Should You Draw up a Birth Plan?

Birth Plan

My older daughter is 19 now, but I still remember writing a birth plan before she was born. Its main point: I wanted as few interventions as possible. I had a wonderful OB, who wasn’t defensive about the plan in the least and put it in my chart, which was a good thing, because she wasn’t on call when I delivered my daughter in the middle of the night.

I got my wish for no interventions, but I really don’t know whether my birth plan deserves all the credit. When I was pregnant with my second daughter two years later, I didn’t write a plan. I think I figured it wasn’t necessary because I had the same OB, although she had switched hospitals. Or maybe I was just too exhausted from caring for a toddler while pregnant. Even without a written plan, my second delivery went as smoothly as the first in half the time.

Was my experience typical for women with birth plans? Researchers at UCLA and Cedars-Sinai Medical Center in Los Angeles examined that question in a study of 109 pregnant women who arrived at the hospital in labor and holding a hard copy of their birth plan. The scientists identified 23 unique requests, the top two being no intravenous analgesia and exclusive breastfeeding, they report in the June issue of the journal Birth.

They found that the women most satisfied with their delivery had had the most birth plan requests fulfilled. That’s not exactly earth-shattering, if you ask me. On the other hand, women with a high number of requests in their birth plans were the least satisfied. Again, not exactly surprising, because, of course, having a ton of requests ups your chances of not getting requests fulfilled.

That might be because a jam-packed birth plan might contain a lot of requests that are unrealistic and impossible to fulfill, suggests a new article published online in the American Journal of Obstetrics and Gynecology.

Google “birth plan” and you’ll come up with a variety of checklists, handy templates for conveying your preferences for labor and delivery, as my colleague Dr. Diego Wyszynski wrote about recently. One problem, though, writes Anne Michelle Debaets, author of the new article, is that the checklists “frequently include both trivial and outdated considerations that do not reflect current practices or significant choices in care.”

In addition, those checklists typically don’t explain that you can’t have your cake and eat it, too, writes Debaets, an assistant professor in the department of biomedical sciences at Oakland University William Beaumont School of Medicine in Rochester, Mich. For example, she writes, if you prefer to walk around during labor, you can’t also choose to have continuous internal fetal monitoring.

And, Debaets notes, research suggests that birth plans might not have their desired effect of improving communication between pregnant patients and their doctors or midwives. “Some women feel that their values and choices are not respected, and providers (doctors or midwives) frequently believe that women come in with birth plans that are uninformed and unrealistic,” Debaets writes.

She suggests that women replace one-sided birth plans with “birth partnerships.” Early on in their pregnancy, women and their prenatal care providers need to start discussing their philosophies and practices surrounding birth to see if they’re a “good fit.”

Some obstetrical care providers plan for an extended visit around 34 to 36 weeks into the pregnancy at which to discuss women’s values and preferences related to labor and delivery and whether they’re realistic, Debaets writes. A birth partnership, she says, “can build trust and effective communication between patient and provider through a process of mutual education.

Rita Rubin
An ob-gyn's daughter and the mother of two teenage daughters, Rita Rubin has covered medicine ever since earning a BSJ from Northwestern. Based in Washington, D.C., Rita has written for WebMD, JAMA, POZ, and NBCNews.com and previously worked for USA TODAY. She has won numerous awards for her stories and authored What If I Have a C-Section? Rita earned an MA in writing from Johns Hopkins and spent a year as a fellow at the Harvard School of Public Health. You can follow her on Twitter @RitaRubin.

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