Overview

A birth plan is much more than a piece of paper you hand to your care provider. A birth plan is a process you go through to prepare for the birth experience you want. This process will lay the foundation for you to be prepared for the scenario in which everything goes as intended and for what should happen if things do not go as planned. While parents write a birth plan and go into labor with the best intentions, birth plans are not always successful. Having your requests not fulfilled or having a birth not go as planned can leave you disappointed in your experience and feeling like you failed. This episode examines the top reasons birth plans fail and how to avoid those mistakes to create the birth experience you want.

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Birth Plans

A birth plan is your plan of how you envision your birth and what happens directly following the birth of your baby. A birth plan is much more than a piece of paper you hand to your care provider. A birth plan is a process you go through to prepare for the birth experience you want. This process will lay the foundation for you to be prepared for the scenario in which everything goes exactly as planned and for what should happen in the event things do not go as planned.

The idea of the birth plan as we know it first appeared in the 1970s or 1980s. This was a time when labor was becoming more medicalized. The birth plan emerged as a tool for birthing women to communicate about the birth experience they wanted with their care providers.

Over the last four decades, there has been a lot of research, evidence, and more resources available to expecting parents. The information you have access to allows you to make informed choices about the labor, birth, and postpartum experience you want. A perfect way to create and communicate those preferences is with a written birth plan.

Birth Plan Support in the Medical Community

The World Health Organization advocates developing a birth plan and reviewing it at each visit. The American College of Obstetricians and Gynecologists has not released an official opinion on whether they support birth plans. The Guidelines for Perinatal Care released by ACOG and the American Academy of Pediatrics note that “if a woman has a birth plan, she should be encouraged to review it with her health care provider before labor.” They also state, “The development of a birth plan that has been discussed previously with a woman’s obstetrician-gynecologist or other obstetric care provider and placed in her medical record may promote her participation in and satisfaction with her care.”

Birth Plan Fulfillment

While parents write a birth plan and go into labor with the best intentions, some of those birth plan requests are not fulfilled. In a study of 178 low-risk mothers with birth plans, only 7.9% reported that their birth plan was fully met. 3.4% said the birth plan was not fulfilled on any points. For 27%, only 25% of their total preferences were met. 32.5% reported half of their preferences were met. 29.2% reported it was fulfilled 75%. Evidence shows that having requests fulfilled influences your satisfaction with your birth.

Why Some Birth Plans Fail

Having your requests not fulfilled or having a birth not go as planned can leave you disappointed in your experience and feeling like you failed. You can better prepare by examining why some birth plans fail.

You Don’t Collaborate with Your Care Provider When Creating Your Birth Plan

The number one reason birth plans fail is that expecting mothers do not collaborate with their doctor or midwife when creating their birth plan. It is not enough to hand your doctor your birth plan when you arrive at the hospital in labor. You should review your birth plan with your doctor or midwife during your prenatal care.

A study investigated the impact of presenting a birth plan on the women’s personal experience, focusing on their expectations and the level of satisfaction reached. In this study, the primary care midwife provided information about the birth plan. The expecting mother created her birth plan. Then a meeting with the woman and her partner took place to discuss the possibilities and limitations of the hospital’s services. Overall, they found a birth plan should be considered a useful document that improves communication between expecting parents and health staff.

Although this study is small and has limitations, focusing on communication between medical staff and expecting parents is important. The key to creating your birth plan is the process you go through with your doctor or midwife to hash out all the details. It will be challenging to achieve the birth experience you want without the support of your doctor or midwife. Plus, they are your trusted partner during pregnancy and birth. You want their input and expertise as you are crafting your birth plan.

Your Care Provider or Other Staff Doesn’t Know About Your Birth Plan

One study of 432 mothers who had completed a birth plan found only 51.2% presented their birth plan. 5.3% did not feel it was necessary. 13.6% forgot, and 61.2% did not present a birth plan because the hospital midwives did not request it. 19.9% cited other reasons, which, unfortunately, the study authors did not publish. If your care provider does not know that you have a birth plan, how can they work with you to help you get the birth experience you want? Again, you should review and discuss your plan weeks before you go into labor. If you have people supporting your birth, like nurses or other staff, you need to give them a physical copy of your plan.

