Birth plans: worse than useless

Yesterday I wrote about birthzillas, pregnant women who are hypersensitive, obsessively controlling, and rude to healthcare providers. They justify their behavior with the all purpose excuse “It’s my special day.”

Several commenters took umbrage at the idea that a birth plan is the hallmark of a birthzilla. What’s wrong with making a birth plan they ask? The answer: a lot.

Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. But the worst thing about birth plans is they don’t work. They don’t accomplish their purported purpose, make no difference in birth outcomes, and, ironically, predispose women to be less happy with the birth than women who didn’t have birth plans.

Birth plans were instituted based on the philosophy of various natural childbirth advocates such as Penny Simkin and Lamaze International. They basically made up what they thought would improve the birth experience for women without any study at all about what actually improves birth experience for women.

Joanne Motino Bailey, CNM et al. write in Childbirth Education and Birth Plans, Obstetrics and Gynecology Clinics – Volume 35, Issue 3 (September 2008):

Advocates of birth plans claim that they can improve communication with staff, enhance choice and control during labor, and make women more aware of available options for their birthing experience. Too raised concerns that birth plans offer meaningless choices and “create an atmosphere of distrust between patient and physician or have the opposite effect by setting up the patient for a sense of ‘failure’ if the birth does not go as planned.”

There are no randomized controlled trials that analyze birth plans and the literature that does exist reaches varying conclusions … Lundgren and colleagues found “although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.” Brown and Lumley stated that “women who made use of a birth plan were more likely to be satisfied with pain relief, but did not differ from women not completing a birth plan in terms of overall rating of intrapartum care, or involvement in decision making about their care.” Whitford and Hillan found that most women who completed a birth plan found it useful and stated they would write another birth plan in a future pregnancy, although most did not believe it made any difference in the amount of control they felt during labor and many did not think enough attention had been paid to what they had written.

Why are birth plans ineffective?

1. Most birth plans are filled with outdated and irrelevant preferences. As childbirth educator Tamara Kaufman writes in Evolution of the Birth Plan (J Perinat Educ. 2007 Summer; 16(3): 47–52):

… [Women] identify the Internet as the resource they use most frequently to gather information about pregnancy, birth, and birth plans… [M]any of the birth plans detailed on these sites are outdated. For example, several on-line, interactive tools start with questions regarding being shaved or receiving an enema. Because these procedures are no longer routine in most areas, such details may cause parents to devote too much attention to unimportant issues and cause the hospital staff to dismiss the couple as being uneducated regarding routine hospital procedures…

2. Birth plans are gratuitously provocative, as Kaufman notes:

On-line birth plans are frequently more than one page in length, which may inhibit the hospital staff from closely reading the plan. On-line birth plans also have a tendency to use phrases such as “unless absolutely or medically necessary”—a phrase that is not always useful when caregivers usually believe the intervention they recommend is medically necessary at the time …

3. Birth plans have no impact on outcomes. The most important component of any birth plan is requests around the issue of pain relief. As Pennell et al, point out in Anesthesia and Analgesia–Related Preferences and Outcomes of Women Who Have Birth Plans:

Women who elected birth plans were primarily white, college-educated, primigravida, and under the care of a certified nurse-midwife. One-third of births were induced, 10% required instrumentation, and 29% were cesarean births. Nearly every birth was associated with at least 1 labor and birth complication, although most complications were minor. Analgesic preferences were reported to be the most important birth plan request. Greater than 50% of women requested to avoid epidural analgesia; however, 65% of women received epidural analgesia. On follow-up, greater than 90% of women who received epidural analgesia reported being pleased. The majority of women agreed that the birth plan enhanced their birth experiences, added control, clarified their thoughts, and improved communication with their health care providers.

4. Birth plans encourage unrealistic expectations. Just the idea itself is unrealistic. There is very little that can be planned about birth: not the timing, not the length of labor, not the amount of pain experienced, not the relative size of the baby’s head and the bony pelvis, not the adequacy of contractions and not how well the baby tolerates labor. Yet all birth plans implicitly assume that labor with fall in the normal range in every possible parameter. Disappointment is inevitable.

In Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:

… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect.

It appears that the birth plan may have actually set women up to be disappointed with their birth experience.

