Our Best-Laid Birth Plans

Lobster dinner, dim lighting, and a little skin-to-skin contact. Sounds like a dinner date, right? Guess again.

Those are components of the modern-day birth plan.

Birth plans — written documents expressing parents’ wishes for the delivery room experience — are quite standard in today’s delivery rooms. The key to a good birth plan is threefold: Make the plan pre-delivery and show it to your obstetrician; keep the labor room requests sensible; and be flexible.

That last item is key. In the age of labor and delivery doulas and birthing aids such as birthing pools, bars and balls, an unexpected or even emergent medical situation can still arise. Doctors and nurses are first tasked with the safety of the mom — as well as bringing baby safely into the world.

Some parents-to-be, who have “alternative” birthing ideas, have made some downright crazy requests. A Facebook post by Scrubs Magazine read, “Nurses! We wanna know: What is the most ridiculous birth plan you’ve ever heard? We’ll publish the best answers in a future article!”

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The results were hilarious (and frightening). One nurse replied, “It involved an African birthing swing. Unfortunately, there are no trees on L&D (Labor and Delivery) to hold it up.” Another responded, “Giving birth in a pool of dolphins — yes, I understand they are sweet creatures, but they still animals!”

One nurse posted on the website allnurses.com, “As for the craziest birth plan I’ve ever seen, I had a patient request that images of rainbows be hung all over the labor room so she could visualize herself transcending through the different color levels when she was experiencing pain.”

It’s a pretty good bet that didn’t happen.

So what constitutes a sensible birth plan?

Jennifer Doyle, a nurse practitioner and advanced practice nurse for Summa Health in Akron, Ohio, a Level 3 hospital that takes care of the highest-risk maternity patients, takes care of very high-risk patients as well as about 100 maternal high-risk transports — delivered by helicopter from surrounding areas — each year. She explained what a birth plan should include.

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“A good birth plan should consider first how labor starts — whether you are a woman who wants her labor to start on its own, or an induction,” she said. “Nurses believe in moms going the ‘full forty’ [40 weeks’ gestation], and we discourage elective induction — inducing someone just because they want to have their baby on, say, a Friday.” (Elective inductions have been very common in the past, Doyle says, but are less common now.)

“A well thought-out birth plan also looks at labor options. Do you want to walk during your labor, or do you want hydrotherapy, or a birthing ball?” she said. “Also, pain control — were you wanting to go natural? We are not going to suggest or offer you pain medication or an epidural — not that you can’t have it if you later want it. But your nurse is going to advocate for you, and tailor his or her assessments based on your birth plan.”

Doyle says that birth plans should be developed prenatally, and shared with the mother-to-be’s health care provider or midwife. That way, a conversation can occur early on to ensure that all requests are understood, and that they match up with the patient’s personal clinical condition.

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Doyle’s hospital, Summa Health, has a standard birth care plan that patients can print from their website, fill out, and fax into the hospital (as well as tuck another copy in the hospital bag). Hospital culture has a lot to do with what a woman is offered, Doyle says. Some have birthing pools and bars, while some offer more traditional care.

In an emergency situation, however, the birth plan may go straight out the window.

“We want everyone to have the experience they want, and we want to be inclusive,” says Doyle. “We do consider the whole family, but in an urgent situation we do have policies, procedures, and processes that we’re going to follow, and the patient and family will have to be flexible. If the fetal heart rate drops and stays down, we have to get the baby out, probably by Cesarean. Safe outcome is first, and the birth plan becomes secondary.”

What are reasonable requests for the experience of birth?

Quiet in the room, dim lighting, personal music playing, special in-room dinner for new parents after birth, and immediate skin-to-skin contact with baby — these are a few.

Deciding who will be allowed in the delivery room and whether Dad will cut the cord are other birth plan choices.

Moms-to-be can have a say in when they begin to push, too. A woman can opt to wait until she feels the urge to push, even if she is at 10 centimeters (the maternal measurement at which birth normally occurs).

Bottom line? When developing a birth plan, consult your doctor and keep it reasonable.

And if you ask for hanging rainbows, well, the answer will probably be a resounding “no.”