flexible and let them do their job. They believe that birth plans set unrealistic expectations for birth experiences and are a “detriment” to the relationship between patient and provider.
This is a dangerous precedent to set and creates a power dynamic in which the patient’s desires, wishes, and opinions are unimportant and the doctor is in charge. They have recently retracted their statement, stating that it was an outdated letter that somehow got slipped into their welcome packets.
As a doula, turned labor and delivery nurse, I have seen the eye rolls and heard the negative comments from some of the other nurses and some physicians about birth plans. “A ticket to the OR” is how birth plans are often labeled. Cue my own eye roll about that statement.
Be willing to be flexible. Of course, not everything will likely go exactly according to your plan and you may need to go with the flow as unexpected things occur, but this is not unlike parenting or anything else in life. When things come up in labor, as they often do, ask questions and remember to use your B.R.A.I.N. What are the benefits of the intervention being offered? What are the risks? Are there any alternatives and what are they? What does your intuition or your gut say about what is being offered? What happens if you do nothing? Ask if you have some time to think about what is being offered so you can talk it over with your birth partner. Some emergencies may not allow for much time, but you deserve to be able to give your fully informed consent.
Remember, just because one thing has changed, does not mean the entire birth plan is out the window. I always ask my patients for their birth plans and can’t tell you the number of times that I have a patient getting a medically indicated induction who tells me “well, we did have a birth plan, but I guess it doesn’t matter anymore now that we are being induced.” Yes it does! Just because you aren’t able to labor at home like you had envisioned or go into labor naturally does not mean you can’t still labor out of the bed, make your room cozy with LED candles and your favorite music, or have immediate skin to skin and delayed cord clamping. Just because your baby stayed breech and you now need a scheduled cesarean you hadn’t planned on does not mean you can’t have a little delayed cord clamping or skin to skin in to OR. You still have choices!
Educate yourself on your birthing facility. Do you absolutely want a water birth and it is a non-negotiable for you? Does your facility even perform water births? Do they even have tubs? Does your birth facility have wireless monitors if you wish to walk around a lot and be out of the bed? Do they offer nitrous if you’re wishing to utilize it in labor? Do they require a negative COVID test to be able to use the nitrous? Make sure that what is going on your birth plan is relevant to the facility you have chosen to deliver at. If it isn’t, are you willing to budge on this, or would you like to consider moving your birth to a different facility that does offer what you want.
Educate yourself on the choices you are making. Do you want to refuse certain interventions or procedures? What about in a true emergency? As a labor and delivery nurse, I dig a little deeper into the motivations and wishes behind certain things on a birth plan. We may need to have a conversation together and figure out how we can come together collaboratively.
Keep it short and simple. As much as I would love to believe that everyone involved in your care is going to read you 5 page birth plan, it isn’t realistic or likely that they will. Headings like labor, delivery, newborn care, immediate postpartum care with bullet points underneath with your desires keeps everything organized and easy to access. When working with doula clients, I also like to have them put the category of cesarean, in case things do end up in the OR, they are still informed of their choices and have presented on their birth plan what they prefer in the event that their baby decides to be born by cesarean.
A birth plan is the start of a conversation. While you are researching your options, talk to your provider at your prenatal visits about what you are learning. This may help you determine how aligned they really are with the experience you wish to have. Are they making you feel safe, supported, and affirmed in your choices or do you walk out of appointments feeling ignored and belittled? Can you envision this person being the first one to hold your baby as they enter the world?
You are important. Your opinions and wishes for your birth experience are valid and important. A birth plan is a great way to inform yourself about the various options that exist for your birth and aids to empower you to make choices that feel right for you and your baby. I want you to be able to look back on your birth and feel like you had choices, were fully informed, and made decisions that you feel comfortable with.