5. It is not really surprising that birth plans fail to achieve their stated aims when you consider that they are not plans for births. No one writes in their birth plan that they want to have a 16 gauge IV in each arm at all times; no one demands active management of labor; no one insists on extra blood tests for the baby. A more accurate name for birth plans would be “I refuse all these things regardless of whether they are routine and/or medically indicated because I know much more about the scientific evidence than any obstetrician or nurse.” In other words, birth plans are an extended tantrum in written form.

Why do women write absurd ultimatums? Why do they think their a priori refusal of medically indicated interventions is remotely appropriate? Why do they think they have a better understanding of the scientific evidence than the professionals who create it, read it faithfully and are legally responsible for being completely up to date on it? Because people like Henci Goer (who has never delivered a single baby) and Ina May Gaskin (a woman with no training in midwifery, who let her own baby die, and who believes that birth is controlled by invisible “forces”) told them so.

Why do they write these extended tantrums (“I’m not gonna and you can’t make me!)? Because they’ve completely lost sight of the goal. Doctors and nurses are HEALTHCARE providers whose goal is to make sure that mothers’ pregnancy complications are treated or prevented and that they give birth to healthy babies. Their role is not to facilitate birth goddess fantasies. Women know so little about birth, and are so sure (erroneously) that complications are vanishingly rare that they’ve confused birth with a piece of performance art. Birth plans are not about birth; they’re about creating the most esthetically pleasing tableau.

That’s why NCB and homebirth advocates can, with a straight face, have arguments about whether a C-section is actually a birth. It makes sense when you realize that for them birth is not about the baby being transferred from inside the uterus out to independent life. For them, a birth is an intricately choreographed performance that follows a pre-approved script. Deviate in any way, and the performance is ruined.

Ultimately, birth plans are not merely useless for their stated goal of achieving control over birth. They are worse than useless because they are filled with outdated nonsense, alienate providers, fail to achieve their stated aims and, through unrealistic expectations, encourage disappointment.

By all means share your most important preferences with your providers, but think long and hard before you present your provider with a list of refusals and ultimatums. Birth plans have been encouraged by ancillary birth personnel (childbirth educators, doulas) as a thumb in the eye of obstetricians. They accomplish nothing besides gratifying a desire to defy authority.

  • Jah See

    “Why do they think they have a better understanding of the scientific evidence than the professionals who create it, read it faithfully and are legally responsible for being completely up to date on it?”

    Because the power of the medical lobbyists’ $$$ compels these very professionals to overlook it.

    “Why do they think their a priori refusal of medically indicated interventions is remotely appropriate?” 

    It because of the fact that when the cascade of interventions snowball into worst case scenarios, it then becomes “we’ve done all in our power to successfully deliver, and thus we’re exempt from any litigation.”

    • Box of Salt

      Jah See “Because the power of the medical lobbyists’ $$$ compels these very professionals to overlook it.”

      Huh?

      Would you care to explain how you think a lobbying group, paid to talk to politicians and influence changes in the law, impact the way doctors and nurses interact with their patients on a day to day basis?

      Then you state:
      ” thus we’re exempt from any litigation”
      Exactly whom do you think is exempt from litigation?
      Obstetricians, who pay huge amounts in malpractice insurance to cover possible litigation costs? Why would that be an issue if they’re exempt from litigation?

      • Captain Obvious

        Most medical malpractice is to protect the patient as much as the doctor. At least patients have an avenue to litigate in case something goes wrong. Most Homebirth midwives don’t even carry insurance. Do you truly believe a lawyer, who is not a doctors friend, won’t take a case against a doctor if they think they could win? The way lawyers make money is different than how a doctor makes money. A lawyer can and do make a lot of money against medical lawsuits. But a lawyer likely won’t take many cases against Homebirth midwives, because there is so little to win.

  • Jah See

    It would seem to me that you are quite the inflexible OB, who only has regard for patients when you aren’t questioned.

    • Jah See

      ” Birth plans have been encouraged by ancillary birth personnel (childbirth educators, doulas) as a thumb in the eye of obstetricians. They accomplish nothing besides gratifying a desire to defy authority.”

      You are an obstetrician; a guide [in a doctor], not an “authority”.