Your Birth Plan is Unrealistic

For you to have a successful birth plan, it must be realistic. This means you need to consider the particulars of your pregnancy, your care provider’s policies, and the venue where you are giving birth. For example, an expecting mother may want to have a water birth. She verifies that her hospital has birthing tubs available and includes in her birth plan that she wants a water birth. She needs to know if the hospital will support her being in the tub for the second stage of labor. ACOG’s official opinion is that it is safe to be in the water for the first stage only. There may also be contraindications to using the tub under certain conditions, and she needs to know what those conditions are.

Making a realistic birth plan also requires understanding how interventions work together. As an example, you may not be able to avoid IV Fluids if you opt for Pitocin. You cannot both delay cord clamping and bank cord blood. Anything you put in your birth plan is useless if it is unrealistic. The best way to ensure your plan is realistic is to discuss it with your doctor or midwife ahead of time.

It is Obvious that You Didn’t Do Your Homework

By crafting a well-thought-out plan, you show that your plan is important to you and that you have done your homework. There are a lot of templates and sample birth plans online that contain outdated information. If you present a birth plan with preferences relating to procedures that providers no longer utilize shows that you really didn’t do your homework. As a rule of thumb, if you see a sample birth plan that mentions shaving your pubic area or getting an enema, don’t use that as a template. Those are outdated practices that, thankfully, are no longer utilized.

I also recommend against using a checklist-style template. This may seem like a quick and easy way to complete your birth plan, but it also looks like you didn’t put a lot of work or effort into it. If you want your care provider and other staff to take your birth plan seriously, you should be able to show that you took it seriously and spent more than five minutes checking some boxes.

Your Birth Plan Contains Too Much Information

When creating your birth plan, it may seem like there are so many things to include that it will be several pages long. Hopefully, you have been working with your midwife or doctor throughout your prenatal care, and you are on the same page about your plan. You will provide copies of your birth plan to additional support staff present during your labor. Nurses, doctors, and hospital staff are busy and have many other patients. No one wants to spend a long time sifting through several pages of requests. Not only will they miss some of the things you have listed. They may miss the items that are really important to you.

You need to edit your birth plan down to make it concise, and it should be a maximum of one page, printed on one side only. You can shorten long-winded birth plans by taking out duplicate information and information or requests that are not necessary.

Your Birth Plan is the Wrong Tone

Your birth plan is not a list of demands. Respectfully striking the right tone can go a long way. This is especially true if you give a copy of your birth plan to someone with whom you do not have an existing relationship. A birth plan can create tension between you and your provider if they see it as you questioning their expertise or feel that you are unwilling to negotiate your plan if complications arise. Using a collaborative and respectful tone in how you word your birth plan can help set you up to work together towards the birth you want.

You Don’t Adapt Your Birth Plan to Changing Policies

COVID-19 brought some of the most drastic changes to prenatal care and birth policies in decades. Hospitals required masks during labor, limited visitors, and in extreme cases, partners and doulas could not attend births. Changes in hospital policies affected many mothers who had babies during the pandemic, and not all mothers prepared for these changes.

An analysis of birth plan alterations in response to COVID-19 found overall, 45.2% of participants reported changing some aspect of their birth plans because of COVID-19. Hopefully, we don’t have another global pandemic. If there is an event that changes hospital policies and procedures, you need to consider that when planning your birth. In the case of COVID-19, policies changed often. If you ever have questions about the policies of your care provider or the venue where you plan to give birth, please discuss them ahead of time with your care provider.

Your partner Doesn’t Know Your Birth Plan

Labor and birth can progress and change quickly, and your partner should know your birth plan and be able to advocate for you. Simply putting a sentence in writing does not guarantee doctors or midwives will follow it. Throughout your labor, it can be helpful to continue to advocate for the things you want. This is especially true as staffing shifts change and new medical staff is assigned to assist you. Your partner can be invaluable as an advocate for you. To fulfill this role, they need to know your birth plan inside and out. Having a hard copy is nice if they need to refer to it, but they should also understand it well.

You Do Not Have Room for Flexibility

A significant reason birth plans fail is that they do not leave room for flexibility or deviation from the desired plan. There are aspects of labor and birth that are not in your control. There is always the possibility that your birth will not go as planned, and deviating from your envisioned birth can impact your experience.

A small study interviewed women to explore how women develop and negotiate their initial birth plan and how subsequent changes made to the plan affect overall birth experiences. They found that positive and negative recollections of birth experiences are related more to feelings and exertion of choice and control than to specific details of the experience. Changes to a birth plan impacted overall birth experiences. The more drastic the changes, the more negative the experience. The researchers conclude that it is not simply the fact that the birth plan changed that leads to positive or negative feelings. It is the degree to which the initial plan is modified and, importantly, the degree of control that women have over the changes as they are happening.

