"With my first pregnancy, I went into preterm labor while I was eating a taco, and my coworkers had to drive me to the hospital. It was definitely an eventful day at work. Four days later, we welcomed a baby boy. With my second, at 18 weeks, I earned a bumpy ambulance ride for going into preterm labor—again. Quick conversations on what to expect with a baby in the NICU and how to prepare myself for what could go wrong—to sum it all up—it was pretty scary. With these experiences, I quickly threw the idea of my ideal birth plan out the window. I just wanted my babies to be delivered safely.
In fact, whenever I find myself in a room full of moms, among the topics of nighttime routines, potty training hacks, and how to get a toddler to eat veggies, we seem to always hit the topic of our shared birth trauma experiences. Stories I’ve heard had moms “ditching” their birth plan or being angry over how their baby’s birth didn’t go “as planned” at all. With this alone, I think birth plans are pointless.
But are they really pointless? What’s the disconnect here? I reached out to Valerie Opila, a Labor and Delivery Nurse with 10 years of experience, and Dr. Lauren Demosthenes, an OB-GYN and Senior Medical Director with Babyscripts, to discuss whether or not birth plans are actually pointless, what your medical staff wants you to know about birth plans, how to make it more of a collaborative experience, and more.
Editor’s Note: The information is not intended to replace professional diagnosis, treatment, or medical advice.
Dr. Lauren Demosthenes
Dr. Lauren Demosthenes is an OB-GYN and Senior Medical Director with Babyscripts, the leading virtual care platform for managing obstetrics. As the first female OB-GYN to practice in Greenville, SC, Dr. Demosthenes came to Babyscripts with over 35 years of experience: in private OB-GYN practice, development and course direction at the University of South Carolina School of Medicine Greenville, and as director of Innovation and High Value Care in the Department of OB-GYN at Prisma Health Upstate.
Valerie Opila, BSN, RN
Valerie Opila is a dedicated nurse with 10 years of experience in labor and delivery and OB-GYN care. When she’s not welcoming new life into the world—or being “Auntie Val” to her friends’ little ones—she’s traveling and building homes alongside her husband. Her passion for caring for others extends from the hospital room and beyond.
What is a birth plan?
What is a birth plan, exactly? According to The American College of Obstetricians and Gynecologists (ACOG), “A birth plan is a written outline of what you would like to happen during labor and delivery.” Common items included in a birth plan are whether or not you prefer an IV line for medications, anesthesia preferences, who will be cutting the umbilical cord, how you want to feed your baby after birth, and more.
What moms have to say about birth plans
One mom took it to Reddit to express, “Why must every mention of my birth plan be met with warnings about its potential failure?” A Reddit user commented, “Every one of my friends who had an inflexible birth plan came out of their birth with trauma because it didn’t go exactly to plan.” Another mom stated she “had a lot of friends who envisioned something super specific and rigid, and when it didn’t go that way, they felt like a failure.” So, why do births historically not go as planned? Is having a formal birth plan even useful?
Why birth plans don’t go as planned
When I asked Valerie Opila if she thought birth plans are helpful, she excitedly said, “Yes!” It’s at least comforting to hear that a medical professional who puts these plans into practice thinks so. She says it’s a great way to have an open discussion with your provider on what your expectations and preferences are during your birthing experience.
She acknowledges that birth plans aren’t always followed to a T, but it does happen. While helpful, Opila wants patients to know “there are so many maternal and fetal factors that contribute to the progression of the labor and delivery process” that there is “no way to know ahead of time how [the events of birth] will play out [exactly].” ‘Birth Plans’ can be a little misleading because planning means you’re committing. But when it comes to medical care, “unexpected things can occur [that] may require being flexible with the plan,” says Dr. Demosthenes.
“‘Birth Plans’ can be a little misleading because planning means you’re committing. But when it comes to medical care, unexpected things can occur.”
‘Birth plans’ vs ‘birth preferences’?
Opila adds that she believes birth plans should be renamed ‘Birth Preference Lists.’ By knowing that you’re providing preferences and not a set plan, you can understand that your medical team will try their hardest to stick to what you prefer. However, what takes priority is delivering the baby safely. ACOG even advises to “keep in mind that having a birth plan does not guarantee that your labor and delivery will go according to plan” and that the common goal is to have “the safest possible delivery for you and your baby.”
How to discuss a birth plan with a provider
So if the common goal is to deliver your baby in the safest manner, what should you be discussing with your provider and medical team when it comes to a birth plan?