      • Dr Kitty

        You know, instead of resurrecting old posts, you could come and post your insights on today’s post.

        That way more people are likely to read and reply to you.

        Assuming you actually want people to reply, and didn’t just parachute in.

        Birth plans need to be like military plans…lots of contingencies because you can’t predict everything.
        Most birth plans aren’t like that.

  • Kat

    I was always under the impression that the purpose for a birth plan (and I may stand corrected), is to be your voice when your unable to say what you want due to he pain of child birth. I think during pregnancy, especially for first time mums or VBAC’s (vaginal births after c-sections) they tend to have a certain idea of how they want their labour experience to be, now I don’t know about you all here, but I’m a worse case scenario person. I always like to know my options, but at the same time I think realistically about what the midwives can do for me. I’m actually a nurse by trade, which is good and bad at the same time. I know how hospitals work, and a lot of the time the situation is taken out of your own hands. It can be a very scary and dis empowering time, imagine that when your in pain and about to give birth…..I would s**t my self lol seriously I would! Despite working in a hospital before, I am probably the most vulnerable person when it comes to being treated. If anything I’m quiet and undemanding, mainly because I feel uncomfortable asking for things because I know how hard it is in the care profession. I think that birth plans are good, if it is up do date with current treatment for that mothers specific condition. It helps a lot to have a midwife read it before it is implemented, so that any requests do not sound too demanding. Okay I’ll shut up now I’ve written an essay here!

    • Young CC Prof

      Good point. A birth plan where someone who doesn’t know much about medicine makes a three-page list of every little thing she wants like she’s planning her wedding is dumb. Guaranteed that mother is going to leave unhappy!

      A much looser sort of birth planning, though, makes sense. Find out what the standard hospital policies are, and make choices about things that actually are a choice, like who’s going to be with you. Talk to your doctor or midwife in advance about various contingencies, especially if there are specific contingencies that you feel anxious about. Definitely, even if you’re planning med-free, I’d walk into the hospital knowing what types of pain relief they provide in labor.

  • ngozi

    I thought about making a birth plan at one time, but then I thought it would be better to just talk to my OBGYN about hospital policies, what my OBGYN’s policies were, educate myself from reliable sources, be honest about my own health, and be willing to say no to what I didn’t want or need. I think that has worked out well for me. The problems with staff that I did experience in labor probably wouldn’t have been fixed by a birth plan.

  • My Uterus is Magic

    Oooh! This article is going to piss some people off!!! I love it! thanks for speaking your mind. It’s great to hear another opinion than those of women insisting that I need a birth plan. I am 38 weeks pregnant with my first and there is a lot of conflicting information out there. I feel lucky that I like and trust my doctor and I chose to get my information from her instead of from the internet or an untrained consultant. Here is my birth plan: “Deliver a baby from the inside of my body to the outside, hopefully by way of my vagina and without pain medication, but by any means necessary. Thanks for your help!”
    http://www.myuterusismagic.blogspot.com

  • B

    Your insane. And an ass. And this article is bullshit and very insulting to pregnant women.

  • nadia

    we are supposed to be respectiveful of you, do you have the same respect for us? we are on you territory, not ours. why don’t obgyns help women with birth plans instead of being snotty after the fact?

  • J

    Hmmm… I have had two children, both in hospitals and both with birth plans. While neither of my births were “textbook” the things that bother me the most about my experiences were things that were in the OB’s control that were blatantly ignored. For instance, in my birth plan I specifically stated that I wanted to wait until the cord stopped pulsating to cut and clamp. Even though my son was completely healthy and required no resuscitation or interventions the OB specifically ignored my request and when I reminded him as he was clamping he blew me off and did what he wanted anyway. It’s that type of gross paternalistic “I know what’s best for you and your family and you get no say,” attitude that compels women to write birth plans (and hope and pray that at least some of their requests are honored).

  • lete

    Wow. “Women know so little about birth, and are so sure (erroneously) that complications are vanishingly rare that they’ve confused birth with a piece of performance art”. Glad you’re not my OB – I would run, or rather, waddle as fast as I could :). I have yet to see an OB observe a full labor, so I’m not sure how they learn “so much” about birth. You could educate them, then, or just keep mocking women – the people you’re supposed to be in a profession to help. Your poor patients who’d have to apologize for trying to avoid dangerous complications caused by interventions, at the same time that they’re trying to trust you to help them manage actually medically necessary procedures.

