Creating a birth plan is an important part of preparing for your baby’s arrival, and most women make their plan after a lot of thought, research, and discussions with their healthcare provider. While you may be very certain about the decisions you record in your birth plan, the document isn’t legally binding on you or your providers. So how can you be sure to get the type of care you want, and stand up for your rights during labor and delivery?
Being specific, but also flexible
Amy Poehler shared a copy of her “birth plan” in her book, Yes, Please. Regarding what she wanted in the hospital room, she wrote, “the mother would also like a punching bag, a screaming pillow, a mirror to smash, and a small handgun. The father would like a George Foreman grill, just to have.” While Poehler’s plan was clearly tongue-in-cheek, most birth plans are designed to provide just that kind of detailed information, ensuring healthcare providers understand a mother-to-be’s wishes related to labor and delivery.
A well-thought-out birth plan is many things at once: a document that reflects a mother’s requests; an outline preparing for contingencies and providing information for medical professionals; a written reflection of the mother’s birth philosophies. However, it’s important to understand that the document is not binding—on either party.
At any point during labor and delivery, the medical professionals might have to make decisions contrary to the wishes expressed in the plan. By the same token, a mother is always free to change her mind from what she wrote in her birth plan.
As an example of how important that flexibility is, the Journal of Midwifery and Women’s Health looked at outcomes related to anesthesia for women who had birth plans. In a survey, the majority of women agreed that “the birth plan enhanced their birth experiences, added control, clarified their thoughts, and improved communication.” The results were the same, regardless of whether the use of anesthesia during the birthing process reflected what the mother had documented in her birth plan or not.
In other words, freeing both the mother and the medical team from rigid requirements generally produces positive outcomes.
Medical directive
Birth plans can play an important role similar to a living will. The birth of a baby and end-of-life decision-making might seem like polar opposites, but there are similarities in the planning and drafting of these documents. Both state a person’s desires regarding their medical treatment, should they lose the ability to provide consent or refuse treatment.
Nanya C. Philipsen and Dorothy Hayes, both attorneys and registered nurses, addressed the similarities in The Journal of Perinatal Education. Philipsen and Hayes explain that routine protocols at the hospital are important to maintain a certain standard of care, but patients, including mothers-to-be, have a right to refuse standard protocols in non-emergency situations. “Written birth plans and living wills are health-care directives—both of which are active responses and can become part of the ‘medical record’ at our request,” they write.
A birth plan is a tool. It is not a solution to all problems or contingencies.
Practical advice
Legal issues regarding the binding nature of birth plans aside, mothers and their partners and families can take some practical steps to establish a successful birth plan:
Use the birth plan as a catalyst for conversation
The process of developing a birth plan presents an opportunity for the mother-to-be to discuss her wishes, fears, anxieties, and questions. By using it as a tool for clear communication, she can be assured that her team of family, supporters, and medical providers all understand her wishes regarding medication, medical procedures, personal care, and more during labor and after delivery of the baby.
Focus on positives
“Don’t” commands in birth plans set the wrong tone, which can affect your care,” explains Dr. Aaron Caughey, the chair of the department of obstetrics and gynecology at Oregon Health and Science University’s School of Medicine, in U.S. News & World Report.
In other words, no one, particularly highly trained and skilled medical professionals who want to deliver your baby safely, will respond well to a negatively-worded birth plan. Focus on what you do want, and keep the tone as clear and positive as possible.
Pack your patience and your flexibility in your hospital bag
Be prepared for the unexpected: no matter how solid your plan is, don’t be surprised if things change. Circumstances may make some of the items in the birth plan impossible or impractical. Focus on making good decisions for yourself and your baby.
Speak up
A birth plan is not a replacement for asking questions and standing up for your rights as a patient. Be an advocate for your own care and your baby’s care. This is another reason why it’s important to discuss your birth plan with your physician, family, and support team. Being as informed of your desires ahead of time will help everyone make better choices throughout the labor and delivery process.