You can start discussing your preferences early
A birth plan isn’t a must, but you can start talking about it with your provider early into your pregnancy. “Having a birth plan is a gateway to discussion,” adds Opila, and “pulling out a birth plan last minute at the hospital can lead to major letdown and panic if you are realizing your preferences are not possible the day of [when you go into labor].” Even if all of your preferences can’t be met, your provider can discuss options with you.
Sharing your birth preferences early on can further educate you
One labor and delivery nurse shared on Reddit that she once had a patient who stated, “No Pitocin during or after labor,” on her birth plan. When asked what the patient’s hesitation was, the patient responded with, “Well, I don’t know. What is Pitocin, really?” A preference like this can open up the conversation with your medical team. It can turn into an educational experience for patients who can then make more informed decisions when they know the ‘why’ behind a decision.
Pick a birth plan that works for you
Dr. Demosthenes recommends using the sample birth plan that the ACOG website provides. Opila advises you to either look for a birth plan or put one together that covers your priorities. You can also see if your hospital or facility provides one for their patients. One Reddit user said, “My OB gave me a questionnaire halfway through my pregnancy that was considered a birth plan. Many of the questions were things I had never thought of, so it was helpful for me. Besides pain management, it included items such as who you want in the room, who to cut the cord, how you want the baby right after birth (cleaned off straight skin to skin), etc.”
Come prepared with questions
“There is a common thought that providers will discuss every detail of delivery with you at your prenatal appointments,” says Opila, but unfortunately, it’s not always the case. Opila encourages patients to come with questions in case something is not covered during your appointments. If you don’t understand how your doctor is explaining something, you can speak up with questions. It can be as simple as asking, “What does that mean?”
Review your plan with your medical team and tailor it together
By discussing your plan with your provider, “adjustments and clarifications are made as needed,” says Dr. Demosthenes. Helpful things to add to your plan if your facility doesn’t already, according to Opila, are:
- Deciding who you want in the room
- Your medication preferences
- How you would like to manage your pain
- Preference on IV access
- If you are choosing to do cord blood banking
- If you know the gender of your baby (and who will announce the gender if not)
- Permission for an episiotomy, vacuum, or forceps delivery in the case of an emergency
- Preference for delayed cord clamping
- Whether you are keeping the placenta vs. OK with discarding it
- Your thoughts on having a C-section as a backup plan
- Skin-to-skin preferences after having a vaginal or cesarean delivery
- If you would like for medical staff to leave or wipe vernix off the baby
- Whether or not you want your baby to have a circumcision performed
- Preferences on how you would like to feed your baby (breastfeeding, bottle feeding, formula feeding)
Discuss what an emergency situation can look like
If you’re someone who likes to be in the know and you’re anxious about something like the possibility of an emergency C-section, ask your physician or nurse to explain to you what that is or what the process is.
Think about your communication style
Another way to make your experience collaborative is to think about how you like to receive information. Are you someone who likes for people to be direct with you, or are you someone who needs lots of explanations as to what is going on in a situation in order to make a decision? Knowing your communication style and adding this into your birth plan may be helpful to your medical staff when needing to make decisions in your care.
Non-medical preferences are still important
Non-medical preferences, like wanting to have music playing or having the lights dimmed during labor and delivery, can still be added. This information can be helpful for someone like your support person to execute.
How to have a successful birth plan
Opila has some advice if you’re someone like me who is skeptical about the success rate of birth plans. She states that ‘successful’ ones “are those where the parents have a flexible mindset… and understand that the birth plan is a goal, but [it is] not an end-all-be-all above mom and baby’s safety.” One Reddit user stated that birth plans are also a “reminder to advocate for what you want during pregnancy care/birth,” and added, “[Birth plans are] an incredibly important and meaningful experience that I want to feel good about!” Being part of the decision-making process and having open communication is key.
After discussing birth plans with Valerie Opila and Dr. Desmonthes, I don’t think birth plans are completely pointless. What I do think is that it can be a collaborative experience. Knowing that birth plans are a helpful tool in the decision-making process is beneficial for parents.
Patty Schepel, Editorial Assistant
As the editorial assistant, Patty works with The Everymom’s team on pitches, creating original articles, updating existing content, photo sourcing, writing shopping product descriptions, inputting freelance articles, and more. When she’s not working, you can find her spending time with her family, training for half marathons—she ran one 16 weeks pregnant—traveling, cooking, reading a rom-com, and keeping her sourdough starter, Rose, alive.