    • Amy Tuteur, MD

      You have yet to see an OB observe a full labor? What an excruciatingly stupid comment; do you think women OBs are asleep for their own labors?

      • Anj Fabian

        In addition, due to the miracles of information technology and monitoring technology, a labor can be documented in full for review at a later time.

        This is particularly useful when comparing evidence to various people’s memories of the event. The cumulative research on human memory shows that humans not only can’t remember events accurately, we have a tendency to rewrite our own memories to more closely align with a preferred narrative.

    • Shantel

      Agree. My cousin actually took an extra course where they got to go to the maternity ward and sit with a mother the entire time and see a natural vaginal delivery, no interventions/medication. It was not required but she wanted to do it so she would know. she has never experienced childbirth herself and wanted to be as prepared as she could be. She is now an OB and the only one I know of that has done this.
      The best way to get the hospital to follow your birthplan is to go to the hospital as late as possible. the further into labor you are the less interventions you are prone to. I am actually not sure why so many women go in at 3/4 cm. It could be HOURS and HOURS before you hit transition! Just silly to me.

  • Kim

    Things are clearly done differently in Australia… I am going through a birthing centre and will be birthed by a midwife only, the usual way here unless something goes wrong or you go private rather than public. It is connected to a hospital, so if anything goes wrong, I am literally 30 seconds away from help by doctors. The midwife has asked me to do a birth plan and my next appointment goes through that plan. Obviously, things change, me writing a ‘plan’ won’t make it set in stone, I know that if I need an epidural for instance, I can be admitted to the hospital, but at this stage, that’s not something I would prefer. Likewise, a c section may be necessary etc. That’s life. I think if a medical practitioner sat down with women with their birth plans, everyone would be on the same page. The women just want the best outcome – a healthy baby and mum. Instead of criticising Internet birth plans, perhaps hospitals should provide women with templates of care that can occur in their hospital and spend an appointment going through it?

    • Lizzie Dee

      In theory, a birth centre within a hospital is an ideal compromise. But, going from the various scandals here in the UK, it works less well if the midwives won’t surrender control. My daughter was IN hospital, under the care of a MFM. The midwives didn’t want her to have an epi, so she didn’t get one. They were a bit po-faced about administering the antibiotics she needed for GBS as well, but they got short shrift on that one. It was a “lovely” natural birth, and we are both still angry three years later.

      It is the supremacy of “natural” that has to be dismantled. Terrific if it turns out that way. Striving for it is unwis, and the advantages are over-played..

      • EllenL

        You make excellent points!
        I have a problem with any health care system that puts midwives in charge and makes them the gatekeepers to more expert care.

        I believe any woman should be able to have an OB in charge of her care, if that’s what she wants. In The US, that is the norm. Insurance plans pay for it. No one has to see a midwife if they don’t want to.

        Time and time again, it’s been demonstrated that midwifery-led systems don’t “risk out” to OB’s all of the cases they should. They erect roadblocks to prevent women from getting the pain relief they want (specifically, epidurals). They shame women who don’t want to “tough it out” in labor. They impose their philosophy and agenda on all women in their care. That is unacceptable.

        I am so sorry for what your daughter had to go through.

        • Lizzie Dee

          It wasn’t SO awful for her – second baby, young and generally healthy – but it wasn’t her choice. Such NICE young women, but more patronising than any doctor I have ever come across, and they did not inspire confidence.

  • Namebat

    epidural medication does get into the baby. there have been studies that confirm that it crosses the placenta. That said, the amount that the baby gets is very small, especially in today’s epidurals. Most babies have minimal to no effects from them.

  • Namebat

    My mother in law had a cancer plan. She had choices. Did she want a mastectomy with reconstruction, or surgery with radiation. Radiation meant that reconstruction in the future (should cancer resurface) was less likely to be successful. Her doctors discussed these options with her, informed her of the risks and allowed her to make her decision.

    There are some medical situations where patients have choices. There are some where they don’t.

