Unexpected Interventions Women Often Leave Off Their Birth Plans

In teaching childbirth classes, I always spend some time on the birth plan. While you can find countless examples of birth plans online, there are some unexpected things that women often leave off their birth plans.

I wanted to get some expert opinions on this topic– what DO many moms leave off their birth plan that ends up surprising them later on? These are the answers from some of my favorite childbirth educators and doulas.

These are wise words. Take heed!

Pitocin after the birth: In the absence of definite hemorrhage, you should ask to breastfeed first to get the natural oxytocin to shut down your uterus. So many places do it as a matter of course, even if you’re clamping down fine. 

Another one is the baby warmer: Be a mother bear. Don’t let them take your baby. You can warm your baby better than their equipment. You need your baby and your baby needs you. The warmer is for emergencies.”

Lauren McClain, Birth Teacher, Bowie, MD

unexpected interventions women leave off their birth plan

Requests regarding delivery of the placenta are often left off the birth plan. No cord traction. Otherwise, the care provider starts pulling on it very soon after birth to ‘get it over with’. This is more uncomfortable for mom and could lead to an inverted uterus!”

Maryellen Yates, RN, Childbirth Educator, and Doula, Lafayette, LA

Unless you really spell it out, delayed cord clamping and skin-to-skin do not always go together, depending on your care provider. Some care providers will only “allow” delayed cord clamping if they hold the baby lower than the level of your placenta for a few minutes to allow the cord to stop pulsing. This also delays the mother’s immediate skin-to-skin with her baby, whom she just worked so hard to bring earthside!”

Alecia Cumberworth, Childbirth Educator, Dallas, TX

unexpected interventions women leave off their birth plan

Sometimes an unexpected intervention comes long before you’ve gone into labor. Vaginal exams are considered a normal part of the routine in the last weeks of pregnancy. They are, however, an unnecessary intervention that can lead to unwanted membrane sweeps, pressure to induce, or deflated feelings when you are already in an emotionally fragile state.”

Hailie Wolfe, Doula and Childbirth Educator, Abilene, TX

unexpected interventions women leave off their birth plan

Third trimester sonograms to measure size of baby are not necessary and can lead to unnecessary inductions. The best way to avoid unnecessary interventions is choosing a good, evidence based provider before labor.”

Beth Dickerson, Doula, DFW, TX

No matter where or how you birth, someone is going to be rubbing your belly after delivery to make sure your uterus is firm. This is not fun and many times you don’t know it is coming. The baby is out, the placenta is out…why do they need to keep messing with that area? Aren’t you done?? Knowing that this “massage” is going to happen every so often after delivery can help you prepare. Take deep breaths just like during labor and keep your bladder empty when possible. You may put in your birth plan to have your provider show you how to feel your uterus under your belly and do your own massage. It probably won’t hurt much when you do it and if you do it every once in awhile when your provider checks you your uterus will be nice and firm so she does not have to rub you very long.”

Maria Pokluda, Doula, Doula Trainer, Dallas, TX

Being on your back and in stirrups is what we see in movies but it is not a optimal/natural position for a baby to descend. Pick a provider that is supportive of you pushing in a position that is most comfortable. Consider a position where gravity is working for you and helps widen your pelvis. Above all, remember to listen to your body.”

Kendra Parry, Childbirth Educator, Pocatello, ID

Electronic fetal monitoring:

  1. Moms can request the level of monitoring: intermittent, continuous, or even by doppler.
  2. Moms don’t have to lie in bed on their back while being monitored. They can often switch positions to stay more comfortable while still being monitored, such as sitting on a birth ball or standing and leaning over the bed.”

Cameo Sherman, Birth Doula, Bowie, MD

I wrongly assumed that intermittent fetal monitoring would be available if I asked for it but didn’t ask about hospital policy first. So, this made it to my birth plan but it was useless. I have since attended another birth at this hospital and saw continuous monitoring on a normal low-risk mom.”

Andrea Powell,  Childbirth Educator, Houston, TX

I love these suggestions from experienced birth workers about what women often leave off their birth plans!

If I were to add a few things that are sometimes forgotten on birth plans, I would add things that are important, but not medical. Though they aren’t necessarily medical interventions, they are often forgotten and worth thinking about if they are important to you!

unexpected interventions women leave off their birth plans

  • Presence of support people: Do you want your whole family there? Your children? Your doula? If you do, make sure you address this in your birth plan and know your options no matter how your birth proceeds. And discuss during visits!
  • Who can catch the baby? If you want your partner to be involved or catching, address this in your birth plan!
  • Video/photography: Having a video of the birth is super important to some women but isn’t allowed in many hospitals. Include this in your birth plan and discuss with your provider if it is important to you!
  • Simple environmental things like lighting may be important to you and very influential on the birth vibe- is it up to you if the lights are on or not?
  • Family-centered cesarean? If you do need a cesarean, does your birth place have a family-centered cesarean option available so that you can hold and nurse your baby quickly afterwards?
  • Pain scale: Do you want to be asked about your level of pain on an hourly basis? If not, mention it in your birth plan.

Do your research, take a great childbirth class, hire a fabulous doula, picture YOUR ideal birth, and work from there. You can write a birth plan that covers your bases and facilitates communication between you and your provider.

Photo credits in order:

Ernest F / Foter / CC BY-SA (Fresh baby)

The U.S. National Archives / Foter / No known copyright restrictions (baby in warmer)

Thirteen Of Clubs / Foter / CC BY-SA (sonogram)

bengrey / Foter / CC BY-SA (siblings at birth)


9 thoughts on “Unexpected Interventions Women Often Leave Off Their Birth Plans”

  1. Why is it that only Birth Boot Camp is referenced under your childbirth class link at the end of the article. ICEA trains great educators. This year we celebrated 55 years of advocating for family-centered maternity care. Please give us a mention next time.

    Thanks!

  2. This is why childbirth education is so important – to know what to ask for and what your options are! When I was pregnant, I had no clue what I wanted on my birth plan until I took Birth Boot Camp!

  3. As a trainer for ICEA, I love that our educators are committed to evidence based practice! Providing parents the information to make the decisions that are best for their new family is so important!

  4. I love this and I’m sharing! One thing ~ when the article talks about giving medications to prevent postpartum bleeding / applying traction on cord of placenta to help placenta deliver, they are referring to an evidenced-based practice. It’s called “active management of third stage” … It is an intervention and which mom can decline if she chooses. But it’s not offering her informed consent to say “they do it for no reason”. There is a reason, best evidence states active management can help prevent postpartum hemorrhage. Read: http://www.pphprevention.org/amtsl.php and http://www.ncbi.nlm.nih.gov/m/pubmed/19941729/

  5. These are some great suggestions! I forgot to put the newborn procedures on my birth plan with my oldest, but I had a wonderful nurse who saw that and asked me my preferences. 🙂

  6. As a midwife, I will also add that you need to ask these questions well before you show up in labor. If your care provider doesn’t address your concerns, blows you off, or you find out the hospital policies are not in line with evidence-based, family centered care that acknowledges the normalcy and importance of supporting physiologic birth, consider switching birth providers or location.

  7. Might be worthy to mention vaccines, and the onslaught that the pharmaceutical world is pushing on pregnant women, and newborns.

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