In my experience, birth plans, written outlines for a woman's birth experience, often create tension, frustration, and dread for labor and delivery nurses and establish unrealistic expectations for parents. While childbirth education provided by a certified instructor is a must, in my opinion, birth plans are unnecessary in labor and delivery settings.
Birth plans represent a woman's desire to maintain control over her birth experience. Unfortunately, with a birth plan we suggest to women that they can have control over one of the most uncontrollable events in their lives: the birth of their baby. In actuality, the parents do not dictate the birth plan, the baby does. To some professionals, birth plans represent unrealistic expectations and inflexibility on the part of the parents and, in some cases, may be perceived as unreasonable.
Do birth plans improve outcomes of childbirth? Berg, Lundgren, and Lindmark (2003) found that for high-risk women, "an individual birth plan does not appear to improve the overall experience of childbirth; rather, it seems to intensify the negative feelings in several aspects" (p. 1). In addition, in situations where the birth process may have been different from a patient's plan, the labor and delivery nurse may feel a sense of loss and disappointment in not meeting the patient's expectations.
Birth plans grew out of consumerism and the advocacy for women's rights. In the 1960s and 1970s, women fought to change obstetrics, not wanting the operating-room-style births their mothers experienced. Today, the presence of family and friends at the birth in homelike hospital environments such as LDRs (labor-delivery-recovery) and LDRPs (labor-delivery-recovery-postpartum) enable women to have birth experiences that combine the best of obstetrics and family-centered care.
While a birth plan can be used as a tool for communication among the expectant parents, the healthcare provider, and the healthcare professionals, it may also include options that do not meet current standards of care, and may therefore be unsafe. For example, should parents be asked to answer yes or no to the choice of administration of newborn vitamin K injection and eye treatment? Both vitamin K and eye treatment are required by law in most states. Giving these options on a birth plan is confusing and may cause parents to misunderstand and doubt what are, in fact, best practices in medicine.
A birth plan implies that women can have control over one of the most uncontrollable events in their lives: the birth of their baby.
Other common options on birth plans include consumption of food, fluids, or ice chips and episiotomy. Do women know that the gastrointestinal system slows down during labor, and that many laboring women are nauseous and vomit? Food increases the risk of discomfort and vomiting, as well as increases the risk for aspiration. Do women know that the American Society of Anesthesiologists (ASA, 2005) recommends small amounts of clear liquids only during labor? Regarding episiotomy, while Hartman et al. (2005) have shown that routine episiotomy has little value, there is still much controversy about preservation of the perineum and episiotomy. The best option for women concerned about episiotomy is to discuss this with their provider during prenatal care. Simply listing "no episiotomy" on a birth plan cannot lead to appropriate communication between doctors, patients, and nurses in labor and delivery.
Labor and delivery facilities should provide evidence-based care and birth experience. If the best care is available and standards are met, there should be no need for birth plans. Discussions about clinical practice and philosophy of care in obstetrics and pediatrics should take place long before birth. Women should choose providers who give the best care in accordance with their desires. In my opinion, birth plans in labor and delivery serve no positive purpose in contemporary obstetric care.
References