A doctor wants what’s best for the patient. That doesn’t always mean that what the doctor decides will align with the patient’s wishes. And one time that this difference of opinion can really cause clashing – that really has a lasting impact on the patient – is during a woman’s labor and delivery.
Most doctors and childbirth professionals will encourage pregnant women to have a “birth plan,” but they will rather quickly follow this up with emphasizing that a birth plan isn’t something that should be set in stone. It’s not something that says, “Things WILL go this exact way.”
Birth plans are really more a chance for pregnant women and possibly also their partners to sit down and at least think about their wishes and desires, their goals and dreams for the general path they would like their labor to take, including where it takes place, who is present, and coping techniques that will – or will not – be used.
Labor is an organic process and so can be rather unpredictable. Sure, it will start with contractions and end with the birth of the baby and afterbirth, but hormones, the woman’s body and positioning, the positioning of the baby, and more are all at play, meaning many possible scenarios may develop when all factors combine.
Craft your plan with an open heart and an open mind, seek care from professionals with philosophies that align with your own, and peruse these 15 plans that many doctors just won’t be down to follow.
15 Blocked Exit
Sometimes the fertilized egg implants in such a place that the placenta grows to either completely or partially block the cervix. This not-infrequent condition is known as placenta previa, and it will be diagnosed during an ultrasound.
It can cause a risk for bleeding during pregnancy, so if you have it, your doctor will not allow you to exercise, have sex, or do any heavy lifting. And she or he will also not allow you to attempt a vaginal delivery.
If you have placenta previa, it’s a C-section for you.
Moms may hear of the condition at around the 20-week mark when they have an ultrasound to learn the baby’s gender.
If the placenta is completely or mostly blocking the exit, a C-section it is. If it’s just nearby or only partially covering the cervix, they’ll likely be evaluated again later on to see if the placenta has shifted.
14 Double Trouble
A vaginal birth may be an option for a woman carrying twins more often than you’d think. About 40 percent of all twins are born vaginally, according to the United Kingdom’s National Health Service – a much higher number than I would have thought!
It all depends on a variety of factors, such as the health of the mother and the health, size, and positioning of the babies in the uterus.
Fit Pregnancy says that if these things all come together to create the right circumstance, a mom may be able to deliver vaginally: the babies are near full-term, the mother is in good health, there are no complications, and the babies are positioned well.
If, however, the mother has health complications, the babies are in a transverse or breech position, they are too small or too large, or there are other complications, a doctor may not recommend a vaginal birth.
13 Pushing On Porcelain
A midwife may encourage it. It may feel like a natural position to let your body open up and bear down. But when you are actually in the hospital laboring, nurses and doctors may not allow you to push while sitting on the toilet.
Maybe you feel that it’s a great way to get your pelvis to open up – not to mention convenient because you may be having bowel movements and even diarrhea throughout labor and it’s really just cleaner and easier that way. Maybe you realize your body is trained to relax the right muscles and feel ready to push in that exact pose.
But nurses and doctors probably don’t want to be the ones responsible for a baby plopping out into the toilet – and they can’t gauge what’s going on and see the baby’s progress if you’re in that pose.
12 One And Done
There are strong opinions on both sides of this one. It’s the great VBAC (vaginal birth after C-section) debate.
Many women are super upset to find that no doctors in their area will allow them to have a vaginal birth if they’ve already had a C-section before in the past. They feel they should get a second chance, that each birth goes differently, and that they’re being robbed of getting their ideal birth experience. And it can be easier to approach a second labor with a can-do attitude when it comes to birthing vaginally and even naturally (without drugs), because of the fact that you’ve experienced at least some of what labor is like before.
But others, still, have an all-to-real understanding of why the practice is commonly disallowed: There are horror stories of scars rupturing, complications developing, and hysterectomies (removal of the uterus) being required.
11 Strep Steps
Some women who want to have a labor with zero medical interventions are bummed to discover that they’ve tested positive for carrying group B strep.
It’s common enough (1 in 4 pregnant women) for strep B to be present that doctors routinely screen for it in all pregnant women. A swab of the vagina and rectum will reveal that yes, it is present or no, it is not.
The presence of the bacteria can be harmless for the birthing mother and yet be very dangerous to the baby, whom it can be passed to during a vaginal birth. It can cause health complications for the child and even death.
Doctors simply give the 25 percent of women who test positive for Strep B antibiotics during labor, through an IV. If a woman includes “no IVs” or “all natural birth” in her plan but tests positive for strep B, she’s out of luck.
10 Rollin’, Rollin’, Rollin’
An important focus of a birth plan for some mamas, especially those whose goal is to labor all naturally, is to avoid the feeling that the birth is being over-medicalized. They don’t want epidurals. They don’t want IVs. They say no to pain-relieving drugs, induction, and catheters.
But if they still choose to actually deliver the baby in a hospital, there’s one thing they probably can’t say no to – because it’s doctor’s (and nurse’s and hospital’s) orders: riding in a wheelchair.
After delivering the baby, even if you managed to walk into the joint yourself and labor and deliver without any medical intervention whatsoever, you will still be put in a wheelchair when it’s time to transfer you to your recovery room. This is how it worked where I gave birth.
And though I was a naturally laboring mama from start to finish, I didn’t really mind the postpartum ride.
9 No Funny Business
More and more hospitals are including jetted tubs in their birthing suites, the better to soothe a mom during the hard work of her labor. She can let the warm water support her, let the warmth relax tense or sore muscles, and give in to the sensations of the contractions that are bringing her closer and closer to meeting her little bundle.
