Birth Plans: Do they work?

So you have a Birth Plan signed by your carefully chosen care provider: All set, right? Well… maybe not… because: Who’s on call?

Here are some thoughts about what Birth Plans DO and what they DON’T DO:

Birth Plans DO provide a tool for communication between you and the many people involved in your care: your partner, your support team, your doula, your care provider. Then, when you are in labor, the birth plan communicates your plans to your nurses AND the care provider on call at that time.

Creating your personal Birth Plan offers a great opportunity for you to learn about and discuss different birthing options with your support team/partner/doula. It’s a great way to figure out what is important to you, and figure out what options fit your values about birth.

Discussing the Birth Plan with your care provider helps you balance your preferences with the needs that go with your personal health profile. This discussion also helps you discover if your health care provider shares your values about birth, and is comfortable with the choices you want to make.

When you are in labor, the Birth Plan is a great way to let your nurses know what you prefer, what you have prepared for, and how you want your birth to go. The Birth Plan also helps the nurses communicate your preferences to the care provider on call, especially if this is not the person you have been seeing during your pregnancy.

On the other hand: Birth Plans DO NOT GUARANTEE what options will be available to you during your actual labor and birth. Here’s why:

1. Labor is unpredictable, and sometimes interventions are necessary. For example, your signed Birth Plan may call for intermittent monitoring and a saline lock, both safe options for most normal labors. Then, one day, just after your due date, your water may release (SPROM: Spontaneous Rupture of Membranes), and even after waiting a while, maybe no contractions will start. If an induction is needed to get labor going; continuous monitoring and an IV will probably be necessary in order to keep your labor safe and to stimulate contractions.
2. It all depends on who’s on call. If you labor and also give birth during regular business hours, it is likely your chosen care provider will be available and will come see you during labor and attend your birth. So Monday-Friday, 7am to 5pm (more or less), you’re good. But most labors take longer than an 8 hour work day. And babies don’t know or care what time of day it is or even what day of the week. When labor starts on its own, most human babies are actually born during the night shift, when there are fewer people around and it’s quiet and dark outside. That’s because humans like to give birth in privacy, and less people are around to bug you during the night. But that means that there is a good chance, if you don’t get induced, that your chosen care provider will NOT be the person directing your care during labor and birth. So who’s on call? And is that care provider comfortable with the Birth Plan you created with your care provider?

During labor, it’s the care provider on call who makes care decisions based on his/her comfort level, training and birth philosophy.
 
So what do you do? During prenatal visits: talk to your care provider about their call schedule. Ask them if the other care providers with whom they share call will respect your birth plan as written. What parts will they be OK with, what parts may raise some issues?

If you are not getting the answers you prefer, you might want to see if another care group better meets your needs.

Not sure what to put on a Birth Plan? Our comprehensive childbirth classes can help you decide what’s important to you.