Should I Write A Birth Plan?

By Dr. Brooke Kalanick

Sitting on a Chucks pad because I was peeing a little with every single contraction.

Getting so dehydrated that I needed two bags of saline before I could start speaking in complete sentences again.

Laboring for 27 hours, stuck at 4 centimeters, and ultimately needing what felt like all the Pitocin the hospital had in stock.

birthplan-aromatherapy-450x298None of this was in my “birth plan.” I’d wanted a natural, non-medicated, beautifully candlelit birth with my first daughter, and I had the three-page birth plan to ensure it would all happened that way.

Being that New York City has among the highest C-section rates in the country and my doctor had been repeatedly described as "knife-happy" in her online reviews, not only did I want to make my wishes very clear for what type of music would be playing in my room, I was terrified of getting swept away in a big Manhattan hospital for an unnecessary C-section.

For me, having a birth plan was an attempt to control a situation that I dreaded would be out of my control.

As my birth experience started going down a path far from my ideal scenario, I lay there with an epidural I my spine and an IV in my hand. I turned to my husband Joe and said, “I feel weak and like a total failure.” He replied, “Like Mike Tyson said, 'Everyone’s got a plan until you get punched in the face.' ”

Therein lies one of the downsides to having a birth plan.

birthplan-brookejoehospital-450x300No mother needs one more reason to feel like she’s doing a slack job. Trying to control a situation like birth is like trying to wrangle a tornado: impossible. It’s completely human to feel the need to control a situation as overwhelming and rightfully scary as giving birth, but an overly detailed plan can give you a false sense of control and take you away from being present in this incredible, I’m-so-blessed-to-have-done-it-twice, life-changing experience.

All that said, I’m actually still a huge fan of the birth plan—or at least the possibility of what it can be—and I help women in my practice write them on a regular basis. Are you surprised?

Well, for starters, I call them Birth Preferences instead of Birth Plans.

In my personal experience, as well as talking with many other mothers, what we really want during our birth experience (besides a healthy baby, of course!) is more about power and choice than it is about control.

We want a say in how we are cared for. We want to have a sense—barring an emergency, in which case we put our faith in our OBs—that we have played a role in the many decisions made every step of the way, from the start of labor to the delivery.

birthplan-joebrookebaby-450x338Thinking through the various situations that may arise during your labor and birth ahead of time can give your partner a more clear idea of how to support you and how to advocate for you should that become necessary. If done right, a birth plan or birth preferences sheet allows you to be more present, more relaxed, and less afraid because you’ve made many choices in advance.

The concept of the birth plan is very polarized. It seems there are two camps: the women like me, who tried to manage every detail, and those who say, “Pfft, you can’t control it, so skip the elaborate written plan, and don't be such a Type A!”

I believe there’s a middle ground that allows you to have a say in how your birth experience goes, while allowing you to let go of control and surrender to the experience a bit more. The middle ground is to forgo the step-by-step plan and opt for stating your birth preferences for your ideal scenario, then you're able to comfortably go with the flow on the big day.

While a blow-by-blow plan like this one from is just a click away, what I recommend instead is making a list of preferences that will lessen the stress of major decision-making during one of (if not the most) vulnerable experiences you’ll ever have.

By all means, discuss all of this with your OB well in advance. Troubleshoot or compromise if necessary. Some examples of Birth Preferences include:

  • If you’d prefer to labor without pain relief, state whether you want them to periodically offer it, or if you’ll ask if you change your mind and to not offer it.
  • If you’d like minimal vaginal exams to be performed and only by your OB (vs. additional residents, etc.)
  • If you’d prefer to deliver with or without an episiotomy.
  • If you want your baby placed on your chest immediately after birth, before any weighing or measuring, etc. takes place.
  • When and who you want to cut the cord.
  • What you want done with your placenta.

