Why the birth plan blows up in your face

I was in a certification training course just this week for labor and delivery and nursery nurses.  Our instructor smiles during one of the lectures and says “Who knows what a birth plan really means?” and we all smiled and yelled “C-Section!” Which, I am afraid happens more often than it doesn’t for many moms who come in packing that dreaded sheet of paper…

I know, you have it all planned out in your head–you’ve followed all the online guides to the T and you’ve written it all down, discussed it with your birth coach and had it signed by your doctor. But honestly girls, that birth plan means squat to your nurse when you are in labor.  It’s a bit of a soapbox for me, but listen to me closely…if you don’t want to me monitored, don’t want your water broken, don’t want Pitocin (can’t say I blame you there though) and want to deliver hanging from the light fixtures, then don’t come to a hospital to have your baby. Instead, seek out a birthing center, or do it at home with a trained midwife. I know, home births are quite risky and that’s another blog entirely, but hospitals and medical care that is delivered there is focused on prevention and treatment. Pregnancy is not an illness, I know that. But many people treat it as such. And I’m afraid many labor and delivery units are the same way–simply because they have to be prepared for anything.

Monitoring is essential to know when and if your baby goes south…and I don’t mean down toward your feet. I mean, there may be a complication that you won’t “just feel”–it  must be seen on a monitor and treated in order for you and your baby to have the best outcomes. You can have a plan if you must, but know and understand that those plans go straight out the window the minute something changes.  I can easily say that I have only cared for one or two mothers who actually had a birth that went according to their documents. Everyone else ended up with the most invasive, complication-riddled Cesarean Section you could imagine.  Their babies, that they wanted to have no bath, no vaccines and no invasive care ended up in the NICU on a vent and clinging to life–and it just happens.  Sure, we nurses joke about how freaky it is that it turns out that way, but it is very upsetting to parents who had their heart set on something completely different.

Birth plans are not really birth plans.  Confused? In reality, they are a mother’s attempt to maintain some sense of control in a situation when she has none.  Labor is one of the few events in life, aside from death that happens to us whether we are willing to go through it or not. And that’s really scary for a lot of women. I can absolutely see why having a birth plan might bring you a sense of reassurance and I hope for you that it works out that way.  (Am I a pessimist today or what?)

  • guest

    I have a lot of interest and passion about this topic, and especially now as an expectant mother myself, I really appreciate this blurb. You are right, labor is one of life’s “everything flies out the door” scenarios. However, I feel the need to comment and remind everyone that not everyone has the option of birthing at home, even if they planned for it. Insurance companies are not always cooperative to compensate for out of network midwives fees, even though it is significantly cheaper than being in the hospital. Also, many states and big metropolitan areas don’t even have birthing centers, which is crazy. (I live in Las Vegas and it’s either hospital and all the accompanying bs, or home.) I wanted to be at home, and chose to do so long before conceiving. Unfortunately, my unborn son has been  diagnosed with AV canal heart defect, and screened as being very high chance of having Down Syndrome. My midwife is amazing, along with my new-found OB, and everyone will be working together to make sure that I feel as in control as possible, given the circumstance. Grieving a dx is hard enough, but then having to grieve the loss of your desired birth plan, too is insult to injury. Medical professionals should really care enough to at least humor their patients and pretend to respect their wishes, even if they know chances are, it’s not going to end up going how they want it to. My concern is not the doctor, I mean he/she probably just breezes in for 5 minutes anyway! It’s the nurses and other staff at the hospital that concern me, for they do not know you or have that rapport, and have to emotionally distance themselves in that line of work, I would imagine, so yeah, why would they give a rat’s ass about your silly birth plan? I just hope, despite it all, that my plan is at least attempted to be adhered to and respected, as a paying “customer,” and that as few interventions as necessary are administered, just as I hope that for any of you expectant mommies out there, too!

  • Rachel

    You are exactly right–your birth plan should be honored as much as possible…no doubt about it. Where the rubber meets the road though, many parents come to the hospital expecting few interventions, and it’s just not always the “style” of the hosptial–as a nurse who works with mom’s just like you, I can honestly say that we care very much for you, and you’re baby (or we need a new career!!) but it is a two-edged sword in that the care we WANT to give is dictated by hosptial policies and the future possibility of a lawsuit–so we must protect our patients while also protecting ourselves, and the facility that we work in.

    My hope for you, is that your baby is born, and provided the best of care by understanding and compassionate nurses who give their best. Perhaps you may consider writing up an ammended birth plan–discuss your fetal monitoring requirements, IV wishes, activity, and bonding plan for after birth to accomodate your most important goals as well as the requirements of your hospital.

    I can’t stress enough the need to talk with your OB doctor, as he/she may be able to write orders in the chart for intermittant monitoring, walking during labor, and eating/drinking as necessary. Your nurses will be more likely to follow written orders.

    My very best to you for a healthy baby, and delivery. Thank you so much for your feedback.
    –Rachel