  • Namebat

    You know, in ANY field clients who don’t have your training come in with a list of demands about how things should be done.

    When my clients do that I tell them where it is possible to meet their demands, and where it just isn’t. (I’m in engineering). It is part of the professional’s job to manage client expectations.

    • Amy Tuteur, MD

      Do they tell you HOW to do your job? What tools you may or may not use? What measurements you may or may not make?

      Do they tell you that you are doing it “wrong” and they know more than you because they “educated” themselves about engineering on the internet?

      Do they insist that the safeguards you build into your engineering projects are useless and done simply so you can pad your bill?

      How would you react if they did those things?

    • KarenJJ

      I’m in a similar field and have similar issues. Like you say it’s part of the job. I appreciate that there isn’t an entire industry on the internet promoting ‘natural engineering’ and how empowered it is to build their own bridge or hook up their handmade generator to the grid using fencing wire. I appreciate that when I say ‘this particular method won’t work for xxx reasons’ I’m generally believed or they can get a second opinion or whatever. Nobody’s telling them my information is useless or actively trying to undermine me. Clients come to me typically because they need something done that is difficult for them to do on their own and they appreciate technical input. I’m not accused of trying to manipulate their plan for a glorious unnassisted skyscraper..

  • Namebat

    Most of the studies you’re quoting say that women were satisfied with their birth plans and were glad they’d written them. I think that’s a good outcome.

    Also, birth plans with outdated info mean that the patient’s medical team could educate the patient about what will actually be happening. It’s a good opportunity.

    I wrote a birth plan after actually talking to my birth hospital. It included a lot of things that the staff found helpful. Conversations with patients actually make the big unknown of your first birth a lot less scary for them.

    For instance, I went drug free and didn’t want even the recommended hep lock (I hate intravenous things). My doc explained that the hep lock was a good idea because in case of blood loss, veins clamp down and it’s harder to get the needle in. That made sense to me, so in my birth plan I requested that they just tape over the hep lock really well so I couldn’t see it or feel it move.

    Also, I gave them a big warning flag about not allowing my mom in under any circumstances. I didn’t plan to tell her I was going into labor, but she’s mentally ill and weirdly psychic about stuff like that and I was afraid she’d show up anyways.

    Also, my husband gets low blood sugar when he forgets to eat and starts acting grotsky and sick. I put in my birth plan that if they notice him being less than his usual cheerful self, they should offer him some juice and he’ll become helpful again.

    Other than that, I let them know that I would prefer to labor without drugs for pain relief or augmentation. After researching my hospital, I learned that they had wireless fetal monitoring available, so I requested one of those. I let them know that I intended to breastfeed. That’s all they needed to know to support me properly in my birth. My plan was about 1/2 page long with lots of white space.

    I learned all this stuff by ‘breaking hospital protocol’ and visiting them before 28 weeks (when they usually allow you to schedule your appointment). I think they should allow this initial visit early for everyone so they know what to expect, what to research, and what to prepare for. It was great!

    I get that several pages of ‘don’t do this, don’t do that’ is frustrating for medical personnel. But telling moms (who are all a bit nervous and scared and don’t know the hospital staff) to just listen to all these strangers and do exactly as they say is scary. This is some very delicate, intimate stuff going on! Moms who bring in birth plans just want hospital staff to know something about their specific situations.

    Moms need to be educated by professionals as they research labor and delivery. They need to be told that unexpected things happen, so the birth plan is not a script. But they need to feel that their wishes are known and followed as far as is possible.

    • KumquatWriter

      If you’re expecting that level of attention to your husband, I strongly suggest an additional support person – for you or for him.

    • Bombshellrisa

      I totally understand about not letting your mom (or anyone else who shows up whom you wish wouldn’t) in your room. That is important.
      The part about your husband having to be attended in addition to caring for you too is unfair to the staff and could be solved by tucking some snacks and juice boxes into your hospital go bag and having him set some reminders on his phone.

