How to Write a Good Birth Plan That Protects Your Rights
Photo by Ömürden Cengiz on Unsplash
Writing a good birth plan is about more than just envisioning your ideal birth. Your birth plan gives you a chance to think about what you want when things don’t go according to plan. What if your baby is sick? What if you need surgery? What if someone else needs to take your baby while you get treatment? The best birth plans anticipate these possibilities, and use authoritative language to make your wishes clear
There’s a lot of rhetoric about how birth plans should be flexible, and birthing people should be prepared to have a birth that doesn’t resemble their birth plan. It’s true, especially in the state with the worst maternity care system in the country, that things often do not go according to plan. You might not be able to have a vaginal birth, or prevent a postpartum hemorrhage, or guarantee that your baby doesn’t stay in the NICU. But let’s get something straight: You own your body. Even when there is an emergency, even during a pandemic, even when things do not go according to plan. You absolutely have the right to dictate how you will give birth. A birth plan isn’t a list of preferences or a best case scenario. It’s your opportunity to think about what you want in various contingencies, and to vocalize those requirements to a doctor.
Yes, requirements. Not requests. And if your provider treats your birth plan as anything other than a list of requirements, if your birth plan becomes a source of conflict, you have a bad provider. Switch now.
Here’s what you need to know to make a great birth plan.
A birth plan is not a contract
A birth plan is not a contract. The fact that your provider has seen it or that your hospital has approved it does not mean they will follow it. Legally, you have a right in Georgia to informed consent and informed refusal, but writing a birth plan is not a guarantee that your provider will respect this right. Coercing them to sign off on a birth plan they resent is unlikely to get a good outcome if your provider is otherwise hostile to your needs. So make sure you’ve chosen a provider you can trust.
A birth plan should be clear and specific
The clearer and more specific your birth plan language is, the better. A lot of websites encourage people to use gentle, nonspecific language such as, “If mom and baby are both doing well, I would like…” But what constitutes “doing well” in this scenario. The gap between provider and patient understandings of what common birth phrases mean can be enormous. This gap is where birth trauma often occurs. So don’t assume your provider knows what you mean.
Don’t assume you have a shared understanding of unnecessary interventions. After all, providers don’t typically recommend interventions they think are unnecessary—even when the evidence shows those interventions are not supported by evidence. In fact, one of the best things you can do is note at the top of your birth plan that you do not consent to any intervention without first giving verbal consent. This deters doctors from touching your vagina, giving you an episiotomy, or rupturing your membranes without first asking.
Here are some things to address:
In what circumstances are you willing to accept a deviation from your birth plan? For example, if you do not consent to an episiotomy, in what specific scenarios would that change?
If you have to be separated from your baby, how do you want that to go? For example, if you need emergency surgery, who stays with the baby?
If your baby needs emergency care, how do you want that to go?
Are there any specific interventions to which you do not consent?
Do you have any special needs your provider should know about, such as a history of PTSD or trauma?
Do you have any safety or similar concerns? For example, do you want to ensure that an abusive partner is not allowed into the birthing suite?
How do you feel about the presence of students? What about male providers?
Do you want your provider to get your consent before each intervention? If so, make sure to clarify this.
Remember, you can always change your mind in labor. The key is to use this document to begin shaping the birth you want and assessing your provider’s willingness to honor those wishes.
A birth plan is a chance to memorialize informed consent and refusal
Hospital consent forms cannot override your informed consent and refusal. You have the right to revoke consent at any time. Nevertheless, if a doctor does something without your consent, the hospital might claim you consented because of the blanket forms you signed. A birth plan offers a counterweight, clearly outlining the specific interventions to which you consent in specific scenarios.
Many websites tell you to talk about preferences, or to use gentle, nonconfrontational language. This is bad advice that fundamentally undermines the purpose of a birth plan. Good providers are not threatened by patients who make their wishes clear. So use plain, specific language:
“I do not consent to these interventions…”
“I consent to these interventions only in these circumstances…
A birth plan is not something to leave until the last minute
Many pregnancy websites suggest drafting your birth plan in the final weeks of pregnancy. This is terrible advice. By the point, it is difficult to change providers. Instead, begin drafting your birth plan as soon as you are pregnant. Talk about it with your provider from your first appointment on. Then revise as needed. For example, if you develop gestational diabetes, you should address this in your birth plan.
Cute, image-based birth plans are not effective on their own
Pinterest is filled with birth plans that feature cute images. These are great for posting on the hospital door, and make it easy for providers to quickly skim your chart and know what you want. These “plans,” however, are not plans at all. They are not a substitute for memorializing your needs in writing and discussing them with your doctor.
Hospital threats mean nothing
Some hospitals, upon getting a birth plan that uses plain, specific language rather than cute images and expressions of “preference” say that they have to “involve risk management” or “consult a hospital lawyer.” This means nothing. A hospital lawyer cannot override your wishes. You have a right to informed consent and refusal, and you have a right to treatment in labor, even if the hospital thinks you are unreasonable. The only exception to this rule is if a hospital seeks a court order compelling life-saving treatment. The opinion of a hospital lawyer is not a court order—though the involvement of a lawyer is a sign that the hospital intends to be needlessly combative, and is a strong signal that you may want to change providers.
A birth plan is a tool for conversation
It’s not enough to draft a good birth plan. You need to ensure your provider reads it. So discuss its contents at each appointment. Ask your provider if they have any questions or concerns, then ask them to sign it. The most important benefit of a birth plan is that it provides a tool for flagging providers who do not respect their patients. If you get pushback against your birth plan, expect pushback in the delivery suite, too.