When preparing for the birth of her third baby, Grace Greene of Jackson, Mississippi, had every reason to believe that her planned home birth would go smoothly. She had delivered her second child at home with no complications and was familiar with the process.
“I went to my 40-week appointment and everything checked out perfectly,” Greene told HuffPost.
But her plans changed drastically before contractions even began.
“A few days after that appointment, I woke up and noticed my baby wasn’t moving,” said Greene. She headed into the hospital for monitoring, where she learned that the baby had no measurable amniotic fluid and that labor would need to be induced.
“At that point, my birth plan completely changed because he needed to be born quickly,” Greene said.
“I felt overwhelmed at the severity of the situation and the speed at which everything happened,” she said. “After I gave birth, I began to learn more about fetal movement and realized what a close call it was when he had stopped moving. The more I learned, the more I realized how necessary it was to change plans.”
Greene said that over time she “learned to sit with the tension of thankfulness over the outcome coupled with disappointment for not having the birth experience I had hoped for.”
Though not all changes to a birth plan are so dramatic, they are common. Most births include at least one element of surprise, and it may or may not be a welcome one.
Given that birth is so likely to veer from the plan, what is the point of making a plan to begin with? And how receptive are providers to birth plans, anyway?
Writing a birth plan is a meaningful exercise in itself
If you’ve been avoiding thinking about your impending birth because it scares you, writing a birth plan can give you an opportunity to work through some of those fears. And if you can hardly bring yourself to think of anything else as the big day approaches, writing your birth plan can bring you peace of mind that all of your caregivers will know what your preferences are.
“I love the process of the birth plan,” said Mandy Irby, a former labor and delivery nurse who currently works as a childbirth and nurse educator in Virginia.
That process, she said, involves “listening to your intuition about what choices you might make or what you might want your experience to look and feel like. And you’re going to find competing ideas.”
Though you may write out a longer version for yourself, your partner, and perhaps your doula (if you’ve hired one), Irby suggest keeping the version that you bring the hospital “short and sweet, one page, so everyone can read it.”
In talking over your birth plan with your provider, you may find that you can omit a number of things.
Maureen Hodges, a labor and delivery nurse who is training to become a certified nurse-midwife, explained that some preferences are likely to be the standard of care at hospitals, so you don’t need to specify in your birth plan that you want them. These include skin-to-skin contact after delivery, delayed cord clamping, breastfeeding assistance and having a doula or support person accompany you to the operating room if you have a cesarean section.
Hodges mentioned, too, that she sees many birth plans indicating people don’t want intravenous fluids, which are also standard in a hospital setting — although you may be able to get a saline lock, which allows for quick access to a vein without tethering you to an IV pole. This is exactly the kind of thing that writing a birth plan will force you to consider and discuss with your provider when you share it with them.
Your birth plan is an opportunity to connect with your providers
It’s one of the most important days of your life, but to the doctors, midwives or nurses caring for you, it’s simply Tuesday. A birth plan is an opportunity to present yourself as an individual with your own story, knowing you will help them care for you better.
Rather than approaching it as a checklist of preferences, like items on a menu, Irby suggests using your birth plan to communicate something personal. She calls this the “connection section” of the birth plan.
If you write, for example, your baby’s name and explain that they’re a rainbow baby you’ve been waiting years for, you’ve gone from being the induction in Room 3 to a complete person with your own history.
Though your nurses will meet you and read your birth plan for the first time when you arrive at labor and delivery, your provider should have seen the plan before.
“Discuss your birth preferences with your provider in your second trimester, and then discuss specifics with them during your weekly prenatal visits from 36-40 weeks pregnant,” Hodges advised.
“Your provider should be interested in explaining their usual practices to you, as well as hospital policy,” she said. “It’s a warning sign that your provider and you might not be a good match if you feel dismissed when discussing your birth preferences.”
— Margaret Russell, MD, MA, AAHIVS (@Margaret1473) June 19, 2022
Sometimes they want things that aren't realistic - but better to talk about that before everything is too intense to have a calm and coherent conversation.
A birth plan is a gift of insight into the patient's expectations and values regarding birth #ReproductiveJustice
It’s good practice in advocating for yourself
For many people, delivering a baby is their first time staying in a hospital. You may not have had a lot of previous interactions with health care providers, and it’s normal to feel somewhat intimidated by their expertise. But no one knows your body like you do, and writing a birth plan gives you the opportunity to practice communicating your preferences and needs.
In an emergency situation, such self-advocacy can be lifesaving. Articulating your own needs also prepares you for your new role: “a parent who’s going to have to advocate for this tiny human forever,” Irby said.
Because they often end up changing, birth plans sometimes get a bad rap and the occasional eye roll from a provider. Medical professionals are prone to “bristle,” Hodges said, when they read a birth plan full of “I don’t want this” and “Do not,” which she believes indicate “a distrust of the hospital birth setting.”
Rather than writing down a list of demands, use your birth plan to let your providers learn something about you that they won’t see on your medical chart. Perhaps you need to inform them of your partner’s pronouns or explain that it would help you if they ask for permission to touch you before every examination. You might let them know that you’re afraid of hospitals and are hoping dim lighting will help you forget where you are.
No matter how your birth story unfolds, advocating for your family’s needs can help you feel a sense of control.
Even an unplanned C-section, which Hodges said she often sees mentioned in birth plans as “a terrible last resort,” can be a “necessary, lovely, family-centered, joyous experience.” When you’ve communicated your needs and you trust your provider, it will be easier to accept a change in your birth plan and move forward without regret.