“Do I need to write a birth plan?”
This is a frequent third trimester question. My answer is always the same: if you want to, go ahead, but if you don’t, things will still be OK.
A birth plan, in general, is a list of wishes that a pregnant woman and her partner have for their labor, delivery, and postpartum experience. It usually contains information about what kind of pain control she wants, who is going to be in the room for the delivery, who will cut the umbilical cord, etc. I have no idea when this concept came into vogue, but now is a commonplace discussion on most pregnancy websites and in childbirth classes. There are even online “create your birth plan” tools with multiple choice options to create your personalized plan with a few easy clicks.
From my perspective, the main benefit of the birth plan is to give families reassurance that they have some control over a frightening situation. Many women fear that once in the hospital, they will be subjected to interventions against their will, and the birth plan is a way of expressing their wishes ahead of time and making sure that they are heard (or at least seen). If you need that kind of reassurance, then, yes, you should write a birth plan. But the truth is that you really don’t need one. After delivering thousands of babies, with and without plans, there are a few things that I have learned.
- Birth is totally unpredictable, and no matter how well you plan for it, no one–not you, your partner, your doctor, or your nurse–knows what will happen.
- Patients often choose (on their own) to deviate from their plan in the course of labor and delivery. This is normal and expected, as they wrote their plans long before they experienced labor first-hand.
- Most birth plans say the same thing, and most patients who do not have birth plans have the same wishes as those who do.
- Birth plans are almost always a first baby thing. Second time moms rarely write them because they realize that they are not necessary.
- Real births almost never follow the plan exactly.
These observations alone should be reassuring to you if you are feeling apprehensive. Why? The reality is that your doctor’s only goal in managing your labor and delivery is getting you and your baby through it safely. We will treat you the same whether or not you have a birth plan; that is, we will let labor proceed as naturally as possible and intervene only when necessary if that is what you prefer. If you don’t want pain medication or if you want to listen to a particular song while you push, that’s fine. If your Marina doctor (or Monterey, Salinas, and Carmel doctors) thinks that things are getting complicated and some sort of intervention is required, you must give your consent before it can be done. The bottom line is that when you are in the hospital, nothing can be done against your will (the one exception being a dire emergency where you are incapable of providing consent).
Perhaps more important than writing a birth plan is researching hospitals in Salinas, CA and surrounding areas and choosing a hospital that adheres to “baby-friendly” principles (note that this is this does not necessarily mean the hospital must be certified “Baby-Friendly”–many hospitals practice these principles without that certification from the state and very few hospitals have obtained certification to-date). This means that the hospital has a commitment to encouraging bonding between parents and their newborn and will automatically do the things you probably would request in your birth plan, such as skin-to-skin contact immediately after delivery (when safe), procedures and tests administered to the baby in your room whenever possible, and exclusive breastfeeding. At Salinas Valley Memorial Hospital, where we work, these practices are standard, so when reading patients’ birth plans, I am able to reassure them that half of what they request will be done without them saying a word.
Other things, like whether or not you need an IV, are generally negotiable, and if you discuss your concerns with your doctor ahead of time, you can often reach a mutually acceptable decision. If you do write a birth plan, you absolutely should bring it in to your prenatal appointments to discuss it with your doctor ahead of time>. We see your birth plan as a way of exploring your concerns about labor, and often a short discussion of your requests can allay many of your worries.
The bottom line: communication is key. If you want to write a plan, by all means, go ahead. But even if you don’t, tell us your concerns so that we can take those worries off your mind!