The Pros and Cons of Birth Plans

Childbirth, Featured Article, Pregnancy

Having a baby is an exciting, often overwhelming experience that can leave parents with more questions than answers: Will she have my nose? What will his first word be? What will she be when she grows up? But despite the endless “what-ifs” that moms and dads are powerless to control, there is one aspect of the baby birthing process in which they can have a say.

From the type of anesthesia used (or whether drugs will be administered at all) to a song-by-song labor and delivery soundtrack, moms- and dads-to-be have a right to dictate their every wish via a comprehensive birth plan. Unfortunately, for every successful water birth conducted under low lights with Kenny G playing softly in the background, there is the need for an 11th hour, emergency C-section. And it all begs the question: should expecting mothers bother with a birth plan? Here we weigh both sides of the coin with insight from two women who deliver babies for a living.

Planning as a Door to Effective Communication – Barb Dehn, RN, MS, NP

As a women’s health nurse practitioner who cares for pregnant women, I love birth plans even though I know that things rarely to never go as planned. I love them because birth plans give women and couples what they really, really need when they are so vulnerable: a sense of control. When couples have a birth plan, it means that there is at least some open communication with their OB provider. I tell my patients that we can spend hours or even days discussing every imaginable scenario that could happen in labor and delivery and still not anticipate what will happen in their case, but what I can do is:

  • Be clear that, no matter the scenario, I am partnering with her. As a provider, I have the knowledge and experience, and I will give options and recommendations based upon years and years of experience; however, I also recognize that it’s her body and her baby, and she has a right to make decisions.
  • Discuss options with her and then make decisions together about what is best.
  • Promise to always provide the patient with information about what’s happening when she can hear it, not when she’s in the midst of a contraction.
  • Let her know that we both have the same goal: a healthy, happy baby, and a healthy, happy mom!

After working for years in Silicon Valley with lots of engineers who want to know what we will do in every scenario, I realized that questions come from worry. So for my patients, a birth plan is a springboard for continued communication that starts at the first prenatal visit. I spend at least an hour with my patients, even on their first visit. This is a highly vulnerable time for women and couples, and they need to know that they are being heard and that we are going to honor what is important to them. Everyone’s motivations and priorities are different, and I can’t assume that everyone wants the same thing.

I see birth plans as an opportunity to help allay fears, honor wishes and ensure that all parties involved will communicate respectfully.

The Dark and Disappointing Side of Birth Plans – Linda Rice, CNM

I always tell my patients that birth is a great introduction to parenting because now the baby is in control!
 Birth plans are actually contrary to birth itself because birth is a process of letting go, and plans are about control.

That said, I do encourage my patients to explore options and have a vision of what they’d like from their birth experience. I usually start at the most basic level and review the risks and benefits of pain management options, like epidurals or IV medications. I discuss their options for childbirth classes and other resources for information about the birth process. And when deciding between natural childbirth or pain medication, I usually tell them there’s no right way to give birth, and that they should think about the type of experience they want. I’ll ask, “Do you want to climb the mountain or take the tram up?”

In general, though, I’ve found that obsessing over minor details only causes stress and hinders the birth process because sometimes, a birth does not go as planned. Personally, I had what felt like a very modest birth plan. I wanted skin-to-skin contact immediately after birth, and I didn’t want to be separated from my baby. I also wanted to try to have natural childbirth, though I wasn’t 100 percent committed to that idea. One by one, the elements of my birth plan fell apart. I developed a fever in labor, which meant my son would have to be taken to the special care nursery after birth. Then I needed a cesarean section, which wasn’t horrible, but my epidural didn’t work and the problem wasn’t discovered until the surgery started, so I was put to sleep.

Afterwards, I had a really hard time having missed the birth of my first child. For the first few years, just thinking about it brought me to tears. I was awake for the birth of my second child, which brought me some closure, but I still think of that moment I’ll never get back. I also had another C-section the second time around, meaning I’m a nurse midwife who’s never personally experienced a vaginal birth.

I believe we in healthcare don’t acknowledge the grieving process some women go through. Women are often told, “You and your baby are healthy, and that’s all that matters,” and then women feel guilty about feeling loss. I say it’s like having your beach wedding getting rained out — it doesn’t mean you love your spouse any less, but you do feel disappointment that things didn’t go the way you wanted.

I think it’s great for women to think about what they want from their birth experience, but if they have an iron-clad, down-to-the-last-detail birth plan, it’s very likely that something isn’t going to go as planned, which can end up causing anxiety and disappointment.


What do you think? Is a birth plan a smart thing to get in order or a complete waste of time? Tell us about it! Email [email protected] to share your story.

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