Do I Need a Birth Plan?

While pregnancy can be a very exciting time in a woman's life, it can also lead to anxiety and feelings of being overwhelmed, particularly for first-time mothers. Fortunately, creating a birth plan can help alleviate the stress by giving mothers some control over what happens during their baby's birth.

Birth plans, which are documents that dictate preferences for various aspects of labor and delivery, have grown in popularity over the past several decades as women have sought to feel more empowered and knowledgeable during pregnancy and labor. Having a birth plan can encourage women to actively seek out their options and abilities while delivering their child.

Do all pregnant women need a birth plan?

Women who are looking for a way to plan (as much as possible) how things will go during labor should certainly discuss a birth plan with their birth team. Birth plans are personal to each woman, factoring in circumstances including medical history, the baby's health and the maternity services available where the birth is taking place.

Birth plans often include a woman's preferences, such as:

• Positions to try during labor
• Types of pain relief that are options
• Who is present at the birth
• Placenta delivery and how the baby will be fed after birth
• Special facilities, such as a birthing pool
• Other requirements or traditions, such as religious customs

During pregnancy, while many women elect to receive care solely from an OB-GYN, others seek additional support along the way, from a midwife or a doula.

While their roles differ, these providers can all work side-by-side to assist women with achieving their goals during birth. To gain perspective on this additional side of labor and delivery, I spoke with a practiced doula who has been present at 16 live births.

Bailey Wilson is a birth and postpartum doula and co-owner of Whole Mama Wellness Collective. Witnessing many different births and supporting women through every moment of labor has resulted in her strong belief in women advocating for themselves all throughout their pregnancy and delivery.

Wilson described the situations in which birth plans are effective and the instances where a mother's healthcare team can band together to advocate for her.

"Most clients who are seeking more holistic, mom-centered prenatal care with homebirth midwives, CNMs [certified nurse-midwives] and a handful of OBs [obstetricians] usually bring up the desire to create a birth plan," Wilson shared. "The general attitude is positivity and a firm belief that creating the plan will help the mother have clear goals."

How can women (and their partners) advocate for a birth plan during pregnancy and labor?

Having a supportive, aligned birthing partner and team can completely alter the experience positively, so women need to determine what they're looking for from all their providers. Wilson recommends shopping around (within your financial means) to actively seek the type of care that will best support you during the biggest moments of your life.

"Remember that you are the one hiring your provider. They're serving you," Wilson stated. "If you don't like the option(s) presented, there is likely a different provider who will help you meet your goals. You're paying that provider a lot of money to care for you, and it should be care that feels supportive and empowering."

All birth preferences should be discussed with the healthcare staff who will be involved in labor and delivery. This is a great opportunity for a birth partner, doula or midwife to establish a rapport with the staff to best achieve the mother's birth goals.

What if the ideal birth plan can't be achieved during labor?

While birth plans are a positive way for women and their partners to plan, there is a level of control that can't be achieved during birth. This natural phenomenon rarely unfolds exactly how we think it will.

"Going through a birth plan with your partner, doula or provider opens the door to a lot of the things that can present themselves during birth, whether that be due to the baby's circumstances or hospital policy or anything in between," Wilson said. "It brings up conversations that might not otherwise occur during routine office visits, and helps moms ensure their provider's policies and statistics line up with their goals for their birth."

Wilson elaborated on how, when the delivery gets complicated, having a birth plan can still support a woman even if she doesn't get the birth she wanted: "It creates an opportunity to talk about those B, C, D and even E options if plan A goes out the window, so that Mom has more autonomy (and therefore higher satisfaction) in what occurs, even if her original goals can't be achieved."

This scenario is exactly what happened to Megan Psyllos, a first-time mother in Texas, while delivering her son in May 2021. Psyllos' doctor recommended induction at 38 weeks to prevent any complications during labor due to her chronic hypertension.

What began as a calm induction, with high expectations of a vaginal birth, spiraled into nearly three days of labor, intense pain and various medications to try to trigger dilation. All to no avail—Psyllos' body did not respond to the medications, and because her water had been broken, delivery was essential for the safety of her son. After nearly 30 hours of labor, her doctor recommended a C-section.

While experiencing immense gratitude at the birth of her son and for the team who took care of her and provided a safe entry into the world for her baby, Psyllos expressed disappointment and some trauma over her experience.

"I didn't really feel prepared at all," she told me.

Leading up to the induction, Psyllos' birth team had discussed that labor would be long and hard. "But how do you plan for something you've never experienced?" Psyllos said. "[My doctor] did tell me to prepare for a C-section as an option, since we never know what could happen. We didn't discuss my pain management options—I figured an epidural was the only option."

The postpartum period has given Psyllos ample opportunity to process her birth experience and what she would do differently.

"If anything, I could have had more information upfront about why I needed to be induced due to high blood pressure. What were the complications if we just waited until I naturally went into labor? That kept me feeling guilty, like both my son and my body weren't ready for labor, and we just forced it," she said.

Without an established birth plan (outside of being induced), Psyllos had no real expectations for her delivery. She feels that if she had the support of a birth plan, the trauma and disappointment she experienced may have been easier to cope with.

While many women successfully deliver vaginally after being induced, about 25 percent of women who begin labor with an unripened cervix may need a C-section. With or without a birth plan, women should be informed of the likelihood of every option and choice they make during labor.

This isn't to say Psyllos' care team didn't do exactly what they should have, particularly in her high-stress situation. At the end of the day, her son was born healthy and she recovered well from the surgery. However, open conversations should occur, in order to support women like Psyllos who have experiences that differ from their expectations. Keeping the lines of communication open can help alleviate any trauma or guilt the mother feels when things don't go according to plan.

"Every birth is different and tells its own story of triumph," Wilson said. "I genuinely find that if Mom feels like she was informed prior to laboring, and is in the driver's seat [during delivery], she does really well."