When Myndee Corkern got pregnant for the first time about seven years ago, her birth plan looked like this: Go to the hospital and have a baby. “I had no plans to do anything besides have the baby however that worked,” says the now-35-year-old mother of three in New Orleans. “Whatever needed to be done would be done.”
But after learning more about childbirth through online forums and discussions with her provider, Corkern realized she could have more control over the process by developing a birth plan – a document stipulating her desire for or against interventions such as pain relief and labor induction. A birth plan might also outline which family members and friends are welcome in the room, the desire for a tool like a birthing ball to make different positions more comfortable or requests for dim lighting or calming music.
“To me, a birth plan is a guide – an idea of how you want things to go, says Corkern, a social media coordinator and writer for the New Orleans Moms Blog. “Just like when you go on vacation, you make plans. The car might break down on the way there, but that doesn’t mean you don’t make a plan.”
Research and expert opinions on the value of birth plans are mixed. On one hand, the plans can help women gain a sense of control over the process, clarify their thoughts and improve communication with their providers, research shows.
“Having babies is something most of us are only going to get to do a handful of times, maybe fewer … and so it’s probably worthwhile to think about the process,” says Dr. Aaron Caughey, chair of the department of obstetrics and gynecology at Oregon Health and Science University’s School of Medicine. “We generally think that allows you to frame the experience.”
Birth plans can also help you and your partner think through decisions before you’re under the influence of, say, strong pain medications, Caughey adds. “That’s not the time to be making decisions like, ‘I don’t want my brother-in-law in the room, but I’m fine with my father,'” he says.
On the other hand, research suggests birth plans don’t lead to any better outcomes for moms or babies. They can also create false expectations among women and provoke irritation among providers, midwives reported in a 2014 study in the journal Midwifery.
“The term ‘birth plan’ can raise the hair on the backs of providers only because professionals know that a lot of different things can happen,” says Catherine Ruhl, a certified nurse-midwife and director of Women’s Health Programs for the Association of Women’s Health, Obstetric, and Neonatal Nurses. “It’s a road uncharted.”
If you choose to create a map, beware these common road bumps:
A birth plan should be the result of ongoing discussions with your doctor or midwife – not a document sprung upon them when you go into labor. “Before the woman shows up with a plan in hand, she should first have a conversation [with her provider] that goes along the lines of, ‘I’ve done a lot of reading and there are some things that are really important to me that I’d like to discuss with you,'” Ruhl says.
If you’re delivering at a hospital, Ruhl also suggests scheduling a meeting with a nurse manager in the birth unit to discuss your potential plan with him or her. Your provider may support certain aspects of your plan that the facility or medical team does not. “Find out if those things are also possible for the hospital,” Ruhl says.
Your partner or other supporter should also be involved in the process from day one, says Eileen Ehudin Beard, senior practice advisor at the American College of Nurse-Midwives. “If you’re in a situation where you really need to pull from the plan things that are important to you, your partner can advocate,” she says.
2. A Carbon Copy
Though women have thought about how they’d like their childbirth to go for years, they now often turn to the Internet to copy and paste points from other people’s plans, Ruhl says. That’s “a detriment,” she says, since women might not always know what they’re requesting or have a good reason for it. “You don’t want to put in anything that you don’t understand fully what it means … and you don’t want to put in things that don’t really matter to you,” Ruhl says.
3. The Word “Don’t”
“Don’t offer me an epidural.” “Don’t induce labor.” “Don’t give the baby formula after birth.” “Don’t” commands in birth plans set the wrong tone, which can affect your care, Caughey says. “If you come into that experience thinking about it with the wrong frame, it’s going to produce a negative result no matter what you do,” he says.
In an emergency, for instance, the team needs to act fast. “What you don’t want is for people to tiptoe around you and to slowly approach an emergency because they’re worried about how you’ll respond,” Caughey says. “One of the dangers of the ‘don’t’ birth plan is it scares people away from wanting to take care of you.”
Instead, phrase your plan more positively – “I’d like to labor without medications for as long as medically possible,” “Please explain any nonemergency interventions to me before performing them,” or “Please bring positive energy to our experience,” for instance – and remember the providers are rooting for you.
“Recognize that most people who care for women in labor … are doing it because they’re really committed to birth and committed to pregnant women,” Caughey says. “We want your experience to be good.”
4. Extra Pages
Just like a Christmas wish list, a birth plan should highlight a few items you really want – not a scroll of items you kind of want. “You don’t go onto Amazon and check off 132 items. Santa’s not bringing you 132 items,” says Caughey, who’s seen birth plans as long as eight pages. “My suggestion is you prioritize.”
One effective way to do that is by writing down the two or three things that are most important to you – be it having a birth with as few medical interventions as possible or as quickly and painlessly as possible. Leave the nitty-gritty details of medical management to your care team, Caughey says.
“It’s almost wrong to call it a birth plan,” Ruhl adds. “It’s an idea of what, from your reading, you’ve realized what matters to you.”
One of his patients who had planned a medication-free birth, for instance, wound up requesting an epidural – and apologizing profusely to her husband. “Because they had made plan and she wasn’t sticking too it, she was quote-unquote ‘a failure,'” Caughey says. “That I think is a dangerous proposition.”
While more rigid plans tend to lead to more disappointed women, the reverse is true too:
“The women who tend to come out with the very most surprised and delighted kinds of outcomes are the ones who really have very open minds,” Ruhl says. In fact, one study found that 50 percent of women who wrote birth plans wanted to avoid an epidural, but 65 percent of them ended up receiving one. In retrospect, 90 percent of the women who got the drug were happy about it.
Corkern, for one, doesn’t regret deviating from her first birth plan, which requested as few medical interventions as possible. When she still wasn’t in labor several hours after her water broke, she agreed to Pitocin, the drug used to induce labor. After enduring painful contractions for six hours, she requested an epidural. Thirty minutes later, her daughter was born. Corkern has since had two births without any medical interventions.
“Even though the birth didn’t go according to plan,” she says, “to me, it was still very worth it because then you have a guide and you have a starting point.”