You Don’t Have a Backup Plan

One way to prepare for the unexpected is to create a backup plan. If you plan for a vaginal birth, create a separate backup plan if you need a cesarean section. This serves a few functions. First, it allows you to keep your primary birth plan short without including a lot of other preferences relating to your backup plan. Second, it will enable you to explore your options if your birth does not go as planned. This lets you be more confident and prepared for an alternate labor and birth, giving you more control over procedures and interventions.

Without a backup plan, the minute your birth doesn’t go as you hoped, you are suddenly not in control of anything. When complications come up, you may not have time for an in-depth conversation to obtain adequate informed consent. Your care provider may not have the time to educate you about your options thoroughly. By creating a backup plan, you can do this work ahead of time, so if your birth doesn’t go as planned, you are still prepared and confident in your decisions.

Additional Research on Birth Plans

There are a few additional studies worth mentioning. A review of 13 studies spanning the globe had three big takeaways. First, the construction of the birth plan positively influences the delivery process and maternal-fetal outcomes. Second, unrealistic expectations can cause dissatisfaction with the delivery experience. Third, caregivers play a crucial role in supporting and performing the Birth Plans.

One study compared obstetric and neonatal outcomes between women with and without birth plans. Mothers with birth plans tend to be older, better educated, and have a higher employment rate. Cesarean sections were less common in primiparous women with birth plans (18% vs. 29%). There were no significant differences in instrumented births, 3rd–4th-degree tears, or episiotomy rates. Newborns of women with birth plans obtained better results on 1 min Apgar scores, umbilical cord pH, and advanced neonatal resuscitation. This study took place in Spain, where a health initiative in 2007 encouraged the use of birth plans.

A systematic review concluded that there is insufficient evidence to support or refute that a birth plan can improve the birth experience or satisfaction with the birth. This study examined three clinical trials of 1,132 women in Egypt, Sweden, and Taiwan. There is a big difference by country in medical professionals’ attitudes and maternity care.

There is a clinical trial underway to investigate the effect of implementing the birth plan on the childbirth experience of women as well as other maternal and neonatal outcomes. Unfortunately, the results of this study have not been released yet.

Overall, there isn’t one study with fantastic data on the benefits or downsides of having a birth plan. We do know a lot by looking at all of the research together. No doubt working with your care provider to plan your birth is beneficial, whether or not you end up with a written birth plan. Hopefully, we will see more research on the effects of implementing birth plans in the future.

Should You Make a Birth Plan?

The decision to create a birth plan depends on the level of involvement you want in your labor and birth experience. Some expecting parents are comfortable letting their doctor or midwife make all of the decisions. If you want to know your options and be involved in the decisions that drive your birth experience and how your child is brought into the world, creating a birth plan is necessary.

The Pros of Creating a Birth Plan

It takes time and effort to create a birth plan. To have a successful birth plan, you also need to involve your partner, doctor or midwife, doula, or anyone else supporting you during labor. There are many benefits to putting in the work to create a solid birth plan.

• You will understand everything that can impact your labor and birth. 
• You will be on the same page as your care provider, partner, and anyone else who will be by your side when you give birth. 
• You will be confident in the decisions you are making and confident in your ability to have the birth experience you want. 
• You will be prepared for whatever happens on the magical day that you get to meet your baby, even if things do not go as you envision. 

The bottom line is that the more preparation that goes into your birth, the more you can be in control of your experience and how your baby enters the world. A birth plan allows you to make choices. You get to choose where you want to have your baby, who you want to be there, what procedures are done to you, and what procedures are done to your baby. If you don’t make these choices, someone else will make them. You know your body, lifestyle, preferences, and priorities better than anyone. How the birth goes and how you and your baby experience it directly result from your planning ahead. 

Putting Success and Failure in Perspective All you can do is prepare and make the best decisions with the information you have. There is always the possibility that your birth will not go exactly as you hope. No one fails at giving birth. In some cases, complications come up, and things go wrong, but that is usually out of everyone’s control. Through this podcast, I know from helping thousands of expecting moms that birth plans are an excellent way to prepare and go into your birth feeling confident and ultimately will get you closer to your ideal birth experience.

Thank you to the amazing companies that have supported this episode.