  • utopicdream

    Dr. Tuteur isn’t laughing at anyone’s sentiments. If you had a serious complication during delivery, you’d end up seeing an OB/GYN or ER physician anyway. The details she addresses are subtle, and I didn’t think she applied broad strokes to all expecting mothers. She’s railing against obnoxious birth plans, that’s all. It’s standard for an OB/GYN to have routine dialogue with their patients and they’ll even ask: do you other concerns that you’d like to address. Being handed a list of ultimatums by a patient, however, violates the spirit of the professional, courteous, respectful doctor-patient relationship. The patient becomes the tyrant, under the auspices of “this is a big day for me.” That’s what I read from Dr. Tuteur’s comments. Not that she hates all expecting moms.

  • utopicdream

    And you’re seeing more of that sentiment in this thread, aren’t you? I’d bet that many of the know-it-alls are: predominately white/caucasian, college-educated, middle class and above. Some may be expecting their first child, others have had their 2nd or 3rd child. I know that pregnancy and the vagaries of bringing a child into the world are stressful and consume a lot of time for new mothers, but there is a MASSIVE health, legal and regulatory environment that doctors (ALL doctors, not just OB/GYNs) who will interact with you and your future child have to deal with. The number of practicing OB/GYNs is low, folks. When you get a serious complication and the midwife can’t tend to it (midwifes don’t know how to properly sedate you, conduct an invasive interventional procedure, maintain your blood pressure while, stabilize you while additional surgeons enter the picture to deal with any unexpected neonatal surgery), OB/GYNs are there. So are the OB/GYN support staff and medical support staff (nurses, medical assistants, nurse and surgical PAs. Labor and delivery is complicated, but knowing that you have a competent medical staff to get your through potential catastrophic clinical scenarios…that’s priceless.

  • Enrico

    This is the second time I’ve had the misfortune of stumbling across your blog. Your arrogance and churlish response in your comments is astounding.

    • T.

      I am always stroke dumb by people that confused being right with being arrogant.

    • Dr Kitty

      How, exactly does one “stumble across” a blog, decide that you don’t like it, comment to say so, and then DO IT AGAIN?

      Don’t like it? Then don’t click the link, don’t read it, don’t comment- simple.

  • Tomas

    Goodness, representing an industry that kills over 100,000 people a year (conservatively), you may wonder why anyone might wish to be a bit more involved in the process. Now, I realize OB’s don’t, but the medical profession must realize people die due to medical mistakes.

    As far as birth plans, if some moron has it written they want x, y, z IV’s for the duration, well, perhaps a psychiatrist may be more appropriate. In my opinion, a birth plan is a way to answer the questions you are going to be asked to consent to BEFORE you are at the hospital, excited to have the baby, or perhaps in active labor, and in no state to make rational decisions. Our last child (no plan) was given multiple vaccines some of which our child has no hope of ever encountering while young (hepatitis for example). I know you guys have your list of things, but just because you make a plan, doesn’t make it a plan I must follow. Since that day, the list of vaccines has grown to ridiculous length, regardless of your stance about injecting newborns w/ multiple vaccines, some of dubious origin, and a fair amount STILL laced w/ compounds known to be dangerous (just look at the materials safety sheet). I realize it is easier on the “pros” if the unwashed would just STFU and take their medicine. Some of us think we need to have a bit more info before blindly signing off on extra profits for the hospital. FYI, our son was kept 24 hours in NICU as a precaution (they left that precaution part out when they put him in there), nice little extra $5k charge to the insurance co. So, you might wonder why we non docs might be a tad skeptical at times.

    • Amy Tuteur, MD

      Really? Modern obstetrics kills 100,000 people per year? Please present some data for that claim.

      • utopicream

        Dr. Tuteur, they won’t be able to find these studies. They don’t know how to use PubMed and even if they did, PubMed would report “0 studies found”.

  • Amy Tuteur, MD

    Which part of “studies show that birthplans are ineffective” are commentors who have just parachuted in having trouble understanding?

    • Namebat

      I think it’s bits like this:

      “The majority of women agreed that the birth plan enhanced their birth
      experiences, added control, clarified their thoughts, and improved
      communication with their health care providers.”

      This was in one of the quotes you selected. Maybe the plans didn’t have any effect on the outcome of the birth, but most women still felt good about their plans.

  • FrustratedNurse/Anthro

    I would like to quickly point out that you are an MD, not a sociologist or anthropologist .. back in the day when you were trained there was no sort of humanities requirement when it came to your education. I think it is silly that you are representing yourself as an expert of human comfort when you resume seems to show that you focused you career on the mechanics of the human body. Doctors like you are the reason people are scared of Labor and delivery!

