Birth Plan - A Critique

One of a labor nurses worst nightmares is the patient that comes in with a birth plan. Not because we disagree with them - but because we know that most of these birth plans are created by first time parents with absolutely no clue as to what to expect during the labor and delivery process. We also know that a birth plan is a setup for disaster and that most individuals with a birth plan will end up with almost everything that they don't want!

Hospital rules were not created out of, "let's see just how many rules we can put in place to annoy our patients." Believe it or not, they are really important to the life and health of your baby (and you!) Do patients forget that? You bet.

Let's all be realistic here. The vast majority of birth plans are a setup for unrealistic expectations - for the patient and for the family. I've attended hundreds of births where the parents had a wonderful birth experience and it didn't have to be scripted out point by point.

In the grand scheme of things - isn't a birth plan more of a self-centered document so that you can attempt to control your birth experience? Isn't a birth plan more for the mother's desires than what may be best for baby?

Here's a breakdown of a recent birth plan:

No medical procedure will be allowed without my prior consent. I have not signed the general consent forms and consent only to treatment that has been fully explained and for which verbal or written consent has been given.

Okay so why bother coming to a hospital? It's not rocket science. If you don't wish to consent to be treated by a hospital - why come to one?

We are performing our own version of a hypnobirth and as such do not want any labor coaching whatsoever unless it an emergency situation that we agree is an emergency.

And just what constitutes your definition of an emergency? When your baby's heartbeat is in the 60's we'll be sure to consult with you first to make sure you agree this is an emergency before making an attempt to save your child's life.

No medications. This specifically includes oxytocics, analgesics, barbiturates, tranquilizers and antibiotics. If we feel a need arises, we will discuss our options.

Okey dokey - we'll just let that Group B Strep infection go untreated. Of course it's fatal in 5 to 15% of newborns and babies that survive can be left with speech, hearing, and vision problems as well as mental retardation. But you're the expert, right?

There will be no routine fetal monitoring, either internal nor external. If there is a medical indication for continuous monitoring, I may consent to a brief period of monitoring provided I am able to choose a position.

Let's say we come to an agreement then - we won't monitor if you won't sue!

I will not be confined to bed during labor. If the birth is happening away from the bed, say in the shower, I do not wish to be moved from this position. This includes the birth itself as well.

By all means give birth on the floor.

The father will catch the baby. This is non-negotiable. If a situation such as shoulder dystocia or nuchal cord or hand, etc., occurs, coaching and assistance is welcome but we still wish for the baby to be caught by the father unless the situation is absolutely life-threatening.

Does he require a catcher's mitt as well?

The cord will not be clamped or cut until the placenta has been birthed and the cord has stopped pulsating, however long that takes. We will decide when it is an appropriate time to cut the cord. The cord will be left long (approximately 5 inches from abdomen). This is due to our personal beliefs on nervous sensation in the cord and is non-negotiable.

There are no nerve endings in an umbilical cord - but if you want a 5-inch scab hanging from your baby's abdomen for about 2 weeks - who are we to stop you?

My vote for all parents who wish to have a birth plan is to HAVE A HOME BIRTH!