The Best-Laid Plan

My birth plan when I was pregnant with my son, Truman, was this: I had no plan. I knew I wanted a hospital delivery, so I selected one that had a birth center known for family friendliness and an OB-GYN with a reputation for erring on the side of safety. Beyond that, I just packed my iPod in my hospital bag, let my doctor know that I’d rather skip the C-section, thank you, and trusted that somehow the process of giving birth would take care of itself.

My friend Lynn was shocked by my nonchalance. “Oh, my God!” she said. “You have to have a birth plan!” Lynn had wanted—and, after 51 hours of labor, got—a completely natural delivery. She firmly believes that her no-detail-overlooked birth plan helped her enjoy the childbirth experience she wanted. “If you don’t have a birth plan,” she warned me, “you forfeit control of this beautiful, natural process to the medical system.”

Oh no! Just as I started to panic—and cobble together a detailed birth plan at 38 weeks—my friend Jeanette, an ultrapractical mother of four, offered another point of view. “Don’t bother,” she advised. “Birth plans don’t work. Something always goes wrong, and you’ll just have to trash the whole thing anyway. Why set yourself up for failure?”

So who was right? Turns out, both—and neither. “Birth plans are useful because they help couples think through the process together and decide what’s most important to them,” says Sharon Phelan, M.D., an OB-GYN who practices at the University of New Mexico in Albuquerque. “Some women like a high-tech birth; others have a Pearl Buck image of motherhood. Either way is fine, but it helps to have those expectations expressed so everyone understands what the goal is.” But Phelan also warns that while you can try to guide it, childbirth is something you simply can’t fully control, so don’t even try. Here are some additional tips from Phelan and other experts for making your birth plan work for you.

Start shopping early
Create your birth plan early in your pregnancy, use it to “shop” for a care provider whose vision most closely matches yours and make sure that person knows about any special concerns you may have, suggests Cynthia Flynn, C.N.M., Ph.D., an associate professor of nursing at Seattle University in Washington and president of the American Association of Birth Centers. “When you show up in the delivery room with a birth plan, you’re saying that you don’t trust your provider to do it your way,” Flynn maintains. “Why not just find someone who normally does it your way?”

Keep it short and sweet
A cursory Web search will turn up any number of lengthy checklist-style plans to help you start the process, but Phelan suggests not getting too detailed (see “5 Key Questions,” on page 2, for topics to focus on). “There’s a grim joke among care providers that the minute we see a three-page, single-spaced birth plan, we get the OR ready because we know it will all go wrong,” Phelan says. “It happens so often, there must be something to it. I think the more attached you get to certain fixed ideas, the more likely you are to tense up around them, and the natural process has more difficulty happening.” Bottom line: Keep your plan to a page, max.

If you do have a detailed plan in mind, Rogers suggests taking it in ahead of your delivery and discussing it with the charge nurse to see where the sticky parts might be. And have your doctor sign your plan prior to admittance. “Your doctor might say it’s fine for you to have no IV, but unless he writes that as an order, the hospital policy will win out and you’ll get one anyway,” Rogers says. “If it really matters to you, get it in writing.”

Watch your language
What you do write down, write with care. “Care providers appreciate language that lets them know you’re working together as a team and you respect their professional judgment,” says Bruce Flamm, M.D., a clinical professor of obstetrics at the University of California, Irvine and spokesman for the American College of Obstetricians and Gynecologists. “You should express your goals and desires in a way that’s not contentious so that it doesn’t set up a boxing match,” Flamm adds. “Would you like it if somebody with no training in your field did some Internet research and then came in to tell you how to do you job?”

Take it with a grain
New York City midwife Elizabeth Stein, C.N.M., M.S.N., M.P.H., has delivered more than 2,500 babies in her 22 years in practice and estimates she’s seen it all. In her opinion, birth plans are best viewed as a wish list. “You have to wait and see how labor goes to have any clear idea about what you really want or need,” she says. “You may think you don’t want any pain medicines, but then find you really need them. Don’t start motherhood out feeling guilty, or feeling that your expectations weren’t met.” Instead, Stein encourages her patients to aim high and focus on what’s most important: “We always shoot for a healthy mom and a healthy baby.”

What mom doesn’t go into the delivery room thinking the same way? I did—and offered up my 11th-hour birth plan in the sincere hope that it would somehow help ease my labor and my baby’s transition into the world. It was literally too little, too late—not that it mattered much anyway. I ended up needing a C-section, a disappointment but—in hindsight—far from a disaster: Truman and I are safe and healthy today.

5 Key Questions
Sample birth plans offer the illusion of control over everything from the light level in your hospital room to whether you’ll have a C-section. The reality of childbirth, however, seldom lines up with these neat little boxes. New York City midwife Elizabeth Stein recommends avoiding yes/no questions and writing open-ended answers to these five crucial questions:

1. If labor begins naturally, when would you like to be admitted?
2. Are you willing to be induced?
3. What is your attitude toward pain relief?
4. Who do you want in the room with you when you deliver and/or need a C-section?
5. What are your desires in regard to breastfeeding?

— Hillari Dowdle for Fit Pregnancy. Read more great articles at FitPregnancy.com.