I recommend including important medical information even though it’s in your chart, such as medication allergies, latex sensitivities, Group B Strep positive/negative. I say this because I was repeatedly examined with a latex glove despite my latex allergy bracelet and the sign over my bed, and I was almost given an antibiotic I was allergic to. I was mid-pushing and could hardly get the words out to stop it! It can’t hurt to have everyone see this type of information multiple times.

birthplan-brooke-breastfeeding-450x300And of course, include how you want your newborn baby to be cared for. For example, if you are breastfeeding exclusively, request no formula or pacifiers be given. If you want to give baby their first bath or to have their initial exam in your room instead of the nursery, list it. Make it clear if you’d prefer to be woken up on a feeding schedule or to let you sleep, and you’ll feed baby only when they wake and cry. This info will be important for your postpartum nurses.

My advice is to put the most important preferences down on paper, along with the ones that will most likely involve medical staff. What probably does not need to be on your birth plan—like it was mine—is the fact that you want lavender essential oil rubbed on your temples while listening to Sera Cahoone. I recommend keeping your Birth Preference Sheet to a single page. This increases the likelihood that it will be read by the cast of nurses and hospital staff coming in and out of your room.

You can do all that other stuff to create your space (music, candles, massage, etc.), but it probably doesn’t need to be typed up. I was repeatedly frustrated with my first birth that not a single person who entered my room had read my Birth Plan taped to the door. I realize this may have just been my crowded NYC hospital, but they may have also seen the multi-page document and just rolled their eyes.

You shouldn’t give up your power for fear of someone rolling their eyes. If you feel that it’s important, get your most essential preferences down on paper.

From there, you can trust that you’ll know what to do at each juncture because you’ve thought it through already. Should conditions warrant it, you can comfortably place yourself in the care of your doctor while not feeling powerless. Having done it both ways, the stance of confidence and power I had the second time felt very different than the fear I felt the first time, trying to control every detail.

Still, even the best laid preferences can go out the window if your birth takes an unexpected turn. It is certainly possible during the very wide range of what’s normal for giving birth that you will be faced with some intense decisions. Should this arise, these questions will help keep you and your birth partner present and avoiding panic that can so easily occur. The stakes are high and medical lingo can sound scarier than it actually is.

When faced with big decisions during birth, be ready to ask these questions:

How much time to I have to make this choice?
This will help give you a sense of whether you have five minutes or five seconds.

What are all my options at this point?
If there is time, get all your options on the table so that you and your partner can more calmly make a decision, viewing all the choices in front of you.

If we do this, what other medical interventions may be needed?
Often, one procedure can increase the possibility of another procedure. If you had wanted a natural birth, this is where you start to feel things slipping out or your hands quickly. For example, if Pitocin is started, contractions are much more painful so an epidural is more likely. Another example is that epidurals can slow the progression of birth if given too early which may increase the likelihood of further intervention. Ask what chain of events this choice may set in motion, and then make your choice.

birthplan-brookesbaby-450x300If we don’t do this, what other medical interventions may be needed?
For example, if you don’t use instruments or assistance now, would you increase the chance of needing a C-Section? Or in my case, if I didn’t allow a small episiotomy cut I would’ve likely torn worse than I did (meaning a 2nd or 3rd degree tear like I had after my first, yeah, ouch!) which takes longer to heal, more scarring, etc.

No matter what you decide, Mamas, you’re doing a good job. You're doing your best to be thoughtful, strong, and healthy. You, of course, are trying to fulfill the wish of bringing a healthy, happy baby into the world. There are a million right ways to be a mom and to give birth, trust that you'll know which ones are right for you.

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About the author:  Dr. Brooke Kalanick

Dr. Brooke Kalanick earned her Doctorate in Naturopathic Medicine from Bastyr University. Known as “The Hormone Whisperer,” Brooke's balanced approach to health, using both conventional and alternative therapies, allows her to successfully treat patients with Hashimoto’s Hypothyroidism and PCOS as well as other female hormone imbalances. Learn more about Dr. Brooke on her website and connect with her on Facebook and Twitter.

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