Here’s the funny part: Hospitals may insist that if you want your partner to get in the tub or shower with you during your labor, he’ll have to pack his Speedos (or board shorts, or swim trunks).
They don’t want any hanky-panky happening in there – not on their watch.
Hey, maybe said hanky-panky is part of your birth plan! And if it is, just be sure to fit it in while you’re still at home.
8 Gates Are Opened
Warm water in a bathtub or birthing tub is the magical ingredient for some women to feel soothed, to lessen pain, and to labor effectively. Birth centers and home births sometimes even involve babies being born in the water itself – while other times women simply labor in the tubs and then push and deliver outside of them.
Some hospitals, though, have policies in place disallowing women to continue to labor in tubs if their waters have broken. There is a risk of infection being introduced at this point forward, and it’s not a risk they want to take.
So if you wanted to labor in a tub but your water’s already broken when you arrive at the hospital, you may be out of luck.
Check with your doctor and hospital, and consider an alternative venue if this is a sticking point for you.
7 Get Low
It’s easy to labor well at home. I can tell you that from experience. And I can also tell you (from my first labor), that it can be really hard to get into comfortable coping positions, feel comfortable and supported, and labor well once you arrive at the hospital. For this reason, many natural childbirth experts will encourage you to stay at home as long as you possibly can, the better to effectively labor and cope with the pain of contractions.
At home, you can be on your carpet on hands and knees, face buried in a favorite pillow. You can find all sorts of comfortable poses in your own comfortable, familiar space.
Once you’re at the hospital, certain positions for coping – and pushing – may be impractical, and some may just not be allowed, especially pushing on the floor or even anywhere that’s not the bed.
6 Killin’ The Vibe
Smell can have such a powerful effect on our thoughts and emotions. The “essential oils” craze of late is proof enough of that.
The right scent can be soothing to the extreme, and have positive associations from your past. The wrong one can do quite the opposite – or even give you a headache.
Because of this, some women choose to incorporate scents such as candles and incense in their birth plans – enough women, in fact, that the hospital where I birthed both of my babies made a point of stressing that candles and incense would absolutely not be allowed.
So if it’s really, really important to you to have strong fragrances around or candles or incense burning during the entirety of your labor, make sure you’ve got the doctor / hospital’s okay, and if it’s a “no,” consider an alternative setting.
5 My Way Or The Highway
Including in a birth plan that it’s your goal to have an all-natural birth is one thing. Saying, however, that you insist on an all-natural birth is another – because in reality, a labor and delivery free of any medical intervention whatsoever is not always possible or practical.
Quick to come off your doctor’s lips when you bring up the notion of an all-natural labor, or any birth plan at all, actually, will probably be that “It’s good to keep an open mind.”
If you go into it not feeling like you’ll have completely failed if things don’t go exactly as you wrote down on some piece of paper, you’re much more likely to have a positive experience. And when complications for mother or baby arise, a doctor’s priority has to be mom and baby’s health and safety.
4 All Alone
Many ladies, like me, labor well when they have privacy. In this case, they’ll want to stay in the dark and welcoming comfort of their own bedrooms, lounge in the tranquil setting of their own backyards, or labor steadily in their familiar living rooms for like as long as they possibly can.
Because when it comes time to head to the hospital, there’s usually no absolute guarantee that they’ll have their own private room. (Remember that scene in Friends where Rachel’s labor is progressing slowly and women – including annoying AF Janice -- keep coming in and out of her non-private room as they more quickly deliver?)
At the hospital where I delivered both my babies, even on busy nights – which I was a part of both times – women could still have their own private rooms in which to deliver AND recover. But we were forewarned that this wasn’t guaranteed.
3 Who, What, When, Where, How
Many women, both those who wish to birth all naturally (without the use of pain-relieving medications) and those who are open to epidurals and other drugs, find it important to at least have a vaginal birth (rather than a C-section). Who wants to undergo surgery – and the recovery that comes after it – if you don’t have to?
But sometimes, doctors will simply not give the okay for a vaginal birth – because they know from experience and statistics that it will simply not work, or that it may put the mother or baby (or babies) at risk.
If the baby in utero is in the breech position with the bottom down instead of the head, a vaginal birth may be a no-go. Being in the transverse position can also eliminate the possibility that the baby can exit through the birth canal.
2 I’m Open!
Is it part of your dream birth that your husband / partner receives the baby as it is born? You’ll want to read up, research, and explore your options.
In a hospital setting, it is likely that a nurse or multiple nurses will be there to assist you during labor and pushing, and as pushing brings you very close to delivery, a doctor will be called in for the birth itself.
A home birth or birth center setting may provide some more options to you if you don’t wish to go this traditional route.
Apparently, some midwives will give the okay for old Dad to catch the baby as he or she makes his grand entrance if there are no dangerous complications with the birth. But in a hospital setting, a doctor will likely give that plan a thumbs-down.
1 Delay Of Game
Labor doesn’t always start like on TV and in the movies with a woman’s water breaking and her rushing out the door immediately to head to the hospital. Many times, cramping sensations that seem to build in intensity and get longer and more frequent turn out to be true contractions, the water breaks at some point along the way, and things progress from there.
Sometimes the amniotic sac doesn’t break until fairly far along in labor or during pushing – and sometimes it doesn’t break during labor at all and the baby’s born “en caul.”
The thing is, no matter what point it is that your water breaks, most doctors will tell you that this is the point to head in to the hospital, rather than keep laboring at home.
The risk for infection increases, and they want you to be at the hospital and ready to deliver.
Sources: MarchOfDimes.org, FitPregnancy.com, NHS.uk, MayoClinic.org, Sansum Clinic, Natural Childbirth: The Best Of Both Worlds, Quora.com