When I was pregnant with Little Jacks, my OB dutifully asked me if I had a birth plan.  I said, “Yup!” and I could see the nearly imperceptible cringe that fleeted across her face.  You wouldn’t have even picked up on it if you weren’t in on the whole story.  She said, “Tell me a little bit about it.”  I said, “I want as many drugs as necessary to keep me comfortable and a C-section the first moment it seems necessary.  Other than that, we’ll just plan to get this baby out however you see fit.”

She practically deflated with relief and even giggled a little.  Then she said, “You and I are going to get along just fine!”

You see, there’s a secret that I’m going to share with you.  Maybe you already know it.  It’s not meant to hurt any feelings, but rather to show what you don’t see from your own view of the delivery room.  Almost uniformly, medical professionals dread the birth plan. And not just a little bit.  I have lived on both sides of the birth plan, and I can tell you from the medical standpoint, feelings about them aren’t warm and fuzzy.  In fact, if your birth plan is longer than a page, is printed in more than 1 color, or is laminated in any way, we strongly believe it is a predictor for complications and/or C-section.  We’re a superstitious bunch!  I also think that it might be a tip-off to some nurses that the patient she’s about to care for during the next several hours might be high-maintenance (despite the fact that perfectly reasonable, lovely women might compulsively plan their birth experiences).  I’ve heard plenty of nurses joking about 6 page birth plans while most OBs and some mid-wives try to ignore them as much as possible.  I’ve seen a few nurse lounges with fake birth plans on the wall that mock some of the more outlandish patient requests.  Again, I don’t say this to hurt your feelings or scare you.  I just want you to be in on the realities of how a birth plan is received by your team.

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I got up the courage to write this post when I had a conversation about birth plans with Mr. Jacks’ cousin.  She’s a nurse mid-wife and generally in the more touchy-feely, granola, home birth crowd, so I was surprised when she said that she does not care for birth plans either.   Additionally, my sister is a labor and delivery/nursery nurse.  I’ve heard some pretty good birth plan stories from her, as well.  I figured if the sentiment extends to the most in tune and sensitive professionals, then I should definitely share with the hive.

First, please understand what your medical professionals already know.  Birth plans are not actually a plan for what is going to happen during your birth experience.  Birth is fraught with lots of unknown and unpredictable issues.  If you read the various birth stories here, you know that sometimes individuals who plan for an unmedicated natural birth end up with a C-section for unavoidable circumstances.  On the flip side, last week a friend of mine went in to deliver her baby and wanted an epidural.  Instead, her baby had other ideas and was born just minutes after she arrived at the hospital.  She ended up with an unmedicated natural birth despite her wishes (though she feels pretty awesome about it now!).  So to the medical professional who has seen it all, it may seem like you are trying to control the uncontrollable… and therefore you are tempting fate.

Secondly, you will want to have your nurse and your doctor or midwife in the room with you as much as possible attending to your every need.  The way to get that to happen best is to avoid being seen as the “difficult patient.”  Now I know this may be upsetting to hear, since you are the medical consumer and you have every right to control your experience and your body to the extent that it is possible.  (In fact, my research career centers around provider patient communication, including how providers should reframe their perception of the “difficult patient”… but that’s a story for a different day).

You want your team to see you as the “easy” patient, since “difficult” patients usually get less face to face time, and arguably decreased quality of care.  Bringing a complicated birth plan is like wearing a t-shirt that says “I might be difficult.”  Rather than having to regain favor with your nurse, it’s better to start off with a blank slate and a happy nurse — she can make or break your experience!

Thirdly, a complicated birth plan might signal a lack of trust in your team.  We’ve all seen The Business of Being Born.  We could debate the relative accuracies and inaccuracies of the portrayal of OBs in NYC and the distinct viewpoint that it originates from.  I watched it and it even scared the bejeezus out of me despite my relative comfort with the medical system around birth.  Still, by and large, your OB or midwife wants the best possible outcome and experience for you and your baby.  I’ve heard a few comments from OBs along the lines of “Doesn’t my patient trust me?” when looking at a birth plan.  You want your birth plan to portray confidence in your team and not read like a list of demands.

Does this mean that I’m anti-birth plan?  Not entirely.  Mr. Jacks’ cousin put it best: she wants her clients to go through the exercise of developing a birth plan in the third trimester… not to be used as a road map to the labor and delivery, but to be used as a learning tool in researching and understanding the possible options that can be used during the birth process.  Ideally,  it would be something that you discuss with your provider towards the end of pregnancy, they would remember the discussion, and no actual paper copy would ever materialize during the birth process… but we all know this isn’t an ideal world.

So what would the ideal birth plan look like to your provider team, in the event that you decide to create one?

1.  Keep it simple.  1 page or less is optimal.  Lots of white space on that one page is even better.  OBs and midwives are really busy, so get right to the point.

2. Convey the absolute necessities.  If you have a religious tradition that should be followed during the birth process or lost a previous baby at delivery, absolutely share your requests around these issues.  But don’t sweat the small stuff.  If you find yourself writing about ice chips, hard candies, yoga balls, aromatherapy or music (all things I’ve seen in birthplans), you might want to re-think including it in the plan.

3. Avoid multiple copies, colors, bold, glossy lamination, plastic protector sheets or anything that says you spent weeks preparing the document.  These are high maintenance signals that you don’t want to send.

4. If you want a natural, unmedicated birth, your provider should know that beforehand, and was hopefully picked with this in mind.  Please understand that pitocin, pain meds, instruments, and resuscitation delaying skin to skin and breastfeeding may be necessary.  Delayed cord clamping may not be possible.  Instead of creating a laundry list of your desires, show your flexibility around the individuality of each birth experience.

5. If you are afraid that you actually will be high maintenance (like I secretly thought I might be!), employ a doula.  They can run interference for you, be the bad guy, and act as keeper of the birth plan while you remain easy to work with.  I had Mr. Jacks’ cousin with me.  She knew that despite the birth plan that I conveyed to my OB, that I would prefer to labor down, avoid episiotomy and avoid augmented labor (pitocin) if possible.  It turned out that she never actually had to talk about any of my wishes because my team was also trying to avoid these interventions.  When pitocin became necessary, I trusted my doc and went with it.  Turns out, it was exactly what I needed!

So there you have it, a backstage pass to the medical professional’s thoughts on birth plans.  I hope you see this as a helpful tool and not a monolithic criticism of the birth plan. If you view your birth plan as a learning and collaboration tool, you’ll be using it in a way that is most helpful to your team, and therefore most helpful to you.  Remember that we’re all in this together and that we all want to achieve the same goal– a healthy mother baby pair!

Hellobee Series: Mrs. Jacks part 7 of 12

1. Attachment Parenting: One strategy by Mrs. Jacks
2. School is now in session! by Mrs. Jacks
3. Babywearing 101: Inward or outward facing? by Mrs. Jacks
4. My baby's head is flat! What's the deal with plagiocephaly? by Mrs. Jacks
5. Responsible media viewing by Mrs. Jacks
6. What to do when your baby goes on bottle strike by Mrs. Jacks
7. Birth plans: the other side of the story by Mrs. Jacks
8. Beyond colic: milk/soy protein intolerance by Mrs. Jacks
9. Cracking the code on toddler tantrums by Mrs. Jacks
10. Talking with children about race by Mrs. Jacks
11. Toddler eating habits cause parental grey hair by Mrs. Jacks
12. A warm winter treat by Mrs. Jacks