Birth Plans: One Doctor's Point of View - Kamm McKenzie OBGYN

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Birth Plans: One Doctor’s Point of View

Originally written and published by Dr. Bernstien in 2015

Most of our patients have some sort of birth plan.  Some are super simple and others are ten pages long.  Some patients don’t even write it down.  They just tell me “Dr. B, we just want a healthy mom and a healthy baby.”  Most patients who do write their birth plans have similar ideas such as:

  • I prefer not to be induced.
  • I would like as natural a childbirth as possible.
  • I prefer no Pitocin, but if I need Pitocin, I would like the provider to explain why that intervention is needed.
  • If I want pain medications, I will ask for them.
  • I would like to be able to move around as much as possible.
  • I would like intermittent monitoring.
  • I would like to eat.
  • I would like to push in different positions besides just on my back.
  • I do not want an episiotomy.
  • I do not want a vacuum or forceps delivery, but if it is deemed necessary, I would like the provider to explain the situation to me in detail.
  • I do not want a c-section, but if I have to have one, I would like my partner to be in the operating room with me.
  • I want my baby skin-to-skin right away.
  • I want delayed cord clamping.

Believe me, this list covers about 95% of all birth plans. As one of your providers, I can promise you that if I had my choice, 100% of patients would arrive in very active labor, require no Pitocin, have clear amniotic fluid, and would quickly push a baby out that was showing no signs of distress on its fetal heart rate monitoring.  This would make your birthing experience wonderful for all of us.  Unfortunately, this is not always the case.  Sometimes induction of labor is considered the safest intervention for mom and/or baby. Sometimes labor stalls out and adding Pitocin can lead to the goal of vaginal birth with higher success. AND if Pitocin is needed, it is hospital policy to have continuous monitoring.  Sometimes your baby has meconium-stained fluid and will need to have immediate suctioning by the pediatricians rather than direct skin-to-skin. Sometimes the baby is showing signs of distress requiring a c-section or operative vaginal delivery (vacuum or forceps). Our providers are going to be with you along the ride and are going to explain our recommendations. But please know we are in no way trying to compromise your desires according to whatever plan you have created. We are all on the same team, with the same goal of a healthy mom and healthy baby. 

So why do people make a birth plan? To me, the main purpose of a birth plan is patient education. For those of you who are unaware of interventions that can possibly occur during labor and delivery, researching for a birth plan can often enlighten you.  But please be careful. A birth plan by definition has some rigidity to it, as it is a “plan”.  Labor and delivery, on the other hand, is a fluid process that doesn’t always follow a straight line. To be satisfied with your experience, you should try to allow some flexibility to what you consider your ideal labor, just in case things don’t go 100% according to your plan. In return, we will do our best to stick to your plan to the best of our abilities.

One of my friends who lives out of state told me that during her hospital labor and delivery class, she and her husband had to create a birth plan as part of their homework assignment.  When they arrived at their class the next week the teacher (a doula I believe) asked everyone to pull out their birth plans.  She then made each couple tear up their plan, a way to symbolize that the birthing process may not always go as planned. My friend told me she enjoyed the experience of learning what was available during labor and what her preferences would be, and also appreciated the honesty of the doula. 

Having recently experienced labor and delivery and 7 months of fatherhood for the first time, let me leave you with one more piece of advice. The labor and delivery process is a very small window in the time of caring for your new baby. I felt that I would have benefited more from a “post-birth plan” than a birth plan. I would have loved to have researched and learned about goals and expectations to set with regards to raising a newborn, keeping my married life healthy, balancing my career with being a father, etc. These things ultimately will have more impact on our life than the 18 hours we spent in room 25 on L&D. A similar analogy would be the amount of time, planning, and effort that goes into the wedding day rather than focusing on a healthy relationship for the rest of your life. 

In closing, we are here to make your experience as close to ideal for you as possible.  We hope your birthing experience goes according to your plan.  But please know that any interventions we suggest are being done in the best interest of your health and that of your baby.

P.S.  For those of you who would like us to review your birth plan, please bring it with you on the day you come into labor and delivery.  There is no need to review it with your provider in the office.

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