  • VeronicaHome

    Birth plans that are “filled with outdated nonsense” are an opportunity for medical providers to provide education. People should be encouraged to be informed about what to expect during labor and should have their choices honored. If a medical provider views a patient who is seeking an exchange of information as “defying authority” – they need further professional development.

  • Melissa

    A birth plan is absolutely necessary. This comes from a mother who did not institute one with her firstborn and knows why its important to make your wishes known to the service providers, the hospital staff.

    • Melissa

      Wow! i just read some of the other comments and must ask, since when is it offensive to make requests for services, especially healthcare, to be carried out in a certain manner? The patient that does not take an active part in his/her healthcare is foolish. Nurses and doctors are people, too! You should always question your healthcare provider! One should never assume that the nurse or doctor treating them is infallible. You are aware of the major medical blunders that occur every single day due to humanity’s never failing ability to make mistakes, right?! You must be very fortunate to never have experienced malpractice… Well, good for you!

  • DirtyOldTown

    Really? I seem to recall a reading post on this blog some time ago about midwives in a forum discussing their patients in less than flattering terms. Midwives laugh at patients behind their backs, too Keri. All the way to the bank.

  • http://www.facebook.com/ta.ra.5439 Tara Birth Doula

    As a birth doula (get out your pitch forks!) I wholeheartedly disagree about birth plans. Yes. Moms who have a birth plan that is unbelievably specific are setting themselves up for disappointment if they aren’t keenly aware that this is just how you would like things to be and NOT how things will go. I encourage my clients to have a birth plan and I help write one. It helps open up the conversation with them as well as their doctors about how they feel about sensitive subjects. Expecting women to blindly follow their doctors orders is absurd and reminiscent of something straight out of the 1950′s. Not all practices routinely done are evidence based and women should be educated and encouraged to advocate their approval or apprehension about certain routines. It’s time to face facts. Doctors are only human and they make mistakes or even decisions based on concern for lawsuits, convenience and countless other things that aren’t always in a mom/baby’s best interest. When 1 in 3 women are giving birth in the operating room, having a plan of action, list of procedures you plan to avoid is more than just a suggestion, it’s a necessity.

    • DirtyOldTown

      Please inform us, O wise birth doula, which practices that, according to you, are routinely done in hospitals, are not evidence-based. I’m eager to hear what particular piece of drivel you were taught at your DONA workshop.

      • Kristina Vazquez

        I don’t know what “particular piece of drivel” you are wanting to hear, but at least she learned something unlike you who obviously failed manners 101. Seriously? Is Snarky your middle name?

        • DirtyOldTown

          Oh, I’m sorry – is this Miss Emily Post’s Blog of Manners, Courtesy, and General Nicety? My mistake. I thought it was a blog where people had to back up any claims with evidence. Tara made a claim, I presume based on drivel, that hospitals routinely perform procedures on pregnant women that are not evidence-based. I’m willing to be proven wrong. (Just so you know, Snarky is actually my first name, but I usually go by Sparky, because I think it’s prettier.)

        • Simran

          A doula has no medical training. None. A certification in 3 days does not make them knowledgeable about “birth” practices. She didn’t learn anything.

    • Bombshellrisa

      We don’t do pitch forks, as we have some amazing doulas here who understand their scope of practice. They also understand the term “evidence based”, so would never suggest having a birth plan “makes things go” in any direction.

    • Erin

      Thank you for your post. Birth plans CAN be helpful to parents who have personal views about circumcision or even how soon to cut the umbilical cord. I can see how a doctor would be displeased what what seems like “demands”, but we are paying them for their services.

  • Gen Tor

    This article sounds more like a rant from a medical practitioner. My choice to create a birth plan is simply to help keep us on the same page. For instance, due to spinal problems, I cannot have an epidural. I’d rather just have that information on the birth plan. Furthermore, my husband and I would like skin-to-skin time with the baby and some time with just us 3 before my horrible mother-in-law comes in and starts making everyone uncomfortable. I’d like to request the nursing staff to help with these objectives. Anything more detailed than that, I’m sure I can answer myself that day.

