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5 Most Common Pitfalls of Birth Plans and How to Address Them

Birth plans can be a wonderful tool in preparing for your birth. But some birthing folks feel like their plan failed despite the amount of time and effort they put into writing it. They’re left wondering what went wrong or what they should have done differently.


My goal here is to help pregnant parents reduce this disappointment by discussing the 5 most common pitfalls of birth plans and how to address them.


Pitfall #1: It’s Too Long

Hospital medical providers are busy bees, working hard to provide quality care to you and all other patients. If your birth plan is too long, it’s less likely that the staff will read or follow every part of it. There's no need to include each tiny detail.


Tip:

A birth plan is more likely to be read and followed if you:

· Begin with a warm, personal note to introduce your family and thank the staff

· Keep it brief (1-2 pages max)—stick to the main goals or preferences that are most important to you and any essential info your care provider(s) should know


Pitfall #2: Just a Checklist of Do’s and Don’ts

It’s certainly important to outline your preferences, just be careful that your birth plan isn’t only a checklist of do’s and don’ts. Checklists are quick and easy to understand, but they can be black and white at face value, even though birth comes in all shades and colors. For example, a checklist by itself doesn’t communicate WHY those preferences are important to you or your overall goal. They also don’t account for circumstances when you might change your mind.

Tip:

State the intention or reason behind your preferences to your care provider(s).


Instead of: “Quiet room during birth”

Try: “We want to perform a cultural blessing ritual for our baby and ask for your respectful silence.”


Instead of: “No IV”

Try: “Please know that I have a phobia of needles and wish to avoid them.”


Pitfall #3: Trying to Dictate Outcomes

Many people, myself included, like drafting plans because it gives us a sense of comfort or control. We feel like we know exactly what to expect and are therefore prepared. But plans don’t always turn out as written. Like all of life, birth is filled with unknowns. Birth is the unknown. When circumstances change and challenges arise, you and your birth team will have to adapt accordingly. Becoming too fixated on any specific outcome of your birth invites potential disappointment or guilt if it doesn’t unfold as expected.


Tip:

Balance your hopes and goals with an open-mind and flexibility.

· Think about contingencies. How might you maintain a positive experience even when things change? (ex. If you were hoping for a vaginal birth, how will you adapt if a cesarean becomes necessary?)

· Remember some changes can be a blessing in disguise. Some folks find their birth experience was better because they veered from the plan.


Pitfall #4: No Discussion with Care Provider

If you hand over your birth plan at the last minute (when you arrive in labor), there’s a greater likelihood of misunderstanding. You may be disappointed if your care provider’s practice isn’t aligned with your personal views/goals, or if they’re unable to meet your requests due to certain conditions.


Tip:

· Talk to your provider(s) ahead of time to make sure you’re on the same page.

· If you don’t feel like it’s a right match, consider whether you’re willing and able to switch providers.

· Discuss your birth plan with other members of your care team too. This may include your partner, a family member, friend, or doula. In the event that your OB/midwife/doula cannot attend your birth, they usually have a pre-arranged colleague as backup. Ask to meet with the backup as well.


Pitfall #5: Outdated Practices / Limited Research

Some online birth plan templates still include procedures that are largely growing out of favor, such as the routine use of episiotomies. In their position paper on episiotomy, ICEA reported “In the United States, the overall rate has dropped from 17.3% to 11.6% during the period from 2006-2013.”[1],[2] Of course, rates still vary widely by provider and location.


But this raises the key point. As you go through your birth plan, check to see if any of your decisions may be based on outdated practices or limited research.


Tip:

The power of a birth plan lies greatly in the knowledge you gain by researching all your options. Look for info that is up-to-date and evidence-based (research-based) to learns pros, cons, and alternatives. You might learn something new that impacts your preferences.


As you continue your birth preparation, I hope you will be empowered with knowledge and gain clarity for the birth experience you desire, while also remaining open to the great unknown journey ahead.


References:

1) Berkowitz, L., Foust-Wright, C. Lickwood, C., Eckler, K. Approach to Episiotomy UpToDate 2017 www.uptodate.com/contents/approach-to-episiotomy accessed 08/22/2017

2) Smith, E. (2017). ICEA Position Paper on Episiotomy. https://icea.org/wp-content/uploads/2015/12/Episiotomy-PP-2017.pdf [accessed on 6/12/2020]

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