fbpx Have a Preference, Not a Plan

Have a Preference, Not a Plan

When it comes to your labor and delivery expectations, experts say flexibility is key.
Britany Robinson
Written by

Britany Robinson

When Christine Greves, M.D., an OB-GYN in Orlando, Florida, was preparing to deliver a patient’s second child, she was given one very specific instruction.

"She said, ‘I don’t want to be called ‘mama’ when I start pushing—I want to be called by my name,'" Greves recalled.

A birth plan is an outline of preferences for labor and delivery that may include how and where you want to labor, how you prefer the environment to look and feel, who you want to be present and whether or not you want pain relief. A birth plan might also include what you want to be called.

Birth plans became popular in the 1980s in response to the increasing medicalization of labor—to reclaim women’s autonomy and power, and to help them effectively communicate their wants and needs. Since a laboring person is often distracted by pain, anxiety or simply the focus on bringing a new life into this world, having these things written down is a helpful way to preserve your wants and needs before it’s go-time.

A birth plan might include preferences, such as laboring in the tub, having a yoga ball available, playing a specific playlist or keeping the lights dim and voices low. Plans range from just covering the basics to extremely detailed expectations.

In considering everything that might go into a birth plan, many parents find in it a sense of comfort and control. But also, labor and delivery are often anything but expected.

"No one can ever really plan for what a particular woman’s birth will be like—not the midwife, obstetrician, partner or even the woman herself," explained Kathy Fray, L.M.C., a senior midwife trained in New Zealand and president and founding director of the International Integrative Maternity Health Care Organisation.

So why have one if you’re just setting yourself up for disappointment? Can you create a birth plan that is both specific and flexible?

Do you really need a birth plan?


"It really depends on the person, their level of angst, their level of desire to know," Greves said.

She offers the analogy of how different people approach flying. "Some people just want to pay for the ticket and not think about how the plane is flown and how their luggage is getting from one place to the next—they just trust the system. Other people want to know everything about how it works."

If you are someone who finds comfort in knowledge and control, then researching and writing a birth plan can be extremely helpful.

It's also a chance to discuss all the details of labor and delivery with your doctor, before those things are happening. In researching different suggestions and methods for creating a birth plan, parents often discover questions they wouldn't have thought to ask otherwise.

Crafting the plan


Start with your hospital, birthing center or the midwife you'll be working with for a home birth. They may have birth plan templates for you to use and can advise you on your options—that way, you're not including preferences that are unavailable where you'll be giving birth.

What to Expect When You're Expecting offers a free birth plan template on their website. It prompts users to circle options, such as "eat and drink during labor if practitioner allows it" and "have a partner take photos or video." Having something like this printed out can help your birth team stay on the same page. There is also a section on medical interventions, pain relief and newborn care.

Looking at different birth plan suggestions online might be overwhelming, but it can also give you the chance to ask questions of your doctor you wouldn't think to ask otherwise. (Like, is it okay if I have snacks while laboring?)

Asking friends who have been through labor can also prompt you to consider details of labor and delivery you might never have thought of—especially if it's your first rodeo. Some moms find it helpful to have a playlist of music they can control. Others like rotating options for scent diffusers, so they can mix it up depending on whether they need to relax (lavender, jasmine, vanilla) or get energized (lemon, eucalyptus, mint).

It might be most helpful to think of a birth plan as a "best-case scenario." Similar to writing down goals for the future, writing down a birth plan can focus and clarify your intentions going into birth and delivery. It might even help to keep you focused and grounded when things get really hard. There will be aspects of a birth plan that are easier to stick to, but other preferences might be impossible for the sake of your health and your baby's.

"Don't be inflexible," Fray urged. "Plans may need to be thrown out the window, especially for a first birth."

The downside to a detailed birth plan


A goal of many birth plans is the avoidance of certain interventions, such as the administration of Pitocin to increase contractions when labor is taking too long (based on a debatably arbitrary timeframe) or a cesarean section. (For other birth plans, those things might be preferred.)

Regardless, both doctors and midwives agree that, unfortunately, certain interventions are sometimes necessary. And it shouldn't be seen as a failure if the plan to avoid those doesn't work out.

Fray said what concerns her about overly detailed birth plans is they "later become a documented disappointment when the mother's childbirth took an entirely different path."

In preparation for things potentially not going as planned (and in the moment, when things are changing), Greves encourages patients to ask as many questions as possible. "We're more than happy to explain anything, because we want to provide that sense of peace to give you the best possible outcome, both emotionally and physically."

If the way your doctor is explaining something doesn't make sense to you, it's okay to ask for another explanation from someone else, like a nurse.

The most important thing—in making the plan and adjusting the plan—is for the mom to stay as calm as possible under the circumstances of labor and delivery, advised Elizabeth King, a certified fertility coach.

Stress hormones trigger increases in cortisol, which makes your breathing and pulse quicken. Some of this is unavoidable during labor, but avoiding excess stress is key. "You need to be calm and everything to be in line in order for your body to function as it needs to during that time," King explained.

If having a birth plan will help to keep you calm, then that's a great thing to have. But if deviating from the birth plan will stress you out, you might consider not calling it a "plan" at all.

Increasingly, birth attendants are encouraging women to think in terms of "birth preferences" rather than birth plans. This allows women to understand and document what they want—without feeling like it's a failure when things change.

Ultimately, you can call it whatever you want. Not everything in labor and delivery will go according to plans or preferences—but there's nothing wrong with starting with your best-case scenario and then making necessary adjustments along the way to meeting your new baby. No matter what, the health of you and your baby comes first.