    Women going into labor–particularly with their first pregnancy–face a number of issues as well as fears. Women who do not work in the medical field can feel very out of control of their bodies. I know I do. Here I think I have this ‘pregnancy thing’ figured out and a new symptom arises. Medical practitioners need to respect these fears and the need these women have to have some sort of input in this very frightening experience. It is a matter of patient dignity and comfort.

    May I simply say that your article here makes me even more grateful for my sister-in-law who is an RN and my doctor, who both support my choice to write down what I need in my birth plan and submit it to them for feedback. I wouldn’t use your services because you don’t seem to care for the psychological needs of the patient.

    Furthermore the comment below of the OB resident is disturbing. It states, “ob doc • a month ago−I’m an ob/gyn resident in my final year. Your summary of birth plans is spot-on.They are absurd and insulting. I didn’t sacrifice an entire decade of my life and go $200,000 into debt to have someone who knows nothing about medicine tell me how to practice.” I don’t care how much money you paid or how many years you were in school. This is my body–not yours. I have to live with it and take care of my child for the rest of life–not you. You think we owe you unwavering trust; you are sadly mistaken.

    You are one of those resident doctors that I will respecfully request NOT be in the room for the birth! You are unprofessional as well as uncaring. Continue laughing behind the back of your patients and it will come full circle some day.

  • Gen Tor

    This article sounds more like a rant from a medical practitioner. My choice to create a birth plan is simply to help keep us on the same page. For instance, due to spinal problems, I cannot have an epidural. I’d rather just have that information on the birth plan. Furthermore, my husband and I would like skin-to-skin time with the baby and some time with just us 3 before my horrible mother-in-law comes in and starts making everyone uncomfortable. I’d like to request the nursing staff to help with these objectives. Anything more detailed than that, I’m sure I can answer myself that day.

    Women going into labor–particularly with their first pregnancy–face a number of issues as well as fears. Women who do not work in the medical field can feel very out of control of their bodies. I know I do. Here I think I have this ‘pregnancy thing’ figured out and a new symptom arises. Medical practitioners need to respect these fears and the need these women have to have some sort of input in this very frightening experience. It is a matter of patient dignity and comfort.

    May I simply say that your article here makes me even more grateful for my sister-in-law who is an RN and my doctor, who both support my choice to write down what I need in my birth plan and submit it to them for feedback. I wouldn’t use your services because you don’t seem to care for the psychological needs of the patient.

    Furthermore the comment below of the OB resident is disturbing. It states, “ob doc • a month ago−I’m an ob/gyn resident in my final year. Your summary of birth plans is spot-on.They are absurd and insulting. I didn’t sacrifice an entire decade of my life and go $200,000 into debt to have someone who knows nothing about medicine tell me how to practice.” I don’t care how much money you paid or how many years you were in school. This is my body–not yours. I have to live with it and take care of my child for the rest of life–not you. You think we owe you unwavering trust; you are sadly mistaken.

    • Amy Tuteur, MD

      Which part of “studies show that birthplans are ineffective” are you having trouble understanding.

    • utopicdream

      I didn’t get from Dr. Tuteur’s commentary that she was absolutely against a birth plan, insofar as a birth plan constitutes open dialogue with your OB/GYN. This has everything to do with fine details: extensive, laborious lists of demands are exhausting. The number of practicing OB/GYNs is dwindling across the country. I would’ve liked Dr. Teuteur to maybe introduce a novel concept: the concierge OB/GYN. If I were to practice as an OB/GYN, I would take on fractious patients, but at a steep cost. Also notice, from the literature that Dr. Tuteur introduced (and no one has really commented on this peer-reviewed, evidence-based data, did they): these fractious patients are predominately first-time, white, college educated women. Not minority, less-educated, economically impoverished women. Pretty interesting.

  • Ali

    I used a birth plan for my first delivery, and I’m so glad I did. My doctor was not on call that weekend, and an OB I’d never met delivered my daughter. The birth plan helped communicate my wants to the nursing staff, and I was able to have a natural delivery. I edited the birth plan with my own preferences, which allowed me to request and not demand. I will probably not use a birth plan this time, but it definitely prepared me for the first birth.

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